Silent Sessions

I am going to talk, hmm type, about a part of therapy, well a few parts. The quiet parts.

Establishing goals in therapy is important, they can be long range or short term. Goals will change as therapy progresses, often hurdles need to be overcome, so the goals change to help with those hurdles, progressing toward the initial or primary goals we established.

As a therapist we see the goal and know how to reach it, we can just say to the patient, do this, this and this, stop doing this this and this. But this will not achieve anything. It really is not that simple.

Therapy often proceeds at a crawl, slow steps, as many forward as possible but with the understanding there will be many taken backwards too. Therapy is often a retraining, this does not occur overnight.

There will be times when it seems there is no advancement at all.

Sessions become silent

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Striving to reach the set goals, patients may try to please the therapist, tell them what they think they want to hear, perhaps not tell them when issues or items brought up in previous sessions may be tormenting them, so as not to upset their therapist. This quickly grows into a large thorn in therapy. The patient wants to please, often there are fears of abandonment that are very powerful. In therapy with personality disorders, this is much more of a likelihood. The patient fears their therapist will fire them, so they strive to please. If something came up that was upsetting, they may skirt around it, if comments the therapist made upset or were misconstrued, they may not question. They often will not revisit an issue that they felt the therapist may feel was covered, even though it is still tormenting them. Some issues may not be brought up at all, for the same reasons, they may be similar to something previously discussed or they may feel they will be upsetting.

Therapists will, or should, sense when this occurs, when the patient is trying to please, reassurances must be made that the therapy is not about the therapist, there is no set speed set to reach the goals, the goals may never be met, other goals may appear that replace the initial goals. Allowing the patient to lead toward the goals, resistance is not as likely. They discover at their own pace, sometimes blisteringly fast, otherwise not. Though it often appears this way, therapists do not read minds. Sometimes it may be difficult to know that an issue is still bothering the patient/client, the patient may appear to be off, but the reason will be eluding without clarification. The therapist will ask what is bothering, but the answer is not always forthcoming, being asked what is bothering may force the patient to tighten their mask, the therapist seems to be upset, so it is time to work harder to please, appease, so as not to upset.

Therapy will often stagnate when this occurs. Pause, stop, stall, freeze.

We can also encounter resistance. A stalling, but something different, the patient wants to continue but seems unable to. those long silent periods where the patient struggles, they felt it has all been said. There can be many reasons for this too, but… this is not a bad thing. It does occur often. When the blockage is removed therapy often leaps forward.

The therapist needs to not lead the patient, leading can occur many ways, it is important for the patient to discover on their own, at their own pace. The patient pulls the therapist through discovery, if the therapist leads, they can cloud or shape discovery. Even tiny suggestions can send the patient off in the wrong direction. 

Resistance can also indicate it is time to dig deeper. Often with therapy this is not necessary. In cases of child abuse or missing memories, leaning coping tools, learning to control anger and redirect it, learning to adjust or curb emotion and emotional responses and much more, can eliminate the need to dig into memories. It is not always necessary to visit each one.

There may be times though, when a memory needs to be released to address an issue that is tormenting the patient, perhaps they know of it, suspect or perhaps not at all, the memory may be blocked or held by different parts that have not been forthcoming. Resistance can occur when the patient does not wish to relive those memories.

Resistance or a stalling may occur for reasons outside of therapy, outside pressures may have changed, they should be discussed. 

Resistance may be felt when there are no goals to work toward, suddenly the patient realizes this. Without goals, how does the patient judge how effective therapy is for them. Goals must be however, agreed upon by both the patient and therapist. 

Some therapies, CBT as an example,  involve “homework”. When the patient shows up for the next session, having not completed or tried to do the homework. Therapy stagnates. Not all exercises can be accomplished in sessions. Practicing the tools taught are necessary. When failure occurs, or triggers occur, this is a good thing, the patient can then go back and explain what happened, the patient and client can work through it. We learn from failure. When no attempts are made, there is often nothing to discuss in a session. The reasons for not doing homework can be explored of course, and should be.

Sometimes patients know more than their therapist… or think they do,  or they can feel inadequate before their therapist, So they argue more, question more, the sparing becomes a game of sorts. The therapist can be seen as an authority figure, and many do not get along with authority figures. Many that have histories of abuse resent not being in control. If the therapist can offer choices rather than giving direction, this can be overcome, allowing the patient to choose, to direct the way therapy continues gives them the motivation to try.

As therapies continue, and patients overcome issues they realize they can now do things that maybe they could not do before, but this still can cause anxiety, so they may resist the healing, they do not really want change, or to go where triggers existed before or see an end to therapy. Change is often not welcome. Sometimes it indicates therapy is over, the patient, in truth, has healed, or has the tools to continue to cope on their own, it is time to let go, or to schedule less intensive sessions. 

Not having the “full story” can cause therapy to stall. If the patient does not mention some key part of their past or present life, something that happened or is happening, the therapist can’t provide help or may be providing the wrong help, possibly becoming frustrated with the patient for not trying something.  An example may be the therapist suggests a walk around the block, the patient doesn’t mention the bully that lives downstairs that torments them when ever they pass. The therapist becomes frustrated or may appear to the patient they are frustrated, that the patient will not attempt to go out, to test learned skills at overcoming anxiety.

