The Process of the Exploration Stage
In this section, I describe several steps that helpers can use in their first session. These steps include getting started, facilitating exploration, dealing with difficult client situations, and developing one’s own style.
GETTING STARTED Before the session, it is ideal for the helper to take some time to “center,” to get in touch with current feelings and take some time to relax (use deep breathing), put aside (bracket) other issues and concerns, and focus on being present in the moment with the client. At the beginning of the session, the helper can also take a deep breath and assume a helping posture that is comfortable yet professional. The helper then introduces himself or herself to the client, explains what will happen in the session, and describes confidentiality. Then the helper turns the floor over to the client by asking the client what him or her to the session today or what she or he would like to talk about today. The helper listens attentively and allows the client to do most of the talking.
The helper can never know or be prepared for everything that will occur in any given helping session. This lack of control is often hard for beginning helpers who are used to doing well and mastering situations. My best advice is to prepare by practicing the skills a lot, and in different situations, so that they become automatic, and then go into the helping situation without a specific agenda. In other words, the helper goes in prepared to attend and listen and focus on the client using whatever skills come naturally given all the practice she or he has done. In Chapter 19, I focus on intakes, which is a different version of an initial session.
FACILITATING EXPLORATION If the client seems focused mostly on talking about ideas, stories, or narratives without much emotional content, the helper might start by listening carefully. When the client pauses (try not to interrupt and make sure that the client is done talking), the helper might use a mix of restatements and open questions and probes about thoughts to demonstrate understanding and to encourage further clarification and exploration. If the client has difficulty continuing, the helper might ask open questions and probes to encourage exploration of other aspects of the problem. After establishing some rapport, the helper might tentatively introduce reflections of feelings and open questions and probes about feelings to gently help the client think about feelings.
If the client is clearly in touch with feelings and able to experience and express them, the helper might start with reflections of feelings and open questions and probes about feelings to help the client go deeper into the feelings (remember to go with the cutting edge of the feelings). The helper will probably occasionally intersperse these feeling-oriented interventions with restatements and open questions and probes about feelings to help the client explore other aspects of the problem.
At the end of the session, helpers might summarize what the client has said to
see whether the client has anything else to add and provide closure. For example, a helper might say,
You’ve been talking a lot today about your feelings about your roommate. You seem concerned that the two of you are not as close as you have been in the past. You are not sure what you can do to fix the relationship. How does this summary fit for you?
Alternatively, helpers might ask clients to summarize (e.g., “Could you sum up what you learned so far?”) to get a sense of how much clients have absorbed. Ideally, summaries are a joint effort, with helpers and clients trying together to explicate what has been learned. Sometimes, of course, summarizing is not necessary because clients naturally move directly to insight.
CONCEPTUALIZING THE CLIENT In addition, the helper observes the client throughout the session and begins to formulate hypotheses about what is going on for the client. In other words, the helper begins to conceptualize how the client got to where she or he is (e.g., what contributed to his or her current state) and what the helper can do to get the client unstuck and functioning better. These observations and conceptualizations form the basis for interventions during the insight stage. Some questions that the helper can ask him or herself after each session:
What is the client’s problem? What is motivating the client to seek help now? How does the client think and feel about the problem?
In the previous editions of this volume, I talked about determining when the client had explored enough so that the helper could know when to move onto the insight stage. I now think that the idea of having explored enough was somewhat misguided. Clients continue exploring throughout all three stages of the helping process, so it is not quite right to talk about an adequate amount of exploration. I now think a more appropriate construct is to determine whether the client is ready for deeper exploration and insight. In other words, there are sometimes windows of opportunity in which clients are open enough to go deeper. Thus, rather than helping involving a linear process in which clients go through exploration, then insight, and then action, it is more typical that clients spend the majority of their time in exploration and occasionally are able to venture deeper into insight or action and then go back to exploration.
DEALING WITH DIFFICULT CLIENT SITUATIONS I can hear trainees asking, “But what do I do when the client won’t talk, or when the client is too talkative, or when the client is suicidal, or when I’m attracted to the client?” and so on. For now, I’ll ask you to hold off on the questions and focus on developing your skills. Once you begin to master the skills, it is time to turn to focus on difficult client situations—these are covered in Chapter 19.
