Silence in Psychotherapy

The talking cure without talking.

Posted Dec 08, 2010

Some of the most powerful moments of the "talking cure" include no talking. You heard right, paying to not talk in talk therapy can be beneficial. On the other hand, silence may reflect a problem that results in a colossal waste of time and money. Here's how to tell the difference.

We typically think of therapy as an energized conversation between two people working together to understand what's going on and why. The client raises questions, concerns and observations about himself while the therapist clarifies, summarizes and makes connections between past and present or thought and behavior. Most of the time, a lack of words is not the problem.

But the words don't always come. In some cases, talking would get in the way of experiencing deep thoughts or feelings. Other times the words are blocked and the client feels stuck. First, a look at times when silence is helpful:

Experiencing emotion: There's no need to rush putting words to feelings. Sometimes it's enough just to feel deep grief, anger or joy without speaking. Talking can have a way of pulling you out of emotion and into your head as you piece together the stories, details and prior experiences of the feeling. When a client comes to session after losing a loved one, the emotion is heavy and the words are few.

Realization: Therapy sometimes provides "Ah-Ha!" moments of insight that need a few moments to sink in. "Wait a minute - I bought a house I can't afford to fulfill my depression-era grandfather's dream?!? Give me a minute here..."

Being instead of doing: Some people have such a strong need to perform and achieve that doing nothing for a few minutes may be the hardest (and most enriching) work they do in therapy. There are a lot of people pleasers out there. They might set a goal of not dazzling their therapist with an intriguing problem, fascinating insight or dramatic story - and accept that it's okay.

Centering: Clients coming from the chaos of work, traffic and relationships may need a few minutes to collect themselves. Rather than fill the space with small talk, it's okay to sit in silence. I ask clients to come ten minutes early for this, but that may not happen or might not be enough time. It's okay to take a few minutes to do nothing but sit with yourself and enjoy the company. When you're relaxed, the topic of the day will come.

Sounds pretty good, huh? Makes you want to run out and get in a quiet therapy session. Well, there are also times when silence is a cause for concern:

Performance anxiety: Therapy is a stressful experience for many people. They feel like they're under the searing light of the third degree and are so afraid of scrutiny they become a deer in the headlights. There's nothing beneficial about this panic. You might try shifting this paralysis to the centering I mentioned above.

Don't know what to say: This is a major problem I'm trying to address through this blog. Many people simply don't know what they're supposed to talk about to get the help they want. They're not sure how to describe their symptoms, access emotion or talk about feeling stuck in therapy. (Some tips here)

Punishment: Not all therapy is as adversarial as In Treatment, but the occasional conflict or resentment is common. Clients might be angry with their therapist and decide one way to show their displeasure is not to talk. Sure enough, a client going mute for no apparent reason will probably make the therapist squirm. While it might feel good to exact revenge in this passively resistant manner, it may not be the most effective. It's pretty expensive, too. How about just talking about it instead? You could start with this: "I don't want to talk today because..."

Big disclosure: Sometimes a client has a big secret she's never told anyone before, and today is the day to say it. She feels paralyzed with fear of the therapist's reaction or of hearing herself say the words. So she sits in agony, trying to find the courage. Letting the therapist know there is something on your mind can help ease the discomfort.

Unconscious resistance: The loss for words might come from deep places beyond our awareness. Ralph Greenson, the analyst who gave couch time to Marilyn and the Chairman of the Board wrote that "The patient may be aware of his unwillingness, or he may perceive only that there seems to be nothing on his mind. In either case our task is to analyze the reasons for the silence.....we would pursue the feeling of "nothing on his mind" [and ask] 'What might be creating the nothing in your mind?' Our approach is based on the assumption that the only blanks in the mind occur in deepest sleep, otherwise the "nothing" is caused by resistance." (Technique, p. 61)

He adds something that makes me nostalgic for old school analytic thought: "Sometimes despite the silence, the patient may unwittingly reveal the motive or even the content of his silence by his posture, movements, or facial expression ... If simultaneously the patient absent-mindedly removes her wedding ring from her finger and then pokes her little finger through it repeatedly, it would seem that despite her silence she is revealing to me that she is embarrassed by her thoughts of sexuality or marital infidelity. Her silence indicates that she is not yet conscious of those impulses and a struggle is going on between an urge to uncover and an opposing impulse to bury those feelings."

Yowza. Sometimes a wedding ring is just a wedding ring. But to Ralph's credit, he's highlighting the importance of exploring non-verbal communication, which is valid.

So what can we do when words fail? If you're truly stuck, it's always okay to ask the therapist for help. Don't be surprised if help comes in the form of questions about the stuckness rather than a divergence into small talk. If the therapist's zeal is intruding on a comfortable silence, you're welcome to say something like "I'm at a loss for words, but I'd like to stay here for a while. I'll let you know when I'm ready to talk again."

You know, therapists aren't always comfortable with silence either. We might feel tempted to jump in with a question or interpretation to relieve our own anxiety. Some believe we aren't doing our job if no one's talking. But I think learning when to shut up and let the client be is a valuable skill.

Glen Gabbard, one of my go-to-guys for psychotherapeutic wisdom recommends this approach: "If gentle inquiries about the origins of the silence fail to re-engage the patient, a therapist might wish to say, 'Maybe you'd prefer to sit in silence together for a while.' The therapist conveys not only acceptance of the silence but also a message that the patient is not alone during the silence." (Long Term Psychodynamic Psychotherapy, p. 101)

Accepted and not alone. That's saying a lot.