[humanser] Handling Silence in Therapy

Tue Sep 30 02:35:14 UTC 2014

Great thoughts, JD!  This question makes me think of three people I saw in which silence was key.

The first one happened after I'd been a therapist for less than a year.  My client was a recently divorced man in his very early thirties with a drinking problem and anger issues.  You haven't lived until you've sat in a session with someone who's switching his switchblade for the whole hour and talking through gritted teeth!  That was a tough one for me, as I knew I needed to be very careful.  He didn't talk much that hour but the anger was very palpable.  We got it named that hour and that's about all we did but hopefully it was enough; he lived and I lived.

The 2nd one was a teen who did not want to be in therapy.  She had been hospitalized after being steadily non-compliant with her diabetes medication.  She was a Type I diabetic and HATED it!

She did not say one word to me for the entire hour.  I offered her pencils and paper to draw on and she refused.  I talked with her about how it was important for me to get audible cues from her; nothing.  Not only was she silent, but she was still.

I put my hand on her shoulder before she left to ask her if she'd come back.  I thought if I touched her shoulder I could detect movement.  She shrugged her shoulders. I asked her to bring me a picture of what her life was like when she came back, and maybe we could talk about it.   I didn't expect to see her again and she did not come back.  That was a tough one, too.

The third one was a 13-year-old girl who had just lost her leg.  She had a new prosthetic leg, which she hated.  Her mother was trying to encourage her to stay in athletics, especially track and field, which she loved, but the girl was not interested.

She wouldn't talk to me when I asked questions.  So I operated on a hunch and started talking with her about her anger, and my own identification with it.  As a blind teenager, I hated the white cane which was introduced to me in 8th grade.  And so I told her it was OK to have her anger.  I asked her to use the passion behind that anger to motivate her while working out to run again.  That anger could be the fire underneath which she would train.

I didn't see her again either, but I ran into a relative of hers socially, who told me that she was running and was competing in school sports and doing well.  She didn't talk much with anyone about our conversation, but the family saw an almost immediate change in her demeanor.  I know the family really was afraid of her getting stuck in anger, so I imagine that she had not been encouraged to own it.

Anyway, so much for my thoughts and experiences.  I hope this is in some ways helpful.

Thank you, Allysa, for having the courage to bring up this topic.  All the best to you!
Susan

-----Original Message-----
From: humanser [mailto:humanser-bounces at nfbnet.org] On Behalf Of JD Townsend via humanser
Sent: Monday, September 29, 2014 6:54 PM
To: Alyssa Munsell; humanser at nfbnet.org
Subject: Re: [humanser] Handling Silence in Therapy

Alyssa, what a great question.  I’m looking forward to how others answer this one.

First, your uncomfort with silence is absolutely normal for blind as well as 
for light dependent psychotherapists.  The answer, for me is answered by the 
individual patient and their place in treatment.  For an anxious patient who 
may panic due to the pressure of silence, for the depressed patient who may 
be crushed by silence I would avoid it like the plague.

For the fully engaged patient faced with a difficult decision I’ll let the 
process go on as long as the session takes.

I like the book and the movie ANTWAN FISHER;  in the story the young man is 
forced to see a psychotherapist due to anger issues.  He sits in sessions 
for a long time until he decides to talk, then it all comes out.  We don’t 
have the luxury of weeks of psychotherapy with nothing said, but the process 
would work.

Personally I listen to clues like shuffling feet, finger play and breathing 
to determine when patients are rolling their eyes or playing on their video 
games during treatment.

I often have patients who have little knowledge that their words have any 
power, so I actively work to engage them in talk, talk about almost anything 
at the start of treatment to engage them in the process.  I’ll talk 
football, alien invasion, or food if it will get them to talk.  Treatment is 
in the relationship and without that engagement little progress can be 
realized.

Your discomfort with silence may be a reflection of the patient’s uncomfort 
and it may be being reflected back and forth between you.  I would engage 
your supervisor in discussing this transference/counter-transference 
relationship.

Thank you for bringing up this great topic.

-----Original Message----- 
From: Alyssa Munsell via humanser
Sent: Monday, September 29, 2014 7:27 PM
To: humanser at nfbnet.org
Subject: [humanser] Handling Silence in Therapy

Hi everyone!

I hope this message finds you all well. I have a question for those of you
who practice mental health therapy. I've been doing therapy for my final
year internship, and I am noticing that I'm not comfortable when there is a
long period of silence between my clients and I. This is because I'm not
able to see their body language well, and therefore, am having a hard time
assessing whether or not the silence is productive. As you probably already
know, silence can be powerful and necessary in therapy, so I don't want to
diminish it. However, without being able to see non-verbal cues about what's
going on with the person (e.g. they're just thinking or looking at me to say
something), it is hard for me to know what to do. I was wondering what you
all do in those types of situations.

Any feedback would be immensely appreciated.

Thanks so much,

Alyssa

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JD Townsend LCSW
Helping the light dependent to see.
Daytona Beach, Earth, Sol System 

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