17 The Silent Patient Book Club Questions to Get Stuck Into

Looking for The Silent Patient book club questions for your next reading group meeting? Here are 15 thought-provoking discussion questions to get you guys going!

The Silent Patient by Alex Michaelides was a huge success when it was released in 2019. A heart-pounding psychological thriller, it tells the story of Alicia, an artist arrested for the murder of her husband. Alicia refuses to speak. It’s up to psychotherapist Theo to get her to talk, and uncover the truth about why she murdered her husband.

This is a story full of twists and turns. It’s a pretty fast-paced read and makes for a fun choice for a book club. If you’ve chosen this as your next group read, the following book club questions for The Silent Patient may help to get the discussion going!

The Silent Patient Book Club Questions

The book opens with a diary entry, and the following line: ‘I don’t know why I’m writing this.’

What did you think of the opening diary entry? Did it intrigue you, and did you have any idea of where the story would go based on this first section?

According to the first chapter, Alicia Berenson (the silent patient herself) completed a painting in a few days. She then went on to kill her husband. Brutal murder aside, this was an unusual situation for Alicia: she usually took painstaking care to complete her paintings over a series of months.

What clues can we pick up from the painting itself? Did it give you an idea of the final outcome?

The main character, Theo Faber, is a psychotherapist. He trained in psychotherapy because of his own problems. He says that helping others was a bit of a lie; he actually wanted to help himself.

What did you think of Theo’s character at the beginning? Do you think a person can practise psychotherapy effectively if they have unresolved issues to deal with in their own lives?

Theo describes the state Alicia was in after the murder. She’s trembling and clearly sedated, and she refuses to speak. This goes on for a long time, as it takes Theo quite a while to ‘crack’ Alicia.

At this stage of the story, did you believe that Alicia committed the murder?

In Chapter Four, Alicia enters a frenzy and attempts to attack Theo. It’s a distressing scene, which ends in Alicia being sedated. Meanwhile, Alicia’s previous doctor tells Theo he’s wasting his time, as he believes that Alicia will never speak.

What did you think of Alicia’s behaviour at this point? What did you think it would take for her to speak?

Theo realises his wife, Kathy, is acting strangely. He quickly discovers that she is cheating on him, and he begins to monitor her to a level that becomes a bit unsettling.

What did you think of Theo’s actions here? Did you guess who Kathy’s lover might be?

Alicia’s painting, Alcestis, is based on the Greek myth of the same name. Alcestis was a goddess. She was sent to Hades instead of her husband, and is later saved, but never speaks again.

What do you think Alicia was trying to communicate with this painting? Did you enjoy having this as a clue to think about as the story developed?

The writing style in this novel is snappy, with short chapters and an easy-to-read style. Theo’s sections are occasionally broken up by Alice’s longer, more descriptive writing.

What did you think of the writing style? Did you find it an easy book to get into? Did it hook you, or did you find it hard to get through?

Alicia has a tragic backstory. Her mother tried to commit suicide with Alicia in the car, and she ponders this in her diary: ‘Was she crazy?’ She wonders whether the ‘craziness’ is within herself, too.

What did you think about Alicia’s backstory? Do you think that she was targeted on purpose because she was a little more vulnerable than another woman may have been?

Gabriel and Alicia have a whirlwind relationship. Max, Alicia’s brother-in-law, insists that Gabriel and Alicia are happy. But Alicia’s diary suggests otherwise, and the ending of the story certainly suggests that she wasn’t happy.

What did you think of Gabriel and Alicia’s relationship? Did you feel that you found out enough about Gabriel’s character?

We’re getting into spoiler territory now, so be careful if you haven’t finished the book yet!

Just as Theo has a breakthrough with Alicia, he returns the next day to find her in a coma – someone has injected her with morphine.

Did you guess who really put Alicia into a coma?

Right at the end of the story, the big twist is revealed: the plotline involving Theo following his wife is, in fact, set in the past.

Did you enjoy this twist? Was it a surprise, or did you see it coming? What worked/didn’t work about it for you?

We also find out that Theo’s wife, Kathy, is cheating on him with Gabriel.

Did you guess this before the big reveal? What did you think would happen next?

Ultimately, we find out that Theo is the one who broke in, tied up Alicia and Gabriel, and forced Gabriel to choose who Theo would kill. Gabriel chooses to spare his own life, but Theo leaves them both alive.

What was Theo’s motivation here? Why did he leave them both alive, and how did he expect to get away with his crimes?

Ultimately, we find out who killed Gabriel. The ending got mixed reviews from professional reviewers: some readers absolutely loved the twist, and others saw it coming a mile away.

What did you think of this outcome? Did you guess who it was? Do you feel satisfied with the ending in general?

Alicia says of Gabriel that ‘he killed me’.

What do you think Alicia meant by this? How do you think she felt in that moment?

Ultimately, Theo is in trouble because Alicia’s diary is found, containing the true story of what happened. Theo is relaxing at home with Kathy when he is arrested. The officer at the door reads Alicia’s diary aloud to him.

What do you think will happen to Theo? Did the ending answer all the questions you had, or are there elements of the story that you wish had been explained in more detail?

Hopefully, these book club questions for The Silent Patient will help facilitate your next discussion!

Megan Bidmead

Guest writer

Megan is a freelance writer based in Somerset, England. When she’s not writing about books, video games, and pop culture, she’s running around after her two kids and trying to squeeze in the occasional walk in the countryside.