Beyond Words: The Experience of Silence in the

Therapeutic Room
By

Katarzyna Dobosz

Submitted in partial fulfilment of the requirements of the MA Psychotherapy at

Dublin Business School, School of Arts, Dublin

Supervisor: Dr. Gráinne Donohue

July 2020

Department of Psychotherapy

Dublin Business School

1
 Table of Contents
Acknowledgments .......................................................................................................i

Abstract ...................................................................................................................... ii

List of Tables ............................................................................................................ iii

Chapter 1 – Introduction........................................................................................... 1
1.1 Background and Context .................................................................................... 1
2.1 Research to Date ................................................................................................ 2
1.3 Aims and Objectives .......................................................................................... 3

Chapter 2 – Literature Review ................................................................................. 4

2.1 Introduction ........................................................................................................ 4
2.2 Silence in therapy ............................................................................................... 4
2.2.1 Silence and the therapeutic orientation ....................................................... 5
2.2.2 Types of silence in the therapeutic space .................................................... 7
2.2.3 Silence as a therapeutic intervention ......................................................... 10
2.3 The person of the therapist ............................................................................... 14
2.3.1 Therapist’s clinical experience .................................................................. 14
2.3.2 Therapist’s personal development............................................................. 16
2.3.3 Therapist’s attunement to client’s needs ................................................... 18
2.4 Summary .......................................................................................................... 21

Chapter 3 – Methodology ........................................................................................ 22

3.1 Introduction ...................................................................................................... 22
3.2 Methodological Approach ................................................................................ 22
3.3 Method of Data Analysis ................................................................................. 23
3.4 Sample and Recruitment .................................................................................. 24
3.5 Overview of Participants .................................................................................. 26
3.6 Data Collection – Semi-Structured Interviewing ............................................. 26
3.8 Ethical Issues .................................................................................................... 27

Chapter 4 – Results .................................................................................................. 29

4.1 Introduction ...................................................................................................... 29
4.2 Theme One: The client’s experience of silence ............................................... 30
4.2.1 When silence is helpful ............................................................................. 31
4.2.2 When silence needs to be broken .............................................................. 32
4.2.3 Therapist’s experience of silence in their own personal therapy .............. 33
4.3 Theme Two: Therapist’s experience of silence ............................................... 34
4.3.1 Finding comfort in silence ........................................................................ 34
4.3.2 Staying present .......................................................................................... 35

2
 4.3.3 Attunement to clients’ needs ..................................................................... 36
4.4 Theme Three: How personal development affects the experience of silence .. 37
4.4.1. Psychotherapeutic training ....................................................................... 38
4.4.2 Clinical experience .................................................................................... 39
4.4.3 Personal therapy ........................................................................................ 40
4.4.4 Self-care .................................................................................................... 41

Chapter 5 – Discussion and Conclusion ................................................................. 42

5.1 Introduction ...................................................................................................... 42
5.2 Theme One: Client’s experience of silence ..................................................... 43
5.3 Theme Two: Therapist’s experience of silence ............................................... 46
5.4 Theme Three: How personal development affects the experience of silence .. 48
5.5 Strengths and limitations of the study .............................................................. 51
5.7 Suggestions for further research....................................................................... 52
5.6 Implications for psychotherapy ........................................................................ 54
5.8 Conclusion ....................................................................................................... 54

References ................................................................................................................. 56

Appendices ................................................................................................................ 61
Appendix. 1 – Centre Advertisement ..................................................................... 61
Appendix. 2 – Email Invitation .............................................................................. 62
Appendix. 3 – Information Sheet ........................................................................... 63
Appendix. 4 – Consent Form ................................................................................. 64
Appendix. 5 – Demographic Sheet ........................................................................ 65
Appendix. 6 – Interview Schedule ......................................................................... 66
Appendix. 7 – Transcript Excerpt with Codes ....................................................... 67

3
 Acknowledgments
I would like to thank my supervisor Dr. Gráinne Donohue for all of her guidance along
the way. Your wisdom and enthusiasm for research has made this a really enlightening
and enjoyable experience.

I want to express my gratitude to all of the participants that dedicated their time to take
part in this research. It was an honour to have the chance to get an insight into your
experiences.

Thank you to all of the educators at the Department of Psychotherapy in Dublin

Business School – it has been a pleasure to learn from you.

Thank you to all my classmates – I am so grateful to have shared the last four years
with you.

Finally, thank you to all my loved ones – your constant support and kind words of
encouragement will not be forgotten.

i
 Abstract
It has been widely accepted that psychotherapeutic work consists of both verbal and
non-verbal processes. This study set out to explore the experience of silence in the
therapeutic room. Five practicing therapists participated in semi-structured
interviews that aimed to explore the factors that affect silence in therapy. The
participants were invited to reflect on their clinical work, personal development and
attitudes towards the use of silence as a therapeutic intervention. The study found
that the clinical practice and personal therapy were the two main factors that impact
the experience of silence in the therapeutic work. The study also found that the
therapists base their use of silence on the strength of the therapeutic alliance and the
usefulness of it as an intervention.

ii
 List of Tables
Table 1. Participant's Details ...................................................................................... 26

Table 2. Subordinate Themes ..................................................................................... 29

iii
 Chapter 1 – Introduction

1.1 Background and Context

It is widely accepted that the phenomenon of silence is present in all human

communication. Kenny (2011) suggests that silence manifests itself in many forms,

and theoretical approaches to the functions of silence reflect such variety. Sabbadini

wrote “Silence is an element of human language, not its opposite; it is a complement

to words, in constant dialectical interaction with them, not their converse” (2004, p.

231).

It cannot be argued that silence plays an important part in psychotherapy. As Lehmann

(2014) suggests, moments of silence with a wide spectrum of meanings will emerge

in the development of any psychotherapeutic process. Knutson and Kristiansen (2015)

suggest that while silence has the potential of creating an environment where the

relationship between therapist and client is sensed, not spoken, it can also limit or

block further communication in the therapeutic space. O’Toole (2015) further suggests

that using and working with silence in the therapeutic space may give the therapist a

unique access of the privacy of the self within the context of the therapeutic

relationship.

As proposed by Knutson and Kristiansen (2015), silence in the therapeutic space can

be loaded with a variety of possible interpretations, functions and meanings. All of

these will have an influence on the communication process between the therapist and

the client. They propose that research into the topic of silence can help to acquire a

1
better understanding of verbal statements, and can potentially lead to a wider range of

possible interpretations of communications.

2.1 Research to Date

In-dept review of the previous research on the concept of silence in therapy will be

presented in the next chapter. It is important to note a shortage of quantitative and

qualitative research on the topic. The two most notable studies on the concept of

silence in therapy were conducted by Hill, Thompson and Ladany (2003) and Ladany,

Hill, Thompson and O’Brien (2004).

Hill et al (2003) conducted a survey among eighty-one therapists, which explored their

use of silence during a specific event in therapy and general attitudes towards the use

of silence in therapy. The research examined how the therapists use silence and what

conditions would prompt them to introduce it to the therapeutic room. The study found

that the therapists primarily used silence to facilitate reflection, encourage

responsibility, facilitate expression of feelings and convey empathy. It was also found

that clinical practice was the main source from which the therapists learned to use

silence.

Ladany et al (2004) interviewed twelve experienced therapists on their perceptions of

why they would chose to use silence in therapy. The study found that the interviewed

therapists typically used silence to convey empathy, facilitate reflection, challenge the

client, facilitate expression of feelings and to take time for themselves to figure out

what to say next. The participants of this study stressed the importance of a good

therapeutic alliance when silence is being used as an intervention. The participants

2
also determined the conditions in which they would not chose to use silence – for

example with highly anxious, angry or psychotic clients. The participants also

recognised that their use of silence changed when compared to the start of their careers

– they became more flexible, comfortable and confident with the use of silence as a

therapeutic intervention. In this study, the participants believed that they typically

learned about the use of silence from supervision or their own experience as a client.

1.3 Aims and Objectives

The aim of this research is to provide an in-dept and nuanced understanding on the

experience of silence in the therapeutic room. The researcher aims to explore how

silence is used in therapy and when the therapists opt out from introducing silence into

the therapeutic room. Furthermore, the researcher aims to explore the factors that

affect the therapist’s experience of silence and determine how this experience changes

over time.

The research has the following specific objectives:

- Are therapists comfortable with the presence of silence in the therapeutic

setting?

- What are therapists’ perceptions in relation to silence being used as a

therapeutic tool?

- Do therapists see a link between being able to tolerate silence and their

personal development?

3
 Chapter 2 – Literature Review

2.1 Introduction

The purpose of this literature review is to explore the existing literature that relates to

the research question. When looking at silence in the therapeutic relationship, the

researcher identified the need to look at both the phenomenon itself and how the

occurrence of it is managed by the therapist. This will give a well-rounded background

for this research and will allow a better understanding of the data collected.

This chapter is divided into two sections. The first section will look at silence as a

phenomenon in psychotherapy. Firstly, it will explore silence from the perspective of

different therapeutic orientations. Secondly, different types of silences occurring in

the therapeutic setting will be examined. Finally, silence will be looked at as a

therapeutic intervention that can be used by the therapist during the sessions. The

second section of the literature review will concentrate on the person of the therapist.

This section will firstly look at clinical experience and how it affects therapeutic

process. It will follow an examination of how the therapist’s personal development

affects their work. To finish off, the researcher will explore the therapist’s attunement

to their client’s individual needs.

2.2 Silence in therapy

Lehmann (2014) suggests that in the development of any psychotherapeutic process,

moments of silence emerge with a wide spectrum of meanings. She suggests that the

focus on silence faces the challenge of polysemy and polyphony when conceptualising

its’ functions and their role in affective regulation. O’Toole (2015) suggests that

4
working with silence gives a therapist a unique access to the privacy of the self within

the context of the therapeutic relationship. This section will explore silence in the

therapeutic encounter from different angles, aiming to capture the essence of it and

the impact that it might have on both the therapist and the client.

2.2.1 Silence and the therapeutic orientation

In classical psychoanalytic theory, silence is viewed in terms of patient’s resistance as

well as patient’s transference toward the analyst (Lane et al., 2002). Traditionally,

psychoanalysis held more interest in verbal communication rather than the non-verbal.

Silences during analysis were seen neither as random intermissions nor analytic rests.

Instead, they are seen as richly over-determined states and “together with the allied

processes of verbalization, thinking, remembering, and posturalization, provide an

essential continuity to the psychoanalytic process” (Zeligs, 1961, p. 14).

Psychoanalysis sees silence as a potential barrier to the psychoanalytic method, and

failure to analyse its meaning may undermine and disrupt the treatment. Silence may

also impede the analytic process by prolonging it (Zeligs, 1961). Psychoanalytic

theory often sees silence as manifestation of the transference and the therapist’s

reaction to silence linked to the countertransference (Lane et al., 2002).