DEVELOPING YOUR OWN STYLE There is no “right” way to implement this (or any other) stage in this helping model. Each helper has to modify the skills to fit his or her personal style, and then modify that style to fit the needs to individual clients (all of whom have different needs and reactions). I suggest that you try out the skills and see how they work for you. Practice a lot. Get feedback from clients and observers. Become a personal scientist—see what works and what does not work.
There are a number of cultural considerations to consider when implementing the exploration stage. First, the humanistic theory behind the exploration stage is in tune with a Western philosophy that encourages open examination of thoughts and feelings and emphasizes self-healing and self-actualization. Other cultures, particularly Eastern cultures, value collectivism more than a strong emphasis on self (Pedersen, Draguns, Lonner, & Trimble, 2002; D. W. Sue & Sue, 1999). Clients from non-Western cultures may thus be less amenable to exploration than to action, so the exploration stage may need to be shorter than it would be with a Western client (note that many Western clients are also uncomfortable exploring feelings). Helpers must be mindful of not imposing their own values about open communication on people from other cultures. I caution, however, that some exploration is necessary to get a firm foundation of understanding before rushing to action. Furthermore, helpers must be careful not to stereotype clients from other cultures or assume all people from a given culture have similar values. Remember that there is more variation within a given culture than between cultures (D. R. Atkinson, Morten, & Sue, 1998; Pedersen, 1997).
Another important cultural consideration in the exploration stage relates to gender. Although in general women are more comfortable expressing feelings than men, given that men are typically socialized to hide feelings of sadness and fear, helpers should not assume that all women will enjoy exploration and all men will not.
A general guideline is that it is important to explore cultural differences when these seem salient to the client. The helper can mention cultural differences in the first session and ask about these (e.g., “I am aware that we are from different cultural backgrounds. I wonder how that is for you?”). The helper can also be attentive to client discomfort throughout the helping process and ask the client whether this discomfort is due to cultural differences (e.g., “I notice you seem uncomfortable when I probe for feelings. I wonder if opening up to a stranger is frowned on in your family or culture?”). In addition, it can also be helpful to ask about cultural values related to the helping process (e.g., “What is the reaction in your family and culture to people seeking help from counselors or helpers?”).
Finally, helpers can ask clients to talk about their culture, so that they can learn more about the experience for each client uniquely (e.g., “Tell me about what it is like for you to be a Korean student who has just arrived in the United States”).
Difficulties Implementing the Exploration Stage
Here are some difficulties that beginning helpers have talked about when they are first learning to implement the exploration stage. If you are aware of these obstacles ahead of time, you will be more likely to cope when difficulties inevitably arise.
It is important to remember that none of us are perfect, and even experienced therapists have difficulties, given that helping is a human endeavor. Indeed, my purpose in talking about these difficulties is so that novice helpers can become aware that these difficulties are normal.
INADEQUATE ATTENDING AND LISTENING Several factors might interfere with helpers’ ability to attend and listen adequately to their clients. Many helpers get distracted from listening because they are thinking about what to say next (“I wonder if I should bring up that she seems sad?”) or are distracted about something unrelated to the session (e.g., “What’s for dinner tonight?”). Helpers sometimes judge the merits of what clients are saying rather than listening and understanding them. One type of judgment that is hard to avoid is evaluating clients using one’s own cultural standards. For example, a European American, middle-class, female helper might have difficulty listening to and understanding an upper class African American man or a very poor Asian woman. Sympathy can be another impediment to listening because helpers sometimes become so involved with and feel so badly for clients that they cannot maintain objectivity; they try to “rescue” clients instead of attending to feelings.
ASKING TOO MANY CLOSED QUESTIONS Beginning helpers often ask too many closed questions because they feel they need to gather all the details of a problem. Many helpers think the helping process is similar to a medical model in which they should collect a lot of information to diagnose the problem and provide a solution for the client. However, in this stage the helper’s task is to aid clients in coming to their own solutions, so there is little need to know all the details. Instead, such skills as facilitating exploration of thoughts and feelings are important for helping clients explore.
