Silence In Psychoanalytic Treatment
The Use of Silence in Psychoanalytic Treatment: A Relational Approach
(A paper written for Institutional Graduation with minor redactions to protect case material)
Theory abounds in psychoanalytic writing while suggestions on technique that feel accessible to a new clinician can be incredibly hard to find. While there are books on techniques such as joining or mirroring or interpreting, it is rare that one would find two texts that agree. As it is rare to find a text that gives a clinician some decision-making ground for when and how to use the techniques that are suggested. Many would argue that this is by design. Psychoanalysis is, in many ways, a theory without a manualized directive on technique. As psychoanalysis has evolved, even questions about the necessity of laying on the couch or attending multiple times a week have been raised and avidly debated. The question of “what is psychoanalysis?” is, indeed, a curious one. Without a manualized technique how are we to know? Indeed, psychoanalysts don’t even all agree on one theory of mind!
As a bit of a maverick myself, I love these truths about psychoanalysis. So many brilliant women and men have engaged in the deep observation of the human mind. So many have written about their observations and allowed us to see the psyche from a plethora of angles. A psychoanalyst can practice very differently from another and see the mind very differently and still be understood to be practicing psychoanalytic psychotherapy. In this way, psychoanalysis resists dogma and allows for a unique treatment for every analyst/analysand dyad.
My mentor reminds me often that the task is simply to help our patients to talk more. When I first heard this idea, I found such relief. I am very good at helping people to talk by nature and so this grounding statement about our work allowed me to have something to return to when I was lost. He also believes that the definition of psychoanalysis is any form of inquiry that puts transference, countertransference and resistance as the core of its exploration. A belief that came from Freud himself. (Mitchell et. al., 1995)
One of the things that sets psychoanalysis apart from other forms of psychotherapy is the seemingly unanimous position that one must have their own analysis and supervision. While all psychotherapists are required to utilize supervision for the first few thousand hours, psychoanalysts often remain in some form of consultation for their entire career. In this way, we attempt to fill the gap between theory and technique for our students. Students can learn experientially from the skill of their mentors.
I fear that this is not enough to develop “good enough” therapists. As Winnicott (1965) argued (and I agree) we are not seeking to be perfect mothers. In fact, Winnicott believed that the perfect mother was far more psychologically harmful than the “good enough” mother. It should then follow that it should be our aim to be “good enough” therapists and “good enough” trainers and supervisors. At this time, I fear that we have fewer “good enough” therapists than ever as manualized treatments that are wholly mis attuned to the patient are the treatments of choice for many new clinicians.
But how are we to learn to be “good enough”? Even having two supervisors and an analyst only provides us with the experiential learning that is possible by absorbing the technique of three people. And, as our supervisors and analysts will be attuning their treatment to our unique needs, we are not privy to their technique with another type of psyche.
As a clinical supervisor I have a great deal of of contact with clinicians who are just entering the field. They have often been outright told that psychoanalysis is a theory of the past with no relevance today. They are given a million wrong ideas about psychoanalysis and hardly any right ones. Those who have decided to pursue psychoanalytic training and supervision following their schooling are brave indeed. They are already going against the grain. But as any wise human would do, they wish to dip their toes into the theory to see if it aligns before jumping all the way in. When psychoanalysis was the only game in town, there was a high motivation to brave the complicated and complex world of psychoanalytic theory. In today’s world theories of counseling abound and options far more accessible and immediately gratifying than psychoanalytic training are readily available. In this way, more accessible published work that gives students simple ways to try out psychoanalytic therapy is needed maybe more than ever.
As they seek this toe dipping, they find only very deep pools of water with curling vines that grip and pull and, truly, cause panic. There are very few easy entry points to psychoanalysis. We are seemingly stuck between allowing the complex and nuanced beauty of psychoanalysis to be over simplified and therefore broadly utilized or dying as a profession at our own hands. I believe we must try to find a balance in the way we write about our work. I believe new students need access to technique and simplified foundations of the why of the technique without wandering into the realm of manualized or dogmatized treatment. I believe that doing so will only lead to an increased interest in these more formal, intellectual, complex, complicated and philosophical texts.
Some may argue that it is, in fact, more important than ever that our curriculum and expectations of clinicians be higher, not lower. They may argue that we risk diluting the complexity of the theory and therefore degrading the competence of the clinician.