The concept of silence in humanistic psychotherapy relates to boundaries in person-

centred work. In person-centred therapy, silence can be used creatively as a form of

facilitation for clients – it can promote the opportunity for client self-disclosure and

self-responsibility (Owen, 2007). However, this approach also recognised dangers of

using too much silence, as it has the potential of promoting the processes of

imagination and transference. Furthermore, it can de-skill the client and induce anxiety

5
(Owen, 2007). Rogers believed that therapist’s silence can be interpreted in many

different ways. He believed that it is neither ethical nor helpful to maintain silence if

the therapist perceives that the client is struggling (Rogers, 1951). According to

Rogers and person-centred theory, therapeutic relationship does not allow for an

impartial, disinterested spectator (Owen, 2007).

A study on the use of silence conducted by Hill, Thompson and Ladany (2003)

highlighted the difference in attitudes toward silence, which were based on the

therapist’s theoretical orientation. Psychodynamic therapists used silence to facilitate

reflection, with the emphasis put on the insight. Humanistic therapists, on the other

hand, used silence to convey empathy, respect and support. Furthermore, they believed

that it was acceptable to use silence with a wider range of clients (Hill, Thompson and

Ladany, 2003).

According to Denham-Vaughan and Edmond (2010), verbal dialogues are central to

most forms of psychotherapy – words are often seeking a shared sense of meaning and

the need to be ‘understood’. However, they point out that Gestalt therapy recognises

that verbal contact is only one of the modes of contact. They suggest that withdrawal

from contact is a necessary and valuable polar opposite. They propose that within

Gestalt therapy model, there is a place for the “non-verbal, inactive, quiet self to

emerge” (2010, p. 5). Therefore, silence and stillness can be seen as a universal

language, providing a sense of being most authentically in contact with ourselves and

others.

6
2.2.2 Types of silence in the therapeutic space

Silence in therapeutic space can be loaded with a variety of possible interpretations,

functions and meanings, which will have an influence on the communication process

between the therapist and the client. Silence has the potential to create an environment

where the relationship between therapist and client is sensed, not spoken. On the other

hand, silence can also limit or block further communication in the therapeutic space

(Knutson and Kristiansen, 2015). Silence can also be viewed as a form of non-verbal

communication in therapy. Kurtz (1989) wrote “the experience of silence may reveal

to the practitioner what even the best words cannot…the experience includes not

merely wordlessness, but the active suppression of speech” (p. 178).

Langs (1977) proposed that silence conveys many important ego and superego-

building communications. He suggested that silence can be seen as the therapist’s

acceptance of their patient. It can be a way of giving the patient responsibility for the

work being done in the therapeutic space. For Sabbadini, silence is meaningful as it

originates from a psychic conflict – he proposed that “silence is not, or not just, an

absence (of words) but an active presence” (Sabbadini, 1991, p. 232). He suggested

that silence more than just an absence of verbal processes – it is an active process

requiring mental energy. There is an unconscious fantasy behind each silence –

concealing and expressing something at the same time (Sabbadini, 1991).

Levitt (2001) suggests that silences occurring in therapy fall into three higher order

categories: productive, obstructive, or neutral. Three pausing processes were

identified as emotional, expressive and reflective pauses. According to Levitt, these

pausing processes “entailed the productive, or facilitative, experiences of profound

7
emotion, difficult symbolization, and reflexive analysis” (2001, p. 299). Other

moments of silences are identified by Levitt as representations of obstructions that the

clients face in their process of self-exploration. When an issue occurs that was

considered too threatening, Levitt suggests that pauses result from unclear or

disturbing reactions – either from therapists or attributed to therapists. Finally,

mnemonic and associative pauses appear to be more neutral in their effects of the

therapeutic process.

Knutson and Kristiansen (2015) point out that it is crucial to distinguish between

conscious use of silence for power and the intended meaning in the psychotherapeutic

process. They suggest that that unconscious influences can give a different

significance and intention to silence. This would suggest that silence rooted in

transference, resistance and countertransference would be experienced differently in

comparison to silence used as a specific therapeutic intervention.

Studies have shown that silence can facilitate both engagement and disengagement in

therapeutic relationship. Silence has been shown to be useful in reflective

introspection, which contrast the emphasis in the existing literature on silence as an

obstructive process (v. Stringer et al., 2010). Constructive silences can promote insight

and emotional expression for the clients – this is associated with positive outcomes in

therapy. On the other hand, obstructive silences can suggest disengagement from inner

experiences – this can be attributed to underlying anger, withdrawal, depression, fear,

loneliness and anxiety (v. Stringer et al., 2010).

8
Knutson and Kristiansen (2015) suggest that silence should be studied and understood

in context – whether it’s ethnic-cultural factors or past experiences. Merleau-Ponty

wrote “We must consider speech before it’s spoken, the background of silence which

does not cease to surround it and without which it would say nothing” (Merleau-Ponty,

1960, as quoted in Knutson and Kristiansen, 2015, p. 5). A traumatic experience in the

past can be seen as an example of that – in such case, silence might be imposed on the

victim of abuse and it can make them unable to process the experience. Therefore,

silence can be used as an expression of the person’s powerlessness and shame

(Knutson and Kristiansen, 2015).

Therapist’s silence can be seen as also having a significant importance in the

therapeutic relationship. Silence can be used as a therapeutic intervention (Owen,

2007; Ladany et al., 2004; Hill, Thompson and Ladany, 2003) and it is typically used

with an intention of facilitating client reflection. However, silence in therapy can be

also caused by overload of information, countertransference, enactment, personality

traits, therapist’s behavioural patterns or even their cultural and ethnic factors

(Knutson and Kristiansen, 2015). While it can be helpful in the therapeutic process,

he use of silence by the therapist must be understood by the client. Where there is a

lack of understanding or negative perception on its use, silence can create a barrier to

the therapeutic work (Knutson and Kristiansen, 2015).

In their study, Daniel et al (2016) found that it may be possible for therapists to use

in-sessions silence as a source of information on client characteristics and the current

quality of the therapeutic alliance. They suggest that increased frequency of silence,

particularly obstructive silence, could indicate insecure client attachment. Similarly,

9
those characteristics may also indicate poorer treatment alliances. They propose that

this could also work in reverse – since insecure client attachment is associated with

poorer alliances, it may lead to the increased frequency of obstructive silence.

However, Daniel et al (2016) also recognise that higher frequency of productive

silence, when present in mid-treatment, may indicate good treatment prognosis.

2.2.3 Silence as a therapeutic intervention

Langs suggested that silence as a therapeutic intervention is “the most basic, the most

undervalued, and the most misunderstood” (Langs, 1973, p. 367). Silence can

presumed as a powerful therapeutic intervention, as it allows the clients to reflect upon

their thoughts and feelings (Ladany et al., 2004). Silence as part of the therapeutic

process can be seen both as having a facilitating and inhibiting effect of the therapeutic

work. The literature suggests that the use of silence as a therapeutic technique can

have a positive effect on the work. The greater use of silence can be associated with

higher client perceptions of success and insight (Ladany et al., 2004). On the other

hand, it can also be suggested that the use of silence has a potential of leading to

negative consequences in work. This can happen when clients experience silence as

insulting, withholding or critical, which is in turn linked to a greater client dropout

rates (Ladany et al., 2004).

Sharpley (1997) found that most effective instances of silence in therapy fell during

the middle and end sections of therapeutic session. This suggests clients most value

silence when they are at the ‘work’ and the ‘decisional’ stages of a therapeutic work.

Sharpley proposes that this happens when the clients are confronting the discrepancies

between their actual behaviour and the ways they want to behave, and also when they

10
are developing plans to change their behaviour. Sharpley suggests that these findings

are particularly value to novice therapists, as they can help nervous trainees to allow

their silent time during the central and final stages of the sessions. Sharpley suggests

that clients may value time to think and reflect on issues arising in therapy, and

counsellors should not judge silence as these times as a sign of weakness in their

professional expertise.

A study conducted by Ladany et al. (2004) explored the therapist’s perspectives on

the use of silence in therapy. It set out to examine the factors associated with

experienced therapists’ perceptions of their use of silence. Furthermore, it set out to

examine the extent of the participants’ belief that silence can facilitate or inhibit

therapeutic work. The study interviewed participants in the following areas: reasons

for using silence; client variables considered prior to using silence; reasons for

breaking silence; the influence that silence can have on the therapeutic relationship;

what happens to the therapist during silence; examples of when silences did or did not

work; and training in using silence as a therapeutic intervention.

The study has found that silence was used for both client-focused and therapist-

focused reasons. The typical reason for use of silence as an intervention was the

therapists’ wish to convey empathy, respect and support. Silence was used to

demonstrate understanding and provide conditions that facilitate therapeutic work.

The participants suggested that silence can facilitate client reflection, challenge the

client to take responsibility for therapeutic work and facilitate client expression

feeling. The participants also proposed that silence invites the clients to take up a more

active role in the therapeutic process (Ladany et al., 2004). The study also found that

11
the therapists used silence to give themselves time to reflect on the therapeutic process

and decide how they want to respond to their clients. It was determined that therapist

anxiety and level of distraction played a role in the use of silence. The study

established that similar-looking silences could be motivated by a wide range of reasons

– therefore, “silence cannot be conceptualised as a single entity in therapy with a single

therapist intervention and single client perception” (Ladany et al., 2004, p. 83).

A study conducted by Hill, Thompson and Ladany (2003) referenced Ladany et al.

(2004) study, pointing out the importance of exploring therapist perception regarding

the use of silence; however it also highlighted its limitations – particularly regarding

the small sample of participant. Hill et al. developed a survey based on the results for

Ladany et al., aiming to explore the perceptions on the use of silence in a wider sample

of participants. The survey focused on the intentional use of silence by the therapist.

The results indicated that the use of silence in therapy enhanced the therapeutic

relationship. Going through a ‘silence event’ was seen as factor enhancing the work

in the session. The participants of the survey generally felt that silence was helpful in

therapy (Hill, Thompson and Ladany, 2003). Similar to the previous study, the

therapists primarily used silence to encourage clients to reflect and take responsibility

in the therapeutic work. They were thoughtful in their use of silence – they did not use

it to provoke client anxiety, which contrasts to what has been suggested by the

psychoanalytic literature.

Both studies found that the therapists’ use of silence changed with the length of

clinical experience (Ladany et al, 2004; Hill, Thompson and Ladany, 2003). Both sets

of participants indicated that they learned most of what they knew about using silence

12
through clinical experience and supervision. The therapists indicated that they only

“somehow” learned about the use silence as an intervention in the course of their

training (Hill, Thompson and Ladany, 2003). Both studies suggest that silence was

rarely thought as a formal intervention – instead, through process of experimentation

and trial and error, the participants explored what level of silence felt comfortable for

both them and their clients. As they gained experience, the therapists believed they

became more confident and comfortable in using silence as a therapeutic technique.

