Monthly Archives: November 2013

Is Silence in Therapy Golden?

Silence is golden…

But…

 Originally, The Four Seasons

Is silence in therapy really golden?   Even extended silences?

Often,  psychoanalytic therapists seem to think so.  They speak sparingly and are prepared to sit for entire sessions in silence while their clients arrive (or don’t arrive) at something to say.

They will lovingly describe the different kinds of silence they experience — thoughtful, sad, empty, painful, fruitful, calm, reflective, punishing, angry, holding, resentful — or silences in which the client is present, absent, shut off, in another world, etc.  Sometimes these descriptions remind me of those of wine connoisseurs — “gothic,” “tight,” “reminiscent of a Tahitian sunset,” “unctous,” “aggressive notes of spring”, “intensely Romanesque,” “cedarwood undertones and a lingering aftertaste.”  Really?

While I believe I’m as empathic as the next therapist, I don’t honestly believe that it’s possible to know the quality of a silence in the way that such case-history or clinical descriptions seem to imply.  Neither am I convinced that long silences serve the client, or the therapy, in the way some therapists imagine.

Perhaps the ultimate in such descriptions (and silences) are those of Harold Searles, an American analyst who sat (often) in complete silence with hospitalized, very disturbed patients five sessions a week, literally for years.  While I admire Searles’ writing, persistence and attempt to bring psychoanalytic therapy to such clients, I never had much sense that they benefited hugely from the experience.  Certainly not in proportion to the time and effort, they, Searles and the hospital staff put in. And while I enjoyed Searles’ descriptions of those silent sessions, weeks, months and years, with their companionable stomach rumblings and burps, I can’t say that I’m convinced they gave us great insight into what the client was thinking or feeling.

There are many rationales for such silence — often to do with conditions, thoughts, feelings, and blocks that therapists attribute to their clients.  The client was too raw to speak, or the patient had “no skin,” “was too frightened,” etc.

But I often think extended silences are much more to do with therapists than clients.  Their fear of getting something wrong, of being invasive, of directing the therapy, or of imposing their agenda on their client.  Their being caught up in an ideology or therapeutic ideal, like that of “presence” or “letting the client be.

There is also a rather macho aspect, that you (as a therapist) are strong enough to “take” the silence, that you’re not an anxious wimpy therapist who “runs away” from it, or “can’t deal” with it.

It’s not that there isn’t some truth to all this.  Of course a therapist shouldn’t break a silence because of their anxiety — but neither should they prolong one out of anxiety or ideology.

It’s important to allow patients silence so that they can take in interpretations (or reject them), have a chance to register and deal with emotions, thoughts, memories and feelings, arrive at their next thought, and collect themselves to speak.

But clients can get lost in extended silences, lose connection with themselves and the other, despair at the possibility of being known and found.  Clients who come to me from other therapists often complain about such silences, and the lack of input from their therapists.  They feel themselves to have been damaged by them, and have often given up hope of getting help for years as a result of this kind of experience with a therapist.

For me, therapy is best understood as a dialogue, one in which both participants speak and test out their understandings. Donald Winnicott once said, “I think I interpret mainly to let the patient know the limits of my understanding.”  I agree with Winnicott that communicating to the patient the extent of our ignorance is just as useful as communicating our knowledge.

Because our ignorance can be remedied by more conversation, but our projections into silence do not bump into any reality at all.