The Silent Patient1

Since all analytic patients are to one degree or another, or at one time or another, silent, it is evident that this panel might well have been led to survey the whole of the analytic process and the entire range of neurotic behavior with its genesis and dynamics to deal with its topic fully. To do this would have been impossible, but this logic serves to explain the wide diversity of clinical and theoretical observations and insights presented in this discussion. Yet, despite differences in technical approach, and even before that, differences in foci of interest, a number of similar ideas and clinical experiences were reported by several discussants from work with patients in whom silence was a particularly graphic and challenging problem. The thinking of the participants uniformly showed a departure from early unvarying and less sophisticated approaches, which is in line with the ever-widening application of the structural viewpoint, particularly as it illuminates questions relating to ego functions and complex transference-countertransference interactions in the course of analysis.

Rudolph M. Loewenstein opened the discussion by placing the initial emphasis upon the fact that the silences of both the patient and the analyst are meaningful elements of the psychoanalytic process, which in itself inevitably reflects the pre-existing neurotic process. Everything which happens to the patient in analysis is the result of the forces which move him to communicate the data which are relevant to his neurosis, combined with and opposed by resistances to such communication. But the motives of such resistances, and the facts concerning the changing balance between these opposing forces, themselves reveal the nature of the neurotic conflict and thus must be understood as communication too. A silent, discouraged male patient's resistances may be concealing a hostile or critical thought about the analyst, but his silence is at the same time a nonverbal expression of those