In the study conducted by Frankel et al (2006), silences were understood as markers

of internal processes. They see that as significant, as it suggests that there are times in

therapy when clients’ internal experiences are so compelling that they disrupt the

therapeutic interaction. The findings of the study suggest the presence of internal

experiences that unfold for clients within the discourse gaps. The authors suggest that

the findings are consistent with client-centred psychotherapy’s theory of change – they

propose that change results from the accessing of genuine feelings, thoughts and

experiences, which sometimes can be anxiety-provoking. Frankel et al (2006) propose

that avoiding emotional experiences can be negatively associated with psychotherapy

outcomes, whereas bring the focus on arising issues and seeking new ways of

symbolising experience is positively associated with psychotherapy outcome. Overall,

the study found that it can be helpful for therapist to stimulate emotional, reflective

and expressive silences. The study also found that the therapists hesitate to intervene

during a silent period unless the silence appears disengaged – they believe that such

intervention during a productive silence may interrupt clients’ introspective processes.

The authors of the study also suggest that further research required into expressive and

emotional silence.

13
2.3 The person of the therapist

Lapworth, Sills and Fish (2001) propose that the most significant factor in therapeutic

change is the relationship between the client and the counsellor. They point out that

according to the available research, the therapist’s interpersonal skills and the capacity

for forming meaningful therapeutic relationships means more than their theoretical

approach. Many factors will affect the effectiveness of the therapeutic work. Erskine

(2015) further suggests that the unique interpersonal relationship between therapist

and client remain as the central and significant factor in psychotherapy. This section

will explore the role of the therapist from three different perspectives: therapist’s

clinical experience; therapist’s own development; and therapist’s attunement to the

client’s individual needs.

2.3.1 Therapist’s clinical experience

Kolb (2014) states that experience is a core requirement of learning, and it serves as

the basis for which all learning takes place. According to Overholser (2010), years of

clinical experience has been deemed as a necessary but insufficient basis of the

building of clinical expertise. An important question can be put forward – does the

clinical experience of the therapist contribute to the therapist’s ability to handle

complex issues, such as silence, that may present themselves during therapeutic

sessions?

Dawson (2018) considers the relevance of therapist’s amount of clinical experience

and how it can affect their work. According to Dawson, years of psychotherapist’s

clinical experience are related to qualitatively different therapist self-perceptions and

mental states, both inside and outside of therapy sessions. Furthermore, since the

14
process of psychotherapy is centred around a therapeutic relationship, with the gained

experience a psychotherapist may gain new perspectives on their role in the

therapeutic relationship. Additionally, increasing years of experience may transform

the way therapists perceive their own skills and the nature of their role in a therapeutic

relationship.

A number of studies have been conducted to determine how clinical experience affects

the work of psychotherapists. Orlinsky et al (1999) carried out a large-scale survey on

practicing psychotherapists’ perceived therapeutic mastery. The study found that years

of clinical experience was positively and significantly related to perceived therapeutic

mastery across all therapeutic orientations. Furthermore, using the same sample with

more respondents, Orlinsky et al. (2001) examined what factors contributed to the

therapists’ development across a wide range of years of clinical experience. The top

perceived influences were rated by the participants as experience in therapy with

patients, formal supervision or consultation, and receiving personal therapy. Both of

these studies suggest that the years of clinical experience affect how the therapist

perceive their mastery and the factors that contribute to it.

A study conducted by Gildewell and Livert (1992) showed that years if clinical

experience positively impacted the confidence in therapeutic practice. However, it

also showed that this positive impact was not present with the clinicians above the age

of 50 – the researchers contemplated whether this might be the case due to the

clinicians becoming humbler about their abilities.

15
Rønnestad and Skovholt (2003) explored how years of clinical experience affected

professional development among therapist with various levels of clinical experience.

They found that increasing years of clinical experience corresponds with an increased

integration of therapists’ personal and professional identities. According to Rønnestad

and Skovholt, as therapists increase their clinical experience, they increasingly rely on

internal expertise as opposed to external expertise – they bring less rules into therapy

about how sessions should be conducted, and they continue expanding their openness

to other theoretical orientations. Overall, the therapists feel that they continue to

improve their professional skill as they gain clinical experience (Rønnestad and

Skovholt, 2003). The study found that active engagement in reflection and openness

to new learning are key elements to growth as a therapist. The study concluded that

increasing years of clinical experience directly and indirectly influence therapist

professional development.

2.3.2 Therapist’s personal development

The concept of personal therapy for psychotherapists have been present in the

literature since the beginning. In “Analysis Terminable and Interminable”, Freud

(1937) wrote “But where and how is the poor wretch to acquire the ideal qualifications

which he will need in his profession? The answer is, in an analysis of himself, with

which his preparation for his future activity begins”. Yalom (2000, p. 40) writes “To

my mind, personal psychotherapy is by far the most important part of psychotherapy

training”. Beyond personal outcomes and development, the existing literature views

the therapist’s won therapy as desirable or even necessary as part of the development

of clinical practice.

16
A study involving 4,000 therapists from a number of countries (Orlinsky, Botermans,

& Rønnestad, 2001) determined that personal therapy was one of the top three sources

of positive influence on therapist’s development. Personal therapy was ranked ahead

of taking courses or seminars and reading professional journals. The same study

determined that for the most senior therapists, who have been practicing for 25 to 50

years, personal therapy became the second most highly rated influence on their

development.

A study conducted by Daw and Joseph (2007) set out to explore qualified therapists’

experience of personal therapy. The study concluded that the therapists who

engagement with personal therapy found it useful and valuable among many areas of

both their personal and professional life. Personal therapy was deemed a valuable way

to provide self-care – the participants acknowledged the benefits of having their own

therapeutic space to process and reflect upon the impact of their client practice and

also to take care of themselves psychologically so that their clinical work is safe and

effective. Furthermore, the participants recognised that the personal therapy impacted

on their professional practice – it allowed them to learn experientially and helped them

gain a deeper understanding of theories, models and therapeutic processes. Finally,

their experience of being a client allowed them to gain deeper empathy and respect for

their own clients (Daw and Joseph, 2007).

Orlinsky et al (2005) suggest that a personally beneficial experience in personal

therapy should further develop therapist’s interpersonal skills. According to them, the

experience of personal therapy should help them become more sensitive, more skilful

and more flexible in adjusting the impact of their behaviour to the individual and

evolving needs of their clients. They suggest that personal therapy should reduce the

17
degree of pathogenic influence that a therapist, when under stress, might introduce

into the therapeutic relationships. They further suggest that personal therapy should

shield the clients from being influenced by their therapists’ own unresolved personal

issues (Orlinsky et al, 2005).

Another area that can provide the therapists with an opportunity for both personal and

professional development is clinical supervision. Phillips (2001) proposes that

regardless of theoretical orientation, supervision is intended to expand technique and

interpersonal capacities. Phillips suggests that supervision space invites the supervisee

to identify with the supervisor as a mentor as it “offers skills that foster autonomy”

(2001, p. 155). She identifies that the area where supervision crosses with personal

therapy is in the exploration of supervisee’s countertransference – the supervisor may

suggest personal therapy if the countertransference is viewed as an obstacle to clinical

work. She writes “, it is valuable for the supervisor and supervisee to distinguish

between those objective and subjective countertransference reactions that can be

utilized in the service of the treatment and those that actually disrupt or compromise

the care of the patient and the treatment goals” (2001, p. 155). When combined with

the experience of supervision, personal therapy may provide a way to enhance

personal and professional effectiveness.

2.3.3 Therapist’s attunement to client’s needs

Attunement is a term used to describe a relationship in which one person focuses on

the internal world of the other, and the recipient feels felt, understood, and connected

(Siegel, 2007; Stern, 1985). In his study of attunement between parents and infants,

Stern (1985) noted that attunement requires the parent to be able to accurately read the

feeling state of the infant, to then communicate this understanding to the infant through

18
their behaviours, and finally for the infant to recognise their feeling state in these

behaviours. Siegel (2007) noted that attunement is needed in order for people to feel

vibrant, alive, understood, and peaceful in relationships.

Bruce et al (2010) suggest that the psychotherapeutic process depends on a

psychotherapist’s sensitivity to the patient’s signals, both verbal and nonverbal. This

includes what the patient does and does not say, eye contact, voice quality, facial

expression, and body posture. According to them, attunement goes beyond perceiving

signals - it involves the psychotherapist actually feeling something of their patient’s

state of mind.

According to Erskine (2015), in a relationship-oriented psychotherapy, the therapist’s

self is used in “a directed, involved way to assist the client’s process of developing

and integrating full contact and the satisfaction of relational needs” (2015, p. 44).

Erskine suggests that the effective attunement to the client’s needs requires the

therapist to be simultaneously aware of the client’s experience, the boundary between

the therapist and the client, and their own internal processes. It is through the process

of attunement that the therapist can offer a holding space of the client – they can

provide them a sense of validation, care, support and understanding.

Empathy seems appear alongside attunement in the available literature. It can be

argued that the difference between these terms are based primary in language (Bruce

et al, 2010). It can be noted that Siegel (2007) used the terms ‘attuned relationship’

and ‘empathic relationship’ interchangeably. Rogers defined empathy as the

therapist’s ability “to sense the client’s private world as if it were your own, but

19
without losing the ‘as if’ quality“ (Rogers, 1961, p. 284). However, Stern (1985)

recognised the difference between the concepts, as his description on empathy deemed

it a more conscious process.

Bruce et al (2010) suggest that both empathy and attunement describe a “balanced

state that resides between being emotionally withdrawn or cut off from another and

being overwhelmed by another’s internal world” (p. 88). They propose that the

empathic individual opens their mind to the influence of another but does not lose

themselves in the process. Siegel (2007) suggests that empathy enhances the

therapist’s ability to sense when the client may need space – an empathic

psychotherapist will know when to allow space by reducing the intensity of the

empathic connection. Sander (1962) also proposes that an empathic psychotherapist

is sensitive to their client’s signals, most of which are nonverbal, that can indicate the

need for closeness or distance – similar to an attuned mother who senses when her

infant needs space.

Therapist’s ability to attune to the needs of their clients can be argued to be one of the

core skills that are needed to be present for a successful therapeutic alliance. Siegel

(2007) proposed that mindfulness can be seen as a form of self-attunement that can

increase one’s capacity to attune with others. Bruce et al (2010) believe that the ability

to be attuned to others can be learned – they state that this ability is at the heart of a

healing, empathic relationship. Additionally, they further propose that a

psychotherapist’s ability to form an attuned, empathic relationship with the patient can

lead to improvement in the patient’s ability to self-attune. They suggest that

20
mindfulness practice will allow a psychotherapist to increasingly know themselves,

fostering their ability to know the patient.

2.4 Summary

The existing literature suggests that silence can be a very powerful tool in the

therapeutic encounter. Current research suggests that, when used in the most optimal

and appropriate way, silence can allow the clients to reflect and process the thoughts

and feelings that arise in the course of therapy. However, research also suggests that

obstructive silence can disrupt the therapeutic process.

