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Therapist perspectives on using silence in therapy:

a qualitative study
Nicholas Ladany, Clara E Hill, Barbara J Thompson, Karen M OBrien

Twelve experienced therapists were interviewed about their perceptions of why they used
silence in therapy. Qualitative analyses revealed that these therapists typically perceived
themselves as using silence to convey empathy, facilitate reflection, challenge the client to
take responsibility, facilitate expression of feelings, or take time for themselves to think of
what to say. Therapists generally indicated that a sound therapeutic alliance was a prerequisite
for using silence, and they typically educated their clients about how they used silence in
therapy. Therapists typically believed they did not use silence with clients who were psychotic,
highly anxious, or angry. They typically thought they now used silence more flexibly, comfortably,
and confidently than when they began doing therapy. Therapists typically believed they
learned how to use silence from their own experience as a client and from supervision.
Key words: counselling and psychotherapy process, silence, supervision, training

ilence, a pause in the dialogue where


neither therapist nor client is speaking, is
probably used occasionally by most
therapists. Theoretically, silence is presumed to be
a potentially powerful therapeutic intervention
to stimulate client introspection that can either
facilitate or inhibit therapeutic work (Greenson,
1967). From a facilitative standpoint, silence
can allow clients to reflect upon their thoughts
and feelings, raise anxiety, exert pressure to
communicate, and convey respect or empathy
(Basch, 1980; Blos, 1970; Gilliland and James,
1993; Greenson, 1967; Hill and OBrien, 1999;
Moursund, 1993; Reik, 1927; Zeligs, 1961).
Conversely, it has been argued that silence
could lead to negative consequences in
therapeutic work (Basch, 1980; Blos, 1970;
Greenson, 1967; Moursund, 1993; Reik, 1927;
Watkins, 1989; Zeligs, 1961). Some clients may
experience silence as insulting, withholding or
critical. Some may perceive it as reflecting
therapist anger, while others may experience it
as stressful or heightening their fears of
abandonment. Silence can be used to convey,
and be experienced as, anything from cruel
inhumanity to tender concern (Gill, 1984).
The limited empirical investigations on silence
have supported the mixed theoretical contentions

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regarding therapist use of silence. Silence has


been identified as a salient therapist response
mode that occurs relatively infrequently (i.e.,
less than five per cent of the time) across
theoretical approaches (Hill, 1986; Hill, Charles
and Reed, 1981). Furthermore, Tindall and
Robinson (1947) found that therapists most
often used silence to organise their thoughts
prior to speaking, force the client to contribute
to the therapy situation, and terminate a phase
in a therapy exchange. Finally, greater use of
silence has been found to be associated with
higher client perceptions of rapport (Sharpley,
1997; Sharpley and Harris, 1995), success
(Cook, 1964), and high levels of description,
experiencing and insight in the clients immediate
response following the silence (Hill, Carter and
OFarrell, 1983). Conversely, therapist silence
has been related to greater incidence of client
dropout (Davis, 1977) and perceptions of the
therapist as unempathic (Matarazzo and Wiens,
1977). In sum, the empirical findings indicate
that silence occurs relatively infrequently, is
used for a variety of reasons and can have both
facilitating and inhibiting effects on the clienttherapist work. Although these investigations
are important as an initial starting point, they
offer limited insight into therapists perceptions

THERAPIST PERSPECTIVES ON SILENCE

What does this study explore?

Why and how do therapists use silence?

What are their perceptions of silence?

Do therapists use silence to meet their own


needs?
What do therapists learn about silence in
their professional training?

of why they use silence in psychotherapy.


