ROUNDTABLE ON SILENCE

Radio silence

In my experience there are two groups of affects patients experience in silence — overwhelming discomfort and comfortable, calm, inner-directed interest

By Mary Libbey
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” fear—a “deer in the headlights,” and with it, more often than not, a steadily increasing sense of shame and inadequacy. If it continues, it sometimes turns to anger, blaming the therapist for the humiliation. There is also waiting in a patient’s uncomfortable silence— waiting for the analyst to speak, waiting for something unknown, waiting for the session to end. On the other extreme, a patient in a comfortable silence is entering a zone, a gone-on-pause in terms of out loud relating lost in thought, dwelling in a place of going on being, similar to the reverie one experiences sometimes when slowly waking up in the morning. There has been an exit from the here and now—a move inward, with its sense of timelessness. Thoughts float in and out from the nooks and crannies of the patient’s mind, a “ticking over,” as Winnicott (1971) termed it. Sometimes there is a coalescence into something new and important. These, of course, are the extremes of patients’ experiences when silent, and they tend to be related to where in the course of the treatment we are.

I find the silences early in a treatment to be very different from those that occur in the tumult of a middle phase, as well as different from those that occur in the steady work of the last phases of a treatment. In effect, these are developmental stages of the treatment relationship. Early on in a treatment, when I am new to my patient, and he or she is narcissistically vulnerable, there is the greater likelihood of painful silences: “I’m on the spot”; “Is there a right way to do this?”; “Am I safe with this person?”; “Where do I go next?” Self-consciousness coats all thoughts and feelings early on. The patient is in the earliest stage of a relationship, on an emotional teeterboard between hope and flight, psychic safety and psychic annihilation, and which way it teeters will depend upon this stranger’s, this analyst’s, communications of safety or danger. The patient’s silences are the outward evidence of helplessness, and if their silence is allowed to continue, the analyst will have communicated danger. On the other hand, the analyst will communicate safety if he/she helps the patient to pick up and continue after they have been left to their own devices and things have jammed up. In the beginning phase of a treatment, there is too much both persons do not know about the other to make an accurate decision to not intervene, assuming the work will proceed, or interpreting a silence as being useful. When narcissistic vulnerability is too great, and the heightened objective glare of the other is too intense, the patient cannot think, much less work on themselves. When this kind of silence occurs, it is time for guiding and educating, conveying your total interest in the patient’s experience, as opposed to allowing apprehensions to grow.

In middle phases, I find that patients’ silences are more often associated with the deeper, more ingrained transferential and conflictual aspects of the patient’s character. The re-creation of long-standing internal dyads, fears of strong negative feelings, and fears of criticism or retaliation from the analyst have been activated and are available for working through over and over. Silences often turn out to be the unconscious expression of the reluctance to get into this kind of material, or the enactment of an earlier relationship or event, the full experience of which has never been felt. For example, one patient of mine seemed to grip the couch in long silences, her body seemingly frozen. As a teenager she had been raped by her older brother and several of his friends; she had actually gone along with this, needing to be valued and included. Holding herself down in silence on the couch was an enactment of that trauma, as was much of her frozen life.

Another patient who had long painful silences on the couch that neither of us could help her with turned out to be enacting mourning for her younger brother, who died in childhood and whom she had never mourned. After several years of treatment during which I only knew about the emotionless fact of his death, out of one silence she spoke of her feelings about him for the first time. It was as if, on the couch in her long silences, she was in his coffin with him underground, and in turn instead of him, and in turn being him on the couch. Memories of the brother, and all of her mixed feelings about him, emerged after an initial sad memory came up in a long silence, which she then told me about. Visits to his grave for the first time since his death many years earlier followed these sessions, where she talked to him. In such cases, intervening is trickier. Interrupting the silence and bringing the patient back to the here and now can mean sacrificing important links for the patient from the there and then.