While reviewing the available literature, the researcher identified a number of gaps in

research on the topic of silence in the therapeutic space. Firstly, most of the literature

looked at the use of silence as a psychotherapeutic intervention from psychoanalytic

and psychodynamic perspectives – there seems to be a lack of literature exploring the

concept of silence from a humanistic perspective. Secondly, most of the literature

explores silence from a theoretical point of view. The researcher was able to find one

quantitative study and a few qualitative studies involving silence in therapy, however

it’s important to note that those were conducted a number of years ago and there seems

to be a lack of contemporary research on this topic. Thirdly, there seems to be a gap

in qualitative research which focuses on the experience of silence – most past studies

concentrate on the use of silence as a therapeutic intervention. Finally, the researcher

failed to find any research conducted among therapists practicing in Ireland.

Therefore, the researcher believes that the current study can fill in the gaps listed

above.

21
 Chapter 3 – Methodology

3.1 Introduction

This study aims to explore the experience of silence from a perspective of a practicing

therapist. It sets out to gain detailed descriptions of the participants’ experience of

silence, their attitudes towards in and their ability to cope with it when it arises in the

therapeutic room. The aim of this chapter is to outline the methods used in this research

project. The chapter explores research design, sample of participants, method of

recruitment and the mode of enquiry. It further discusses the collection and analysis

of the data are examined and any potential ethical issues of this study.

3.2 Methodological Approach

According to Knox and Burkard (2009), all research methods are founded on

philosophical beliefs regarding the acquisition and interpretation of data, and they

propose that these beliefs drive the researchers’ interview approach toward study

participants. However, in recent years they point out emerging emphasis on

constructivist-interpretivist perspectives among qualitative researchers. They point

out that researchers are more likely to work collaboratively with participants to

understand the phenomenon of interest, and they use interviews as a way of

exploration of the meaning of the participants’ experiences.

According to McLeod (2003), qualitative research represents a number of approaches

with a fundamental goal to uncover and illuminate what things mean to people. He

uses a definition of qualitative research as “a process of systematic inquiry into the

meanings which people employ to make sense of their experience and guide their

22
actions” (McLeod, 2003, p. 73). He highlights that the key idea of qualitative research

is the search for meaning – the researcher must strive to describe understandings of

the participants on the choses topic. With this in mind, the researcher decided that

qualitative method would be best suited for the exploration of this area, which sets out

to explore the participants’ experience of silence in the therapeutic room.

3.3 Method of Data Analysis

The study chose to use thematic analysis as a method for identifying and analysis data

collected during the semi-structured interviews. Braun and Clarke (2006) propose that

thematic analysis should be seen as a foundational method for qualitative analysis.

According Braun and Clarke (2006), one of the benefits of thematic analysis is its

flexibility of this approach. There are methods of analysis that tied to a particular

theoretical or epistemological position and there are others that can be applied across

a range of a particular theoretical or epistemological approached – according to Braun

and Clarke (2006), thematic analysis firmly fits into the latter category. The method

differs from other analytic methods in allowing the researcher to not subscribe to the

implicit theoretical commitments of other methods. Therefore, Braun and Clarke

propose that through its theoretical freedom, thematic analysis is a flexible research

tool which can provide “a rich and detailed, yet complex, account of data” (Braun and

Clarke, 2006, p. 78). They also propose that thematic analysis can offer a more

accessible form of analysis, particularly for novice researchers.

According to Braun and Clarke (2006), thematic analysis is a method for identifying,

analysing and reporting patterns within data. This method goes beyond organising and

23
describing the data collected – it can aid the interpretation of various aspects of the

research topic. It can generate unanticipated insight through organisation of data into

themes, and it allows for both social and psychological interpretation of data.

Therefore, Braun and Clarke suggest that the thematic analysis can be a method that

works both to reflect reality and to unravel its surface.

Thematic analysis sets out six steps of data analysis. In the process of data analysis for

this research, the recommended steps were followed. Five semi-structured interviews

were conducted as part of this study. All interviews were transcribed and the

transcripts were then coded. This allowed for the deeper interpretation of the data

collected and the identification of themes and patterns presented in the data. The coded

were organised into possible themes, and the data from each interview was divided

into each emerging theme.

Using a Microsoft Word document, the audio recorded interviews were transcribed

verbatim by the researcher with an aid of software called Otter. Thematic analysis was

used as a method of data analysis. The results were analysed to determine any

repetitive descriptions and patterns. These patterns were categorised by the researcher

and main themes were identified. Following the steps identified by Braun and Clarke

(2006), the researcher has coded the data collected into potential emerging themes.

These themes provided a framework for deeper data analysis

3.4 Sample and Recruitment

The study set out to recruit five to six experienced psychotherapist, working within a

humanistic integrative model. Certain inclusion and exclusion criteria were identified

24
for the recruitment process. The therapists participating in this study was required to

have at least five years post accreditation experience. The presence of clinical

experience will allow a comparison of how silence was tolerated as a trainee therapist

versus how it is tolerated as an experienced therapist. The therapists’ experience will

also allow for richer clinical examples, which in turn will allow the study to identify

common themes access diverse sample of therapeutic encounters. The study set out to

recruit therapist who work within the long-term psychotherapeutic model. The

recruitment process excluded any therapists whose main way of working is CBT or

other short-term therapies – the researcher deemed that those types of therapeutic work

wouldn’t allow for sufficient period of silences and therefore were deemed unsuitable

for this research.

The recruitment of participants for this study was mostly conducted by word of mouth

– details of the interested therapist were provided to the researcher by their colleagues

and the interviewees who have already participated in the study. Advertisements for

the study were displayed in three different centres (see Appendix 1), however only

one interviewee was recruited through these advertisements. One interviewee was

contacted directly by the researcher with an invitation to participate.

A brief description of the study was provided to each potential participant (see

Appendix 2). If they agreed to take part of the study, they were provided with an

information sheet, consent sheet and a demographic sheet. Each document was signed

by the participant and returned to the researcher. The chosen participants were

allocated pseudonyms to ensure anonymity.

25
3.5 Overview of Participants

Five participants were recruited to take part of this study. Each participant took part

in a semi-structured interview. Participants are anonymised by pseudonyms in Table

1. below.

Table 1. Participant's Details

Age Training Orientation of Years of

Pseudonym Gender
Group Level work experience
Humanistic
Margaret Female 60+ H.Diploma 19
Integrative
Humanistic
Barbara Female 40-50 MA 8
Integrative
Humanistic
Claire Female 40-50 MSc 13
Psychodynamic
Humanistic
Susan Female 50-60 MSc 15
Integrative
Humanistic
Niamh Female 60+ BA 14
Integrative

3.6 Data Collection – Semi-Structured Interviewing

Semi-structured interviews were deemed by the researcher to be the best way of

gaining data for this research project. It is evident that personal interviews are widely

used as a method of data collection in qualitative research. According to McLeod

(2003), interviews allow the researcher on-going monitoring of the relevance of the

information that is being collected, and they also enable the researcher to check out

their understanding of what is being said by the participants. Personal interviews

provide greater control and will allow greater depth of information to be collected.

They also provide flexibility in a complex topic (Heppner, Kivlighan and Wampold,

1999). Considering that the topic chosen in this study can be considered complex,

personal interviews will best suit this research topic.

26
Originally, the researcher aimed to conducts all interviews face-to-face. Face-to-face

interviews would allow the observation not only of verbal but also nonverbal data

(Hiller & DiLuzio, 2004). However due to a change of circumstances, video and phone

interviews were set up instead, with the researcher acknowledging potential

limitations to this mode of interviewing. The researcher prepared a number of open-

ended questions, aiming to explore the participants’ experiences and attitudes toward

the occurrence of silence in the therapeutic space. Using semi-structured interviews

allowed to keep the participants on subject of this research while also allowing

flexibility and freedom of expression.

Each interview took an average 40 minutes. Three interviews were conducted over

Zoom, one interview was conducted over Skype and one interview was conducted

over the phone – this was the case because the participants were given a choice of their

preferred method of communication. The interviews were recorded with an audio-

recording application called Otter. The application recorded the audio and also

provided a rough transcription, which was later adjusted by the researcher. The

researcher took field notes immediately after the interview – this allowed to capture

any first impressions and note any content of the interviews that were found by the

researcher to be significantly impactful. Through the transcribing process, the

researcher gained a deeper understanding of the data, which provided a good basis for

the process of data analysis.

3.8 Ethical Issues

Prior to the commencement of this study, approval was granted by the ethics board of

Dublin Business School. As part of the recruitment process, participants have been

27
furnished with an information sheet (Appendix 3) and a consent form (Appendix 4) to

allow them to give informed consent to take part in this research. These forms

contained an overview of the research topic and advised the participants of their right

to withdraw from the present study at any point. A the start of each interview, the

researcher gave a verbal explanation of the study. Each participant was assured of the

safety and anonymity of their personal details and contributions. Participants were

asked to sign a consent form, which outlined that they have been informed of the

subject of this study, research design, rights as participants and potential risks. Each

consent form, alongside a signed information sheet and a demographic sheet, was sent

to the researcher via email prior to the interviews. Participants were also invited to

contact the researcher or the module tutor should any queries arise at a later stage.

The personal details of the participants in this study are held by the researcher in line

with the mandatory practice laid out the General Data Protection Rights (GDPR) Act

2018. In line with the GDPR legislation and DBS requirements, any data collected as

part of the interviews will be stored by the researcher for five years and will be deleted

afterwards.

During the recruitment process and at the start of each interview, participants were

made aware that the interviews were being audio recorded. These recordings, along

with transcribed notes, were coded and securely kept in adherence with Dublin

Business School’s ethical procedures. Pseudonyms where used to de-identify

participants. All collected data was stored on the researcher’s computer and protected

by a password, known only to the researcher. A software called Otter was used as an

aid in the transcribing process. This software is compliant with GDPR regulations.

28
 Chapter 4 – Results

4.1 Introduction

This chapter will explore the data collected from five semi-structured interviews

conducted as part of this research. During the interviews, the participants were invited

to reflect on their experience of silence in the therapeutic room.

The researcher identified the following three main themes that have emerged from the

research:

- Theme One: Client’s experience of silence

- Theme Two: Therapist’s experience of silence

- Theme Three: How personal development affects the experience of silence

The above themes were further broken down into subordinate themes, as demonstrated

in Table 2 below.

Table 2. Subordinate Themes

Theme One Theme Two Theme Three

How personal
Client’s experience of Therapist’s experience
development affects the
silence of silence
experience of silence

When silence is helpful

Finding comfort in Psychotherapeutic training
silence
When silence needs to be
Clinical experience
broken
Staying present
Personal therapy
Therapist’s experience of
Attunement to clients’
silence in their own
needs Self-care
personal therapy

29
Each theme explored in this chapter is highlighted with extracts from the interviews

which the researcher deemed as best representations of the issues explored in the

theme. Each participant is identified by a pseudonym and the extracts are written

verbatim.

4.2 Theme One: The client’s experience of silence

The first theme that emerged from the interviews focused on the client’s experience

of silence in the therapeutic work. All of the participants agreed that the use of silence

in therapy can be a powerful tool. Margaret proposed:

Margaret: I think some of the best pieces happen in the silence.