Examining therapists perceptions of their use
of silence could shed light on how they were
likely to approach using it to facilitate
therapeutic work.
We believed that therapists beliefs about
using silence could best be studied from an
in-depth qualitative perspective. We chose a
consensual qualitative research approach (Hill,
Thompson and Williams, 1997) because it
allowed us to (a) examine the wisdom of
experienced therapists, (b) look at sequences
of events that were not likely to be orderly
and predictable, and (c) explore domains about
which we did not have enough information
to hypothesise.
The purpose of the investigation was to
understand the factors associated with
experienced therapists perceptions of their use
of silence as well as to examine the extent to
which therapists believe that silence facilitates
or inhibits therapeutic work with adult clients in
individual psychotherapy. We also wanted to
understand when and for which clients therapists
think they should not use silence. Several
authors (Basch, 1980; Moursand, 1993) have
written about the importance of therapists
curbing their use of silence in brief therapy, in
the initial therapy session, or when clients are
in crisis. We speculated that therapists might
choose not to use silence when clients are
excessively anxious, suicidal or psychotic. It
seemed possible that therapists would
occasionally resort to using silence when they
were struggling with how to respond to a client
or needing to reflect about a given client
statement. We also hoped to learn about
instances when therapists used silence to meet
their own needs.
We were also interested in what therapists
had learned during their training about using
silence. As with other interventions, it seemed
reasonable to assume that psychotherapy trainers
would convey to, and model for, their students
both positive and negative ways to use silence

in therapy. We were also interested in whether


therapists changed over time in how they used
silence. It has been suggested that novice
therapists may hide behind an analytic silence
as a way to manage their anxiety regarding not
knowing what to do or to manage their fear of
doing something wrong (Basch, 1980). They
may be reluctant to use silence due to their
discomfort with it (Gilliland and James, 1993).
Experienced therapists are more likely to use
silence than novice therapists (Davis, 1977). For
these reasons we believed it was important to
examine the training that therapists received as
well as how their use of silence changed with
professional experience.

Method
Participants
Twelve psychotherapists (seven men, five women;
all white) who ranged in age from 37-56,
participated in this study. All were doctoral-level
licensed psychologists with degrees in clinical
(n=7), counseling (n=4), or educational (n=1)
psychology and all practised in the United
States. Their experience as therapists ranged
from 10 to 25 years. All were in independent
practice at least part time. Eight described
themselves as primarily psychodynamic, three
as integrative and one as cognitive-behavioural.
Participants noted that they were somewhat
comfortable (n=4) or very comfortable (n=8)
using silence in therapy and rated their belief
about the importance of therapist silence as a
construct to study as somewhat important (n=2),
very important (n=6) or extremely important
(n=4). Half of the participants reported that
they used silence with most of their clients. Ten
therapists reported that of those clients with
whom they used silence, they typically used it
in every session.
Researchers
The researchers for this study were four white
counselling psychologists (three women, one
man; age 35-50 years; years of postdoctoral
experience doing research and psychotherapy,
eight to 25 years). The first three authors
served as the interviewers and data analysts,
and the fourth author served as the auditor for
the coding tasks. The researchers identified
their theoretical approaches to counselling as
integrative; humanistic/psychodynamic;
eclectic (humanistic, interpersonal, cognitivebehavioural); and psychodynamic.
Prior to the data collection, researchers
engaged in a bracketing task (Rennie, Phillips
and Quartaro, 1988) whereby they recorded

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and discussed their biases and expectations


regarding therapist use of silence. This task
helped the researchers become aware of and try
to reduce the influence of preconceived ideas
or biases on the data analyses. A summary of
the biases and expectations of the three primary
researchers provides a context for evaluating
the results that we obtained. We all believed
that silence had the potential to be a powerful
and useful therapeutic intervention that should
be used infrequently and judiciously to be most
effective. We all thought that therapists would
believe that they used silence to increase the
clients anxiety, gain power in the therapeutic
relationship, communicate empathy, challenge
clients, be withholding, allow clients time to
reflect, facilitate a positive therapeutic
relationship, and decrease client anxiety. We all
thought that therapists would have received
limited training in using silence but would feel
more comfortable using silence as they gained
experience. As therapists, none of us wanted to
use silence in a withholding manner or as a
way to increase the clients overall level of anxiety.
The researchers preferences for silence for
themselves as clients varied from general
discomfort to general comfort. We tried to
bracket our biases and expectations and pay
close attention to the data from the cases.
Measure
On the basis of a review of the literature, as
well as reflecting on our therapy and training
experiences, we developed an interview protocol.
The interview was semi-structured to gather
consistent information across participants but
also encouraged probes so that we could clarify,
expand and deepen our understanding of the
participants use of silence (McCracken, 1988).
Two pilot interviews were conducted with
licensed counselling psychologists, after which
the protocol was revised. The final interview
protocol consisted of questions relating to the
following areas:
reasons for using silence
important client variables to consider prior to
using or not using silence
reasons for breaking silence
the influence of silence on the therapeutic
relationship
what happens with the therapist during
silence
examples of when silence did and did not
work well
training in using silence and changes in use
of silence with experience
demographic information.

