Therapeutic Silence: The Positive and Negative Implications of Using Silence As A Clinical Tool in the Therapeutic Dyad

Abstract

This study utilized a Grounded Theory methodology to investigate the positive and negative impact of silence in the therapeutic dyad. Thirteen licensed psychotherapists of different theoretical traditions related their experiences of using silence as a clinical tool to increase patient contact with unconscious affect needing to be expressed and integrated. Investigation centered on both the generative as well as the destructive impact of silence in the patient’s psyche, the therapeutic relationship, and the ability of silence to create a mirroring presence for the introjection of therapist as object. Generative silences were seen to move the therapy forward by deepening the therapeutic alliance, allowing regression to earlier ego states, creating a safe and containing alchemical vessel for the transformation process, and ultimately allowing for an increase in observing ego functions, greater ability to regulate affect, and the liberation of choice in seeing new ways to view the problem and generate a solution.

Destructive silences, whether real or perceived, ruptured the therapeutic relationship causing the need for repair. Patient’s expressed affect covered the spectrum from mildly increased emotional turmoil, to quasi-psychotic eruptions of rage toward the therapist with sometime irreparable outcomes.

The research generated a new theory that noted pre-conditions, intervening variables and outcomes for the appropriate use of therapeutic silence. The main pre-condition was a strong therapeutic alliance. Intervening variables were the stage of treatment, the patient’s level of personality organization, and the level of attachment deficit seen in the patient. The therapist’s own comfort with silence was also seen to be an intervening variable. Conclusions focused on the need to educate the patient about the use of silence in therapy, training in its use at the graduate level, and more careful assessment of patient characteristics.