Barbara reflected on the presence of silence in therapy:

Barbara: It’s quite a paradox – that there are no words, it looks like nothing's
happening but actually beyond that there's so much going on.

All of the participants seem to use silence in a similar way – to facilitate reflection for

the clients and allow their clients to slow down when work begins to get

overwhelming. However, the participants also stressed that using too much silence

may not be optimal for the therapeutic work.

Barbara: When silence is used, it can be very powerful. I also think that it has
to be used carefully, because if somebody is not ready for it, they can be
overwhelmed too early.

Susan further reflected on the role of silence:

Susan: A bit of silence is really good to help things connect, but then when you
go to the too much side of it, that becomes a problem as well. It can feel like
it’s been used as a weapon against you as opposed to something that
facilitates.

30
The further exploration of this theme will be divided into three subordinate themes:

when silence is helpful; when silence needs to be broken; and the therapist’s

experience of silence in their own personal therapy.

4.2.1 When silence is helpful

The participants recalled some instances when they would see the use of silence as a

helpful therapeutic technique. The most common instance would be allowing the

client to reflect on their work. All of the participants stressed that they would hesitant

to jump in when the client is processing. They believe it’s more beneficial to allow the

client to make the connections for themselves.

Margaret: It’s about allowing reflection for the client. It's all about allowing
the person to make the connection for themselves. You might have some
insights, but allow them to come to it themselves.

Niamh suggested that she would introduce silence when she believed the client needs

to be challenged. By staying silent, she would allow the client an opportunity to

challenge themselves.

Niamh: If I feel the client needs to be challenged on something, I might just

stay quiet and let them hear themselves rather than challenge too quickly, and
risking being interpreted as colluding.

The participants agreed that silence can be used as a way of slowing the client down.

In the instances of the client becoming too overwhelmed or too upset, introducing

silence allows the client sufficient amount of space without overwhelming the client

further.

Claire: If somebody is unable to slow down, I probably use silence a lot more
because I'm trying to let them dump it all out but I would eventually interject
to try and push it out and slow them down.

31
 Barbara: If someone is massively overwhelmed, you need to give them space.
You're not looking for them to re-live the pain. Instead, you bear the pain with
them in silence.

Some participants linked the presence of silence to grief. They recalled working with

clients, who were able to use silence as a way of containing and processing their grief

Barbara: Silence can allow containment of situations like grief - creating a

space for the grief to be present in the silence, giving the pain space.

Susan: Just giving her space in silence and allowing her to connect with what
was present for her seemed to bring up unresolved grief.

Niamh: A client that was experiencing grief found comfort in silence. I knew
the client was comfortable – she was even answering her own questions
without me asking them. Work was being done, without the words.

4.2.2 When silence needs to be broken

While silence can be a useful technique in psychotherapy, the participants agreed that

it may not always be helpful to the therapeutic work. In some instances, the use of

silence may cause the clients more distress and overwhelm.

Barbara: When somebody is dreadfully silent because they're scared is just an

overwhelming experience… I want to create something to ease them and I think
silence won't bring that to somebody who is quiet.

Susan: I think if you hold in the silence too long, the clients won’t come back,
because they might find the therapy too uncomfortable. You need to go back to
that attunement piece.

The participants agreed that silence should be avoided when the client begins to

dissociate. The therapist should then step into a more directive role and stay connected

to their client. Barbara proposed the following question:

Barbara: Let’s say I’m working with a deeply traumatised client who
dissociates. If I leave them in the silence and I can see them dissociate… Do I
run the risk of them going into a state that I can't reach, or that they can’t
reach me?

Margaret reflected on her work with a client who had a tendency to dissociate:

32
 Margaret: When she was beginning to talk on the difficult stuff I would notice
the silence, and she would begin to dissociate… I would have to intervene and
stay connected. I think with dissociation there could be the danger of allowing
the silence but then allowing dissociation at the same time.

Some of the participants also pointed out that client with certain mental health issues

or psychiatric diagnosis may not be able to tolerate silence in the therapeutic work.

Claire: With psychiatric patients, or people with personality disorders… I

don't think they do well with too much silence. Certainly some people who need
a much more directive approach, and containing approach. It's actually very
risky and unethical to work in a way, in kind of tug-of-war to open somebody,
rather than actually closing them and containing them.

Margaret: She had a bipolar diagnosis so there would have been so many
instances when silence wouldn't have been helpful. Sometimes with mental
health issues there isn't the same tolerance for silence.

4.2.3 Therapist’s experience of silence in their own personal therapy

The participants were invited to reflect on their own experience of personal therapy.

The researcher enquired whether they experience silence in therapy themselves, and

how were they able to manage such experience. All of the participants recognised the

presence of silence at various stages of their personal therapy. Their reflections on this

would suggest that silence may be uncomfortable in the early stages of the therapeutic

relationship, but this discomfort eased with time. Niamh recalled:

Niamh: When I was years younger I was squirming – thinking “why isn’t she
speaking”. Now, I’m very comfortable if a therapist is silent. It’s a space in
itself for me, for reflection.

Most of the participants agreed that the level of comfort with silence in therapy is

strongly linked to the therapeutic relationship itself. They stressed the need for the

therapist to be attuned to the client’s experience.

Claire: For me, it was always tied up in how comfortable I was with a
therapist. With some therapists, I've felt entirely comfortable. But then there
were other times when I wasn't comfortable, it just didn't work at all. And that
experience was awful.

33
Niamh further added:

Niamh: If I have a sense that the therapist is not attuned to me, I might even
be irritated with her silence. If I have a sense she’s just allowing me to hear
myself, it’s useful.

Barbara concluded:

Barbara: In my own therapy, silence allowed me to sit back and allow myself
the therapeutic space. But it all depends on what headspace I’m in. I think my
therapist reads it well.

4.3 Theme Two: Therapist’s experience of silence

The second theme that emerged from the interviews was the therapist’s experience of

silence. The participants were invited on how they feel when silence is introduced to

the therapeutic space. Their experience was divided into three subordinate themes:

finding comfort in silence; staying present; and attunement to clients’ needs.

4.3.1 Finding comfort in silence

The participants reflected in length about their comfort levels, and what factors might

add to the level of comfort or discomfort in the silence. Their responses seemed to

suggest a link between their level of comfort and their own process.

Niamh: I think the more comfortable we are in our own selves, the less we find
ourselves as lost or overwhelmed or disempowered. We don't know what a
client is going to bring until they walk in the door and maybe it could be
tapping into something that we haven't even checked out in ourselves.

Susan: Sometimes we are much more connected in ourselves when we're in

session, and sometimes we’re not. That's where staying with your own work
and your own process is so important. I think the more experienced you are,
the more aware you are of this.

Some of the participants recognised that sometimes they find themselves lost for

words. It can be suggested that the main reason that can cause this can the dept of the

client’s experience. Barbara recalled:

34
 Barbara: There has been situations where I have been lost for words, because
of the depth of somebody's experience. And this is where I always feel that
language fails. I might just put my hand on my chest and I might go “that
sounds horrendous” and then just sit there and be there for the client.

Niamh further added:

Niamh: I have had that experience, where I felt… Maybe overwhelmed by the
energy of the client… Or maybe I felt the balance of power in the room was
inaccurate… And it’s an uncomfortable place. It's more a loss for words, and
losing your own power.

4.3.2 Staying present

All of the participants stressed the importance of staying actively present when during

silence in therapy. They suggested that by staying present, they are able to track the

clients and notice if the silence becomes too distressing for them.

Barbara: I’m quite present in the room, so people are able to feel that I am
there for them. It’s like saying “I am here”. I'm not necessarily thinking of the
next intervention. I’m just staying with the moment, the issue at present.
Listening to the client.

Susan further added:

Susan: I do feel it's important to observe in a way that doesn't feel too intense
on the clients. It's very non-verbal process and hard enough to describe. But
it's about staying really present with them and picking up those non-verbal
cues – they will help you get a sense of what the clients are processing.

Niamh recalled instances when she might have not been fully present in the therapeutic

encounter, however she stressed the importance of bringing yourself back to the

awareness.

Niamh: I think it depends on is the process going on. I can sometimes slip
away, but my intention is always to be present. And if I do go somewhere I
bring myself back, because I want my awareness to be in the room, with the
client.

35
4.3.3 Attunement to clients’ needs

All of the participants agreed that attunement of clients’ needs is extremely important,

particularly when introducing a technique such as silence. With the risk of causing the

client more distress, the participants recognised the importance of tracking where the

client is in the therapeutic space.

Susan: You need to stay attuned to where the client is at. You will see the
people who feel the pressure to come in and just speak for the sake speaking,
versus people who are comfortable being silent, allowing it to unfold and
coming in when they feel it's right for them to come in.

Niamh: I think that's an energy thing that you pick up, isn't it? You get a sense
that some people are perfectly comfortable and working in silence, whereas
other people are just waiting in silence.

The participants also recognised that each client is different, and therefore the

attunement of their individual needs is extremely important. Margaret suggested:

Margaret: It’s about creating the space for every client’s needs. You never get
two times the same, you might get themes that are the same, but the experience
is never the same.

The participants agreed that they would be cautious when breaking the silence in the

therapeutic room. Some of the participants highlighted the fact many therapist might

have a tendency to jump in and save the client in a silent period.

Niamh: I think a lot of us have this tendency – “it's up to me”, “I must do

something here”, where it's not necessary to do anything. It’s about realising
“this is not about me, this is about the client”.

Claire further added:

Claire: We want to be so engaged and involved and you know your mind might
be jumping all over the place in terms of what you might do with a client.

36
Some participants suggested that they would be reluctant to break the silence, as they

recognise that a certain level of discomfort can be beneficial to therapeutic work.

Susan suggested:

Susan: I might hold back and really be with that pressure, as it might be
necessary for the therapy space.

Barbara added:

Barbara: Leaving the silence longer has tested me hugely, but also let me see
what could eventually come out of it.

The participants seemed to agree that they would only break the silence if they would

see something in that process that might need to be interrupted. This awareness of the

destructive side of the process closely links with the attunement to client’s needs.

Susan reflected on this as follows:

Susan: I would be reluctant to intrude the silence, until there was a sign that
there was something that needs to be interrupted. It's very much about using
your countertransference and seeing what the client's needs are. When your
client becomes too uncomfortable with it, I know that it's not going to aid the
therapy work.

4.4 Theme Three: How personal development affects the experience of

silence

The third theme that emerged from the data collected covered the question on how

personal development affects the therapist’s experience of silence. The participants

were invited on their personal development in the following four areas:

psychotherapeutic training; clinical experience; and personal therapy. One further area

– that of self-care – was identified by some of the participants which prompted the

researcher to include in the subordinate themes, as it provided further understanding

how this can affect the experience of silence in the therapeutic room.

37
4.4.1. Psychotherapeutic training

All of the participants recognised that silence in therapy was first introduced to them

during their psychotherapeutic training. The overall feeling that the researcher got

from the interviews was that the experience of silence in training caused some

discomfort and frustration among the participants. Margaret reflected on her

experience as follows:

Margaret: I think it’s something that takes a while to settle into, it depends on
the person.

