LISTENING TO SILENCE

ABSTRACT I have examined the function of silence - its possible role and meanings - in the psychoanalytic encounter. I have argued that silence is complementary to words in general, and to analytic free associations in particular, and that silence in the patient is often more than just the expression of his resistance. It could be useful to consider the silent space within a session as a sort of container of words - words that for complex, overdetermined, unconscious reasons cannot be uttered. I have insisted on the significance of analytic silences and warned against responding to them either through a retaliatory silence or through a flood of premature interpretations. These inadequate reactions often stem from the analyst's own anxiety evoked in him by the patient's silence. Anxiety and silence are closely connected. Each silence is a compromise formation, concealing the unconscious fantasy from which it originates, while expressing a conscious one, often related to the transference situation. It is the task of the analyst to listen to his patient's silences in order to help him understand their meanings.     

SILENCE LENDS INTEGRITY TO SPEECH: TRANSCENDING THE OPPOSITES OF SPEECH AND SILENCE IN THE ANALYTIC DIALOGUE

In this paper the interplay between silence and the spoken words used by analyst and patient will be explored within the context of clinical practice. Both analyst and patient, it is argued, are engaged in a personal struggle to try to discover an integrative connection between silence, often experienced as nothingness, and speech, often experienced as suffocating or mendacious. The uses of silence in aiding speech to attain integrity will be described with reference to two clinical vignettes. Selections from psychoanalytic theory and practice will be discussed, throwing some light on silence and analytic spoken dialogue, and it will be argued that a Jungian perspective contributes a further, unique, insight through the concept of transcendent function. This is a way of seeing silence and speech as opposites, out of which new levels of meaning arise as a result of union and unconscious cooperation in the relationship between them. This union is known as coniunctio.     

SOME DEVELOPMENTAL FACETS OF SILENCE: A CASE STUDY OF A STRUGGLE TO HAVE A PROXIMITY FIGURE

ABSTRACT The phenomenon of silence in therapy has not elicited a great deal of research in the past 50 years, but cases that were published acknowledged the many facets of silence in therapy and its having a communicative function and being part of the transference. The aim of this article is to demonstrate a case in which a patient exhibited different kinds of silences which stemmed from different sources over the course of nine years of psychotherapy. In analysing the case, it was proposed that the patient used silences in order to attain proximity to the therapist as an attachment figure and to base the proximity and distance in relation to her. It was also proposed that his silences matured and developed from expressing avoidance to the expression of intimacy thus facilitating the maturation of his capacity to maintain a dialogue. The possibility of interpreting silences is discussed in terms of attachment theory.     

Evil,Imagination and the Unrepressed Unconscious: The Value of William Blake's Satanic ‘Error’ for Clinical Practice

The images and writings of William Blake offer profound insights for the clinician in a form that clearly reveals his visionary ability regarding the unrepressed unconscious. He is particularly helpful with the work of imagination and the presence of evil concerning unconscious process. This paper explores the creative value of Blake's contribution when working with certain patients in the consulting room and for the purposes of psychotherapeutic research: he has inspired many psychoanalytic and Jungian papers in the past. However, in the world of psychotherapy, Blake's complicated but illuminating mythology has been somewhat neglected in favour of interpreting him through the lens of analytic thought. While setting this paper within an analytic frame, the writer aims to offer an overview of Blake's central concepts – particularly those concerning Satan and the state of ‘Error’ – that are revealed in their most refined form in his celebrated ‘Illustrations of the Book of Job’. A number of Blake's paintings and etchings illustrate this paper, providing an additional and vital avenue of communication through image. Clinical vignettes related to psychotic levels of the psyche illustrate the central theme.     

Exploring Silence in Psychoanalytic Theory and Clinical Work

Silence, as an element of the therapeutic encounter has been of interest in psychoanalytic theory from the early stages of its development. Theoretical views on the functions of silence have broadened considerably since the phenomenon was first examined, in line with developments of theory and technique. This literature review aims to explore silence in psychoanalytic theoretical literature and proposes three broad categories of silence in psychoanalytic psychotherapy, namely: silence as defence; silence as connection; and silence as withdrawal. From this review it appears that silences in psychoanalytic therapy may often be multidetermined in nature; it is suggested that there are limits to the extent to which these can, and possibly should, be understood. The implications of the theoretical understanding of silence for clinical practice are then explored, and the importance of each therapist finding their own way to incorporate silence into their work with each patient is acknowledged. Debate within the literature as well as research in this area are important to further understanding of this phenomenon.     