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Procedure
Recruitment and data collection
Participants living in the northeastern United
States were chosen randomly from the National
Register of Health Care Providers. We did not
choose therapists whose listing in the Register
indicated that their theoretical orientation was
solely behavioural because we reasoned that
these therapists would probably rarely use
silence. Potential participants were sent a letter
describing the study. They were informed that
participation was voluntary and would involve
a one-hour audiotaped telephone interview.
We chose a one-hour interview to increase
the likelihood of participation of full-time
psychologists. We also sent the interview protocol
so that potential participants could see our
questions and reflect on their use of silence
with adult clients in individual therapy, as
suggested by Hill et al (1997).
Approximately one week after sending the
letters, one of the first three authors (all of
whom had extensive experience conducting
qualitative interviews) called to see if therapists
were willing to participate. Of the 92 potential
participants contacted by phone and letter,
14 agreed to participate and completed the
interview. In appreciation, each participant was
sent a pound of coffee, tea or hot chocolate.
Code numbers were given to each interview to
ensure participant anonymity. Tape malfunctions
eliminated two interviews, resulting in a final
sample of 12 participants.
Data analysis
Consensual qualitative research (CQR)
methodology (Hill et al, 1997) was used to
analyse the data.
First, the audiotaped interviews were
transcribed verbatim, omitting minimal phrases
(e.g. um, hm) and identifying information.
Second, 10 of the 12 interviews were
reviewed and a list of 18 domains or topic areas
(e.g. reasons for using silence) were created by
the primary team of the first three authors.
Interview data was then placed in the domains
independently by the three researchers, who
then met together and reached consensus
about the placement into domains.
Third, transcript data within each domain, for
each participant, was summarised into core ideas
independently by the members of the primary
team, and then combined through discussion
and consensus.
Fourth, the domained consensus versions
(consisting of core ideas within domains for
each case) were audited by the fourth author

THERAPIST PERSPECTIVES ON SILENCE

to ensure accurate representation of the data,


after which the primary team made revisions
via consensus.
Fifth, all the core ideas within domains were
compiled.
Sixth, the primary team created categories
(i.e. clusters of responses) for the core ideas
within each domain (called cross analyses).
Seventh, the cross analyses were audited to
ensure that the categories were appropriate
and that data was assigned accurately. The
primary team then made revisions via consensus.
Eighth, we reviewed the cases to make sure
we had not missed or misrepresented data.
Then the final two cases were domained,
coded for core ideas, and added to the
cross-analyses. Adding the two new cases did
not substantially alter the domains or categories
and so we considered the structure of the
cross-analyses to be stable and saturated.
Another extensive auditing process was then
conducted whereby the entire team re-reviewed
the cross-analyses to ensure that the wording of
the domains, categories, subcategory headings
and placement of core ideas accurately
represented the data.

Results and discussion


Adhering to the criteria established by Hill et al
(1997), we identified a category or subcategory
as general (or all) if it applied to all 12 cases,
typical (or most) if it applied to seven to 11
cases, and variant (or some) if it applied to
three to six cases. We did not include categories
that applied to only one or two cases. The next
sections contain descriptions and examples of
the core ideas from categories and subcategories
within the various domains. We also include
narrative examples of effective and ineffective
uses of silence in therapy.
Reasons for using silence:
client-focused reasons
We subdivided reasons into those that were
client-focused and those that were therapistfocused. The sole general client-focused reason
to emerge was that therapists believed they
used silence to convey empathy, respect or
support (e.g. to give the client space; to honour
something the client said; to hold, nurture or
give permission for clients to be themselves).
Thus, silence was used by all therapists as a
means to demonstrate understanding and
provide therapist conditions that would
facilitate the therapeutic work.
Typical reasons were to facilitate client
reflection (e.g. to pay attention to underlying

thoughts so that clients can hear themselves);