Claire added:

Claire: I remember learning the skill of it, and being really frustrated because
I wanted to jump in and I wanted to do so much, you know, be the therapist.
But actually, I remember distinctly the value of it, despite the discomfort.

Barbara reflected on the main learning she took away from the experience of silence

in training.

Barbara: We were told we didn't have to keep jumping in to save the client, so
that's stuck with me.

For Susan, the most memorable experience of silence in training was through

participation in process groups. As she reflected on the discomfort of silence, she

noted:

Susan: I remember the chief trainer’s response was “now isn't that interesting,
and you're finding it difficult, I wonder what does that say about you”. And it
was like the penny just dropped. And this was profound.

Some participants believed that there was enough emphasis on silence in training and

they didn’t believe that the silence piece was missed out.

Susan: There's so much to training in groups and process groups, I think we

were in a great place for learning to be with silence.

38
However, other participants believed that silence could have been given a bigger part

in psychotherapeutic training. They suggested that introducing more emphasis on

silence could be beneficial to the initial development of a psychotherapist,

Niamh: I remember it being alluded to, but I didn't come away from my
training thinking about the necessity of it.

Barbara: I think it would be beneficial to push for silence in training courses.

It was the most uncomfortable thing to do, but there was something in that.
Yeah… I think there's something lacking in the training to bring in more
silence.

4.4.2 Clinical experience

The length of clinical experience seemed to a factor that all participants recognised as

something that helped them get more comfortable with silence. They all recognised

that in the beginning of their clinical practice, silence in the therapeutic room was

something that felt quite uncomfortable. Some participants recalled jumping in and

breaking the silence to reduce that level of discomfort.

Barbara: As a therapist at the beginning, I had to work really hard to be in the

silence. I now know that when I wasn’t able to stay with it, I jumped in to
reduce the stress.

Niamh: It's not something that I was comfortable with when I first started
seeing clients. I would have rushed in to fill the space.

The participants were in an agreement that the longer they practiced psychotherapy,

the more they were able to bare the silence in the room. They all recognised that the

length of clinical practice transformed their initial discomfort with silence.

Claire: The massive difference between then and now. It’s like two different
people, absolutely huge difference. The journey is to trust yourself and allow
time.

Margaret: The more experience you've had of this therapist, the easier it is to
cope with silence and be more in tune to where to use it, where to step in and
where to step out.

39
 Susan: I think the longer you're working, you certainly are able to separate
out when you come into the therapy space. It's like you're you step into a very
different space so you can leave your own personal stuff outside the door.

They attributed this shift in better integration of their skills and life experience. They

deemed expose to silence and reflection on their work as key factors in reducing

discomfort with silence.

Claire: It’s in the experience – experience of every part of this work and being
able to integrate all them, put them all together.

Niamh: When I started seeing clients, I started reflecting on the importance of

the silence. I think it's something that I developed myself as I became more
comfortable in my work as a therapist. And also, like exposure to silence is
key, it’s really where we do our most of our learning.

4.4.3 Personal therapy

Some of the participants recognised that the experience of personal therapy helped

them to bare the silence better in their own therapeutic work. They pointed out that

personal therapy helped them to explore the concept of silence as therapeutic

intervention, which helped bring this skill into their own work.

Barbara: My training impacted the idea of the usefulness of silence. Personal

therapy helped me explore it.

Niamh: I suppose through our own growth and personal therapy as well, it
brings us to those places without any actively planning to go there. It happens
organically. Any work that you do on it, any inner work or any personal
growth, that changes you.

Margaret: Early on I would have struggled with silences in myself and

therapy. But now, I actually welcome it.

As Niamh reflected on the lack of silence in her current personal therapy, she made a

striking link to the continuity of personal therapy. She pointed out that she attends

therapy every couple of weeks, and with that she brings a “backlog” of things. The

40
researcher found it interesting consider the continuity of therapy as a factor which

influences the presence of silence.

Niamh: I feel, because it's not weekly, you don't have that continuity. When
you go to therapy every week, you have more space to reflect […] I want to get
maximum benefit from this hour. I'm not going to be sitting in silence, but
maybe that shows an impatience… So I'd say maybe I'm not giving myself even
enough space for silence.

4.4.4 Self-care

Two of the participants mentioned self-care as an important factor that is allowing

them to sit better in silence. Claire reflected on the practice of mindfulness and

meditation.

Claire: The preparations that we do when getting ourselves ready for clients
are important. I think of my training, when I did loads of mindfulness and
meditation. That gave me a really good grounding in how to prepare myself in
terms of life skills, my inner kind of stillness and my inner kind of sanctity, and
calmness, which I would equate all of that with silence.

Barbara recalled attending a silent retreat earlier this year. She believed the experience

of the silent retreat gave her an extra insight into silence and allowed her to find more

comfort in silence.

Barbara: I think the silence piece has made me stronger, and having been at
silent retreat has made me stronger as an individual. Thanks to that, and
meditation every morning, I can sit easier with clients.

41
 Chapter 5 – Discussion and Conclusion

5.1 Introduction

This chapter will discuss the results obtained as part of this study, as outlined in

Chapter 4. The overall aim of the research was the explore the experience of silence

in a therapeutic training. The researcher hoped to gain a better understanding of, when

silence is typically used in therapy and what factors affect the level of comfort around

silence.

As discussed in Chapter 3, Thematic Analysis was selected as a method of data

analysis. Three main themes were identified in the process of analysis of five semi-

structured interviews. This chapter will look at those themes and in-dept discussion

will be provided, keeping in line with the relevant literature presented in Chapter 2.

The three themes identified in the results of this study were: client’s experience of

silence; therapist’s experience of silence; and how personal development affects the

experience of silence. The findings suggest that the experience of silence in therapy is

affected by many factors and it changes over time. Personal growth seemed to be

acknowledged by all the participants as the most important element that influences

how they are able to manage silence in the therapeutic room. The experiences gained

in both training courses and personal therapy allowed the participants to explore the

concept of silence and improve their comfort levels during their a silent period in the

therapeutic room. The participants concurred that clinical experience positively

impacts their ability to cope with silence – the longer they have been practicing, the

easier it was for them to manage it. Furthermore, the participants stressed the

42
importance of being actively present during the silent period in therapy. They also

reflected on their attitudes towards the use of silence as a therapeutic intervention.

They identified a number of factors that would encourage them to use silence with

their clients, and the conditions where silence could be potentially damaging to the

therapeutic work.

5.2 Theme One: Client’s experience of silence

Theme one explored the role of silence in the room. It looked at when silence is useful

for therapeutic work and when the silence needs to be broken. Furthermore, it explored

the participant’s experience in their own personal therapy. The results of this study

provided a descriptive picture of what happens for the client in a silent period during

therapeutic work.

Langs (1973) saw silence as the most undervalued and misunderstood therapeutic

intervention. O’Toole (2015) suggests that working with silence give a therapist a

unique access to the privacy of the self within the context of the therapeutic

relationship. The results of the current study echo a similar attitude among the

participants. The participants agreed that, when used in an optimal setting, silence can

be a very useful technique, allowing the client sufficient space for the deep work to be

done. Some suggested that some of the best and most difficult pieces of work can

happen in silence. The participants suggested that using silence can provide a non-

verbal challenge to the client’s process. It allows the client to make the connections

for themselves without the therapist interrupting the process.

43
In the survey conducted by Hill, Thompson and Ladany (2003), the results showed

that the reason why the highest number of participants used silence in the therapeutic

space was to facilitate reflection. Other high agreement reasons included: to encourage

responsibility; to facilitate experiencing of feelings; to not interrupt the flow; and to

convey empathy, respects and support. Similar findings were identified by the current

study. When looking at both their clinical work and their own experience of personal

therapy, the participants agreed that silence first and foremost facilitates reflection in

the therapeutic room. The participants also linked silence to allowing their client to

process difficult emotions, such as grief.

The participants of this study have emphasised the distinction between productive and

unproductive periods of silence in the therapeutic work. According to Levitt (2001),

silences occurring in therapy can be categorised as productive, obstructive or neutral.

V. Stringer et al (2010) suggested that constructive silences can promote insight and

emotional expression for the clients, which is associated with positive outcomes in

therapy. On the other hand, obstructive silences can reflect disengagement from inner

experiences. The participants of this study agreed that a productive silence can

facilitate reflection and can allow the client to make connection and insight into their

own experience. When silence becomes obstructive, it can potentially disrupt the

therapeutic work if not caught in time. The participants stressed that when the client

becomes disengaged, whether through overwhelm or dissociation, the silence can

potentially cause harm and it needs to be broken.

Hill, Thompson and Ladany (2003) have found that the therapists were thoughtful in

their use of silence – they would not use silence as means to provoke anxiety. This

44
finding matches the findings of this study. The participants all agreed that they would

not introduce silence if the clients seemed overly anxious. It seems that all participants

concurred with the fact that one of the most important factors in therapy was the

containment of the client and the creation of safe space. The results suggest that the

participants would interrupt the silence if they believed that it was not promoting a

productive and safe environment for their clients.

There has been some stark differences between the results of Hill, Thompson and

Ladany (2003) study and the current study surrounding the reasons why therapists may

choose to use silence in therapy. Hill et al found that the therapists were moderately

likely to use silence with clients who were manic or had a personality disorder.

Furthermore, they found that humanistic therapists thought it was acceptable to use

silence with a wider range of clients, including those who are psychotic and with

whom they have a poor therapeutic alliance. These findings directly contradict the

finding of this study. While some participants did not touch on the use of silence with

clients who hold a psychiatric diagnosis, others stated that they would be cautious in

using silence with those clients. They believe that some mental health disorders,

particularly personality disorders, affect the client’s ability to tolerate silence. The

current findings would correlate more with a study conducted by Ladany, Hill,

Thompson and O’Brien (2004), which found that while some therapists would use

silence with clients with a personality disorder diagnosis, others would see that as

factor for the silence to be avoided.

Another contradiction found between the current study and the study conducted by

Hill et al (2003) concerned the use of silence and the therapeutic orientation. Hill et al

45
found that humanistic therapists thought it was acceptable to use silence with a wider

range of clients, including those with whom they have a poor therapeutic alliance.

However, the participants, who all had a core humanistic orientation, agreed that their

use of silence would depend on the depth and strength of the therapeutic relationship.

The results further suggest that silence is perceived as more comfortable when the

therapeutic alliance between therapist and client is strong. While reflecting on their

own experience of personal therapy, the participants concurred that their level of

comfort with silent periods in therapy is strongly linked to the relationship with their

therapist. All of the participants stressed the need for the therapist to be attuned to the

client’s experience. This finding fits with the belief of Erskine (2015), who suggested

that the relationship between the therapist and the client is a central and significant

factor in psychotherapeutic work.

5.3 Theme Two: Therapist’s experience of silence

Theme two focused on the therapist’s experience when silence in present in the room.

The theme explored concepts such as finding comfort in silence, staying present and

attunement to client’s needs when silence is introduced to the therapeutic room.

