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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
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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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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
Therapists used
silence to give
themselves time
to decide how to
respond to their
clients
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Therapists
typically reported
that a sound
therapeutic
alliance was
needed for them
to use silence
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Although silence
might have
appeared as
uneventful from
an observers
standpoint, it was
actually quite an
active time for
therapists
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Therapists
learned how to
use silence mostly
through clinical
experience and
supervision rather
than through
specific training
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