Productive silence is golden: Predicting changes in client collaboration from process during silence and client attachment style in psychodynamic psychotherapy.

Abstract

We investigated the process and outcome of the first silence event for each of 86 clients and 26 doctoral student therapists in individual psychodynamic psychotherapy. Antecedent client collaboration and client attachments styles did not predict type of client or therapist behavior during silence events. Client collaboration increased from before to after silence events if therapists were productive (mostly invitational) and if clients were productive (mostly emotional and expressive) during silence events. Furthermore, subsequent client collaboration was higher when productive therapist silence occurred with clients who were lower rather than higher in attachment anxiety. In contrast, subsequent client collaboration was higher when productive client silence occurred with clients who were higher rather than lower in attachment anxiety. These results suggest that type of silence and client attachment styles are important factors in the immediate outcomes of silence events. Clinical Impact StatementSilence occurs in psychotherapy, but little is known about its effectiveness, especially across many clients and therapists. Question: We examined what occurred before, during, and after the first silence event in cases of psychodynamic psychotherapy with doctoral student therapists and adult community clients. Findings: If therapists and clients were engaged productively during the silences, the immediate outcome of the silence was positive. It was most important for therapists' behavior to be productive during silence for clients who were low in attachment anxiety, whereas it was particularly important for clients' behavior to be productive during silence when clients were high in attachment anxiety. Meaning: Silence can be helpful if used appropriately with some clients. Next Steps: We need to use this method to analyze silence events across time in a wider range of cases in different types of psychotherapy.

Silences in psychotherapy: An integrative meta-analytic research review.

“…• Offer connecting or invitational silences, which predict productive pauses and appear especially helpful for clients with high attachment anxiety (Cuttler et al, 2019).…”

“…Productive therapist activity (both invitational and connectional silences) was associated with greater client collaboration (Cuttler et al, 2019; Hill et al, 2019). This pattern suggested that therapists’ use of these pauses was effective in engaging clients in the change process (see Table 9).…”

“…Cuttler et al (2019; PM) No relationship was found between pausing processes and client attachment anxiety, when looking at the first silence in each psychodynamic case. No interaction was found either between collaboration or attachment when examining obstructive silences.…”

The Synergistic but Troubled Relationship Between Psychotherapy Science and Practice: Moving Forward

“…We followed-up this study by examining the first instances of silence in 86 cases (Cuttler et al, 2019). Therapists were primarily invitational during these silences (i.e., they were receptive and nurturing of clients, communicating respect and deep involvement during silences).…”

Assessing therapist and clinician competency in parent-infant psychotherapy: The REARING Coding System (RCS) for the Group Attachment Based Intervention (GABI)

“…Some infant observation studies describe the utility of restraint and curiosity when engaging with communities that are perhaps socially and culturally different from the clinician’s (Ellis, 1997 ; Grier, 2002 ; Lin, 1997 ; Maiello, 2000 ). There are studies that also indicate that meaningful pauses or silences can be productive to the process of psychotherapy and facilitate patient collaboration as well (Cuttler, Hill, King, & Kivlighan Jr, 2019 ).…”