Sharpley (1997) suggests that clients may value time to think and reflect on issues

arising in therapy, and counsellors should not judge silence as these times as a sign of

weakness in their professional expertise. This statement was somewhat reflected in the

results of this study. The participants agreed on the value of silence in the therapeutic

room, however they did acknowledge anxiety around having to bear with the silence

in the room. Most of the participants acknowledged a tendency to jump in and “save”

the client during longer periods of silence. They stipulated that this tendency might be

46
common among psychotherapists. They suggested that bringing this tendency to their

awareness helped them to cope better with the anxiety of a silent period in therapy.

Acknowledging the value of silence as a psychotherapeutic intervention and the

necessity of its presence at times seems to influence the comfort levels of the therapist

in the room.

Staying present during a silent period in therapy seemed to be important to all of the

participants in this study. It became evident from the results that most of the silence is

a very active place for a therapist. The participants suggested that staying actively

present allowed them to develop a better attunement to their clients’ needs. Ladany et

al (2004) found that therapist reported doing a number of things during silences. These

included observing clients, examining their thought and feelings and conveying

empathy. They concluded that although silence might appear as uneventful, it’s

actually an active time for the therapist. It certainly seems to be the same for the

participants of this study, as they spoke at length about the importance of staying

active in a silent period.

According to Bruce et al (2010), the psychotherapeutic process depends on a

psychotherapist’s sensitivity to the patient’s signals, both verbal and nonverbal. The

participants all agreed that staying actively present during silence in a session allows

them to track the clients and pick up on those non-verbal cues that are so important

for the assessment of the client’s emotional state. This would suggest that active

presence in a silent period is key to a better attunement to client’s needs.

47
Siegel (2007) suggests that empathy enhances the therapist’s ability to sense when the

client may need space – an empathic psychotherapist will know when to allow space

by reducing the intensity of the empathic connection. This further suggests the

importance of therapist’s attunement to the client’s needs, which is in line with the

results of this study. The participants all agreed that working on their attunement to

the needs of each individual client allowed them to use silence in therapy in the most

optimal way. They concurred that through this attunement they are able to sense their

client’s comfort levels around silence, which then allows them to assess when silence

is helpful and when perhaps it is not serving its purpose. It can be suggested that this

of significant importance when using a therapeutic intervention such as silence, as it

has the potential of provoking anxiety and overwhelming the client.

All of the participants agreed that when it came to breaking the silence, they preferred

to wait for the client to break it. They would only step in if they perceived the silence

as being either unproductive or overwhelming for the client. Otherwise, their

preference was to allow the client enough space to make their own connections. This

falls in line with the results of Ladany et al (2004) study, which found that therapist

typically broke the silence if they believed that the clients were not using the silence

productively. They recognised that sometimes uninterrupted silence can lead to

harmful effects on their clients.

5.4 Theme Three: How personal development affects the experience of

silence

The third and final theme looked at factors that affect the experience of silence in the

therapeutic room. The literature shows that many factors affect the professional and

48
personal development of a therapist. The current study invited the participants to

reflect on their development over the course of their training and psychotherapeutic

careers. The researcher hoped to gain a deeper understanding of what factors

contribute to personal and professional development of a psychotherapist. With that

in mind, the study hoped to explore how these factors affect the participants’

experience of silence in therapeutic work. The participants were invited to reflect on

their experience of psychotherapeutic training, clinical practice, personal therapy and

self-care.

In their 2004 study, Ladany et al found that silence was rarely thought as a form of

intervention throughout psychotherapeutic training. The participants of that study

suggested that they were more likely to learn about silence through supervision and

clinical experience. An interesting comparison can be made between these results and

the current research. The findings of this study established that the concept of silence

as a therapeutic intervention was first introduced to the participants during

psychotherapeutic training. The participants highlighted the impotence of training in

shaping their ability to manage silence in therapy. However, some participants

acknowledged that although silence was present in their training, there potentially

could have been more emphasis put on it. They suggested that more exposure to

silence during training could have positively contributed to their ability to manage

silence early on in their careers.

According to Dawson (2018), the length of clinical experience relates to qualitatively

different therapist self-perceptions and mental states, both inside and outside of

therapy sessions. Additionally, it can transform the way therapists perceive their own

49
skills and the nature of their role in a therapeutic relationship. Rønnestad and Skovholt

(2003) suggest that as therapists increase their clinical experience, they increasingly

rely on internal expertise, bringing less rules into therapy and continuing to expand

their openness to other theoretical orientations and therapeutic interventions.

Furthermore, Ladany et al (2004) found that with experience, therapists found

themselves becoming more flexible, comfortable and confident about using silence.

They began trusting themselves and the therapeutic process more when silence

occurred, and they found themselves using silence more judiciously. All of these

statements seemed to be echoed in the results of the current study. On reflection of

their clinical practice, the participants concurred that clinical experience positively

impacted their comfort level around the presence of silence in the therapeutic room.

They suggested that the more experience they had, the easier it was for them to cope

with silence. Clinical experience allowed to be more in tune with their clients’ needs

and the ability to gage when using silence would prove to the helpful to the therapeutic

work.

According to Daw and Joseph (2007), personal therapy has a huge impact on therapist

in many different areas of their lives. They found that personal therapy is seen as a

valuable way to provide self-care, as it gives the therapists a space for reflection on

both client practice and personal issues. Furthermore, Daw and Joseph found that

personal therapy impacts the professional practice (2007). The therapists are able to

use personal therapy as an opportunity for experiential learning and the deepening of

their understanding of different theories and therapeutic processes. It also allowed

them to develop deeper empathy and respect for their clients. A similar finding was

discovered as part of this study. The participants acknowledged that personal therapy

50
had a significant positive impact on their personal and professional development.

Personal therapy allowed them to experience how it feels to sit in silence in therapeutic

room, which provided them with a better understanding of their clients’ experiences.

While they might have struggled with silence in the beginning, having the experience

of it allowed them to develop comfort around it.

Orlinsky et al (2005) further suggest that the experience of personal therapy can

therapists become more sensitive, more skilful and more flexible in adjusting the

impact of their behaviour to the individual and evolving needs of their clients. They

also suggest that personal therapy should shield the clients from being influenced by

their therapists’ own unresolved personal issues. This attitude towards personal

therapy seemed evident through the interviews in this study. The participants

concurred that personal therapy allowed them to work through their own stuff, and

thanks to that they were able to stay some actively present in the therapeutic room.

Furthermore, personal therapy allowed to grow both as human beings and

practitioners. All of the participants agreed that any personal development changes

you as a person and helps you to evolve your clinical practice.

5.5 Strengths and limitations of the study

The choice of semi-structured interviews as a method of data collection and Thematic

Analysis as a method of data analysis corresponded well with the nature of this study

and allowed for an in-depth insight into the participants’ experiences. The data

collected filled the existing gap in literature on the experience of silence among

therapists practising in Ireland. The participants suggested that the issues raised in the

interviews made them reflect on the areas of their work that perhaps they would not

51
otherwise. All of the participants agreed that going forward they will reflect more on

the topic of silence in both their therapeutic practice and personal life.

The study had a number of limitations. Firstly, the small sample size can be seen as

the most significant limitation of the research. It provided a limited insight into the

experience of silence in therapy as it relied on the reflections of five participants. As

the outcomes of the study needed to be generalised, some nuanced differences among

the experiences of the participants could have been potentially missed. Secondly, all

participants of this study were Caucasian cis females, with English as their native

language. This could suggest a gender, ethnic and cultural imbalance in the results of

the study. Thirdly, the participants of this study were all accredited therapists with an

average of 14 years of experience. The study excluded trainee and notice therapists,

which could have provided further insight of the experience of silence at different

stage of the therapeutic career. Finally, all participants had a core humanistic

orientation, which excluded the experiences of therapists that choose to practice in

different modalities.

5.7 Suggestions for further research

The researcher believes that further enquire into the experience of silence in the

therapeutic room would be beneficial for both trainee and practising psychotherapists.

The interviews conducted as part of this study suggested that the experience of silence

in the early years of psychotherapy practice differs significantly when compared to

the experience further into the career. A better understanding of those different

experiences can potentially provide valuable information to the training courses and

52
professional bodies as an influence to shape the content of psychotherapeutic training

and further professional development courses.

As mentioned earlier in this chapter, this study had a number of limitations, most

significant being a number of participants. The participation of five practicing

therapists provided a limited insight into the experience of silence in the therapeutic

room. Knutson and Kristiansen (2015) suggest that silence should be studied and

understood in context, whether it’s past experiences or ethnic-cultural factors. The

researcher believes that it is important to conduct further research among Irish

therapists, as it can be suggested that experience of silence might have a strong root in

the cultural background of both the therapist and the client. The researcher feels that

a study conducted on a bigger scale could fill in the current void in the literature

available, particularly on the experience of a therapist who practices in Ireland.

It is important to note the similarity among the participants of this study. Perhaps

further research among therapists of different genders, cultural backgrounds and

therapeutic orientations could expand the understanding of what affects the experience

of silence. Further research with a more diverse sample could provide a better overall

understanding of the experiences of silence in therapy. It could explore whether

different genders have a similar or contrasting experience of silence. Furthermore, it

could explore the differences, of any, in the experience of silence among therapists

practicing from different therapeutic frameworks. Finally, it could also provide an

insight of what the experience of silence is like for a therapist whose native language

isn’t English.

53
5.6 Implications for psychotherapy

While silence was acknowledged by the participants as being part of their

psychotherapeutic training, some suggested that a bigger emphasis on silence could

benefit the development of a therapist in the early years of their journey. Participation

in group situations where silence is present seems to be a strong and positive influence

on the comfort levels of the participants.

Perhaps a stronger introduction of silence into the training courses could benefit the

personal and professional growth of a therapist and allow them to establish their

comfort levels with silence early in their careers. Some participants also suggested

further emphasis on mindfulness and meditation as a way of developing a better

understanding and insight into what silence can offer as a therapeutic intervention.

5.8 Conclusion

This study has identified a number of factors that affect the experience of silence in

the therapeutic room. Through the exploration of both the client’s and the therapist’s

experience of silence in therapy, the researcher was able to gain a deeper

understanding of what affects the comfort level during a silent period in therapy.

By exploring the participants’ attitudes towards the use of silence as a therapeutic

intervention, the researcher was able to identify the conditions that affect the

usefulness of silence as intervention. The reflection on their own clinical work allowed

the participants to determine what prompts them to introduce silence into the

therapeutic space. Productive silence seemed to promote deeper reflection and allows

the clients to make connections for themselves without the therapist needing to step

54
in. Silence also allows the client to process difficult emotions in a safe space. On the

other hand, obstructive silences can potentially cause harm and overwhelm to the

client. The participants stressed the importance of being attuned to the client’s needs

in order to determine when silence can potentially become threatening and unsafe. The

participants agreed that the depth of the therapeutic alliance influence their use of

silence as a therapeutic intervention.

