A common complaint among the patients of psychologists and other mental health providers is that it seems to them that their therapist hardly ever speaks during a session. This can bring up feelings of isolation or anger and dislocation. The sense that we are not being fully heard, or that we are not being paid adequate attention or respect is extremely frustrating and difficult, and in fact, may be part of the reason why a patient has sought out counselling in the first place.
This is completely understandable, as conversation is the way in which we as humans bond with those we are the closest to from infancy on. Many of us look to the traditional patterns of conversation and sociability as being appropriate in most situations. This confusion about how much the therapist should engage in conversation and commentary springs from a basic misunderstanding over the role of the therapist. Psychological therapy is different from all of our other interpersonal encounters. The therapist, as is evident in the word itself, is there to provide a therapeutic service.
A different kind of relationship
A patient may feel insecure or unsure about the role of each individual in the therapeutic relationship and may have expectations that are quite out of context in what is, after all, a doctor/patient relationship. You would not expect your cardiologist or dermatologist to engage in a prolonged back and forth about the weather and the high cost of petrol while you were there for your ECG or to discuss your arthritis.
Although you confide your most painful and private thoughts, and often share your joyous ones – the therapist is not your friend in the conventional sense. Clearly, it is a complicated issue, and clients often expect that their therapists will respond much as we think a caring friend should – by offering advice, by challenging our perceptions, by trying to bond with us through shared emotional experiences, or by following social conventions of conversation which usually involve a give and take between two or more parties who all engage in the exchange.
While it can seem that the therapist is not reacting during long periods of silence, it is probably far from the case. Silence from one’s therapist can permit room for reflection and analysis. It can hush the mindless chatter we often find ourselves immersed in – even from the chatter within our own heads. The patient’s reaction to silence can offer clues about the patient’s state of mind. Does silence provoke anxiety, or anger, or sadness? Does the patient experience a sense of pressure to break the silence, or does the patient instead pull back, or even welcome the respite.
Usefulness of silence
It is true that silence can often be uncomfortable, but silence is a therapeutic tool with which the provider can gain insights that would likely not have emerged, or may have been minimized, or simply lost in the talk. It is in these long stretches of less than golden silence that many patients come to new realizations about their life. It is meant to be hard; there is a reason why therapy is called “work”.
With that in mind, however, there are limits to the amount of discomfort that is useful. It is important to realize that there are many different forms of therapy, and some are more concerned about the therapist retaining an emotional distance from the patient in the name of objectivity or neutrality. Great damage can be done by a misspoken statement or a careless remark.
Naturally, there are differing takes on how too much silence in therapy might mean that the therapist’s approach is dependent on letting each patient’s narrative unfold in its own way, with the therapist acting as a wise guide. If the therapy does not seem to be meeting your needs, it is worth bringing it up to the therapist. Ask him or her what role their silence plays in your treatment. This may be very difficult to do, because it seems to challenge the therapist’s wisdom or authority or it implies that we think we’ve been ignored or we have in some way failed to engage the therapist’s full attention.
Popular recent approaches have been less centred on long-term therapy, however, and are using new techniques that are more focused on interaction between the therapist and the patient in setting and establishing goals. Just as the usefulness of “talk therapy” in the age of psycho-pharmaceuticals has been questioned, some experts are beginning to think it is time to say enough already with the silence.