I found that steady, loving, supportive, playful and yes, sometimes simplified training and supervision has built our psychoanalytic community to sizes we have never seen in Asheville. I have had no trouble filling training sessions that I provide in this community and am often asked when and what we will be discussing next. I am finding that as their confidence and excitement about the theory builds so does their capability and excitement to read more complex texts and master more nuanced concepts. Indeed, I do believe that taking this approach has led to a much larger population of “good enough” therapists in Asheville than ever, and I am proud to say so.
As our psychoanalytic institutes struggle to find new students and as those who currently hold the torch are nearing retirement or death with few skilled clinicians to pass that torch to, one can barely argue that we are doing a “good enough” job at transitioning to and being willing to change for the needs of incoming clinicians.
It is our job, after all, to resolve resistances.
So, in this paper, I wish to write on the topic of silence in the treatment room. I intend to advocate for a nuanced and attuned use of silence in the psychoanalytic treatment room. This paper is specifically for the psychoanalytically curious clinician. Many of them tell me of their fellow students who think that psychoanalysis is antiquated, sexist, awkward, manipulative, elitist, intellectually defended and cold. These rigid stereotypes, if allowed to remain prominent, are hurting our ability to recruit new psychoanalytically curious clinicians and impeding our ability to get clients who will dismiss the idea of a distant and aloof clinician before even giving us a try.
While I will, of course, identify my own personal use of silence in the treatment room, I hope to allow for a deeper curiosity about the why of silence. What is the history of silence in psychoanalytic treatment? What purposes can it serve and what harm can it do? I hope to relieve the reader of their assumption that punitive, uncomfortable silence is a requirement of psychoanalysis.
The History of Silence in Psychoanalysis:
Many classical analysts are known to have taken the position that silence on the part of the analyst provides not only the feelings of safety, calm and opportunity needed to say anything, but also provides the necessary frustration required for a client to speak about their unconscious. Many classical analysts insist that silence on the part of the analyst is an essential and non-negotiable feature of the analysis setting it apart from those other social interactions in which the patient can fall into small talk and wind themselves in circles in the same old conscious word patterns. In Listening with the Third Ear Reik states “The patient may perhaps now turn to the analyst to ask for his help, but the latter is silent as if that were the only natural attitude and as if the social world which avoids such embarrassing silence in conversation does not matter.” (1948, p124)
When one understands Freud’s theory of mental struggles, one can begin to understand why classical analysts value silence differently than many Modern Analysts or Objects Relations Analysts might. Freud believed that most mental struggles arise as a response to unresolved childhood fantasies. He believed that once a person made those childhood fantasies conscious, they would be cured. In fact, he believed disordered Narcissism to be resulting from a lack of sufficient frustration in the mother/child dyad. Freud believed that silence allowed for transference onto a “blank screen” which would provide information helpful to the archeological dig of the patient’s psyche and the following interpretations. The value of transference in the treatment was not in its inherently corrective relational properties, but in its ability to unearth information (Mitchell, 1995). You can understand, based on these ideas, why Freud might have believe that the treatment must be sufficiently frustrating and without many words from the analyst. If the task is to unearth and then make sense of, one must ask the client to talk and talk and talk as if getting a parasitic worm out of one’s belly. It is not meant to be enjoyable; it is to be an excavation.
Langs is quite fond of silence and tends to take a somewhat rigid approach to the therapeutic frame. “Now, if we are going to be thinking of the development of the framework of the therapeutic relationship and the creation of a therapeutic bipersonal field, there will be a preference for a response in which the therapist either maintains his silence or at most nods to the patient.” (1978, p17)
Greenson writes, “There are two basic requirements which the analyst must fulfill in order to promote the growth of the transference neurosis in the patient. The analyst must consistently frustrate the patient’s quest for the neurotic gratification and reassurance, and he must also remain relatively anonymous.” (1967, p. 376) I have found that new psychoanalytically curious clinicians often assume correctly that psychoanalysts often mean to frustrate the patient’s quest for the neurotic gratifications and reassurances through silence. Silence also has the unique ability to have us feel anonymous. (I have my doubts as to its ability to truly grant us anonymity in the treatment room).
