This paper is an exploration of how the state of not-knowing in the therapeutic setting can become an access point to crucial and often unconscious dimensions of knowledge and attunement. Calling this space “the generative unknown,” the author, who is a poet as well as a psychoanalyst, builds on Winnicott’s concept of potential space and Freud’s concept of the life instinct to explore how communication at the deepest levels is a necessarily creative act. Authenticity is named as a vital part of working in the generative unknown, as we engage in an ongoing process of intra-psychic translation and interpersonal negotiation with our patients. Examples from poets Elizabeth Bishop and Lorine Niedecker, and artists Philip Guston and Hiroshi Sugimoto are used to convey how what we think of as ineffable may be that which is still in search of a form, a form we can find in the creative process, in the ways we locate ourselves in relation to other people, and in the co-creation of the therapeutic relationship.