to challenge the client to take responsibility or
control (e.g. to give control of the session back
to the client when the client wants the therapist
to provide answers, doesnt want to let client
off the hook, to wait out an oppositional client);
or to facilitate client expression of feelings (e.g.
to increase intensity of emotions, to give client
space to find their emotions). In these instances,
therapists seemed to use silence to facilitate the
therapeutic work by encouraging the client to
take a more active role in the process. Silences
that challenged the client seemed to facilitate
the therapeutic work by creating a little distance
between therapist and client.
The one variant client-focused reason for
using silence was to help therapists assess client
status (e.g. to learn about clients through their
silence, to evaluate clients early in treatment).
In this instance, therapists seemed to be relying
more on their analysing ego (i.e. observing the
process) rather than direct engagement with
the client.
Therapist-focused reasons
The only typical therapist-focused category was
that therapists used silence to give themselves
time to decide how to respond to their clients.
For example, one therapist reported that he
would become silent in response to a client
with borderline personality disorder because he
needed time to decide how to deal with his
anger. As a variant, therapist level of anxiety
played a role in their use of silence. Interestingly,
when anxious, some therapists used silence less
whereas others used it more. Another variant
was that silence occurred when therapists were
distracted. For example, one therapist noted
that he was sometimes silent when preoccupied
with a previous counselling session. When this
happened, he tried to reflect why his mind was
wandering and examined how this might relate
to the therapeutic work with his current client.
Therapists had many reasons for using
silence. Most were for the therapeutic benefit
of clients but some occurred because therapists
did not know what to do, were anxious, or
were distracted. The results suggest that silence
is a multifunctional intervention. Similar-looking
silences could be motivated by a variety of
reasons on the part of the therapist, ranging
from empathic understanding and gentle
encouraging reasons, to challenging reasons.
Therefore, silence cannot be conceptualised as
a single entity in therapy with a single therapist
intention and single client perception. In
previous literature, silence has been considered

Therapists used
silence to give
themselves time
to decide how to
respond to their
clients

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as a unitary phenomenon (e.g. different types


of reasons for using silence were not
distinguished), which probably obscured results
between different types of silences. These
results indicate that we need to consider the
therapist reason for using silence more than
just whether silence occurred.

Therapists
typically reported
that a sound
therapeutic
alliance was
needed for them
to use silence

Conditions and contraindications for


using silence
In terms of conditions for using silence, therapists
typically reported that a sound therapeutic
alliance was needed for them to use silence.
For example, one therapist reported that a
strong therapeutic alliance was necessary so
clients would not feel that he was critical or
disapproving. Another therapist mentioned that
clients could better tolerate silence when there
was a positive therapeutic alliance. Two variant
client variables emerged. Some therapists used
silence with clients who had features of
personality disorders (e.g. dependent clients
who may be trying to avoid dealing with
issues). Others indicated that they used silence
with relatively adjusted (e.g. higher functioning,
psychologically-minded, reflective) clients. There
were no general or typical responses reported
for stage, session or type of psychotherapy,
although a few variant categories emerged.
In terms of stage of treatment, some therapists
used silence early in treatment (e.g. as a way to
evaluate the client), whereas some used silence
late in treatment (e.g. when they knew more
about the client). In terms of session variables,
some therapists used silence at the beginning
of sessions (e.g. to help clients decide what
they want to discuss), whereas some used it in
the middle of sessions (e.g. when clients are
more into their emotions). Finally, in terms of
type of therapy, some therapists reported using
silence in long-term therapy.
In terms of contraindications, several client
variables emerged as variants. Silence was not
used with clients who had features of personality
disorders (e.g. with dependent clients when
silence could harm the relationship or be
experienced as cruel); who were very disturbed or
psychotic; who were highly anxious; who were
paranoid, highly suspicious or felt persecuted;
who were angry (because it would make them
more angry); who were a danger to themselves
or others; who needed support (e.g. client was
frightened or overwhelmed); or who were new
to therapy.
In terms of stage of treatment, therapists
typically reported that they would not use silence
in the early stages of treatment. For example,

