Radio Silence

After 30 seconds or so, I realize there is no sound. I feel a sudden heightened alertness. Many channels have gone to only one channel. And that channel is silent. Radio silence. All of a sudden, my patient and I are not fellow travelers. I feel a heightened sense of the separate existence of each of the two of us in the room. In the dark, I search for other channels of communication coming from my patient, from the energy in the room, from within myself. This is not business as usual. In my mind, I go back over what was said prior to the silence. As I quell a looming internal scramble, I begin telling myself: give it a little more time. What's occurring to me. I have time to feel this through.

For the patient who becomes silent, an amalgam of thoughts, feelings, and fantasies, conscious and unconscious, somehow in relation to the moment, have come together unawares. A patient's silence is rarely a conscious decision; rather, it accomplishes by virtue of its unknown quality a communication from the unknown. While its specific meaning is different any time it occurs, I think of it as evidence of heightened involvement, whether vis-á-vis the analyst or vis-á-vis something internal, and as such, a patient becoming quiet for longer than usual has this similarity across patients: something is up.

In my experience there are, very broadly speaking, two groups of affects patients experience in silence-overwhelming discomfort, and, alternately, comfortable, calm, inner-directed interest. In the first kind of silence, if I ask what's going on, the patient will respond with a variant of “I don't know” or “I'm stuck.” I've had patients who don't even respond. I usually see this as-again, broadly speaking-anxious blocking. If the patient is left to break this kind of silence on their own, he or she may eventually say something dramatic like, “I can't do this. Maybe I shouldn't be in therapy.” An overwhelmed state has taken over, resulting in an inability to continue, a “petrified”