Some helpers ask too many questions simply because they do not have anything better to say. These helpers do not necessarily want to hear the answers to their questions; they just want to fill time or satisfy their curiosity. When asking
questions, it is important to clarify for whom the question is being asked (i.e., to assist the client or to fulfill the helper’s need).
TALKING TOO MUCH Some helpers talk too much in helping sessions. They might talk because they are anxious, want to impress clients, or like to talk in general. However, if helpers are talking, clients cannot talk and, hence, cannot explore their concerns. Research has found that clients generally talk about 60% to 70% of the time (Hill, 1978; Hill, Carter, & O’Farrell, 1983). In contrast, in nonhelping situations, each person in an interaction ideally talks about 50% of the time; therefore, it can be difficult for beginning helpers to adjust to listening more than talking.
NOT ALLOWING SILENCE One of the most daunting tasks for beginning helpers is to cope with silence. Trainees often rush to fill voids in sessions out of fear that clients are bored, anxious, critical, or stuck. Rushing to fill voids can result in superficial and unhelpful comments. Helpers should try to understand their fears about silence in sessions, asking themselves what concerns they have (e.g., not appearing competent, not helping the client). Once they figure out these concerns, they can work on these fears outside of sessions, rather than rushing to fill silences in sessions.
FEELING AN URGE TO DISCLOSE TOO MUCH One of the biggest problems beginning helpers have is the urge to disclose too much. Because client issues are often similar to their own, beginning helpers want to share their experiences with their clients. It seems natural to disclose and tell one’s stories, as one would with friends. Helpers also may want help for themselves and may be distracted by their own problems while listening to clients. It can be difficult to listen to someone else’s issues when one is going through the same thing. For example, beginning helpers in their early 20s often have difficulty listening to students their own age talk about identity issues, relationship difficulties, problems with parents, and plans for the future because helpers have these same problems. Beginning helpers who are older might have difficulty listening to problems about parenting and aging. Adopting the professional identity of a helper who listens but does not disclose much is a major and challenging shift in perspective for beginning helpers. However, because inappropriate self- disclosure can be detrimental and can hinder the therapeutic relationship, helpers need to learn to restrain themselves and only disclose for the client’s benefit.
GIVING TOO MUCH (OR PREMATURE) ADVICE Beginning helpers often rush into giving advice. They feel pressured to provide answers, fix problems, rescue clients, or have perfect solutions. Many clients and
beginning helpers are under the misguided notion that helpers have a responsibility to provide solutions to problems. Giving clients answers or solutions is often detrimental because clients have not come to the solutions on their own and therefore cannot own them. Furthermore, when given answers, clients do not learn how to solve future problems without depending on other people. Clients most often need a sounding board or someone to listen to them think through their problem or help them figure out how to solve their problems, rather than someone telling them what to do. It is critical to realize that the need to provide answers often originates in the helper’s insecurity and desire to help, which are normal feelings at the start of learning helping skills.
It is important, however, to recognize that some clients do want answers from helpers and do not want to explore. It is sometimes appropriate to move relatively quickly to the action stage with such clients. Sometimes such clients will be more eager to explore after they have made specific changes in their lives; other clients, however, just want changes without deep exploration and understanding. Helpers can educate clients about the benefits of coming to their own solutions after a thorough exploration of their problems, feelings, and situation, but helpers need to be responsive to client’s preferences and needs in terms of exploration versus action.
BEING “BUDDIES” Sometimes beginning helpers err by acting like “buddies” with clients instead of being helpers. The role of helper necessitates providing a connected yet clearly defined relationship to maintain objectivity and offer maximum assistance. Being a buddy can be limiting because helpers might choose interventions to make clients like them rather than to help clients change. For example, Sam, a beginning helper, began every session by talking with his client, Tom, about recent sporting events. Tom responded enthusiastically to talking about sports but was reluctant to discuss more personal issues. Sam avoided changing the topic because he wanted to maintain a friendly connection with Tom. Unfortunately, because of his desire to be buddies, Sam was not able to help Tom explore his personal issues.