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one therapist said he did not use silence early


in treatment because it could easily be
misinterpreted. Other therapists mentioned that
they used silence less often early in treatment
because they were more likely to be gathering
information. In terms of type of therapy, some
therapists reported that they used silence less in
brief therapy. For example, one therapist stated
that she felt pressured in brief therapy to use
all the time in the session. Even though the
therapist knew that silence could be useful in
brief therapy, she gave more advice because of
the limited time. Therapists mentioned that
they were cautious about using silence with
more disturbed clients, early in treatment, and
in brief psychotherapy.
In terms of indications and contraindications
for when to use silence, no clear typical patterns
emerged. It is possible that contextual factors,
such as the relationship or the tasks on which
the client and therapist were working, are more
important than stage in treatment or time in
session when deciding to use silence. These
results suggest that no specific recommendations
(e.g. always begin sessions by being silent, as
some psychoanalysts have suggested) can be
made in terms of when to use silence.
Educating clients about silence
Therapists typically reported that they educated
their clients about how they used silence. For
example, one therapist stated that he explained
the benefits of silence to his clients (e.g. that
silence helps clients pay attention to underlying
thoughts). Another therapist told his clients
that silence is a way for him to demonstrate his
caring for them. In these instances, therapists
explained their silence to clients so clients could
use silence more effectively and negative
reactions were lessened.
To manage and minimise some of the more
severe negative effects, many therapists stated
that they educated their clients about how
silence could be used in treatment. Therapists
sometimes used education to buffer or preempt
a clients potential misunderstanding of silence.
Through this education, clients presumably
could develop skills on how to use silence to
help themselves in therapy, and hopefully use
this skill outside therapy.
Breaking silence
Therapists typically reported that they broke the
silence between themselves and their clients
when clients were not using the silence
productively (e.g. client was not actively thinking or reflecting, silence was losing its value)

THERAPIST PERSPECTIVES ON SILENCE

and when clients were distressed by the silence


(e.g. client appeared disconnected, the silence
created a negative reaction in the client).
Variantly, therapists broke silence to determine
what was going on with clients. For example,
one therapist mentioned she would break
silence by asking why the client was silent.
These results suggest therapists recognise that
sometimes silence left uninterrupted could lead
to harmful effects on clients. Silence should be
used judiciously and therapists should recognise
when to break silence when it is unproductive.
In each of these cases, the therapist recognised
client cues (e.g. client was not actively reflecting)
as a prompt for changing their approach.
Length of silence
Therapists typically could not identify personal
guidelines for how long they would let silence
occur. Instead, they typically indicated that they
let silence last as long as it was productive.
However, a variant group of therapists noted
that they would not let silence last more than
two minutes. These results suggest that there
are no standard patterns for length of silence.
Previous literature indicates that silence occurs
in less than five per cent of all responses (Hill,
1986; Hill et al, 1981), but has not provided
information about average duration of silences.
Perceived influence of silence on
psychotherapy
Typically, therapists believed that silence
enhanced the therapy relationship or process
when used appropriately. For example, one
therapist thought that silence helped to build
trust, allowed clients to feel more in control,
and gave clients space to feel supported and
understood. Another therapist noted that
silence had a positive influence on therapy
when clients had a history of others in their
lives not allowing them space to sit with their
feelings. Conversely, therapists typically stated
that silence hindered the therapy relationship or
process when not used properly. In one case,
the therapist noted that silence was negative
when clients experienced it as withholding or
when the therapist was angry. Another therapist
recognised that silence was dangerous to the
therapeutic process when clients came from
families that used silence destructively.
These findings coincide with the theoretical
literature that warns therapists of the scope of
positive and negative consequences of using
silence (Basch, 1980; Blos, 1970; Gill, 1984;
Greenson, 1967; Moursund, 1993; Reik, 1927).
Specifically, even though therapists may have

