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Coltart, N. (1991). The Silent Patient. Psychoanal. Dial., 1(4):439-453.

(1991). Psychoanalytic Dialogues, 1(4):439-453

The Silent Patient

Nina Coltart, M.D.

The silent patient is defined as one who speaks for less than 10% of the entire analytic treatment period, and for many sessions, not at all. This article derives from the author's experience in the analyses of eight such patients during her working life as an analyst (30 years). After a brief discussion of some basic theoretical issues that are usually kept in mind in the early stages of such analyses, there follows an examination of the particular technical problems presented by extended silence; short clinical vignettes, illustrative of these problems, are woven into this part of the text. Special emphasis attaches to the detailed study and use of the countertransference, probably more valuable in these cases than in any others. The qualities that are desirable, even necessary, in the analyst are discussed, among them the capacity for love, a subject still approached gingerly in our literature. Reference is made to two eccentric forms of silence: absence and sleep. Notes on the study of body language and the uses of humor are discussed briefly. There is a special interest inherent in the work with silent patients, and some thoughts on its rather mysterious quality close the article.

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