The silent patient by alex michaelides

“You think she’s faking?” 

“Yes, as a matter of fact, I do.” 

“If she’s faking, then how can she be borderline?” Christian looked irritated. 

Indira interrupted before he could reply. “With all due respect, I don’t feel umbrella terms like borderline are particularly helpful. They don’t tell us anything very useful at all.” She glanced at Christian. “This is a subject Christian and I disagree on frequently.” 

“And how do you feel about Alicia?” I asked her. 

Indira pondered the question for a moment. “I find myself feeling very maternal towards her. That’s my countertransference, that’s what she brings out in me—I feel she needs someone to take care of her.” Indira smiled at me. “And now she has someone. She has you.” 

Christian laughed that annoying laugh of his. “Forgive me for being so dense, but how can Alicia benefit from therapy if she doesn’t talk?” 

“Therapy isn’t just about talking,” Indira said. “It’s about providing a safe space—a containing environment. Most communication is nonverbal, as I’m sure you know.” 

Christian rolled his eyes at me. “Good luck, mate. You’ll need it.”


“HELLO, ALICIA,” I said. 

Only a few days had passed since her medication had been lowered, but the difference in Alicia was already apparent. She seemed more fluid in her movements. Her eyes were clearer. The foggy gaze had gone. She seemed like a different person. 

She stood at the door with Yuri and hesitated. She stared at me, as if seeing me clearly for the first time, taking me in, sizing me up. I wondered what she was concluding. Evidently she judged it safe to proceed and walked inside. Without being asked, she sat down. 

I nodded at Yuri to go. He deliberated for a second, then shut the door behind him. 

I sat opposite Alicia. There was silence for a moment. Just the restless sound of the rain outside, raindrops drumming against the window. Eventually I spoke. 

“How are you feeling?” 

No response. Alicia stared at me. Eyes like lamps, unblinking. 

I opened my mouth and closed it again. I was determined to resist the urge to fill the void by talking. Instead, by remaining silent and just sitting there, I hoped to communicate something else, something nonverbal: that it was okay for us to sit together like this, that I wouldn’t hurt her, that she could trust me. To have any success at getting Alicia to talk, I needed to win her trust. And this would take time—nothing would be accomplished overnight. It would move slowly, like a glacier, but it would move. 

As we sat there in silence, my head started to throb at the temples. The beginnings of a headache. A telltale symptom. I thought of Ruth, who used to say, “In order to be a good therapist, you must be receptive to your patients’ feelings—but

you must not hold on to them—they are not yours—they do not belong to you.” In other words, this thump, thump, thumping in my head wasn’t my pain; it belonged to Alicia. And this sudden wave of sadness—this desire to die, die, die —did not belong to me either. It was hers, all hers. I sat there, feeling it for her, my head pounding, my stomach churning, for what seemed like hours. Eventually, the fifty minutes were up. 

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