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Therapist silence is a difficult skill for many beginning therapists.
Some feel uncomfortable with silence, whereas others use too much silence as a way of managing their anxiety over not knowing what to do or their fear of doing the wrong thing.
Interestingly, however, basic helping-skill texts barely mention when and how to use silence, raising questions about how therapists use silence in therapy and about how they learn about using silence.
The theoretical literature is contradictory about the advisability of using silence in therapy.
Some theorists suggest that silence can convey empathy and help clients reflect on their thoughts and feelings, whereas others suggest that silence raises client anxiety, exerts pressure on the client to communicate, and results in the client feeling misunderstood or abandons and experiencing the therapist as withholding and critical.
Hence, theorists vary from suggesting that silence be used to convey tender concern to warning that silence can convey cruel inhumanity.
The empirical literature is equally conflicting about the effects of silence in therapy.
The use of silence has been associated with client perceptions of rapport, success, and high levels of description, experiencing, and insight in the client’s immediate response following the silence.
However silence also has been associated with client dropout and perceptions of therapists as unempathic.
Much of this research has been problematic, however, because it has relied on correlating the frequency of silence in sessions with session or treatment outcome.
Clinically, it does not make sense that more or less silence would necessarily be good; rather, it makes sense that silence could have many different impacts depending on timing and client need.
It also makes more sense to examine individual silence events rather than the overall frequency of silence in relation to outcome because this latter method cancels out the positive and negative consequences of silence.
Furthermore, the previous studies have relied typically on observers’ ratings of the silence and its consequences or clients’ ratings of the outcome of sessions, but none have investigated experienced therapists’ perception about their use and consequences of silence.
Because therapists make decisions about whether or not to use silence in therapy, their perceptions on using silence would be valuable.
Ladany, Hill, Thompson, and O’Brien (in preparation) recently qualitatively studied 12 experienced therapists’ perceptions about their use of silence in therapy.
They found that therapists perceived themselves as typically using silence to convey empathy, facilitate reflection, challenge the client to take responsibility, facilitate expression of feelings, and to gain time to think about what they wanted to say.
Furthermore, therapists generally indicated that a strong therapeutic alliance was a prerequisite for using silence.
Moreover, therapists typically thought they currently used silence more flexibly, comfortably, and confidently than they had as beginning therapists.
Finally, they typically believed that they had learned how to use silence through supervision rather than in graduate training.
Hence, these date suggest that silence is a multifaceted intervention that can be used for many different intentions, and that silence can lead potentially to therapeutically rich moments or to misunderstandings and disruptions.
The Ladany et al. (in preparation) study is important because it is one of the few empirical studies to investigated therapists’ perceptions about using silence in therapy.
The study, however, involved a small sample of primarily psychodynamic therapists, raising questions about whether results would generalize to a broader sample of practicing therapists.
In addition, the researchers asked therapists about their use of silence in general rather than about their behavior in specific silence events ; hence, the date might reflect general attitudes toward using silence rather than actual behavior in specific situations.
Furthermore, the Ladany et al.
Study needs to be replicated with other methods.
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