benevolent intentions for using silence, clients


may perceive silence to be anything from
benevolent to intimidating.
Therapist thoughts, feelings and
behaviours during silence
Therapists identified a number of thoughts,
feelings and behaviours that occurred for them
during silences with their clients. First, all
therapists observed (without staring) what was
happening with clients in relation to therapy.
For example, one therapist looked at the clients
body language indirectly and made occasional
eye contact. Another therapist looked slightly
away from clients but always attended to
clients nonverbals, looking for cues about how,
or if, to respond. Similarly, therapists typically
thought about what was going on in the
therapeutic process and what might have been
happening with clients. For example, one
therapist said she was very busy during silence,
assessing what the silence was about, looking
for alternatives, understanding the issues at
hand from different perspectives, and planning
her next interventions. Therapists also typically
reported that they focused on what was going
on with themselves in relation to therapy (e.g.
one therapist paid attention to his own fantasies
or unconscious expressions for connections to
what was happening in therapy). Therapists
also typically acknowledged daydreaming
sometimes during moments of silence (e.g. one
therapist thought about what he was going to
Therapists
do after work), but said that they attempted to
believed that
interpret their daydreams in the context of their
silence enhanced
work with their clients.
the therapy
Two variant categories also emerged. Some
relationship or
therapists reported that they tried to convey
process when used
interest in, or empathy for, their clients during
appropriately
silences. For example, one therapist stated that
she metaphorically held clients during periods
of silence. Finally, some therapists reported that
they tried not to move during silences. One
therapist said that she was aware of not taking
any actions, such as not drinking her soda, so
as not to break the intensity of the interaction.
For the most part, therapists believed that they
were actively engaged in the therapeutic work
during silences.
Overall, during silences therapists reported
doing a number of things that included observing
clients, conceptualising clients and therapeutic
interactions, examining their feelings and
thoughts in relation to the client and therapy
work, conveying empathy, and remaining
relatively still so as not to distract the client.
Although silence might have appeared as

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Although silence
might have
appeared as
uneventful from
an observers
standpoint, it was
actually quite an
active time for
therapists

uneventful from an observers standpoint, it


was actually an active time for therapists.
Examples of helpful and unhelpful silences
In order to understand the results in a context,
we believed it would be useful to examine
times in therapy when silence was used to
either the benefit or the detriment of therapy
process and outcome. Beyond asking participants
about their general use of silence in therapy,
we asked about specific incidents regarding
their use of silence. We asked them for an
incident when silence worked well in therapy
and for an incident when silence did not work
well. We chose two illustrative examples from
which to give the results a context.
Example of when silence worked well
in therapy
This silence event occurred in the eighth session
of therapy with a male therapist working with
a male client who was in mandatory substance
abuse treatment. The client had missed a
mandatory urine screening during the previous
week. When he came to the next session, the
client began by talking about other things and
did not bring up that he had missed the urine
screening. When the therapist brought up the
missed screening, the client ignored the therapist.
The therapist responded by confronting the
client about not taking the treatment seriously,
to which the client explained that he missed
the urine screening because of work. The
therapist then said to the client that if he was
not going to cooperate with treatment, there
was not much point in continuing. The therapist
then intentionally became silent.
Up to this point in the session, there apparently
was much activity, and the silence clearly
interrupted the momentum. In this case, it
seems the silence was used to challenge the
client as well as to facilitate reflection on the
part of the client. The clients presenting
symptoms did not fit any contraindications for
not using silence (e.g. severe disturbance) and
it seems the therapist believed the therapeutic
relationship was strong enough to handle this
silent challenge.
Contrary to the therapists intentions,
subsequent to the silent moment the client
again explained how work interfered with his
ability to make his screening appointment. The
therapist responded by remaining silent, again
to challenge the client and facilitate reflection.
At this point, the client was very uncomfortable
and started talking about how he really did need
to take treatment seriously because he did not

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want to lose his professional licence. The client


then asked if he could talk about something
else, to which the therapist again remained
silent. In this case, silence was used on three
occasions, in a short period of time, to challenge
the client.
Following this third silent intervention, the
client began talking about the importance of
figuring out how to manage his work schedule
so that he could do the required screening. This
discussion was consistent with the therapists
ultimate intention that was to get the client to
focus on changing a particular behaviour. The
therapists use of silence seemed to help the
client confront his problem.
When asked about his thoughts and feelings
during the times of silence, the therapist said
he viscerally sensed the clients extreme anxiety
and felt pulled to take care of the client.
However, the therapist realised that the reason
they had reached that point in therapy was
because he had got sucked into taking care of
the client in the past and had not confronted his
substance abuse. The therapist had to remind
himself to keep silent during the silence.
In this case, the therapist perceived the client
to be responsible for breaking the silence.
Breaking the silence alone though, was only a
partial indication that the client had become
more responsible for the therapeutic work in
that moment. It wasnt until the client discussed
what the therapist believed to be important
that the silence served the function the
therapist had hoped for.
These types of challenging silences seem to
breach the social contract that implies each
person should take turns talking. Initially, the
therapist encouraged the client to engage in a
more traditional therapy role, with therapist as
listener and client as talker (Pressman, 1961).
When the therapist refused to take his turn, he
forced the client to talk. Although the type of
silence may lead to enhanced responsibility on
the part of the client, the actual therapeutic
implications of this approach are unclear. As in
the case above, the manner in which the
silence is delivered is critical.
Example of when silence did not work well
in therapy
To understand the potentially powerful negative
effects that silence can have we now examine a
case when silence disrupted the therapeutic
work. In this case, the therapist used silence
early in treatment with a female client as a way
of building the therapeutic alliance. In this case,
it appears the reason is somewhat consistent

