Does the analyst ever do anything except talk?
Yes, he remains silent. - Wilfred Bion
Silence is such a remarkable thing. Why don't we (clinicians) use it more?
As I started my clinical training, I thought about silence as being something to use when I'm thinking about what I should be doing. Like many trainees, I felt like I had very little idea about what I was doing, and silence made me feel even more incompetent; when silent, I was not doing anything. If I am not talking, I am not doing enough and I am not being helpful.
I've always been comfortable with silence. Even as a little child, I would prefer to listen rather than talk; silence was a respite for me, a place of comfort and ease. Even when those around me would be in turmoil, I would rarely feel the need to talk or reassure them, and felt comfortable being with another in their turmoil. Then I started working with clients and that comfort disappeared. What changed?
I believe that there are many gifts we are given as helpers. We are entrusted to hear someone's story and narrative, their traumas, and their successes. We get to hear their darkest secrets and their deepest desires. We oftentimes hear things that nobody else has ever heard our patients say. Though all of these are all wonderful, with these gifts comes a whole lot of responsibility.
I do not pretend to know much about Bion - I've been attempting to read more, but I have a long way to go before I feel competent engaging in discourse about his ideas. That being said, I do think a lot about his ideas of detoxifying projections and containment. As clinicians (regardless of if you know of Bion or not), we are taking in information from our patients, oftentimes in the form of strong feelings or affect. You might even call these feelings projections or split off aspects of the self. After we make sense of out of these feelings, we hand them back to the patient who internalizes/introjects them in a more digestible form.
This, I believe, is where the difficulties are born. When our clients matter to us, and we feel responsible for them, we have an immense desire to contain, and maybe even control, these split off aspects of our patients' psyches. I was once working with a patient and started to experience an intense, and very real, intrusive thought about handing him a nearby garbage can. All I could think about was handing him the garbage can; I could not listen to what he was sharing with me. I was quite perplexed, but a little terrified, about why I was experiencing this. When my supervisor and I explored this further, I became aware that I may have wanted the patient to put his split off anxiety and aggression in the waste basket; at that time in my training, I do not think I was capable of detoxifying his anxiety and aggression and giving it back to him in a more digestible form. It needed to go in the trash.
Though I haven't experienced anything like that again, I continue to experience anxiety when I feel like I am unable to contain my patients' projections. To compensate, I talk. By talking, I'm reducing my anxiety, but by talking, I am not being helpful and I may actually be doing harm. Though we may think that most of our patients might need more talking (more supportive interventions such as empathizing, reflecting, providing support/advice), I am really starting to rethink what these patients might actually need. By talking, we are not containing, but rather, projecting our own anxieties back on the patient.
We need to cultivate awareness of our desire to speak. Are we talking because the patient needs it? Or are we talking to quell our own anxieties?
- cg