Add To Cart

Section 4
The Silent Client

Question 4 | Test | Table of Contents

Children and adolescents are among the most proficient at employing silence as a weapon in therapy. Marshall collaborated with one ten-year-old client who was especially skilled at avoiding any interaction whatsoever through a variety of means — detachment, indifference, disengagement from anything the therapist might try. Because this child was so brilliantly adept at ignoring questions, he was recruited to help write a list of what it takes to be the most difficult client possible. Marshall therefore suggested that if other children want to be like him and frustrate their therapists, they should say only the following in response to any question:

“I don’t know.”
“Sometimes.”
“It doesn’t matter.” “I guess so.”
“That’s about it.”
“I don’t care.”
“I forget.”
“Yes.”
“Sort of.”
“I don’t remember.”
“It doesn’t make any difference.”

Of course, once the therapist and client had made a game out of their rigid patterns of communication, making the rules explicit, they could laugh at themselves and thereby remove some of the barriers preventing them from exploring other areas.

I don’t know! Of all the responses we get from the silent client, “I don’t know” may be the most difficult of all. Sack has catalogued several of the most common ways a therapist might respond to a client who says “I don’t know” to any query that is initiated. I have presented the therapeutic options in progressive order of how intrusive they might be. My assumption is that we try to do as little as possible to produce the greatest impact. Only when our most benign interventions fall on deaf ears should we resort to more potent strategies.

Balancing Power Options to the Client Response of “I don’t know.”
1. Silence. Respond to silence with silence.
2. Reflection of content. “It is difficult for you to articulate what is going on for you.”
3. Reflection of feeling. “You really feel resentful that you have to be here to answer these questions.”
4. Probe. “What is it like for you not to know?”
5. Labeling of behavior. “I’ve noticed that you say ‘I don’t know’ a lot.”
6. Invitation to pretend. “Imagine that you did know. Take a wild guess as to what form it would take.”
7. Confrontation. “I sense that you may know a whole lot more than you have decided to share with me right now.”
8. Self-disclosure. “I’m having a hard time working with you when you answer ‘I don’t know’ so often. It is as if you expect me to know what is going on inside you without your offering much help.”

Passive Resisters.
These are just some of the response options that are available to us when we are confronted with one common ploy passive resisters use to keep us at bay. On a larger scale, there are even more interventions that are sometimes effective in counteracting exaggerated silence or extreme passivity;
9. Relabel the behavior. “You seem to be quite good at staying within yourself. Most people can’t stay quiet as long as you can.
10. Schedule a silent session. Continued silence now becomes a cooperative response.
11. Prescribe the silence. “I appreciate your keeping so quiet. That will make it so much easier when I discuss the problems with your parents. I’d like you to stay silent so I don’t become confused by hearing your side of things.”
12. Provide structure. “You don’t seem to know what to do with our time together. I wonder if it would be easier for you if I asked you a series of questions?”
13. Provide freedom. “I respect your desire not to talk right now. I am willing to wait as long as it takes for you to open up.”
14. Create a game. I’ll ask you a series of questions in which you won’t have to say a word. Just nod your head when I ask you a question or shrug if you don’t know.”
15. Use nonverbal sources. “As it seems difficult for you to communicate verbally, maybe you could draw a picture describing how you feel.” Other variations include bringing in photos, playing favorite music, playing a game, or going for a walk.

Balancing Your Power by Doing Less
I have read so many books and articles, attended so many workshops, consulted with so many colleagues about child and adolescent therapy that I can easily spout the party line. Provide a sanctuary of trust for the child. Communicate with the child on his or her own level. As play is the primary form of expression, do a lot of play therapy.

My need to do something. Well, even with all the training I have had and permission I have been given from supervisors I admire, I still feel the need to do something in my work. Cases in point: I am seeing three adolescents right now whom I would describe as difficult because they refuse to talk. Their parents insist they get help, feeling guilty about the monsters they believe they have created, so they drop them off at my office once a week for some brainwashing.

All three boys are defiant and surly. They have declared to me that they may have to come but they don’t have to talk. “Fine,” I tell them, “what, then, would you like to do with the time we have together?” I feel proud of myself. I am being supportive, concentrating on being with them on any level at which they can function. With one boy, we play cards — poker and gin rummy. He is not interested in learning any other games, and he will not respond to any question if it does not relate to the game. Another boy brings a ball and we play catch outside. He will not talk either, but I convince myself that on a metaphoric plane we are communicating on a deep level. The third boy walks with me to a drugstore where I buy him some chips and a Coke. He mumbles thank you and then promptly ignores me.

The real surprise. I have been seeing each of these boys for a period of months. I cannot see that their behavior when they are with me has changed at all. We have settled into a routine in which we know what is expected. The real surprise is that the parents of two of the boys claim there has been substantial improvement in their demeanor and school performance. Sometimes they are even nice to their sisters. The parents think I am some kind of magician and ask me what I’ve been doing. "Trade secrets," I tell them. But I think to myself, "This is ridiculous. No fancy confrontations or brilliant interpretations. I just play cards and go for walks. I can’t believe I get paid for this!"

So why are these kids possibly improving? It must be that they sense I really do care, that I am trying to help them. I try to be completely honest, and they know I will not tolerate any crap. I suppose they also realize that I am in a position to get them into even more trouble if they do not cooperate minimally. Maybe I will even be able to do them a favor someday.

The act of not doing psychotherapy is difficult for those of us who are so attracted to progress and change. Yet passively resistant clients do not respond too well to direct intervention. And sometimes with adolescents, the best therapy is to suspend any therapeutic activity temporarily so they do not feel so cornered. I suppose it is awfully arrogant of us to believe that nothing much happens in therapy unless we make it happen; some of our best work comes from allowing resistant clients to move along at their own pace and speed without having to cater to our expectations.

Aguilera, D. C. (2000). Crisis intervention: Theory and methodology. Mosby.

Update
Understanding Client Engagement
in Digital Mental Health Interventions:
An Investigation of the eTherapy
Attitudes and Process Questionnaire

Clough, B., Yousif, C., Miles, S., Stillerova, S., Ganapathy, A., & Casey, L. (2022). Understanding client engagement in digital mental health interventions: An investigation of the eTherapy Attitudes and Process Questionnaire. Journal of clinical psychology, 78(9), 1785–1805.

Peer-Reviewed Journal Article References:
Cuttler, E., Hill, C. E., King, S., & Kivlighan, D. M., Jr. (2019). Productive silence is golden: Predicting changes in client collaboration from process during silence and client attachment style in psychodynamic psychotherapy. Psychotherapy, 56(4), 568–576.

Hill, C. E., Lu, Y., Gerstenblith, J. A., Kline, K. V., Wang, R. J., & Zhu, X. (2020). Facilitating client collaboration and insight through interpretations and probes for insight in psychodynamic psychotherapy: A case study of one client with three successive therapists. Psychotherapy, 57(2), 263–272.

Summers, F. (2017). Sexual relationships between patient and therapist: Boundary violation or collapse of the therapeutic space? Psychoanalytic Psychology, 34(2), 175–181.

Williams, Izaak & O'Connor, Peg. (2019). Power in the Counseling Relationship: The Role of Ignorance. 4. 1-37.

QUESTION 4
What are some interventions to counteract the power dynamic with clients who exhibit exaggerated silence? To select and enter your answer go to Test.

Test
Table of Contents
Top