And yet Greenson noted on the next page, “Excessive frustration and anonymity will produce interminable or interrupted analyses.” And “The analyst must not let the deprivations and frustrations of the analytic situation exceed the patient’s ability to withstand such stress.” Reik admits with ease that there are different emotional messages that the analysts silence may convey, “That means that the silence of the psychoanalyst can have different meanings.” (1948, p123)
It is notable that in Freud’s “An Outline of Psycho-Analysis” (1949) there is no mention of the use of silence in the technique of psychoanalysis nor is the word “silence” even to be found in the index. As I search for the word “silence” in Freud’s complete works (Smith, 2000, 2007,2010) I find only mentions of the patient’s lived experiences of silence but nothing about the psychoanalyst’s position of silence. And yet, this position of the silent analyst seems to occupy the minds of every new supervisee I work with.
I can imagine how more silence on the part of the analyst could have served a developmental need for neurotic patients, especially if the primary outcome of psychoanalysis is to simply make that which is unconscious conscious. If it is our primary and even sole goal of psychoanalysis to make that which is unconscious conscious and we work with neurotic patients, silence can seem as a parent stepping away from the bicycle so that the eager child can do it on their own. Just enough deprivation to encourage the patient to explore their mind on their own uninhibited. Just enough to make them want to bridge the gap... fill the space with what they have never said.
Lacan was often known for utilizing silence to disrupt the patient in his or her pattern of relating with symbolic language. He believed that to expose “the real” or that which cannot be contained in symbolic language, the typical patterns of a person’s psyche must be disrupted in the treatment. Lacan imagined that “the real” contained emotional experiences that could not be put to language—often trauma. Lacan would be quite comfortable and even likely encourage his followers to frustrate the patient to disrupt the norm and expose the unconscious traumatic material. Like Freud, he saw the essential healing factor to be the exposure of the unconscious to the conscious mind. Uncomfortable silence was one way to create this disruption. He also believed ending sessions sometimes only after five minutes was a useful way to do this and ensure that interpretations “stuck”. He also, at the end of his career imagined that the clinician’s use of their own sadism—even to the point of physically abusing patients—was essential to uncovering this unconscious material. (Hewitson, 2014).
But it was not long after Freud’s theory of mind that psychoanalysts began wondering about those who were not being cured by the classical technique. In the 1920s the theory of interpersonal psychoanalysis was forming. In the late 1970’s Kohut began considering narcissism in a totally different way. He believed that those with a Narcissistic Personality Disturbance were not suffering from too little frustration. He believed that they were suffering from a lack of self-resulting from problems in the mother-child dyad whereby the relational needs were not met appropriately. Ainsworth and Bowlby entered the scene with attachment research and object relations folks started thinking about the transference very differently. They began to think of the transference itself as curative. Some went so far as to say that the interpretations are of little to no value at all and it is simply the relationship along with talking that cures. (Mitchell et. al., 1995)
In my experience, it is far more common in 2025 for a new student to be primarily interested in the attachment and object relations vein of psychoanalytic theory. These theories (founded and developed by theorists such as Winnicott, Fairbairn and Klein) would likely see and utilize silence differently. From their perspective, the transference is not only helpful in being able to “see” on the “blank screen” through to the unconscious so that more is known. From an Object relations point of view, the therapeutic relationship serves its own purpose as a corrective emotional experience that allows for stunted, fractured or misdirected development to proceed in a more helpful manner. Lucy Holmes writes in her book “Wresting With Destiny” (2013) about the neuroscience of talking in relationship and its potential to re-wire the brain. She also speaks in her short piece “Reaching the Repetition Compulsion” (2014) about the ways in which emotional communications from the therapist were more effective at changing repetitive behaviors than insight and interpretation ever could be.
Indeed, I have found this to be true. I can recall a time when one of my patients had been, for years, lamented that no one liked her, and she couldn’t make friends. I found this to be unimaginable because I found her incredibly likeable. And yet her friendships floundered again and again. For years we explored this belief, the roots of this belief and attempted to make sense of it. The intervention that worked was a relational one. One day as she was lamenting about this issue and I said, “I know, because I can’t stand to be around you!”. At that point in treatment there was enough love and attachment that she knew I was being sarcastic, and she responded by flicking me off. In that moment, I was telling her that I loved her and loved being with her without saying those words. But I did so with just enough hate that she could feel it as real love. She didn’t feel pandered to. She knew it was authentic and that I thought her line about not being likeable was total horseshit. That turned the tables, and she now has many friends. This has allowed us to start exploring how her friendless situation was a defense of sorts that served a purpose. While one might say that this was an intervention a la Lacan—disrupting what the patient expected, I argue that this intervention couldn’t have worked earlier in the treatment as it would have felt confusing and upsetting to the client.
