When a Client is Silent during Therapy (Part I)

One of the most common questions I have been asked by therapists over the years as a clinical supervisor is, “How do I help a client who consistently attends therapy, but often is silent during sessions?”  It may sound counterintuitive, but therapy sessions with a silent client can be the most mentally draining for a therapist.  Most therapists relate to the experience of feeling that they are working harder than the client during a session and how exhausting that can be.  Therapists can feel pressured to fill the silence or can interpret the silence as their failure as a therapist.

Silence is frequently described by professionals as resistance which can inadvertently establish an adversarial role between the client and the therapist.  Reframing the situation as the client experiencing ambivalence changes the view of the silence into a challenge for the therapist’s clinical skills rather than a fault for which to blame the client.  This sounds so simple, yet is often one of the most challenging goals to accomplish for a therapist. 

Using strategies to meet the clients where they are at is the key concept in helping clients to identify and resolve their ambivalence.  This can be accomplished by using strategies based on the clinical skills the therapists already possess.  Knowing that they already have the skills to resolve ambivalence can increase therapists’ confidence in working with a silent client.  Let’s take a look at some of those strategies.

Believe in the Therapeutic Alliance

Often referred to as rapport, strong therapeutic alliance is one of the primary indicators of a successful outcome in therapy.  Therapeutic alliance is the establishment of a partnership between the therapist and client.  While clients tend to emphasize the importance of unconditional positive regard in building alliance, therapists may judge the quality of the partnership based on the clients’ active participation.  This discrepancy can lead to the therapist misinterpreting the silence as poor therapeutic alliance.  One strategy for resolving ambivalence is to view the silence as confirmation of strong therapeutic alliance, meaning that the therapist is providing enough warmth and acceptance to allow the client to be comfortable sitting in silence with the therapist.  Consider when you are comfortable with silence.  Isn’t it typically with people with whom you have a positive relationship?  When we do not have an established relationship with another person, the silence becomes awkward and we often feel compelled to fill the space.  Choosing to believe in the strength of the therapeutic alliance can reduce the insecure or inadequate feelings of the therapist and, therefore, change the approach used during the session.  One way to communicate this acceptance is offering to engage in a non-verbal activity with the client such as drawing or playing a game.  This removes the pressure of talking and communicates acceptance of the ambivalence.

Get Comfortable with Reflective Silence

Once a therapist reframes the silence as confirmation of a strong therapeutic alliance, it’s easier to become comfortable sitting with the client in silence.  Continuing to build upon that alliance by demonstrating acceptance of the client’s ambivalence then becomes possible.  It can be therapeutically beneficial to allow clients to sit and reflect on their thoughts with your supportive presence.  Therapists can communicate support, understanding, and acceptance with gentle reflections and affirmations. 

Some examples:

“This is really hard for you to process.” 

“Take all the time that you need.”

“It’s very normal to feel at a loss for words.”

“I really value your presence here.”

“Thinking about change is really hard.”

“This is your space and I completely support you.”

“I’m so proud of you for being here.”

It’s important to limit the reflections and affirmations by seeing the potential value in the reflective silence.  Resist the urge to fill the empty space by reframing your supportive silence as unconditional positive regard for the client.  Remember that all change contains an element of ambivalence which can result in feeling frozen.  Remember the last big change that you made and how challenging the journey of change can be. 

Next week in part two, working with clients who are silent through slowing the pace and building the confidence of the client.