Silence as Intervention in Psychotherapy

Intervention in psychotherapy is usually thought of as an active process in which the analyst says or does something. That the therapist's silence may be a stimulus eliciting or inhibiting responses from the patient may be overlooked. The silent patient has from time to time evoked discussion in the literature,1 but comparatively little has been written about the therapist's silence.

In a sense, this is somewhat strange, since every beginner in psychotherapy or in psychoanalysis is immediately confronted with the question, “When do I speak? When do I keep quiet?” It was put well by Ferenczi2 years ago when he said a perpetual problem to decide is “when one should keep silent and await further associations and at what point the further maintenance of silence would result only in causing the patient useless suffering.” The quotation implies that silence may be beneficial or harmful. This paper will discuss some of the situations in which silence is salutary or damaging, and the various technical problems confronting the psychotherapist who has to deal with these situations.

The general meaning of silence has been discussed at length by Zeligs3,4 and by Enelow.5 Briefly, silence may be protective, provocative, or envelop a shared experience, either pleasurable or painful. Silence may express and even enhance empathy, or may express and even enhance misunderstanding or angry disruptive feelings between people. A person may signify his defensive, resistant attitude by his silence. On the other hand, silence may be profoundly expressive and deeply communicative.

Silence may indicate agreement or disagreement, pleasure or displeasure, anger or love. It may be expressive of a sense of fulfillment or of emptiness, of compassion or an absence of feelings. Silence may warm or chill, may be laudatory and accepting or cutting and contemptuous, may say yes or no, or may be giving or receiving.

Silence may reflect many varying moods and feeling states. Its ambigui