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.
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.
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