Late in a treatment, with patients I know well, when there is more of a sense of “fellow travelers” between us, there is the possibility that a patient’s becoming silent is more like going on pause. Without any sense of changing things between us, the patient becomes contemplative. In these silences, I am aware of feeling quiet, watchful, hopeful. I have a sense of opportunity, a sense of impending change, similar to the feeling I have when a patient announces that they had a dream. At these times, conflictual feelings between us lay low in a silently agreed upon peace. In these silences, it is as if, less than consciously, the patient feels the unusual safety of being able to turn, without conscious thought or intent, memory, or desire, completely inward. It seems to me that this is the developmental capacity to be alone that Winnicott (1958) writes about. When the silence ends, it lifts, like a fog, rather than breaks. Often, when the silence lifts, the patient voices positive feelings about themselves or about the analyst. I have come to think of these silences as functioning like a chrysalis, the definition of which is “a butterfly or an insect in an immobile, nonfeeding, transformation stage between larva and imago” (Collins English Dictionary, 2003). A product of growth, preceded by years of work, is emerging, unseen and unheard by the analyst, on its own. What comes into the patient’s mind may ultimately coalesce in the form of a recovered memory, or a new feeling, or a new integration of self and object relationships.

I would like to close with a vignette of this last kind of silence late in a 12-year treatment that ended recently. This patient, a 38-year-old single professional when he began treatment, felt then that he was an unmanly loser, both with women and in his chosen career. His development of secondary sex characteristics had been delayed in his adolescence. His problem went unremarked upon by his depressed father, and minimized—perhaps even liked—by his doting mother, whose position toward him he described as, “You don’t need to go out and have a life in the world. You can stay here with me.” He felt intense resentment as well as guilt toward his parents. He began treatment as a hypermacho, weight-lifting motorcyclist who believed that there was a “Holy Grail”: becoming a rock star and having sexual access to the most beautiful women in the world. He believed anything less meant he was a loser. He actually aspired to this, having sex with as many women as possible, as often as possible, and when alone practiced his guitar for hours at a time into the night. Late in treatment—when these adolescent aspirations for a “perfect life” had disappeared, and he was steadily advancing in what had actually always been a successful career, and living with a woman he loved— he would periodically spend as much as five minutes quiet on the couch, usually toward the end of sessions. When these silences began and I asked him about them, he would say he was just thinking about this or that— his girlfriend, or somebody at his job, nothing special, something ordinary. I learned to leave him to these silences. During this time he was also being given good-bye parties at work, prior to leaving a current position for one of much greater responsibility in another setting. In one session, one of his long silences lifted and he said:

You know I feel ashamed every time something happens in my life that is about me. Just because it’s a thing that’s true, about me, it will lead to public humiliation. Somewhere in my past experience, being true about me occasioned those experiences. It’s a backpack I have to carry. The ashamed boy won’t go away, but the ashamed boy is raising his head and moving forward, shame and all. I’ll live with it. I don’t care. Because I know I’m real. Really me. My sister says about her therapy that she just doesn’t want to die confused. I will not die confused. If I die because I cracked up on my motorcycle, I’ll die happy.

These were new integrations of separate feelings and ideas that had come up continuously throughout the treatment. These integrations came about because of the work that preceded the silence, not because of the silence. The periods of silence were transformation interludes, when many separate images, ideas, and feelings were coalescing, without visible movement or audible sound. The period of silence was the final forerunner to giving his own voice to this new integration, as well as a final forerunner to successfully leaving treatment and living it.

References

Collins English Dictionary-Complete and Unabridged. (2003). New York, NY: Harper Collins Publishers.

Winnicott, D. W. (1971). Playing and reality. New York, NY: Tavistock/Routledge.

Winnicott, D. W. (1958). The capacity to be alone. International Journal of Psycho-Analysis, 39, 416–420.

About the Author

Mary Libbey is a faculty member and supervisor at the NYU Postdoctoral Program in Psychoanalysis and Psychotherapy and a faculty member and training analyst at the Institute for Psychoanalytic Training and Research. She is in private practice in New York City.