Silences in therapy will occur, today the patient is just not going to talk or bring forth, personal reasons may be limiting this at this time, reasons the patient does not feel relative or willing to discuss. Rather than having a silent session or one filled with inane chatter, the session can be used as a review, comparing progress to goals that were set, how some may have been met. Reviewing basic techniques that were taught, judging their effectiveness.  Sometimes this will release the blockage or make aware a new goal.

Discussing the silence is important, more so if it continues into the next session. The questions that the therapist probes with will be annoying, discussing this in advance is healthy, to reassure the patient that blockages in therapy are not uncommon, lets try to see why this one is here, try to answer the questions positively. I don’t know… is not a great answer, though this may be the case. It should be viewed as we have encountered a blockage, not you have. The session can begin with the statement from the therapist, I am going to probe with questions that may annoy you, you can show your anger with me, I can take it, it also may help us realize where the blockage has originated. I will not become annoyed with you nor am I now. Reassurance is important.

Fear can create a blockage to therapy, fearing to relive the memory or fearing to fail. Failing at remembering, or failing at coping with the trauma or techniques. The assigned homework, or the entire therapy program. To go through all of this, and not to heal. It is good to discuss this fear with the therapist, many fears are unfounded, though they may be powerful. Allow the therapist to help, this is why the therapy exists. Therapy must be a safe place, where those fears can be explored. 

Fear is a strong emotion, anger is another that can inhibit therapy, preventing someone from speaking. Rage can build to the point that the patient knows if they say anything, it will be emotionally driven, unproductive. Reliving an experience can build this rage. Frustration builds. This may occur in a group setting more, when another patient discusses something, that awakens a trigger or memory for another patient, or they may remind them of a tormentor or the way a tormentor acted, being bullied feelings may awaken. In group this may be harder to overcome. It should be followed up with the patients therapist one on one, what awakened the trigger that caused the intense emotion/s. 

Resistance or a blockage can occur when a major issue/memory/trigger is close to being discovered by the therapist, the patient may fear its release and build walls, known or unknown.

Transference can also cause this striving to please the therapist, or limit interactions.  This can occur on many levels. The therapist may be visiting unpleasant memories, the patient starts to associate the bad memories with the therapist. It becomes difficult to discuss anything with them. Transference is when, feelings, emotions, thoughts become transferred to the therapist, this begins unconsciously. The therapist can become the tormentor of the past, other feelings can transfer as well, love as an example. The feelings become stronger not to do anything to upset the therapist. Attachment issues and dependency issues form, the patient may want to contact the therapist more, to see them more.  The thought of discussing this brings them feelings of shame. Fear not, this is not something new, talk to your therapist if this occurs, it is not likely the first instance of it for them, you can work through it together with honesty and openness. 

There are many methods to overcoming the silent sessions. Discussing the silence is important. Sometimes it is as easy as playing word association games, the first thing that enters your mind you blurt out. The resistance leads to undiscovered territories that can be explored.  

Often the patient is just unwilling to allow the therapy to help, they don’t wish change. It is very easy to say, that won’t work so I won’t try it, or I tried it, but it didn’t work. Failure is how we learn when it doesn’t work we need to revisit to see why, few things will work with the first attempt. 

There is a lot more to this, and depending on comments I may explore this more.

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About sensuousamberville

I am a Practitioner, teacher and student. I think we should always be students, we should keep our minds open, to continue to learn. :-) Now a mother of two little ones.

11 responses »

  1. Lots of good info on getting through those stuck times. Things I relate to, and things to think about. Personally I prefer silence… on my part. As long as the clinician keeps talking and I can keep quiet, its all good. For some reason she seems to want it the other way around 🙂

    Reply
    • lol yes, I can see how she would want it the other way around. There are many more ways to get through stuck periods. We all have times where we don’t wish to talk, day to day lives are like this, some days things can happen, we don’t wish to talk but we have a session booked, so we go to listen. Sometimes though, if we discuss what makes us not wish to talk, and this is harder, we can discover. Leap ahead too.

      Reply
  2. Wonderful post amber. I’m reading this from my bed and typing on my phone 📱 is not the easiest thing. I will be back tomorrow coz there is a few things I would like to say and maybe the odd point you could perhaps clarify. Some part s made me feel a little queezey but that just proves they mean something. I hope iam not closed off to some of my therapy. Sometimes it might take a while for the penny to drop but hopefully never stagnant.💃🙋✌💤

    Reply
    • I an sorry parts of post struck you so deeply Cat. We can work through that though. Leap ahead perhaps.

      Reply
      • Parts of the post did resonate, but certainly not in a bad way, very positive in fact.

        I would agree that goals, including opinions, do change as we progress through therapy. When I look through old posts and therapy notes, I often think ‘did I really think that?’

        What you said about it not being necessary to trawl through all the traumatic incidents from childhood is very true (for me, anyway) and is one of my big surprises in therapy. Sitting with and observing the emotion is where most of my own trauma started to dissolve, although it still leaves hurt and anger to deal with…..um

        The transference doesn’t happen so much with Paul, but it does with the group Therapists and members are particularly challenging.