The study has identified a number of factors that affect the experience of silence in the

therapeutic room. It has found that personal development has a significant impact on

the therapist’s ability to manage silence in therapy. The participants agreed that

therapeutic training, clinical experience and personal therapy all contribute to their

ability to hold silence. It can be suggested that personal growth contributes to the

therapist’s ability to attune to their clients’ needs and stay actively present in the

therapeutic space.

As proposed by one of the participants, some of the best therapeutic work happens in

silence. Keeping this in mind, the research concludes that some of the most important

therapeutic work can happen beyond the words.

55
 References

Braun, V., Clarke, V. (2006). Using thematic analysis in psychology. Qualitative

Research in Psychology, 3, pp. 77-101

Bruce, N. G., Manber, R., Shapiro, S. L., Constantino, M. J. (2010). Psychotherapist

Mindfulness and the Psychotherapy Process. Psychotherapy Theory,

Research, Practice, Training, 47(1), pp. 83-97

Daniel, S. I. F., Folke, S., Lunn, S., Gondan, M., Poulsen, S. (2016). Mind the gap:

In-session silences are associated with client attachment insecurity,

therapeutic alliance, and treatment outcome. Psychotherapy Research, DOI:

10.1080/10503307.2016.1177673

Daw, B., Joseph, S. (2007). Qualified therapists’ experience of personal therapy.

Counselling and Psychotherapy Research, 7(4), pp. 227-232

Dawson, G. C. (2018). Years of Clinical Experience and Therapist Professional

Development: A Literature Review. Journal of Contemporary

Psychotherapy, 48(2), pp. 89-97

Denham-Vaughan, J., Edmond, V. (2010). The Value of Silence. Gestalt Journal of

Australia and New Zealand, 6(2), pp. 5-19

Erskine, R. G. (2015). Relational Patterns, Therapeutic Presence. Concepts and

Practice of Integrative Psychotherapy. London: Karnac Books

Frankel, Z., Levitt, H. M., Murray, D. M., Greenberg, L. S., Angus, L. (2006).

Assessing silent processes in psychotherapy: an empirically derived

categorization system and sampling strategy. Psychotherapy Research, 16(5),

pp. 627-638

Freud, S. (1937). Analysis Terminable and Interminable. Standard Edition (Vol. 23).

[Electronic version]. Retrieved from PEP Archive database

56
Glidewell, J. C., & Livert, D. E. (1992). Confidence in the practice of clinical

psychology. Professional Psychology: Research and Practice, 23(5), pp.

362–368

Heppner, P. P., Kivlighan Jr., D. M., Wampold. B. E. (1999). Research Design in

Counselling. Belmont: Wadsworth Publishing Company

Hill, C. E., Thompson, B. J., Ladany, N. (2003). Therapist Use of Silence in

Therapy: A Survey. Journal of Clinical Psychology, 59(4), 513-524

Hiller, H. H., & DiLuzio, L. (2004). The participant and the research interview:

Analysing a neglected dimension in research. The Canadian Review of

Sociology and Anthropology, 41, pp. 1-26.

Kenny, C. (2011). The Power of Silence. Silent Communication in Daily Life.

London: Karnac

Knox, S., Burkard, A. W. (2009). Qualitative research interview. Psychotherapy

Research, 19(4-5), pp. 566-575

Kolb, D. A. (2014). Experiential learning: Experience as the source of learning and

development. New Jersey: Pearson.

Kurtz, S. (1989). The Art of Unknowing. Dimensions of Openness in Analytic

Therapy. Northvale: Jason Aronson Inc.

Ladany, N., Hill, C. E., Thompson, B. J., O’Brien, K. M. (2004). Therapist

perspectives on using silence in therapy: a qualitative study. Counselling and

Psychotherapy Research, 4(1), 80-89

Lane, R. C., Koetting, M. G., Bishop, J. (2002). Silence as communication in

psychodynamic psychotherapy. Clinical Psychology Review, 22, 1091-1104

Langs, R. (1973). The Technique of Psychoanalytic Psychotherapy. New York:

Jason Aronson, Inc.

57
Lapworth, P., Sills, C., Fish, S. (2001). Integration in Counselling and

Psychotherapy. Developing a Personal Approach. London: Sage Publications

Lehmann, O. V. (2014). Towards dialogues with and within silence in psychotherapy

processes: Why the person of the therapist and client matters? Culture &

Psychology, 20(4), pp. 537-546

Levitt, H. M. (2001). Sounds of Silence in Psychotherapy: The Categorization of

Clients’ Pauses. Psychotherapy Research, 11(3), pp. 295-309

McLeod, J. (2003). Doing Counselling Research. London: Sage Publications

O’Toole, M. A. (2015). The Phenomenon of Silence in Psychotherapy. Attachment:

New Directions in Psychotherapy and Relational Psychoanalysis, 9(3), p

342-360

Orlinsky, D. E., Botermans, J. F., & Rønnestad, M. H. (2001). Towards an

empirically grounded model of psychotherapy training: Four thousand

therapists rate influences on their development. Australian Psychologist,

36(2), pp. 139–148

Orlinsky, D. E., Norcross, J. C, Rønnestad, M. H., Wiseman, H. (2005). Outcomes

and impacts of the psychotherapist’s own psychotherapy. In Geller, J. D.,

Norcross, J. C., Orlinsky, D. E. (Eds.). The Psychotherapist’s Own

Psychotherapy: Patient and Clinician Perspectives. New York: Oxford

University Press, Inc.

Orlinsky, D., Rønnestad, M. H., Ambühl, H., Willutzki, U., Botersman, J.-F.,

Cierpka, M., David, J., Davis, M. (1999). Psychotherapists’ assessments of

their development at different career levels. Psychotherapy: Theory,

Research, Practice, Training, 36(3), pp. 203–215

58
Overholser, J. C. (2010). Clinical expertise: A preliminary attempt to clarify its core

elements. Journal of Contemporary Psychotherapy, 40(3), pp. 131–139.

Owen, I. R. (1997). Boundaries in the practice of humanistic counselling. British

Journal of Guidance & Counselling, 25(2), 163-174

Phillips, S. B. (2001). Up Close and Personal: A Consideration of the Role of

Personal Therapy in the Development of a Psychotherapist. In Klein, R. H.,

Bernard, H. S., Schermer, V. L. (Eds.). On Becoming a Psychotherapist. The

Personal and Professional Journey. New York: Oxford University Press, Inc.

Rogers, C. (1951). Client-Centred Therapy. London: Constable

Rogers, C. (1961). On Becoming a Person. A therapist’s view of psychotherapy.

London: Robinson

Rønnestad, M. H., & Skovholt, T. M. (2003). The journey of the counselor and

therapist: Research findings and perspectives on professional development.

Journal of Career Development, 30, pp. 5–44

Sabbadini, A. (1991). Listening to Silence. British Journal Of Psychotherapy, 21(2),

p. 229-240

Sander, L. W. (1962). Issues in early mother–child interaction. Journal of the

American Academy of Child and Adolescent Psychiatry, 1, pp. 141–166

Sharpley, C. F. (1997). The influence of silence upon client-perceived rapport.

Counselling Psychology Quarterly, 10(3), pp. 237-246

Siegel, D. J. (2007). The mindful brain: Reflection and attunement in the cultivation

of well-being. New York: Norton.

Stern, D. N. (1985). The interpersonal world of the infant: A view from

psychoanalysis and developmental psychology. New York, NY: Basic Books.

59
v. Stringer, J., Levitt, H. M., Berman, J. S., Mathews, S. S. (2010). A study of silent

disengagement and distressing emotion in psychotherapy. Psychotherapy

Research, 20(5), 495-510

Yalom, I. D. (2000). The Gift of Therapy: An Open Letter to a New Generation of

Therapists and Their Patients. New York: Harper Collins

Zeligs, M. A. (1961). The Psychology of Silence. Its Role in Transference,

Countertransference and the Psychoanalytic Process. Journal of the American

Psychoanalytic Association, 9(1), 7-43

60
 Appendices

Appendix. 1 – Centre Advertisement

LOOKING FOR RESEARCH VOLUNTEERS

FOR MA THESIS
My name is Katie Dobosz and I am a final year student, studying MA in
Psychotherapy at Dublin Business School.

As part of my Masters thesis, I am conducting research on

THE EXPERIENCE OF SILENCE IN THE

THERAPEUTIC ROOM

I am inviting interested psychotherapists to participate in a qualitative interview

that will take approx. 45mins.

The interview can take place at a mutually agreed location. Alternatively, it can
take place online through Skype or Zoom.

I am seeking to interview humanistic integrative psychotherapists with at least

three years post qualification experience.

I would very much appreciate your participation in this research. I can be

contacted by email:

katiedobosz@gmail.com

61
Appendix. 2 – Email Invitation

Dear …,

My name is Katie Dobosz and I am a final year student, studying MA in

Psychotherapy at Dublin Business School.

I am currently conducting research as part of my final year thesis. I am looking to

explore the experience of silence in the therapeutic room.

As stated above, the focus of my research is the exploration of the experience of

silence in the therapeutic room. During the interview, I would be focusing on your
experience of silence during psychotherapeutic training and clinical practice. I would
also be looking at your experience of silence in personal therapy (as a client).

I am wondering whether you would be interested in taking part in an interview for

my research project. The interview should take approx. 45mins. Considering the
current situation with the virus outbreak, I am inviting participants to meet either
over Skype/Zoom or we can set up a phone interview.

If you are not interested in participating in my research, I would be

extremely grateful if you could pass on this invite to any colleagues of yours that
might be willing to take part.

I can be contacted by email: katiedobosz@gmail.com

Kind regards,

Katie Dobosz

62
Appendix. 3 – Information Sheet

63
Appendix. 4 – Consent Form

64
Appendix. 5 – Demographic Sheet

65
Appendix. 6 – Interview Schedule

1. What does silence mean to you (therapeutic space, personal life)? How comfortable
do you feel around silence?

2. When did you first learn about silence as a therapeutic intervention? Training,
supervision, own clinical practice?

3. Can you tell me about your experience of silence in psychotherapy training? Was
silence explored as part of your training?
- If yes, how was it introduced and to what extent was it explored?
- If not, do you think it would have been useful?

4. Have you ever worked with a client who was silent?

- Length of silence, types of silence, remaining engaged

5. Do you tend to break the silence/check in during a silent period with your client?
- Can you think of an example of this (prompt)

6. Do you look at your client during a silent period?

- What do you find is the impact of this (prompt)

7. Have you ever used silence as a therapeutic intervention? Can you give me an
example?

8. What would make you use silence as a therapeutic intervention?

9. Can you give me an example of when silence was helpful in therapeutic work?

10. Can you give me an example of when silence was unhelpful to therapeutic work?

11. Have you ever been lost for words? Can you tell me about a time when you didn’t
know what to say next?

12. Have you ever experienced silence in your own personal therapy? How has this
shaped your ability to hold silence in your own practice?

13. Is there anything else relevant to this discussion that you feel is important to add?

66
Appendix. 7 – Transcript Excerpt with Codes

67