Silence Is Golden: A Mixed Methods Investigation of Silence in One Case of Psychodynamic Psychotherapy

We investigated the antecedents, occurrences, and consequences of 183 silence events in the first 5 and last 5 sessions of a 73-session case of successful psychodynamic psychotherapy. Silences generally occurred within client speaking turns, such that the client often paused to reflect while speakin...

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Bibliographic Details
Published in:Psychotherapy (Chicago, Ill.) Ill.), 2019-12, Vol.56 (4), p.577-587
Main Authors: Hill, Clara E., Kline, Kathryn V., O'Connor, Seini, Morales, Katherine, Li, Xu, Kivlighan, Dennis M., Hillman, Justin
Format: Article
Language:English
Subjects:
Behavior Therapy
Clients
Collaboration
Consequence
Human
Male
Meaning
Psychodynamic Psychotherapy
Psychotherapy
Reflectiveness
Silence
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Summary:We investigated the antecedents, occurrences, and consequences of 183 silence events in the first 5 and last 5 sessions of a 73-session case of successful psychodynamic psychotherapy. Silences generally occurred within client speaking turns, such that the client often paused to reflect while speaking. In the last 5 sessions, as compared with the first 5 sessions, the client was more collaborative before and after silences, silences were shorter, the therapist was more connectional during silences (e.g., shared emotion and meaning with client), and the client was more emotional after silences. Antecedent client collaboration, duration of the silence, therapist behavior during silence events, client behavior during silence events, and who broke the silence all related to change in collaboration from before to after the silence events. We concluded that silence was helpful in this case because of client factors (the client naturally paused a lot during discussion, the client was quite reflective and insightful), therapist factors (the therapist was comfortable with and believed in silence), and relationship factors (there was a strong therapeutic relationship). Clinical Impact Statement Silence occurs frequently in some cases of psychotherapy, but little is known about its effectiveness. This case study provides ideas of what to look for to determine if silence is useful. Question: We examined what occurred before, during, and after silence events in a single case of psychodynamic psychotherapy. Findings: Silence changed across the course of psychotherapy, reflecting changes in the therapeutic relationship. Meaning: Silence can reflect different processes at different moments in the psychotherapy process. Next Steps: We need to use this method to analyze a wider range of case.
ISSN:0033-3204
1939-1536
DOI:10.1037/pst0000196