In a recent posting, I discussed therapists who tend to take too much responsibility for clients who present themselves as helpless, hoping the therapists will magically cure them.
But I have also seen therapists taking this same stance with those who do have some feeling of power over their lives. For example, years ago in Los Angeles, I did group supervision at a clinic/training center where masters and doctoral degree therapists acquired hours of training toward the licensing requirement by working with low-fee clients. Most of the weekly sessions involved the therapist discussing their cases while the other members and I gave them feedback. Each therapist, however, was required to conduct a live session at some point in the several months they were in my group with a client in front of a one-way mirror while I and the rest of the group watched and heard the interactions.
I began to realize while watching the in vivo sessions that I was seeing something I had never become aware of while they discussed their clients in the group: they were too active and didn’t allow their clients and themselves to be silent for more than a second or two. They would also usually start the sessions off with a comment or a question instead of waiting until the clients brought up an issue they wanted to discuss.
This process sometimes seemed to promote passivity in some clients and also prevented the clients to make connections between their various themes, thereby deepening emotional and cognitive awareness. It also prevented the therapists from giving themselves time to observe important aspects of the client: tone of voice, bodily posture, how they seemed to be relating to the therapist, etc. My good friend, Bob Edelstein, has eloquently expressed in a blog he wrote for Psychology Today (ile:///Users/admin/Desktop/The%20Power%20of%20Silence%20%7C%20Psychology%20Today.webarchive) the value of allowing silences to occur in any kind of interaction between two people, including therapist and client.
Bob says in his blog:
When I value silence as a therapist in a session, I discover what is going on within me in the moment. I listen in a finely attuned way to my client so that I understand more of the subtleties of what makes them tick and how they make meaning of their life.
I would add that silences are also an aid to the client .
Of course some of this behavior by the therapists at the Southern California Counseling Center was partially y a function of their anxiety about being watched by me and the rest of the supervision group; they wanted to be seen as helpful to their clients. But it became clear that their over-activity was also a function of them not trusting that their clients would be able to profit by silence and be able to figure things out on their own. It prevented or at least made it more difficult for the clients to develop what psychoanalytic theorists have termed “an observing ego” or what another analyst, Peter Fonagy has termed the “mentalizing function.”
Mentalizing is the ability to think about and experience one’s own mental processes. Allowing the client and oneself to be silent, particularly after the therapist has made some comment to the client, is an important therapeutic strategy. It allows the client to make associations, and for both client and therapist to notice how the client is perceiving and relating to the therapist. Allowing the client to come up with her or her own connections can be very empowering to the client. It is particularly important for those diagnosed as Borderline Personalty Disorder, people who tend to react impulsively with intense emotion to situations where they feel hurt, slighted or rejected by others, including the therapist. They have very little ability to be introspective and often are in an emotional crisis mode. Helping them to think rather than reacting with intense, often chaotic, emotion is something they need to learn to do.
Of course Freudian analysts knew the value of allowing themselves to be quiet in the therapy setting, just allowing the client to free associate, usually commenting only when the client stopped talking and appeared stuck. (But the result for many clients, of course, was that they experienced their analysts as cold and uncaring.)
I’m not advocating a blank screen approach, but giving the client an opportunity to respond to what I’ve said. I then allow their response to what I’ve said to determine, at least partially, what I next say to them.
In practically all my sessions, I wait and allow some silence when the client first sits down. Most clients have already learned that, beyond the first,intake, session, I let them start because I believe they know what’s important to them on that day to deal with.
Sometimes they might say they haven’t prepared anything and I suggest they just wait a moment and see what emerges. I have found that some of the most fruitful sessions have been where the client doesn’t come in with an agenda. Frequently they bring up something that subtly seems relevant to our relationship: how they perceive me, how they feel towards me, what they imagine I feel toward them, whether or not they experience the therapy as being helpful. This last issue is very important for, as much research has shown (e.g., an article on Expertise in Psychotherapy by Tracey, et. al. in the April, 2014 issue of the American Psychologist), therapists are, as a group, very poor at knowing when what is transpiring between them and their clients is helping the latter to grow. Some of the research these psychologists cite actually shows that although more experienced therapists are more confident about their clinical judgments than less experienced therapists, they are frequently actually less accurate than the latter!
Being quiet can also allow the therapist to notice the client’s very subtle body movements and tone of voice, which can indicate what state the client is in at that moment. It also can give the therapist space to become aware of his or her own body movements and feelings in response to the client’s demeanor.
Here’s an example. A past client I will call Jane, whom I had seen for several months, didn’t seem to be making much progress in the therapy. She had had much prior therapy before consulting me and, although her life looked good from the outside, she wasn’t really getting much joy or meaning from it. She led a very busy life, filling every moment with activities. She seemed to be gulping life and rarely seemed to savor the many activities that, in a more calm, grounded person, would be pleasurable and meaningful. She was five minutes late for what turned out to be a pivotal session and I noticed as I went out to my waiting room that she had a cup of coffee with her and didn’t look pleased to see me. Her expression was not hostile, just neutral. She apologized for being late and said that she just had to stop at the local Starbucks to get a coffee. As she sits down, her face is slightly averted and she looks at me for a second, then looks away. I also notice that I am leaning slightly away from her and am feeling somewhat impatient. But I don’t say anything, just wait for about 30 seconds. She then says she doesn’t have anything on her mind. I ask how she feels about being here today and she says “fine.” But she doesn’t sound fine, and I tell her that I am really interested, that I wasn’t just making small talk, I really want to know. She admits with some obvious anxiety that there were other things she wanted to do and that coming to see me wasn’t her first priority. I compliment her for being honest and ask her what she would rather have been doing. She mentions a number of things. As we explore those preferred activities, it becomes clear to me that she has taken the same attitude to her work with me as in the rest of her life: never really committing herself whole-heartedly to it, but always having a vague sense of dissatisfaction and thinking about what she could do after our session. I suggest an experiment to see what that’s about, she agrees. I ask her to say only what she experiences sensorially in my office, that she just tell me what she sees, what she feels in her body and what she is feeling emotionally.
She does this for a few minutes and begins to look more grounded. She is also looking right at me now rather than the somewhat furtive contact she had been making at the start of the session. She begins to tell me that she can’t understand why, despite what looks like a good life from the outside, she is chronically unhappy and dissatisfied. It becomes clear that she has certain unmet needs from other people and feelings toward them that she hardly ever expresses. She was brought up in a very chaotic, dysfunctional family where her immature parents were constantly fighting with each other and were unable to be nurturing, deeply caring and invested in her well-being and growth. She had formed, without being aware, the organizing principle that she couldn’t really count on others to care about her or meet her needs. She tried to nurture herself by constant solitary activities and only superficial contact with other people. She didn’t really expect me to be of help to her and, up to that session, her negative expectations had been borne out.
This session was the start of some very growthful work on her part, much of it having to do with our relationship. I myself began to be more emotionally involved and interested in her because of the more meaningful contact between us.
In conclusion my suggestion to any therapists reading this posting is that they experiment with allowing some silences in their therapy sessions and seeing what transpires. I would welcome feedback.