Winnicott in particular is known for believing that without these emotional experiences, development cannot move forward in a healthy way. His belief was that if one received those reparative relational experiences, the damage done by the harmful relational interactions could be repaired (Winnicott, 1965). In this way, an analyst would think that if the most harmful part of the mother/child dyad was silence it could be harmful to repeat that relational trauma with the use of silence in the treatment. In this way an analyst would believe that using the treatment to excavate the “truth” about the unconscious could be a violent act against the traumatized psyche.
It is true that this Objects Relations theory has been confirmed by modern attachment researchers as well. In fact, most attachment researchers today suggest that to have healthier attachments, one must have new reparative emotional experiences with a securely attached person. In “Attached.” (2011) Levine and Heller suggest finding a securely attached partner. I, for one, believe that because of our repetition compulsions, it is highly unlikely we will do so. This is where I believe the Objects Relations theorists had it right from the beginning. A skilled psychotherapist can cleverly serve as this object without acting out in ways that are familiar to the patient.
In this way, the goal of treatment is not to frustrate sufficiently. It is to balance frustration with gratification much like a good enough mother would do. This sheds a new light on silence in the treatment relationship. Does the baby not need mother to babble back at them? Does the baby not need father to laugh? Do they not need eye contact? Of course, this type of thinking can be dangerous. How do we use the relationship as a corrective intervention without getting into the dangerous realm of re-parenting? Alas, that is a topic for a different paper.
As I touched on earlier, Lucy Holmes explores the Repetition Compulsion in her article “Reaching the Repetition Compulsion” (2014). The Repetition Compulsion, first identified and defined by Freud is, in many ways, a parallel if not overlapping theory to Lacan’s “the real”. Holmes explains that these relational patterns and trauma responses to early unspeakable traumas live deep within the lower levels of the brain and are often unable to be fully expressed symbolically. (While I understand these are separate and unique concepts, their nearness in concept is notable to me at least.) In fact, she cites the large body of neuroscience data that supports this claim. While Lacan and Freud wished to frustrate and disrupt to reach these parts of the psyche, Objects Relations theorists and Modern Analysts believed that the way to this part of the psyche was in fact to provide a new, more emotionally safe and containing experience in relationship.
In one of the courses I attended at a Modern Analytic institute, a student asked the professor “So if it is important that the patient feel that they can express their aggression in the treatment and it is important for them to do so, do you do things intentionally to activate their frustration?” In my view, this question aims at the heart of the idea of using silence to frustrate or activate. His response mirrors my belief. He said, “I have the idea that I am a human and by nature of being a human who frustrates others, I will activate that frustration without making special efforts to do so.”
This does not mean that Modern Analysts, Kohut’s self-psychology or even Object Relations theorists endorsed a Rogerian approach to the treatment relationship. In fact, the way one experiences love in the treatment will vary immensely from one patient to another where one may feel love in your sarcasm, another in your warmth, another in your willingness to get out of their way. The difference is, though, that Modern analysts and Object Relations theorists would suggest that we are not disrupting by frustrating on purpose with silence, we are instead trying to disrupt the client’s relational expectations. We wish to disrupt their idea that they will be punished with silence. We wish to disrupt their idea that they will be shamed or criticized. It is my personal belief that trying to heal trauma by activating aggression on purpose is unethical. Trying to heal trauma by allowing for aggression to be contained and safely expressed is the only ethical path towards use of aggression and frustration in treatment.
I have found that silence in my own treatment has been both a gift and a punishment at different times. When I first entered treatment with my first analyst, I found myself reflecting that sitting in the room with her and having her not speak much was reparative. My own mother talks over much and has over much to say about what she thinks I should do or should have done or what I’m really thinking or feeling which is, of course, different from what I am saying. I reflected to my analyst at one point that I feared laying on the couch because I feared that I would be devoured if I relaxed that much in her presence.
