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In the presence of certain clinical situations, the therapist experiences perplexity, a feeling of not understanding anything, even though the interview or the sessions are unfolding without any apparent difficulties. This associative silence, this blank in thinking, is the reflection in him or her of a silence, an enigma in the history of the patient and his or her family, an intangible trace around which the relational dynamic pivots. The clinician must be able to tolerate waiting so that at the right moment the words of the patient or his or her relatives can reveal the meaning of this silence and this family suffering… Four short vignettes are used by way of illustration.