DISCOURAGING INTENSE EXPRESSION OF AFFECT Beginning helpers sometimes feel awkward when clients express intense affect, such as despair, intense sadness, or strong anger (especially if the anger is directed toward the helper). Sometimes helpers are uncomfortable with negative feelings because they do not allow themselves to feel their own negative feelings. They may deny or defend against their internal “demons.” For these helpers, hearing clients’ negative feelings can be stressful. Sometimes helpers feel a need to make clients feel better immediately because they do not want their clients to suffer. They mistakenly think that if clients do not talk about their feelings, the feelings go away. They might be afraid to have clients get into the negative feelings because they feel inadequate to help. Guilty feelings might emerge for helpers if their
interventions result in clients crying. These helpers err on the side of keeping things “light” or minimizing feelings so they do not have to face “tough” situations in which they feel helpless. Recently, an attractive adolescent client told her helper she felt totally fat and ugly. She expressed disgust with her body and astonishment that anyone would want to be around her. A helper who is uncomfortable with intense negative feelings might give the socially sanctioned response of reassuring this client that she is attractive and suggesting that her feelings are not accurate. Ironically, this response would negate the client’s feelings and could make the client feel worse because she would feel angry and misunderstood.
Now might be a good time to ask yourself how you feel about overt expressions of affect. What do you instinctively want to do when someone begins to sob? Most of us feel an urge to get the person to stop crying and to feel better. How do you react when someone is acting hostile and angry toward you? Many of us get defensive or react with hostility. Helpers need to be aware of their tendencies to respond in these types of situations so they can practice other, more therapeutic ways, to respond. The exploration skills can be particularly valuable tools for helping clients stay with their intense emotions.
DISSOCIATING AND PANICKING Sometimes novice helpers become so anxious about their performance that they feel like they are outside their bodies observing themselves, instead of being fully present and interactive in the helping session. At the worst, these helpers become completely frozen and cannot say anything. These experiences can frighten helpers, who then panic and tell themselves they can never be good helpers. In fact, anxiety is often more of a problem than lack of skills, but fortunately I have seen many students overcome their anxiety and become gifted helpers.
FEELING DISCOURAGED ABOUT YOUR ABILITY TO BE A HELPER At about this point in the course, some students say they feel like they are getting worse at being able to be a helper rather than getting better. They are so focused on each skill and on watching everything they do that it is hard to perform at all. An analogy can be drawn to learning to ski. When you first learn to ski, you are conscious of every little thing you do. Like beginning skiers, beginning helpers focus on each thing they do in the helping encounter. In learning helping skills, helpers practice the individual skills (and often unlearn habits that were not facilitative to helping) and then put all the skills together. Although difficult initially, it often begins to feel easier when you put them all together. Students often feel better after practicing for a few more weeks, although some students come to realize that they do not want to be helpers.
Coping Strategies for Managing Difficulties
For most students, it is possible to overcome these difficulties! I offer several coping strategies in this section, primarily based on findings of research with beginning helpers (Williams, Judge, Hill, & Hoffman, 1997). I hope all helpers find some strategies they can use.
PRACTICE THE SKILLS First and foremost, helpers can practice the helping skills taught in this book. Over and over, students in the past have said the practice is what helped them learn (see also Chui et al., 2013; Jackson et al., 2013; Spangler et al., 2013).
The skills can be compared to tools in a toolbox; helpers learn about the various tools available for different tasks. Some tools work better than others for some helpers and some clients. It is important that helpers have many tools (e.g., helping skills and methods for managing anxiety) in their toolbox.
Before sessions with clients, helpers can role-play using specific helping skills. Helpers can also role-play the mechanics of sessions, such as starting and stopping the session, responding to silence, and dealing with anger directed toward the helper. By using role-plays with supportive partners (e.g., classmates), helpers are more likely to learn the skills at a comfortable pace. The more helpers practice and pay attention to what they do well and how they can improve, the better and more comfortable they are likely to become in helping sessions.
