Silence in Session

What do therapists really mean when they say nothing?

Clinical Conversations

In everyday life, a long silence in a conversation can feel uncomfortable and off-putting. Most people take pains to avoid these gaps whenever possible. Much of the value of ‘small talk’ is as an escape from awkward pauses.

The ‘awkward pause’ also shows up in therapeutic conversation. Clients may wonder why the therapist, an expert in conversation and human relations, would allow such a faux pas. In fact, silence has a different set of meanings for therapists. In therapy, many of the normal ‘rules’ of conversation are turned on their head for the client’s benefit.

Making Room

Sad to say, quality conversation, and more specifically, good listening, can be rare in everyday life. Listening to some people talk in a group can feel exhausting when there is pressure for one person to talk over the speaker, and everyone is more interested in getting their ideas out than paying attention to what anyone else is saying.

One thing I hope every client gets from therapy is the sense that they are being fully and respectfully heard. While some clients revel in therapists’ predisposition to silence and large pauses, others may find it unfamiliar and even unnerving. In ordinary conversation, it is more common to be talked over and feel pushed back by a tide of words. Silence is like the tides going out, leaving a vacuum to be filled. A reserved client may feel drawn into this void and while there may be some discomfort, the value of getting a shut-down client talking is often worth it.

Diagnostic Silence

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Your therapist may very well be silent not only to give you the impression that you’re being heard, but also to listen for clues to what you’re thinking and feeling that may be a problem for you. Most therapists prefer to let the client lead the conversation in both tone and content most of the time.

By remaining silent and avoiding adding direction to the conversation, I find it relatively easy to find out what is important to a client, and what is irrelevant. Sometimes I think of conversation like a car trip. A car comes to a four-way stop in much the same way that a conversation hits an awkward pause. If I as therapist say something at that point, I’ll lose the chance to see which way the driver (my client) will turn. Maybe he’ll turn left, or right, or go straight through. He might even just sit there, do a u-turn or start driving off-road. My experience teaches me that whatever direction the client picks, there’s often something worthwhile to be found in that direction.

Often, what’s important to a client isn’t always what I think is most relevant. Any time I spot such a divergence, a couple of things could be true. First, I might need to adjust my model of what the client values, and know that those values are essential in understanding the client. Second, maybe the client really is missing something important that I need to bring to their attention.

Advice Abounds

Long before I was licensed to do therapy myself, I loved to listen to radio talk shows featuring caring and wise therapists who would dispense short bursts of advice in response to a specific question. Talk shows like this may be entertaining and even useful to callers and listeners alike, but they don’t fairly represent how therapists relate to clients in the office.

Chances are, for any client with a problem serious enough to see a therapist, they’ve already received mountains of advice: from friends, family, and even the Internet. And if any of it had been heeded or had worked, then there would be no problem. If therapy were mostly about giving advice it wouldn’t be worth much, as advice is readily available from much cheaper sources.

Local Experts

Like most things in life, change is far easier said than done. Ready-made solutions (in the form of hastily-given advice) fail for a number of reasons. One of the biggest is individual differences. A particular personality or set of circumstances may make a hash of an otherwise good plan.

If I work with a client for one hour a week for a year, I’ve seen them for 52 hours in all. Meanwhile they’ve lived thousands of days in their own skin. I find it useful to think of clients as the ‘local experts’ in their own lives, and this prompts me to hold back and see what they have to say about their own problems, how they think about them, and what they’ve tried and failed to achieve, before charging in with ideas of my own.

Whose Life is it, Anyway?

I find it very important to break clients of the ‘talk show’ model of therapy, or worse, the ‘guru’ model, where the client comes to the therapist for advice or solutions. It’s not that I don’t think I have solutions. Therapists are chock-full of models, theories, and processes for change. But I also want my clients to know how to solve their own problems, not just use pat solutions. Client dependence can be a very real problem in therapy, and it can persist because it has the potential to meet the needs of the client to be taken care of, and of the therapist to be important. As much as I enjoy working with my clients, ethically, I must help them move towards greater independence: a place where my services are no longer needed.

• in practice
• silence