The silences of psychotherapy

If therapy is a talking cure, why is there so much silence in it?

The professional therapist and patient can answer this no problem. Sometimes, however, it’s forgotton that not every patient is up with the play. It’s a bit like infantile amnesia where adults forget what it’s like to be a child.

What happens in the therapy room is weird* and the non-knowledgeable client is right to be mystified, frustrated, even frightened by an inscrutable one-who-is-presumed-to-know.

Given that client reports aren’t, shall we say, 100% accurate, violentacres does provide food for thought in a recent post ‘When to see a therapist‘.

A brief quote:

She stares at me silently. For some strange reason, she always expects that I will be the first to talk. For an even stranger reason, I continually refuse her quiet request to take the lead.

The key here is that the client does not know why the therapist is silent (“for some strange reason”).

Clients need to be taught what therapy is like – otherwise the reistance is likely to be too huge to overcome (unless the client is very compliant in which case his or her fitting in well is precisely the problem),

It’s not enough to say ‘It’s all grist for the mill’ if the grist never finds its way into the mill.
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* Other weirdenesses: payment (for missed sessions), payment (full stop), the limits of the frame, therapist non-disclosure…. All of these things are there for good reasons, but the client isn’t to know or immediately accept them. (Also, it’s not a bad a idea for therapists themselves to think these through now and then.)

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12 thoughts on “The silences of psychotherapy

  1. Well put.

    A friend and I are trying to re-think therapy. We have a blog about it: http://www.wildchild777.com/wordpress/

    Therapists love to maintain control. It offers some of the benefits of intimacy with no risk (for the therapist).

    Am I saying that this way of doing therapy is neurotic? Yes, I am.

    I would prefer that therapists be educated about clients.

    Resistance is not ‘a problem’ except to certain therapists – those who want clients to do as their told. If the client is resisting why is the therapist insisting (for some reason there is little about this in the literature). Therapists have needed to be compliant with large institutions for a long time to get where they are. I guess they don’t like people who aren’t as willing as them to play the game. I don’t see this as the client’s problem though.

    Some clients find silence comfortable. The deepest communication can occur through silence.

    Hope this response isn’t too annoying but I think there is much to be questioned in how therapy is currently done. Much of it is unhealthy for both therapists and clients IMHO (OK, not so humble).

    Evan

  2. evan – One of the dangers for therapists is that a justification can always be found for anything. These questions still to be asked, though: am I doing/not doing X for my own reasons? Is this the best thing for this client, now? Am I being fair?…
    Years ago I heard a wise old analyst say impatiently when the talk got too theroretical, when there were too many ‘explanations’ – “Let’s not forget that our patients are suffering.”
    I’m looking forward to checking out your site.

  3. I am someone who has largely been unable to speak in therapy and who is about to quit for that reason. I agree with your point that therapists need to teach their clients (or at least clients like me) how to make therapy work.

    “What happens in the therapy room is weird”. Exactly. Everything about the sessions has been bewildering to me, and I feel as lost there as I do everywhere else.

  4. adrivahni – How frustrating for you. May I make one suggestion? You say that you’re “about” to quit the therapy. If you could bring yourself to first say something about this discussion you and I are having to your therapist a lot of good might come out of it. It will give your therapist a chance to address your concerns and maybe retrieve the therapy; it will allow you to leave – if that’s what you decide – feeling that at least you’ve had your say; and it may even be reparative for you to speak about something important and difficult to the other person concerned.

  5. adrivahni.

    I know how weird therapy looks if you’ve never come across it before. One thing I want of therapy is for it to get closer to real life.

    If you are comfortable with anger you may like to voice it before you leave (if you are feeling angry that is).

    Ther therapists job in one way is to be different to everywhere else, in the right way. If they are as bewildering as everything else this is a real cause for concern. I hope the therapist you are with can meet you or that you find someone who can. Good therapy can be tremendously liberating.

  6. Dr. Steve and Evan, thank you for your suggestions. This week, I did manage to talk to my therapist about the more meta levels of this process. It is on the personal levels that I still find myself unable to talk, despite his reassurances and my own inner exhortations to speak up. It is very frustrating in a catch-22 sort of way. If I knew how to be open about my problems I probably wouldn’t have them in the first place. And I don’t understand how a “therapeutic alliance” is to be forged from what is on one level just another commercial transaction.

    Anyway. He did persuade me to try a little longer before quitting the sessions. If only there were a “talk” switch I could just toggle to “on”, it would save us both a lot of trouble.

    Thank you both again for your replies. They helped.

  7. adrivahni – Good stuff! One further idea. It is often the case that a client thinks: If only I could do X then I’d be able to make good use of the therapy, when actually being able to do X is precisely why they’re in therapy; when they’re able to do X they’ll be cured! What I mean is, it’s good to work hard, but don’t be hard on your self for not being able to do something. Yet.

  8. adrivahni: This is really just an echo of Dr. Steve’s last comment, but I’d like to add to it. Therapy really is very weird, and you are not doing anything wrong. Not being able to talk yet is part of the process for you. The way you are when you’re silent, what it took for you to mention this, how you said that, what happens next, these are all aspects of the process. You’re doing important work just by showing up and putting up with the weirdness. Sounds odd, but that’s my experience. The “therapeutic alliance” takes time to form (especially in light of the business relationship, as you rightly point out), and these small things that seem invisible are the way it happens. The same is true for your internal process. There’s a reason you aren’t talking. It’s perfectly appropriate to honor that reason–you’re there for YOU, and if what you need is to stay silent until you trust this person more, or trust your own feelings, or whatever it may be, there is nothing wrong with that. There is no right way to do therapy, what matters is to find the courage to do it at all. Good for you for being there!

    I happen to be one of those people for whom therapy was very fun and natural. As Dr. Steve notes in this post, eventually (and more than I realized until later), that was itself a problem! Pretty funny, all in all.

    Dr. Steve, I love your blog. Just wandered over from ShrinkWrapped and will make this a regular stop. I am a writer interested in psychology, so your blog is so perfect. I have a goal to become more fit, too! Time for some push-ups. I mean, a push-up…. or a push-up stance… gotta start somewhere!!

  9. sarah – great to have you on board! Your book looks real interesting. One of the things I love about day-to-day life in the US is the local diner, long may it prosper.

  10. Dr. Steve: I’ll try not to be hard on myself for being terrible at not being hard on myself.

    Sarah: thanks for the advice. It probably is a matter of trust. After one of the sessions I wrote:
    “He asks a question and I sit there in paralyzed silence, staring dumbly at my hands, while my interior world turns into a scene from one of those old WWII submarine movies, when the sub is hit with a depth charge and all of a sudden there are claxons ringing, horns going awooOOOOooga, frantic crewmen scurrying everywhere, doors and hatches slamming shut, and someone yelling “Dive, dive!!!”.”

    I’ve got a ways to go I guess.

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