DEEP BREATHING One way helpers can manage anxiety during sessions is to breathe deeply from the diaphragm instead of taking short breaths from high in the chest. To determine whether you breathe from the diaphragm, put your hand over your stomach. When you breathe, you should feel your hand move in and out. Deep breathing serves several functions. First, it allows one to relax. When the diaphragm is relaxed, it is harder to be anxious physiologically. Second, taking a deep breath gives helpers a moment to think about what they want to say. Helpers can take time to focus their energy instead of being distracted by thinking about what to say in the next intervention. Third, deep breathing gives clients a chance to think and consider whether they have anything else to say.
FOCUS ON THE CLIENT All too often, beginning helpers are so concerned with their own behavior that they cannot listen attentively to clients. By shifting focus to be more concerned with the client than with themselves, helpers can listen more attentively (Williams et al., 1997). The goal is to facilitate clients in exploring feelings, not for helpers to show off how much they understand clients. By focusing on the client and attempting to immerse oneself in the client’s world, many helpers forget about their anxiety.
POSITIVE SELF-TALK We all talk to ourselves as we do things. We sometimes say positive things like “I can do this” or negative things like “I think I am going to panic.” Some people have called this the “inner game” because it occurs beneath the surface. Positive self- talk has a positive influence on performance in helping sessions, whereas negative self-talk has a negative influence on performance (see Nutt-Williams & Hill, 1996), so helpers need to be attentive to what they are saying to themselves. Helpers can practice using positive self-talk before sessions so they have positive sentences ready to use to coach themselves. Alternatively, helpers can write down positive self-statements (e.g., “I know the skills,” “I am competent”) on index cards and glance at them before or during practice sessions.
OBSERVING MODELS Watching skilled helpers in helping sessions is an excellent way to observe skills being used appropriately. The skills come alive when one sees them demonstrated by experts. Although reading about theories and skills is important, imagining how they come across is hard unless models are available. Bandura (1969) showed the effectiveness of watching a model as one step in the learning process. I recommend watching many different helpers to illustrate that there are many ways and styles of helping (especially see this book’s accompanying DVD, Helping Skills in Practice: A Three-Stage Model and the new one on dreams, Dream Work in Practice, both published by the American Psychological Association).
IMAGERY Through sports psychology, we know that when athletes have the requisite skills, practice through imagery can be a beneficial addition to actual practice (Suinn, 1985). Helpers can imagine themselves using appropriate attending behaviors and helping skills in different situations. For example, a beginning helper who feels uncomfortable with silence might close her eyes and visualize herself in a session with a quiet client. She might imagine herself sitting comfortably with the client and allowing the silence to occur. She might also visualize breaking the silence after a period of time by asking how the client is feeling.
Example of the Exploration Stage
The following is a sample of an interchange in which the helper facilitates client exploration through an integration of the exploration skills. This example is not meant to be perfect but rather a realistic example of what might occur with a beginning helper. After each helper response, I label the skills used and give an explanation of what the helper was trying to accomplish. As you go through the
example, cover the helper’s responses and formulate your response first. You can then see how similar the helper’s response is to yours and determine which is most effective and which you would be most comfortable trying.
Helper: Hi! My name is Sandra. We have 30 minutes today to explore whatever you would like to talk about. (The helper intends to set limits by providing information about what the client can expect from the session.)
Client: Okay. Helper: So, where would you like to begin? (The helper uses an open
question to focus.) Client: I’m feeling anxious about a paper I have to write. I always end up
waiting until the last minute to begin, and then I panic because I don’t have enough time to write it. I know I do this, but I can’t seem to stop myself.
Helper: You’re really upset with yourself. (The helper gives a reflection to help the client experience feelings.)
Client: Yeah, I’m worried that I’m going to ruin my chances of getting into graduate school because I’m not doing as well in my courses as I should be.
Helper: You feel scared because your current behaviors might limit your future goals. (The helper gives another reflection because she wants to stay with the feelings and help the client explore further.)
Client: Exactly, I really think I could succeed in graduate school, and I know I need a graduate degree to do what will make me happy. I’m so worried that I’ll stay in this rut and ruin everything I’ve worked for.
