Indirect communication as a therapeutic technique: a novel use of countertransference

This paper presents a technique to deal with therapeutic impasse in the treatment of resistant or very troubled patients. The novel feature of this technique is the indirectness with which therapists communicate with their patients. Therapists think aloud while not looking at their patients; patients "overhear" rather than hear. In their soliloquies, therapists make use of their countertransference for therapeutic purposes. Direct communication in such situations is often impossible or counterproductive and continued silence may not be in the patient's best interest. This paper provides the background for these ideas, describes the productive use of this technique in three clinical situations, and provides a theoretical rationale for them. The conceptual frameworks draws from Winnicott's ideas of the True and False Self, play as it relates to therapy, and the regulating functions of a positive holding environment for disequilibrating countertransference. Several factors contribute to therapists' concerns about employing this technique: the need to appear sane, fears of relinquishing eye contact, and apprehension over exploring the projective field. Instances when the use of indirect communication is not indicated, ill-advised, or contraindicated are discussed.