THERAPIST PERSPECTIVES ON SILENCE

with the category of using silence to convey


empathy, respect or support rather than for a
therapist-focused reason such as because she
was distracted. That said, unlike the typical
condition for using silence, when there is a
good therapeutic alliance, this therapist wanted
to use silence to strengthen a fragile alliance.
The therapist thought the client was anxious
and was aware that their alliance was fragile.
The fragility of the client is consistent with a
contraindication for not using silence. Thus far
there are two contraindications (weak alliance
and fragile client) which would have led most
participants to not use silence.
Although the therapist reported initially feeling
fine about the silence, the therapist ended up
breaking the silence when she observed the
client sitting rigidly and glaring at her. This
strategy is consistent with all three categories
for when participants would break silence: the
client was not using the silence productively,
the client was distressed by the silence, and the
therapist needed to find out what the client
was thinking and feeling.
When the therapist asked the client what was
occurring, the client responded by exploding in
anger. She told the therapist that she felt
attacked and unsupported by the silence.
The client left therapy shortly afterwards. The
misapplied silence led to negative therapeutic
consequences. The therapist was surprised by the
clients reaction both her initial explosion and
her leaving therapy. The therapist later realised
that silence was not the right intervention at
the time due to the fragile alliance.
Comparison of examples
As can be seen in these two examples, silence
is a powerful intervention that can have both
positive and negative effects on the therapy
relationship as well as on therapy process and
outcome. Silence can have the full range of
therapeutic effects from significant client
insight to premature termination. These findings
coincide with the theoretical literature that
warns therapists of the scope of positive and
negative consequences of using silence (Basch,
1980; Blos, 1970; Gill, 1984; Greenson, 1967;
Moursund, 1993; Reik, 1927). Specifically,
even though therapists may have benevolent
intentions for using silence, clients may perceive
silences to be anything from benevolent to
intimidating. This issue is illustrated in the
second example when silence did not work
well. In this case the therapist thought silence
was used supportively but was probably
perceived by the client to be too challenging

and uncaring, and as a result, was a likely


contributor to the clients unilateral termination.
Training, supervision and changes
with experience
Typically, therapists reported that they had
learned how to use silence through supervision
of their therapy work. For example, one therapist
mentioned that a supervisor helped free her up
by encouraging her to use silence more
instinctively. Another therapist remembered a
supervisor who helped him use silence as a way
to curb his impulsivity. Yet another learned
about silence from a supervisor who said if you
dont know what to say, then dont say
anything. Therapists also typically learned
about silence through specific training (e.g.
silence mentioned in a workshop) or readings.
One variant category was that therapists
learned how not to use silence based on negative
reactions they had to analytic training. For
example, one therapist referred to herself as a
recovering analyst. She thought her supervisors
used silence in a withholding, hostile and
uncaring fashion, which taught her how not to
use silence. Hence, therapists learned most
about how to use silence from supervision and
postgraduate training experiences and seldom
through graduate training.
With experience, therapists typically thought
they had become more flexible, comfortable
and confident about using silence. They reported
that they trusted themselves and the therapeutic
process more now when silence occurred.
Occasionally, therapists reported that as they
gained experience, they used silence less or
were more willing to break silences they
believed were unproductive. Hence, with
experience, therapists found themselves using
silence more judiciously.
These results suggest that therapists learned
how to use silence mostly through clinical
experience and supervision rather than through
specific training, which parallels the limited
training received by therapists when it comes to
other infrequently occurring but important
therapy issues such as sexual attraction towards
clients (Ladany et al, 1997). Rarely was silence
formally taught as an intervention, such as
through coursework. Instead, it was more likely
learned either from a supervisor if the supervisor
was interested in teaching the therapist about
silence or if the therapist sought the information.
Given the lack of theoretical and empirical
literature on silence, it is not surprising that
therapists did not learn about silence through
formal training. Even with limited literature,

Therapists
learned how to
use silence mostly
through clinical
experience and
supervision rather
than through
specific training

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THERAPIST PERSPECTIVES ON SILENCE

What does this study tell us?


