Is Talk Cheap or Silence Golden: The Negotiation of Activity in Psychotherapy

The problem with using case material to illustrate psychotherapeutic success is that just about anyone listening to the material can show you that you were neither doing what you thought you were nor was it a success. In order to avoid this pitfall, I would like to begin by describing a situation that I have mulled over for over a decade under the general heading: “What went wrong.”

The patient was an intelligent, lively, and engaging young businesswoman whose energetic application of her talents brought her success in the first year or two of her career. She sought treatment because of problems and uncertainty in her relationship with her boyfriend who drank. I had come highly recommended from the therapist of an acquaintance, and she began weekly treatment with a hopeful attitude. For my part, I saw her as possessing impressive ego resources in the face of a difficult development. I also felt confident in my understanding that her choice of men had all to do with the early loss of a father and that her good humor protected her from what I guessed was significant depression, which I neither felt afraid of nor was in a particular hurry to uncover. Thus I felt I had every reason to be optimistic that her requests for my verbal interventions would yield to the creation of an “analytic space.” My responses to the questions she asked me and also to her requests that I “talk more” and “advise