Silence is golden: A mixed methods investigation of silence in one case of psychodynamic psychotherapy.

Abstract

We investigated the antecedents, occurrences, and consequences of 183 silence events in the first 5 and last 5 sessions of a 73-session case of successful psychodynamic psychotherapy. Silences generally occurred within client speaking turns, such that the client often paused to reflect while speaking. In the last 5 sessions, as compared with the first 5 sessions, the client was more collaborative before and after silences, silences were shorter, the therapist was more connectional during silences (e.g., shared emotion and meaning with client), and the client was more emotional after silences. Antecedent client collaboration, duration of the silence, therapist behavior during silence events, client behavior during silence events, and who broke the silence all related to change in collaboration from before to after the silence events. We concluded that silence was helpful in this case because of client factors (the client naturally paused a lot during discussion, the client was quite reflective and insightful), therapist factors (the therapist was comfortable with and believed in silence), and relationship factors (there was a strong therapeutic relationship).

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

“…Currently, Psychotherapy (the APA Division 29 journal) publishes what are referred to as evidence-based case studies that integrate clinical case material with measures of process and outcome given at different time points. This standing call has influenced our work at the MPCRL to undertake more case studies in the clinic and integrate qualitative and quantitative approaches to examine phenomena such as silence (Hill, Kline, et al, 2019) and facilitators of client insight (Hill, Lu, et al, 2020). Unfortunately, although sound arguments have been offered for case studies (e.g., Elliott, 2002), such pieces are rarely published in counseling psychology journals.…”

“…Being engaged in research has also influenced how therapists conduct therapy. For example, when we examined silence (Hill, Kline, et al, 2019) and interpretations versus probes for insight , we partnered with graduate students and watched many therapy sessions. We came to consensus about antecedents, events, and consequences in all of their interactions.…”

“…In the first five sessions of the first case study (Hill, Kline, et al, 2019), the silences often involved the client pausing and writing in a journal about his thoughts related to something important that came up in therapy that he wanted to remember. During these silences, the therapist had a hard time connecting with the client.…”

Η Θεραπευτική Σχέση Στην Ψυχοδυναμική Συμβουλευτική Και Ψυχοθεραπεία: Σύγχρονα Κλινικά Και Εμπειρικά Δεδομένα

“…Συγκεκριμένα, τα τελευταία χρόνια δίνεται ιδιαίτερη έμφαση στη διερεύνηση επιμέρους, κυρίως προ-λεκτικών και μη-λεκτικών, μικρο-μηχανισμών της θεραπευτικής διαδικασίας (microprocessual mechanisms), όπως αυτοί προκύπτουν από την επιστημολογική αντιστοίχιση της θεραπευτικής σχέσης με αυτή της πρωταρχικής σχέσης μητέρας-βρέφους. Για παράδειγμα, έχει βρεθεί ότι μη-λεκτικές σχεσιακές διεργασίες, όπως είναι η παρα-γλωσσική επικοινωνία (Rocco et al, 2013), η σιωπή (Hill et al, 2018), ο σωματικός και κινητικός συγχρονισμός (Ramseyer & Tschacher, 2011), και η συνήχηση (attunement) μεταξύ του θεραπευτή και του θεραπευόμενου (Bohart et al, 2002;McCluskey et al, 1997;Rocco et al, 2017;Tanzilli et al, 2018) επηρεάζουν τόσο την ποιότητα της θεραπευτικής σχέσης όσο και το τελικό θεραπευτικό αποτέλεσμα. Ιδιαίτερη δε σημασία φαίνεται να κατέχει μια ακόμη ωριμοποιός διάσταση της πρωταρχικής αλληλεπίδρασης μητέρας-βρέφους, όπως αυτή μεταφέρεται ως δυναμική λειτουργία στο πλαίσιο της θεραπευτικής σχέσης (Winnicott, 1971), «η ικανότητα του θεραπευτή για παιχνίδι» (playfulness).…”

Re-enacting the Bodily Self on Stage: Embodied Cognition Meets Psychoanalysis

“…In contrast to silences that indicate awkwardness or distraction, “connectional silence” points to reflective suspensions or to mixed and ambiguous emotions. While clinical research is exploring pauses within speaking turns (Bartels et al., 2016; Durieux et al., 2018; Hill et al., 2018; Visser et al., 2019), in the embodied view not enough attention has been paid to communicative silence, which can convey social intentions and requests.…”