Helper: Tell me about the last time you had a paper to write. Take me through what went on inside your head. (The helper wants information about what goes on and wants to get the client to talk more concretely about the problem, so uses open questions and probes about thoughts.)
Client: Well, actually, I have a paper due Friday, and I haven’t started it yet. I’ve gathered all the material I need, and I’ve taken notes on the books, but I haven’t written anything. And I’ve been up late several nights already this week, so I’m short on sleep.
Helper: I can hear the panic in your voice. (The helper reflects nonverbal behavior to help the client recognize feelings.)
Client: Yeah, I’m scared that I won’t be able to pull it off this time. Usually I can just pull an all-nighter and get it done, but it seems too big this time. The paper’s supposed to be 20 pages.
Helper: What are your plans for this evening? (The helper wants the client to get more specific about the situation to provide a clearer picture and again focuses by using an open question about action.)
Client: Well, I just want to go home and sleep. I just don’t want to do it. Helper: Is anything else going on in your life that makes it difficult for you to
work on the paper right now? (The helper notes that the client seems stuck and thinks that perhaps the situation is more complicated than the client has expressed. Hence, the helper uses an open question to ask about other issues.)
Client: It’s funny you should ask about that. I just had a big fight with my boyfriend, and I feel very upset. He wants to get married and have kids right away, but I really want to go to graduate school. But if I go to
graduate school, I will have to move away, at least for a while. Helper: So you feel conflicted between being with your boyfriend and going
on to school. (The helper feels pleased that the client has opened up about other parts of the situation. Because the helper wants to get the client to talk about her feelings about this conflict, the helper uses a reflection that focuses on both parts of the problem.)
Client: That’s really true. It just feels like everything has to go his way. Just because he’s already finished his school and is working, he wants me to be done too.
Helper: I wonder if you’re somewhat confused. (The helper’s intent is to identify feelings through reflection, but the helper has inappropriately projected her confusion onto the client because she is in a similar situation.)
Client: No, not really. As I think about it, I feel angry. I shouldn’t have to give up my career for his. My mother did that, and she is very unhappy. She never even learned how to drive. She did everything for her kids, and now that we have all left home, she’s depressed and lonesome. I think I want to have a career, but I don’t know. I don’t know if it’s fair, and I don’t want to risk losing my relationship with my boyfriend.
Helper: (in a softer voice) It sounds like you are really torn up inside. (The helper realizes that the last intervention was inaccurate and shifts focus back to the client’s feelings by using a reflection.)
Client: (cries softly) Maybe I can’t write the paper because I’m so confused about this fight with my boyfriend and what’s going on with my mother.
Helper: (The helper is silent for 30 seconds to give the client a chance to experience her feelings of sadness.)
Client: (cries and then blows her nose) Helper: (softly) I’m sure this is very difficult for you to talk about. (The
helper wants to support the client and gives approval-reassurance.) Client: Yeah, it sure is. What do you think I should do? Helper: Well, I think you should go talk to your instructor and see if you can
get out of writing the paper tomorrow. Then I think you need to talk to your boyfriend and try to work things out. Perhaps you should encourage your mom to get counseling. (The helper inappropriately gets caught up in the client’s request for help and gives direct guidance about what client should do.)
Client: Oh. (silence) Well, I don’t know. (The client stops exploring and becomes quiet.)
Helper: Sorry, I got carried away with too much advice. How do you feel about a career? (The helper realizes the client has stopped exploring and so apologizes briefly. She then tries to go back to the exploration by using an open question to return to the last major issue they were discussing before the client got stuck.)
Client: (Client continues to explore.)
What Do You Think?
