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In discussing the various methods of dealing with cases of this type, the author points out the danger that the analyst may unconsciously respond to his patient's continued silence in a hostile way by being silent himself, or may increase his resistance by making direct appeals to him to speak. The exercise of a great tact and infinite patience is recommended in treating cases of this kind.
As regards the significance of the symptom, the author draws a parallel between talking and seminal emission on the genital level and evacuation on the pre-genital level; and he shows the homosexual and masochistic meaning of silence and its rôle in the Oedipus situation, both active and passive. But he gives no more specific ætiology for it.