Modern Psychoanalysis

Modern Psychoanalysis is a treatment for relieving mental and emotional distress. Its simple technique heals through the talking interaction between patient and therapist. Join us to learn more or post your own thoughts.

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Tuesday, October 30, 2007

Clinical Techniques: #1 - Silence

Clinical Techniques: #1 - Silence

The powerful clinical techniques, or interventions, used in Modern Psychoanalysis have been mentioned in our previous articles, but it may be illustrative to examine some of them in further detail over the next few articles.

Silence is mentioned first, not because it is most important, but partly because it is sometimes overlooked or not thought of as a technique, or as an intervention. Coincidentally, it is most likely to be used, or possibly overused, with new patients or with new analysts.

How do I mean this? With new patients, the analyst has very little information to go on. A good number of modern analysts refuse to look at notes made by others in a new patient’s chart; these analysts want to get to know their patients individually, without any preconceived biases.

Modern analysts are also likely to be the least intrusive of therapists; as a rule they encourage their patients to talk about anything the patients want to talk about; rather than forcing them to answer the therapist’s questions, or requiring talk on certain subjects.

Given this situation, where very little is known about the new patients, silence is almost the intervention of choice, i.e., it is not so likely to damage a new patient’s vulnerable ego.

With new analysts, there is a natural fear of making mistakes, relevant to often justifiable concerns about the possibility of harming new patients, but also relevant to the analyst’s concern for self.

Silence is frequently the ideal tool for creating what D.W. Winnicott referred to as a “holding environment,” a place where the patient can feel safe and be given room to grow. (See e.g., Winnicott, 1986). In this sense, one could say that silence creates a space.

Silence can, likewise, be improperly used. By its nature, silence can be depriving. Analysts who remain unaware of their own strong countertransferences may even be capable of unconsciously using a depriving silence as a weapon against their patients.

Furthermore, silence can be an inappropriate response to some of the real life tragic events that can happen to patients while they are undergoing therapy, such as losing a loved one.

Dr. Spotnitz has discussed some of the different types of silence that may exist in the therapeutic setting. (See e. g., Spotnitz, 1985, pp. 249-50). Patient’s reactions to silence vary greatly. For example, Spotnitz tried remaining silent for a prolonged period with six different patients and noted six different reactions. (1976a, p. 28). Also, the same patient may report that silence provides a sense of power on one occasion and may complain about it at other times. (Spotnitz, 1976b, p.198).

One of the most important considerations in using, or not using, silence is the frustration level of the patient. Spotnitz (1976b, p. 172) says “The treatment may be preserved by controlling the degree of regression. To accomplish this the analyst may… limit the amount of silence to which the patient is exposed.”

However, the analyst must be careful in working with silence:

“It might appear that [a non-stimulating]… climate would be created if the analyst kept quiet. However, silence may at times be more stimulating than words. A great deal of anxiety can be produced by too much silence as well as by too many words. The anxiety level of the patient has to be studied, to determine whether silence or a communication would be more therapeutic in a particular situation.” (Spotnitz, 1976a, p.129).
Spotnitz (1985, p.175) also put the issue in a slightly different light in the following:

“Whereas the relatively stable patterns are just studied silently, the analyst does speak to lower the frustration-level and help the patient verbalize frustration-tension when a sudden intensification of such patterns is observed. Inasmuch as silence can have a soothing effect or exert increasing pressure on the patient, the analyst needs to regulate the amount of verbal communication he engages in, depending on whether he wants to intensify or to diminish pressure on the patient to verbalize."
Analysts need to know a great deal about themselves to effectively work with others where clinical techniques such as silence are involved. This is why modern analysts have their own analysts and supervisors to talk to, or be silent with.
References

Spotnitz, H. (1976a). Psychotherapy of Preoedipal Conditions, N.Y., Jason Aronson.
Spotnitz, H. and Meadow, P. (1976b). Treatment of the Narcissistic Neuroses, NY, Man. Center For Advanced Psychoanalytic Studies.

Spotnitz, H. (1985). Modern Psychoanalysis of the Schizophrenic Patient: Theory of the Technique, Second Edition, NY, Human Sciences Press.

Winnicott, D.W. (1986). Holding and Interpretation, London, The Hogarth Press.


© 2007, James G. Fennessy, M.A., J.D.
Matawan, New Jersey 07747
E-mail: njanalyst@hotmail.com
http://modernpsychoanalysis.org/

Psychoanalysis

5 comments:

Anonymous said...

Thanks for the post.

I have been very thankful for my therapist's ability to allow my silence (although, I have often lamented that it seems so waseful!) I have been able to use the silence to cull the competing thoughts & feelings from a chaotic and contradictory mess to a place where I can actually begin to do the talking.

When I talk about silence, it might be useful to quantify this; I needed massive amounts. This need existed, on and off, for a period of about a year to 18 months.

Of course, silence did not exist for the whole 50. Usually the first 10-15 minutes were taken up with summarizing the issues in my mind, and a few quasi-therapeutic statements (i.e., clarifying, empathic, etc.). But when the "real" questions or comments happened, it frequently took 20 minutes for me to gather myself to respond.

I am amazed that someone had the patience to deal with this for this amount of time. And I am also impressed that my therapist was able to communicate to me (despite my own issues) that this was okay and acceptable as a use of the time.

Silence can be an extremely powerful technique.

CLC said...

Hi Jim,
Re: Anonymous' post and amazement that the therapist had the patience to allow the silence that Anon. needed----as a fledgling analyst, I have had more than a few clients express thanks for my silence, and for not interrupting them as they thought or struggled to give words to their thoughts.

By the same token, as you noted Spotnitz said, the use of silence can differ from client to client. Sometimes a client needs help to talk. Sometimes the silence can be frightening or threatening. It is appropriate that the analyst ask the client if the silence is OK or if he\she would like help to talk.

Thanks for the blog. It's always interesting.
CLC

Anonymous said...

I found this article from google after having a very unpleasant first psychotherapy session where silence was used extensively by the therapist; to the point where no questions or introduction was given and I just could not understand why or where I was supposed to start and I was left feeling bewildered.

I had been seeking therapy to help with problems with social anxiety and he made the comment that I appeared very anxious, what did he expect? It then quickly became clear to me that he had not read my file (presumably for the reasons stated in the article) which confused me and at the time made me feel he did not care.

The almost total silence from him and lack of response caused me to become incredibly anxious, I felt threatened and that I was being made to deliberately feel uncomfortable. I couldn’t to understand why he kept doing this and was being so insensitive.

After I left I was shaking and had to wait to calm down before I could driving myself home. Under no circumstances will I let myself be put through that again by anyone and I will not be going back. I was difficult enough to get the courage to seek help in the first place and such insensitivity really does not help.

Drawn out silences in any social interaction are quite unnatural and so will feel quite unpleasant and uncomfortable to many people and they may not understand why you are doing it. This may well be a powerful technique used in the right context, at the appropriate moment and with the right patient, but please be sensitive to the type of person you are dealing with and consider their possible response to this to avoid them ever feeling what I did.

AIT said...

Wow, that was an extremely unfortunate experience you had. That analyst should be soundly scolded for not helping you talk. It was inexcusable during a first session especially, to let a self-professed anxious client lie there and squirm in silence. I am so, so sorry to hear of your experience, and hope you may be able to find a good therapist, one who will note your initial anxieties and help you through the uncomfortable silences until you can talk with more ease. Perhaps the people who put out this blog can help you locate someone in your area of the world?
Sympathetic Therapist who was also a client who had trouble talking at one time!

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