How would you have handled the situation as the helper in the extended example? How do you explain the client’s being able to gain insight (i.e., “Maybe I can’t write the paper because of my fight with my boyfriend and what’s going on with my mother”) in the example when the helper did not provide interpretations? Discuss whether you think helpers need to go on to the insight stage or whether the exploration stage is necessary and sufficient for clients’ change. Is it possible for clients to explore too much? Check the obstacles you are likely to face in your development as a helper:
____ inadequate attending and listening ____ asking too many closed questions ____ talking too much ____ giving too much or premature advice ____ being “buddies” ____ not allowing silence ____ inappropriately self-disclosing ____ discouraging intense expression of affect ____ dissociating and panicking ____ feeling inadequate
Identify strategies you might use to cope with obstacles as a helper:
____ developing compassion ____ be supportive and listen attentively ____ practice the skills ____ observing models ____ imagery ____ role-playing ____ deep breathing ____ focusing on the client ____ positive self-talk
R E S E A R C H S U MMA RY Silence in Therapy Citation: Hill, C. E., Thompson, B. J., & Ladany, N. (2003). Therapist use of silence in therapy: A survey. Journal of Clinical Psychology, 59, 513–524. doi:10.1002/jclp.10155
Rationale: Silence is a difficult skill for many beginning therapists, who may feel uncomfortable with knowing when and how to use it. The theoretical literature provides little guidance for beginning therapists, given the contradictory advice ranging from suggestions that silence can be used to communicate tender concern to warning that silence can convey cruel inhumanity. Likewise, the empirical literature suggests that silence has been associated with both positive outcomes (e.g., client perceptions of rapport, increased client involvement in the session) and negative outcomes (e.g., perceptions of therapist as unempathic, dropout). The current study is a follow-up to a qualitative study conducted by the same authors (Ladany, Hill, Thompson, & O’Brien, 2004) in which they found that 12 experienced, mostly psychodynamic therapists used silence in various ways: to convey empathy, facilitate reflection, and gain time for themselves to think about what they wanted to say. These therapists thought that a solid therapeutic relationship was a prerequisite to using silence. Hill et al. wanted to replicate Ladany et al.’s (2004) qualitative findings with a larger, more theoretically diverse sample.
Method: Eighty-one therapists from a range of theoretical orientations, most of whom were in full-time practice, completed a survey. The survey, which was developed based on the results of the Ladany et al. (2004) study, asked about a silence event (which could have ranged from several seconds to a few minutes in which neither the client nor the therapist was speaking) in a recent session with an adult client in individual therapy. They were asked to describe the event, indicate their reasons for using silence, report their thoughts and feelings during the silence, and judge the consequences of the silence on the therapy process and outcome.
Interesting Findings: Ninety-three percent of therapists reported a recent silence event, most of which had occurred within the previous 4 weeks, were used intentionally, were less than 1 minute, occurred in the middle of sessions and in the middle phase of long-term treatment, and did not involve an explanation of the rationale for using silence. Therapists most often used silence to facilitate reflection, encourage responsibility, facilitate experiencing of feelings, not interrupt the flow, and convey empathy and support. They rarely used silence to create productive anxiety, to avoid a power struggle, to put up a shield, or because of anxiety or distraction. During silence events, therapists reported that they were most often focusing on what was going on with the client, observing the client, thinking about the therapy, and conveying interest. They were rarely trying to minimize client reactions or daydreaming. Therapists estimated that they generally intentionally used silence with approximately a third of their clients, with 12% never using silence and 4% using it with all clients. Of those therapists who used silence, it was used on average once every other session, with each silence lasting under 1 minute. Therapists indicated that they were most likely to use silence when clients were actively in a problem-solving mode. They avoided using silence when they thought clients might
misunderstand the silence, the client was psychotic or paranoid, there was a poor therapeutic alliance, the client was exhibiting danger to self or other, or the client had a history of using silence as a punishment. Therapists typically indicated that the silence event was helpful given that it enhanced the therapeutic relationship and the therapeutic work during the session.
Conclusions: Therapists are thoughtful and judicious about using silence. Therapists seemed to have a great awareness that silence can be misunderstood and thus needs to be used with caution. Therapists were internally active during silence. They were thinking about their clients and the therapy process. Therapists would not use silence if they thought clients could not handle it.
Implications for Therapy: Silence can be helpful in circumscribed situations but can also create misunderstanding if not used at the right time. Therapists may need to educate clients about why they use silence (e.g., to facilitate clients going deeper into their feelings). Therapists may need to check with clients about how they experienced the silence. Therapists need to think carefully about their intentions for using silence.