Emotional Message of Silence:
While these positions appear to be radically different, let us remember the similarities. From classical analysts through Modern and Objects Relations and more contemporary theories and all branches that extend beyond, there is an agreement that the relationship (or at least the transference) matters and that the more clients can say without censoring themselves the better the cure. So, from this common ground, what questions might we want to ask when we are considering silence in each individual treatment?
For me, the question is always “What emotional message am I sending and is it helpful and why?” Paul Geltner has done a beautiful job of discussing this topic of emotional communication in his book “Emotional Communication” (2012). In this book he explores how we emotionally communicate in treatment and the impact on the treatment.
When is silence a gift in analysis, and when is it a punishment? Some of us have been lucky enough to have known those moments of pure bliss when we share silence with a trusted other. So too have we known those moments when a trusted other leaves us room to ramble through our psyche without structured limits to our symbolic expression. To freely talk without hesitation or limit in the presence of the other is a gift indeed!
We have also all known (maybe all too well) what it is to be frozen out with silence. It has been given a name used most often in marital relationships. The phrase “silent treatment” rarely indicates a relational gift. Silence is also an opportunity for condescension. We have all spoken in a group and experienced the resounding silence that follows, causing us to feel small and mistaken in taking the risk to talk. One can imagine the statement made and not responded to, leaving us feeling judged, misunderstood, or dismissed. The partner who asks for help with a chore and receives silence.... again, and again and again until all trust is lost and resentment reigns.
This is where I believe we can find agreement. Freud came to believe that resistance is not the defense we must breach to get to the unconscious goods. Instead, he came to believe that resolving resistance IS the treatment (Mitchell, 1995). Modern analysts believe that the treatment is in the resolving of resistances to saying more. So, this brings me back to my Mentor’s sage advice that our only job is to help people to talk more and about new things and in new ways.
I believe that this task relies on our ability as analysts to begin to understand the emotional message sent by all our interactions—including our use of silence. It is my belief that the relationship (more than hypnosis or lying on the couch or demanding free association or disrupting or confusing patients) is the path to resolving the resistances to saying anything. Here are the questions I often ask myself when considering my use of silence.
Does my silence help the person to talk more?
If you notice or sense that your words are often brushed away or sharply responded to, it is a good indication that the treatment needs more silence on the part of the analyst. Or in one treatment of mine, the response to every question was minutes of silence. I found that when I mirrored that silence, the patient talked more.
But if, instead, you find that your client stares at you intently when there is silence or you get the counter transferential feeling that the client is likely to leave treatment due to their frustration at the silence, that may be a time for the clinician to use more words. For some patients, having the clinician co-conspire to avoid silence is helpful for the patient to relax and eventually allow for the silence and luxuriate in it. They may need to overcome that hurtle slowly.
If a client starts cancelling sessions with frequency, one might imagine that they have the silence balance wrong a bit (among other balances we might look at in treatment). In other words, if your level of silence does not help the person to talk more, it is wise to adjust the volume one way or another.
What was the role of silence in the patient’s life/what would be the corrective emotional experience?
One way to consider this topic is through the Lacanian lens of Presenting Problem vs. Symptom. In other words, the patient may present with OCD behaviors, but as analysts we are creating theories about the roots of that problem (symptom) by imagining their early years. Lacan would see the “symptom” as a personal expression of how the person interacts with the other, holding unconscious knowledge (Dioguardi, E. (2021). While in my experience Lacanian analysts think about this in terms of unconscious desires, I find it more helpful to think about the symptom in terms of the early mother/child dyad through an Objects Relations lens. What relational interactions led to what blocks to the human reaching their full emotional and actualized potential? What harm was done, what provision was denied, and what relational and soothing tools were needed to survive the childhood? In this way, I like to think of us as different types of plants. A cactus cannot grow properly in a swamp. A maple will be deformed by barbed wire. So, in this way, what function did silence play in making the symptom useful to the psyche? Was it just the right amount of room for the tree to grow or did it leave the tree overly exposed to the elements? Was the silence a cool breeze or barbed wire?