        I googled ‘stuck in therapy’ a couple of weeks ago and up popped ‘resistance’ and my experience is resisting the emotion. This is what scares me the most in therapy. After so long supressing feelings, it’s difficult to know how to experience them while in a session.

        Paul and I get along very well and in the past months, there has been little time for him to contribute, but lately, he has had a lot more opportunity and does not seem to want to sit in silence. I first noticed it two sessions ago, but yesterday he was not so bad. Don’t get me wrong, everything he says is usually a reflection of what I say or he is checking out his own interpretations. However, questions are never part of our session. I don’t feel it’s my place to ask him to start asking searching questions (who knows, maybe MBT discourages this), but I can’t allow him to talk so much and will need to say at our next session. I don’t have a problem with that because I trust him and his response. It’s not something I would allow to continue indefinitely, especially since reading your post about stagnation etc

        Sorry for such a long comment, but I appreciated the time you took to write this post, thanks

      • MBT’s focus is on the now, not the past. To learn to cope with your reactions, feelings that may be misconstrued and reactions in relationships of any kind, interactions. Simply to help learn to “mentalize” as with personality disorders, this skill is not as powerful which leads to “emotional regulation” difficulties.

        It is understood that this skill, which is learned during what I often refer to as the formative years, is often corrupted. Abuse or trauma is often a chief cause. Abuse of any sort. The goal with MBT is not to trod though the past, but to relearn this skill.

        So Mr. Cat, here is where you may be now. As with the group setting, you are more involved with interpersonal interactions, these can bring on emotional responses, for you anxiety and anger may simmer or boil over. You are changing, your sense of self is being reorganized, your perception of responses and feelings is becoming more aware to you. You are adjusting to this change, but it leaves you uncomfortable. You may be struggling understanding responses you feel or how you perceive others feel. The group setting may be designed to have more release of triggers, for this is how you learn, practice and grow, by coping with these triggers that the group brings upon you, and the others. In short, if it is not too late, you are being overstimulated whereas your ability to cope is tested and overwhelmed to a point, which raises your deeper emotional responses, anxiety and anger. Confusion perhaps to why someone responds they way they do, or what their goals are in what they say, ask or do.

        Transference with the group therapists too, as they are provoking more emotional responses perhaps. They will be threatening your comfort zone. So you are resisting the change to what took decades to learn, but also resisting the emotions which are somewhat alien to you, they force you to leave your comfort zone, which perhaps was to zone out when faced with similar triggers?

        You are very welcome Cat. 🙂

  3. Hi Amber, It’s weird I kind of come to your page and think of Katie, strange!
    Ever since she died I’ve always held her in my heart and I know how much you meant to her.

    Anyway, I’ve always struggled in therapy especially when I’ve been hospitalized. For your exact reasons…other peoples misfortune triggers a past memory, never good one!
    I’m well at the moment and haven’t seen my shrink for about 4 months. He encourages me to have therapy with a psychologist, but I won’t. Not because I’m stubborn more that I won’t to try and keep moving forward. To me, talking about it whilst may be good and beneficial to others…brings me down further and my recovery takes a great deal longer. I have actually seen psychologists over the years and this is why I come to this conclusion, for me.

    Same applies to the CBT therapy. You could say when I’m in a good place I think about it from time to time, but then I get put off with the fact I’m well and don’t want to regress. I’m 47 yrs old now and to the this very day my past can haunt me and drag me to places I don’t want to go. Having Bipolar, BPD, Anxiety Mood Disorder and mild OCD certainly doesn’t help the issue. Some people don’t understand how your past can still affect your future from time to time, but my only comment to that is that I’m extremely happy for them that they obviously haven’t experienced that type of trauma to know!!

    I enjoyed reading your post. Hugs Paula xxx

    Reply
    • Katie was very special, her comments are all through my posts, I often reread them, I exchange emails with her daughter who is also very special and quite a bit like Katie. Katie asked me once, to stop by your blog, she was worried about you.

      kk, so I will be biased a bit, for some reason lol, but CBT could strengthen you more than set you back. The saying… make hay whilst the sun shines comes to mind.

      Your past will have a very powerful pull on your present, whilst you do not have to revisit the past necessarily, you can learn tools to help cope when it rears its ugly head.

      I am glad you are in a good place now, you were absent for a while and I was wondering. Keep strong please!

      Hugs 🙂

      Reply
      • Thank you! She truly was something else.
        Who know’s maybe one day I’ll finally to the course and shock everyone. Lol
        Thankfully right now I’m doing okay. xxx

  4. Oh I miss her. Reading about her makes me smile. I go back to her comments every now and then too, I smile some more.

    My friend and I were talking about therapy the other day.. we talked a lot about fear and why the therapist has to make it safe to talk about anything and everything. I learned a lot. Loved your post.

    Reply
    • Visiting memories or triggers can be very fearful, so yes it must be safe, Calming exercises must be learned before hand too, I suspect you are very good with those as they will relate strongly to meditation. You could help her by teaching her some of those techniques too. 🙂

      Reply

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