I want to start by quoting from Neil Gaiman’s novel “Anansi Boys.” The hero, Fat Charlie, is faced with a Dragon who is most unfriendly and very intimidating-as dragons tend to be.

” ‘You’re bored with talking to me now, and you’re going to let me pass unhindered,’  he told the dragon , with as much conviction as he was able to  muster.

‘ Gosh. Good try. But I’m afraid I’m not,’ said the dragon, enthusiastically. ‘Actually I’m going to eat you.’

‘You aren’t scared of limes, are you?’ asked Charlie…

The creature laughed, scornfully.’I’, it said, ‘am frightened of nothing’

‘ ‘Nothing?’

“Nothing’, it said.

Charlie said, ‘Are you extremely frightened of nothing?’

‘Absolutely terrified of it’, admitted the dragon

‘You know I have nothing  in my pockets. Would you like to see it?’

‘No,’ said the Dragon,uncomfortably, ‘I most certainly would not.’

There was a flapping of wings… and Charlie was alone on the beach.”

I wrote last week about boundaries and mentioned the temptation to end a session early if nothing was happening. At the time I thought about putting inverted commas around “nothing” because “nothing” suggests a great deal is happening if we can allow it. An exercise that I give to my students is to ask them to assess a patient. I brief the “patient” to say nothing for the duration of the exercise. The reaction of the students is informative. Some try any intervention possible to persuade the patient to talk. I have students tell jokes; threaten the patient with forced medication; flirt with them; get up and walk out. Therapeutic desperation kicks in. They have been given a task. It must be achieved at any cost. Some students, however, are able to sit quietly with the patient, tolerating their silence. (These students reassure me that the future of mental health nursing is safe in their hands.)

Some years ago I was asked to see a patient on one of the wards for counselling. I was given no information about him except that staff would try to ensure that he kept to the appointment. He arrived at my room on time. Came in. Sat down and said nothing for a few minutes. A  few minutes stretched to 15 minutes and he had said not a word. I made some attempt at interpreting his silence.  The psychoanalyst Donald Winnicott commented “I sometimes think that I interpret to let the patient know the limits of my understanding.” That was cerstinaly the case with this patient who remained mute for the full 50 minutes. I truly had no clear idea what this was all about. At the end of the session I thanked my patient for coming and told him that I would be here at the same time next week if he wanted to come and see me. The next appointment came and my patient arrived on time. Sat down. and was again mute for 50 minutes. Occasionally I would make some comment-posibly to remind us both that I was still alive! At the end of this session i made the same offer. That I would be  here  next week if he wanted to come and see me. Next week arrived – as did my patient. This session followed the same pattern as the previous two. As before when the session ended I invited him to come  back next week if he so chose. The next week came and my patient was not there. I waited for a while before going to the ward to find out what might be happening.  I was told that my patient was better and was now talking. (It turned out he thought he was responsible for his brother’s death and had taken a vow of silence accordingly.)

I do not know what effect our three sessions  had on him. He never came back to tell me. I offered him a space and he took up the offer. I felt under no obligation to “help” him or to talk for the sake of talking. My comments were aimed at telling him that I saw him.  That I did not mind his silence and that I was attending to him.To quote Winnicott again “It is a joy to be hidden and disaster not to be found.” Hopefully he felt found.