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Although the conduct of analysis is dependent on speech, curiously little has been written on the manner in which patients speak. In an early paper, Abraham (1) pointed out that the attitude of each patient to the fundamental rule varies considerably. His observations were confined for the most part to those patients who evade the rule by bringing to the analyst the result of their reflections on life. Despite a superabundance of 'associations' the fact is that they only say those things which are egosyntonic. Behind an outward compliance lies a hidden defiance. Abraham concluded that those patients with the most pronounced narcissism were most inclined to evade the fundamental rule in this way.
Some years later, in discussing the problems of technique, Reich (4) pointed out that the form in which patients convey their thoughts provides an important approach to the study of 'character resistance'. 'What is specific in the character resistance is not what the patient says or does, but how he talks and acts, not what he gives away in a dream, but how he censors, distorts, etc.'
Sharpe (5) examined the use of metaphor in articulate patients. She demonstrated that only when the child has achieved control over the bodily orifices 'can the emotions of infantile life find metaphorical expression'. One might add that not only metaphor but also a considerable amount of double-entendre contains unconscious allusions to important incidents of childhood. For example, a patient who was remarkably blind to the existence of pregnant women one day walked 'slap-bang' into a patient who was in the last month of her pregnancy. 'It's curious', he reflected, 'I always thought