Category specificity in reading and writing: the case of number words

In standard models, word meanings contribute to reading words aloud and writing them to dictation. It is known that categories of knowledge and the associated word meanings can be spared or impaired selectively, but it has not been possible to demonstrate that category-specific effects apply to reading and writing. Here we report the case of a neurodegenerative patient with selectively spared numerical abilities whose brain damage left him able to read and write only number words.     

Psychoanalysis and Psychotherapy: Comments on the Analytic Attitude

SUMMARY. In this paper I have suggested that the analytic attitude is the contribution to psychiatry generally and should, at least to the extent of respecting the significance of and the security provided by symptoms in terms of the patient's psychic reality, characterise every form of psychotherapeutic intervention. I have also sought to make explicit and extend understanding of non-defensive passivity. The latter is implicit in Schafer's advocacy of action language and specifically referred to in his mention of excessive claiming of agency, and in his references to necessity, accidents and happenings (1982, pp. 100, 106).     

THE WEBSITE'GIRL': CONTEMPORARY THEORIES ABOUT MALE'FEMININITY'

ABSTRACT I explore a bisexual male patient's need to differentiate highly problematic'feminine'identifications - originating in childhood sexual abuse and impingement by men as well as women - from identifications with more admired aspects of his mother. My main focus is on the patient's sexual identity - the personal meaning he gave to being male - rather than on his bisexuality - his desire for both sexes. In psychoanalytic literature powerful opposite-sex identifications are usually associated either with psychotic confusion or celebrated as a source of psychic strength. The co-existence of problematic and highly valued cross-sex identifications is rarely discussed. I also look at how this patient re-negotiated his identity through the transference relationship with a female psychotherapist, given that his'masculinity'derived mainly from childhood experiences of 'stealing'his mother's phallic power. Through a wideranging theoretical review I conclude that we need to draw together opposing psychoanalytic perspectives about maternal and paternal power, opening up new ways of thinking about triangular relationships in the transference.     

SANDOR FERENCZI AND PATIENTS' PERCEPTIONS OF ANALYSIS

This article traces the development of Sandor Ferenczi's conviction that patients' analytic material might be understood, in part, as a valid unconscious portrayal and critique of the way their analyses were being conducted. Ferenczi's own clinical records are re-examined and indicate that he failed to appreciate the possibility that the alterations he had made to the frame of his analytic relationships might be represented in such portrayals.     

Shared Phantasy and Therapeutic Structure in a Brief Marital Psychotherapy

ABSTRACT In this, the first of two related papers, the process is examined by which a couple were helped to separate, temporarily and emotionally, through a brief offer of psychodynamic therapy. The therapy comprised six weekly sessions of one hour's duration, an input often considered inadequate for effective analytic psychotherapy. The paper examines the interrelationship between an unconscious shared phantasy which had produced deadlock in the marriage and two structural aspects of the therapeutic offer - its brevity and the decision to see the partners separately. The concept of shared phantasy is discussed in the second of these papers which describes in the context of one model for outcome assessment, in what terms the therapy might be said to have been effective.     

Language and the brain: Implications from new computer models

Computer systems for processing and “understanding” natural language have, up to now, used semantic and syntactic procedures that provide meanings of words in terms only of other words or some structural algorithms that ultimately relate to other words. There is a long-standing and widely held belief that words, or their unknown neuronal correlates, are fundamental to verbal meaning, concepts, and thought but over the last decade, evidence has been accumulating in neurology and psychology to indicate that this is not so.We have developed a new computer system for representing the meaning of words and sentences, by which word meanings are described non-verbally in terms of sensorimotor and other modality codes. It is suggested here that the principles of this system might usefully be applied to understanding the cerebral mechanisms of some verbal and cognitive processes and their disorders. In particular the hypothesis is proposed that verbal meaning is essentially non-verbal, and that it may be represented, for both words and sentences in terms of interassociated modal percepts or their neuronal correlates.     

