Therapeutic impasse presents challenges to clinicians of all theoretical orientations and levels of experience. This study examines therapeutic impasse from the perspectives of two distinct schools of thought within the psychoanalytic tradition---relational psychoanalysis and Lacanian psychoanalysis---and compares their respective approaches regarding such clinical dilemmas. Through an integrative literature review, this study finds that both relational and Lacanian theories agree on an understanding of therapeutic impasse that highlights its dualistic nature. Therapist and patient become ensnared in a malignant, symmetrical configuration, which negates the presence of a "third" that would otherwise allow for the therapeutic effects of symbolization and enhanced possibilities for experiences of self and other. Fundamental differences emerge between the two schools of thought, however, in their respective accounts of what constitutes this third term in the clinical situation. In relational psychoanalysis, the third is only useful as a shared process between patient and therapist; in Lacanian psychoanalysis, the third is first and foremost the function of speech and, as such, cannot be created nor "shared" by the members of the therapeutic dyad. This disagreement proves pivotal as it relates to further theoretical and practical issues, which are explored in detail in this study. The divergent perspectives of relational psychoanalysis and Lacanian psychoanalysis on therapeutic impasse may offer a counterbalancing influence to one another in a way that enriches each position. Two case examples, one culled from relational literature and one from Lacanian literature, are used to illustrate this point.
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