Sounds of Silence: The Need for Presence in Absence

This paper describes certain difficulties encountered in patients whose verbal communications can be considered incomplete or distorted. Using Maiello's (1995) concept of a ‘sound-object’ and her ‘musical vertex’ of analytic listening, I explore how the varieties of sound both in utero and postnatally may have their counterpart in our work. Detailed clinical material from the psychotherapy of a selectively mute, 5–year-old girl and the dream of a phobic, young woman in psychoanalysis are presented to demonstrate how their intolerance to my presence/absence is linked to the lack of a particular kind of containment. Both patients suffered the pre- and/or peri-natal loss of their primary object, leading to a stark awareness of otherness (absence/nothingness) without the mitigating confidence of thereness (presence/being). Using Anzieu's (1989) idea of a ‘sound envelope’, I consider how the need for a ‘background object’ that provides a ‘certainty of continuity of contact’ originates in the background noises of the mother's body in utero, and calls for a rhythmicity and attention to ‘symbol and sound’ both postnatally and in our work with such patients.