FROZEN HARMONIES: PETRIFIED PLACES IN THE ANALYTIC FIELD

In this paper I suggest that here-and-now transference interpretations can be defensive when they keep the focus on the intrapsychic world of the analysand and neglect the unconscious of the analyst and the unconscious-to-unconscious interaction between patient and analyst. Whilst the concept of the analytic field in psychoanalytic literature provides us with a way back to Freud's original consideration of the intersubjective alongside the intrapsychic, this inclusivity has been sustained within the Developmental School of Jungian Analytic thought. To illustrate this I present an adaptation of Jung's model of the transference. Once we engage in analytic work with an individual we are inevitably drawn into a 'dance' together with its own particular rhythms and harmonies. Each analytic couple creates an analytic field from their idiosyncratic energy flow. Within this field, interruptions to the 'dance' occur; mis-steps and disharmonies involve an unconscious refusal within the analyst as well as the patient. Both the dance and the refusal are crucial for the work, and I suggest that our attention needs to be directed here, to the blocks or 'petrified places'. To illustrate how I believe they can be made use of, I provide material from three case examples.     

ABDICATION OF A FATHER: SOME REFLECTIONS ON THE FREUD–JUNG CORRESPONDENCE1

abstract This paper explores one dimension of the complex relationship linking Freud and Jung as revealed in their correspondence between 1906 and 1912. It focuses on Freud's adoption of Jung as his heir, particularly in terms of his repeated proposal to Jung ‘to continue and complete my work by applying to psychoses what I have begun with neuroses’. The paper tracks the fate of this proposal in the words of these two men and suggests that the ambivalence of both can be seen as an expression of an unconscious dynamic portrayed in Shakespeare's King Lear, a dynamic characterized by the author as the developmental task of ‘heriting’. Emma Jung captured the heart of the dilemma of ‘heriting’ in her question to Freud: ‘Doesn't one often give much because one wants to keep much?’ Although the trajectory of the heritage Freud sought for his ‘adopted eldest son’, ‘crown prince’ and ‘successor’ was not the same as that of the tragedy of Lear, it was no less poignant in its tensions and disappointments – even for a time in its reversal of the ‘heriting’– and finally in the disintegration of the relationship.     

Objective correlates of an unusual subjective experience: A single-case study of number–form synaesthesia

There is a universal and often unconscious tendency to mentally associate the number sequence with a spatial continuum (the mental number line). Here we study one individual who reports a strong and vivid sense of space when processing numbers. For him, the number sequence has a precise spatial form: a curvilinear right-to-left oriented line. We used various tasks to demonstrate that this numerical–spatial association is not a mere figment of his imagination, but a constrained experiential phenomenon consistent across sessions and automatically triggered by the visual presentation of numbers. We also show that this idiosyncratic representation can coexist with another implicit association, the SNARC effect (Spatial–Numerical Association of Response Codes, where small numbers are associated with the left side of space). This effect is present in individuals without explicit number forms and is not affected in the present subject in spite of his reversed subjective representation.     

Objective correlates of an unusual subjective experience: A single-case study of number-form synaesthesia

There is a universal and often unconscious tendency to mentally associate the number sequence with a spatial continuum (the mental number line). Here we study one individual who reports a strong and vivid sense of space when processing numbers. For him, the number sequence has a precise spatial form: a curvilinear right-to-left oriented line. We used various tasks to demonstrate that this numerical-spatial association is not a mere figment of his imagination, but a constrained experiential phenomenon consistent across sessions and automatically triggered by the visual presentation of numbers. We also show that this idiosyncratic representation can coexist with another implicit association, the SNARC effect (Spatial-Numerical Association of Response Codes, where small numbers are associated with the left side of space). This effect is present in individuals without explicit number forms and is not affected in the present subject in spite of his reversed subjective representation.     

BION, THE PARIAH OF'O'

ABSTRACT Bion's elaboration of transformations and evolutions in'0'represents one of the profoundest paradigm changes within psychoanalysis to date. The sweep of its epistemological embrace is so radical that it understandably dismayed many of his analytic cohorts, who thereupon marginalized him in the British Psycho-Analytical Society. The concept of'0', I am arguing, unites all the existing branches of culture and epistemology from the religious to the scientific and allows us to begin to conceptualize a boundless horizon of containment for our boundless anxieties about our being-in-the-world.     