There is not a clear answer to more talking or less on the part of the analyst depending on the role it played in the childhood, unfortunately. For example, a patient may have lacked verbal mirroring from the primary caregiver. One might think that the corrective response is to not use silence much. But that patient may need a gradual increase in both parties talking if silence is familiar. Even if silence is lonely—its familiarity is what matters most. While you may have another client who also lacked verbal mirroring from caregivers but their solution to that was to fill silence at every turn. These patients may feel punished by your silence and may need a very conversational type of exchange to relax.
This, of course, takes me back to my first question. While it is helpful to understand the emotional role silence has had in a person’s life, that only fills out a clinician’s sense of how silence and verbalizations can be understood and therefore adapted to over time. A patient who starts treatment talking wall to wall and not allowing the therapist to talk would be seen as progressing in treatment if at some point they make room for the therapist to help. While a patient who starts treatment unable to talk at all without a great deal of help from the therapist, would be seen as progressing if they are able to talk the whole session. At the end of the day, I find it to be helpful to have a working theory of how this emotional communication of silence is experienced by the unique individual in front of me and why that might be.
Am I resolving my anxiety or theirs with my use of silence or verbalization?
I am originally from upstate New York. In my social and familial circles, to allow for silence was to give the message that you were not interested in the person you were talking to. I can still remember moving to Arizona for college and hiking with my fellow students. One peer of mine was from Ohio and she would silently listen as I talked and talked and talked. I was waiting for her to interrupt to let me know she was interested in what we were talking about. But she would patiently wait until I was done. Then she would pause pensively. Then she would respond. I found it so odd until it occurred to me that never would I have a conversation with my friends from childhood and not interrupt or be interrupted. It would not have been considered a particularly good conversation if we silently waited.
For this reason, I must be careful. This part of my subjective experience, I believe, helps me to be a far more playful and improvisational therapist. In fact, I believe it is a large part of why so many people find it helpful to come and talk with me. I have the theory that my ease with talking and my ease with myself helps people to say things to me they would never say to anyone else. Having said that, it has been important for me to keep good track of the why of my own talking.
I find it helpful to consider my own countertransference reactions and analyze them. Am I talking because that will make the time go faster for me? Am I talking because I am uncomfortable with silence? Am I talking because I feel that, as a therapist, I must have something verbal to offer? Am I talking because I’m not being listened to enough by those in my life? Is their flavor of aggression the type I am wanting to avoid even though they need to be able to express it?
This is a difficult exploration indeed for is it not inevitable that the therapist would indeed experience their own sadism or narcissistic need in the treatment? I often tell my supervisees that we are in the impossible position of having our human being selves activated in ways that we would not tolerate in the world outside of the treatment room without acting out. But in the treatment, we must respond in a way that would be unnatural for us to do in that world outside. Much like a mother must not throw her baby out the window when they have made it impossible to sleep, we must not harm our patients because of our own sadism or narcissistic need. As Winnicott so skillfully explains in “Hate in the Countertransference” (1949), it is only natural that we will wish to act out. Our use of fantasy (and supervision and analysis) are excellent tools to avoid doing harm while having these experiences in treatment.
Having said all of that, Sullivan was a wise observer when he noted that the mother who is overly anxious is unable to soothe the baby. He believed that there were two kinds of operations, security operations and integration operations. When the caregiver is anxious, it activates security operations instead of integrating operations (Mitchell, 1995). I tend to believe the same is true in psychoanalysis. While we must investigate our own anxieties and resolve them to the best of our abilities through our own analysis, we must also set our practices up in such a way that we are less anxious and therefore can soothe the patient. For example, I am aware that my countertransference to being cancelled on frequently causes me a great deal of anxiety for a variety of reasons. I have talked and talked and talked and explored and analyzed this reaction. And yet, it does not abate. Despite my mentor’s clear preference that I never have a cancellation policy spelled out in advance of treatment but instead that I navigate it on a case-by-case basis, I have recently determined that I will indeed have a cancellation policy. And that policy is quite strict. In doing so, I have been able to relax in my role and I do believe that has allowed my patients to relax around their attendance. This may not be clinically best, and yet, it is best for me. In this way I have determined if it is best for my nervous system, it will allow my patients also to relax. I believe that if the patient is soothed and relaxed in the treatment room and relationship, they will say more, and free associate more readily than we might achieve by imposing rigid ideas of psychoanalysis onto their treatment. Indeed, I have found this to be so.
