On the Silence and Sounds of the Analytic Hour

This contribution to the panel on the silent patient is essentially a clinical one. I should like to begin by stressing the importance of differentiating between two large categories of silence: silence as a resistance, and silence as a communication. The most frequent silence met with in psychoanalytic practice is the silence of resistance (1). This silence means that the patient is either consciously or unconsciously unwilling to verbalize. Since the patients in our psychoanalytic practice are attempting to communicate to us in accordance with the basic rule, i.e., attempting to put all their thoughts into words, if they become silent, it means that they are opposing the procedure of psychoanalysis. It is then our task to overcome this obstacle by attempting to find the motives for this resistance. Here, we are often aided in our task by the fact that the patient communicates despite his resistance (4). The patient may betray either the motive or even the content of his resistance by his posture, his movements, or his facial expression (7).

For example: a patient who had been talking now falls silent. Her face which had been turned so that it was visible to the analyst now is averted. Her hands which had been lying calmly and openly at her side become fidgety. She plays with her ring and then covers her breasts with her arms. Her legs are now tightly crossed at the ankles. Her eyes are downcast; her lips twitch nervously; her face is flushed. She squirms uncomfortably on the analytic couch. It appears that the patient is embarrassed. Her silence had proclaimed to us that she did not wish to communicate, yet despite this resistance her demeanor revealed the reason