Tag Archives: Silence

Silence as Avoidance

1-1I have a client who uses silence as a defense or avoidance. What can I do to make therapy effective when he isn’t engaging with me to work on his goals?

I previously discussed general guidelines about managing silence in session, which will be helpful to read if you didn’t do so before. In this situation, you are experiencing the client’s silence as an obstacle to therapeutic progress and it sounds like he hasn’t responded to your encouragement to work more actively in therapy. I’ll outline a couple suggestions that may help you reframe the meaning of the silence and respond therapeutically.

My first comment is that this client actually is engaging with you through his silence. My guess is that you have spent a lot of mental energy and emotion in attempting to solve what you experience as a problem between you, so he has been successful in creating a relationship with you. The obstacle or problem lies in the fact that he is engaging with you in his preferred way rather than in your preferred way.

A question I would pose is “why does this client prefer to engage with me through silence rather than through talking?” There are a number of possibilities. He may feel vulnerable to being controlled and/or judged by you if he speaks about what he thinks, feels and wants in therapy. He may be sensitive to the implicit power dynamics between the two of you, and using silence to recalibrate the balance of power. He may be highly anxious and/or obsessive, such that his cognitive process becomes paralyzed or blocked when he thinks about painful or unsatisfying aspects of his life. Other explanations may come to mind based what you know of his history and presenting symptoms, if you frame the question in this way.

Once you have developed a hypothesis about the reason he prefers to be silent, you can make a tentative comment like “I wonder if it feels safer to stay silent than to risk hearing what I might say if you were to talk about what is on your mind.” He may or may not respond to this directly or verbally, but communicating your desire and effort to understand him will have a positive effect on the therapeutic alliance.

I would also recommend thinking about your therapeutic role with this client as containing elements of both joining his interpersonal world and providing a different interpersonal experience than is familiar to him. This is always part of the therapeutic process, but the two worlds or experiences are usually closer together than they are in this case.

You may have an assumption that his goals for therapy will be met only if he talks with you as most of your other clients do. Joining his world means letting go of that assumption and meeting him on his terms. This may mean that you remain silent for some of the session or that you comment on his silence without a requirement that he begin talking, as in the example above. In this context, providing a different interpersonal experience may mean that you accept his need for silence without insisting on an explanation. Maybe he has felt forced into interacting with others when he needed distance, and therapy feels like a repetition of that coercion. He will let you know if and when he is ready to engage in a more traditional form of talk therapy. In the meantime, remember that you are demonstrating your capacity to relate to him differently than he may expect and fear.

I hope you this has been helpful in thinking about silence as a defense or avoidance. Please email me with comments, questions or suggestions for future blog topics.

Managing Silence

LGBT therapyI have a client who has a hard time talking in our therapy sessions. I want him to benefit from therapy so I prepare for the session by having topics for us to talk about. This has been going on for several months now, and I’m beginning to wonder if there’s a different way to handle this situation.

This is a common question for therapists in training. Since the nature of our work is listening and talking, we tend to feel uncomfortable when the back-and-forth flow of our interactions with clients is interrupted by silence. One aspect of professional growth as a therapist, though, is becoming comfortable with therapeutic interactions that are different from social interactions we have with friends, family and co-workers.

When I am working with a client who doesn’t initiate conversation or falls into silence, I usually respond first by simply sitting quietly myself. Often the client will then continue with the previous line of thought or bring up a new issue that we can explore together. In the beginning of therapy, I don’t let the silence continue for more than 20 or 30 seconds especially if the client seems uncomfortable, but that is often enough time for the client to guide the direction of our conversation.

If I do choose to break the silence, I ask an open-ended question rather than bringing up a specific topic. Examples are “is there more you’d like to say about that?” or “what’s on your mind?”. If I notice something in the client’s body language, I might say “it looks like you’re feeling sad about that” or “maybe it’s hard to realize how much pain you’re in.” If you use this type of question or statement, your client will know you’re interested in his inner experience and that he sets the direction of the therapy. Usually he will feel encouraged to continue exploring the thoughts and feelings related to the current issue or to shift to an issue that feels more relevant.

When silence is a recurring part of the therapy and the client doesn’t respond to your open-ended questions or reflective statements, your task becomes one of assessment or conceptualization of the reasons for his behavior. Some possibilities are a lack of familiarity with therapy and self-reflection, social anxiety or skill deficits, and cognitive limitations. Talk with your supervisor about your client’s history, diagnosis and relationship experiences as well as the therapy process and your countertransference responses. This discussion will help you develop an understanding of your client’s experience of the therapy and choose the most therapeutic way to engage him. You may also need support from your supervisor in managing your countertransference with a client who seems passive and disengaged.

When silence is recurring, it is sometimes helpful to provide some education about the therapy process. Clients who are new to therapy may be unsure of what is expected, and clients who have a history of contact with social service systems may have been socialized to take a passive role with professionals. Giving a short description of therapy and your approach and expectations provides guidance in these situations.

Another helpful intervention is to make a process comment or question related to the silence itself. Examples are “what’s it like for you to sit quietly here?” or “it looks like you’re not sure what to say next” or “how would you like me to respond when you’re quiet?”. You may learn that the client has assumptions about your role or your reactions to him that lead to a fruitful discussion between you. For example, the client may express a desire for you to provide an answer to a complicated emotional dilemma or may be worried that you are bored by the circumstances he is describing. In general, process comments and questions serve the purpose of communicating your presence and interest in the client and provide an opportunity to talk directly about obstacles to the client’s engagement.

I hope you found this helpful in managing silence in your therapy sessions. Please email me with comments, questions or suggestions for future blog topics.