What does my countertransference tell me?
When I am silent, does it feel like I am doing so as a withholding or punishing stance, or a loving one?
It is an inevitable occurrence that each of us will, during our career, act out against our clients. It is an unfortunate event when one justifies this acting out in the name of theory, though. A classical analyst who injures a patient with an interpretation, a Modern analyst who injures a patient with aggression or an objects relations clinician who injures a patient with poor boundaries are examples that come to mind. If silence is injurious to our patient, we must consider that we are acting out and need to explore this in supervision and analysis instead of insisting that the patient was not ready for treatment and their injured response is simply due to their lack.
When in doubt, I am inclined to make the treatment more gratifying than frustrating. I am aware that this position is not necessarily a popular belief in all psychoanalytic realms. Nonetheless, I find that the restrictions of the clinical hour and the requirement to pay and attend regularly are often frustration enough at first for many patients. As time goes on, we can find a place in the treatment where our clinical withholding is more playful and developmentally helpful. In my experience starting the treatment in a state of frustration is ill fated and counterproductive to the development of a positive transference or a stable narcissistic transference.
If I feel as if I am punishing the patient because Freud told me to, that is when I re-focus on the patient and what is happening in the here and now with our relationship. Without the should. If I find I am punishing the patient because the treatment is going off the rails and I am chest deep in an enactment, I will be sure to seek out supervision to find another outlet for my aggression. Although there are some cases of masochistic or sadistic patients who benefit from a bit of punishment, even then I find it best done in playful ways.
Conclusion:
In conclusion, it is my assertion that we must talk about technique more often and with more history and context so that new clinicians can fall in love with the incredible psychological art that can be psychoanalysis. The simplicity and the complexity. The agreements and the bitter conflicts within the community. The way a well-read psychoanalyst can make sense of a psyche is unparalleled in any other psychotherapeutic sphere. But making sense of a psyche is not, on its own, sufficient to be useful to the humans it is meant to be useful for.
Regardless of our theoretical foundations, every action we take is interpreted through an emotional lens for the patient. Silence is no exception to this rule. A lack of nuance in how we imagine psychoanalysts use silence will lead to many failed treatments. I take the approach that the treatment relationship is the path towards relaxation that allows for a loosening of the defenses and the flexibility to explore other ways to have their life work. In this we can hope that even if the patient does not walk away with much insight they will, by default of going through this relational process the patient may be more able to navigate the world, their drives and their relationships in ways that thread the needle of “good enough.”
References:
Dioguardi, E. (2021). Lacan’s Sinthome or the Point of Psychoanalysis. European Journal of Psychoanalysis. Vol. 7, No. 2.
Geltner, P. (2013). Emotional communication: Countertransference analysis and the use of feeling in psychoanalytic technique. Routledge/Taylor & Francis Group.
Greenson, R. R. (1967). The technique and practice of psychoanalysis. International Universities Press.
Hewitson, O. (2014). Lessons From Lacan’s Practice—Every Day Psychoanalysis From The Classroom to the Boardroom. Retrieved July 7, 2025 from https://www.lacanonline.com/2014/02/lessons-from-lacans-practice-everyday-psychoanalysis-from-the-classroom-to-the-boardroom-iii/
Holmes, L. (2013). Wrestling with destiny: The promise of psychoanalysis. Routledge/Taylor & Francis Group.
Holmes, L. (2014). Reaching The Repetition Compulsion. Modern Psychoanalysis. Vol. 39. Number One. 27-36
Langs, R. (1976). The bipersonal field. New York: Jason Aronson.
Levine, A. & Heller, R.S.F. (2011). Attached. Penguin Books
Mitchell, S. A., & Black, M. J. (1995). Freud and beyond: A history of modern psychoanalytic thought. BasicBooks.
Reik, T. (1948). Listening with the third ear; the inner experience of a psychoanalyst. Farrar, Straus & Co.
Smith, I. Ed. (2000, 2007, 2010). Freud Complete Works. London. Hogarth Press.
Winnicott, D. W. (1949). Hate in the counter-transference. The International Journal of Psychoanalysis, 30, 69-74.
Winnicott, D. W. (1965). The maturational processes and the facilitating environment: Studies in the theory of emotional development. International Universities Press.