The manner in which silence is delivered is
critical
Therapists believe they use silence to
convey empathy, respect or support
Silence is a multifunctional intervention and
should be used judiciously

No specific recommendations can be made


in terms of when to use silence

There are no standard patterns for length of


silence
Clients may perceive silence to be anything
from benevolent to intimidating

psychotherapy educators could help trainees


practice using silence and use methods such as
Interpersonal Process Recall to help trainees
understand and manage their feelings and
reactions to their clients (Williams, Judge, Hill
and Hoffman, 1997).
Reactions to own therapists silence
A final source of learning about how to use
silence came from the therapists own therapy
experiences. Therapists typically mentioned they
had experienced both positive and negative
reactions to their own therapists use of silence.
On the positive side, one therapist mentioned
that she used her therapists image of being
silent and calm to reassure herself that it was
okay to be silent with her clients. In contrast,
another therapist recalled a negative experience
where his first therapist was silent for almost an
entire session, which left him feeling awful,
misunderstood and harmed. He told his therapist
about his reactions in the next session but the
therapist did not respond well and placed the
issue back on him. The therapeutic relationship
ended shortly thereafter. Hence, participation in
their own therapy seemed to have had a
profound influence on many of these therapists.
Limitations
In terms of limitations, our findings offer tentative
hypotheses to consider for future research
rather than necessarily reflecting the current
state of affairs regarding all therapists use of
silence. For example, it is possible that our
participants, who were all white, may not have
attended to cultural variables relevant to crosscultural therapy relationships. Similarly, we
studied therapists who resided in the United

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States, and therapists practising in other countries


may use silence in different ways. Another
limitation is that we asked participants about
their perceptions of why they generally used
silence rather than asking about specific instances
in which they used silence. Therapists were
relying on their memories to describe their use
of silence, and so we were probably measuring
attitudes about using silence rather than actual
behaviours in sessions. Relying on memory in
combination with possible impression
management (wanting to appear at ones best)
of the self-report approach may have biased
the results. Those who declined to participate
may have had different responses to the interview questions. Finally, even though we considered our biases and expectations throughout
the study, it is still possible that they influenced
the questions in the interview and how we
coded and interpreted the data.

Implications for future research


Additional research needs to be conducted to
determine the extent to which the factors
relating to silence are generalisable to therapists
from a variety of theoretical orientations, to
clients presenting with various symptoms, and to
a variety of settings. The quality and quantity of
silence in actual therapy sessions should be
examined (Greenson, 1967; Stone, 1961). In
these sessions, client reactions and experiences
of silence could be analysed to determine their
consistency with therapist intentions (Hill and
OBrien, 1999). In this way, silence can be more
fully examined as an interactional variable
rather than simply as a therapist behaviour.
Another area of research is to further delineate
types of silence in therapy. Gelso and Fretz
(1992) differentiated between pregnant silences
(i.e. client is working) and empty silences (i.e.
no work is occurring). It is important for
researchers to determine how therapists can
maximise the former and minimise the latter.
Furthermore, investigators need to examine
methods for training therapists to use silence
effectively and examine critical events that lead
to changes in therapists ability to use silence
(e.g. more to less, or less to more). In addition,
it is important to consider the possibility that
therapist personality and family-of-origin
experiences with silence moderate their ability
to learn to use silence effectively. Finally, we
need to study therapist silence using other
methods, such as surveys and descriptive studies
of actual therapy process, to build upon the
findings of this investigation.

THERAPIST PERSPECTIVES ON SILENCE

Nicholas Ladany works at the Department of


Education and Human Services, Lehigh University
Clara Hill works at the Department of Psychology,
University of Maryland
Barbara Thompson is in independent practice in
Baltimore, Maryland
Karen OBrien works at the Department of
Psychology, University of Maryland
Correspondence address: Nicholas Ladany, 111
Research Drive, Counseling Psychology Program,
Department of Education and Human Services,
Lehigh University, Bethlehem, Pennsylvania, 18015.
nil3@lehigh.edu

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