The Sexologist Albert Moll �C between Sigmund Freud and Magnus Hirschfeld

Albert Moll was one of the most influential sexologists during the first three decades of the twentieth century. In contrast to his rivals Sigmund Freud and Magnus Hirschfeld, his achievements have not yet been recognised adequately. The author gives a comparative account of the work of these three protagonists. This shows that Moll formed some ideas which are regarded as psychoanalytical today before Freud, and that he, in contrast to Hirschfeld, was able to reflect critically on contemporary discourses, such as the debates on racial improvement through eugenics. As scientific theories, Freud’s psychoanalysis represented the unconscious, fantasy, experience and latency, while Moll’s sexology represented consciousness, ontological reality, behaviour and manifestation. Moll’s major disagreement with Hirschfeld’s sexology was his advocacy of apolitical and impartial science, whereas Hirschfeld’s aim was to achieve sexual reforms politically. Added to these differences were strong personal animosities. Freud called Moll a ‘beast’ and ‘pettifogger’; and Moll complained about Hirschfeld’s ‘problematic’ character. When Hirschfeld escaped the Nazi terror and went to Paris, Moll denounced him in order to prevent him rebuilding a new existence in exile.     

DISCRETION AS POWER: IN THE SITUATION CALLED 'PSYCHOTHERAPY'

ABSTRACT I use the term'psychotherapy' as the name of a freely contracted relationship between two competent and responsible adults, one paying the other for assisting him, by means of a dialogue, to live his life better. In addition, I distinguish sharply between voluntary psychotherapy, whose wellspring is the patient's need for helping the Self and involuntary interventions called 'psychotherapy', whose wellspring is the family's (or the court's) need for controlling the Other . The former rests on consent, the latter on coercion. It is just as absurd to conflate voluntary and involuntary'psychotherapeutic' relations as it is to conflate sexual relations between consenting adults and sexual assault called 'rape'.
After a brief critical overview of the development of modern psychotherapy - epitomized by psychoanalysis - I offer some observations on the current proliferation of'psychotherapies'under cultural and political-economic conditions inimical to the only therapy I value, which is contingent on a human relationship in which personal assistance is secured by an equality of self-restraint on the part of 'therapist' and 'patient'.
Dare to be fearful, when all about you are full of presumption and confidence. (Edmund Burke 1789/1992)     

The syntax of single words: Evidence from a patient with a selective function word reading deficit

We describe the reading performance of a patient who has selective deficits for reading nonwords, function words, and morphologically complex words in isolation. His reading of highly abstract nouns and verbs, however, is relatively well preserved. He can recognise and comprehend the meaning of written function words, of derivational morphology, and of most inflectional morphology. We suggest that his deficit in reading grammatical morphemes is unrelated to his problems in reading nonwords and cannot be explained by their low semanticity and imageability. The patient's speech is ungrammatical but is not devoid of grammatical morphemes and his reading of functional elements improves when these are presented within the context of sentences. We argue that syntactic information relevant to individual lexical items including information about how the word may potentially be used within a phrase must be accessed during single word reading tasks (e.g., Levelt, 1989). This is particularly difficult for function words due to their linguistic specification, which is different from that of lexical categories (Chomsky, 1995). Both linguistic theory and Garrett's (e.g., 1982) model of sentence processing account for the patient's improved reading of function words in the context of sentences.     

Homework assignments in relational psychoanalytic treatment of personality disorders: A case study of a patient with narcissistic personality disorder

Homework assignments, or specific tasks patients are asked to engage in or complete between sessions, are a controversial topic among psychoanalysts. While many argue these interventions contradict psychoanalytic principles, others believe they can help address problems and promote coping skills. We propose that homework can be a legitimate aspect of relational psychoanalysis when used in a way that is attuned to the patient's experience and that homework may be an important component of treating personality disorders (PD). We present the case of a man diagnosed with narcissistic PD. He often felt superior to and reported that he despised others, though the core self-image was of fragile. He embraced the role of the omnipotent caregiver, which came with boredom and anger and lack of satisfaction in his social life. The patient tried to control therapy, asserting that he could psychoanalyze himself. As a result, therapy was stalled and progress was limited. At this point, the therapist asked him to complete homework assignments that encouraged him to refrain from his compulsive caregiving to better understand what motivated this behavior. Through this process, the patient came to realize he acted out of avoidance, as he did not want to disclose his own vulnerabilities and flaws. At that point he was able to experience relationships while adopting different stances and finding new meanings. We argue that homework can be fully integrated into the relational psychoanalytic repertoire to improve self-reflection and foster change in patients with PD.