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Silence in Counselling

When having nothing to say…

I’ve heard it said in session:

“I can think of anything to say…”

Followed, sometimes, by variations on:

“… this must be a waste of time.”

Let me show you silence.

It’s a short video; I recommend you watch all of it from the beginning for the context to make sense, but draw your attention to 1:19-onwards…

https://www.youtube.com/watch?v=CAID_2iKO5Y

… communicates so much.

Is it not normal that these two individuals are still communicating during silence?

That the encounter between them brings up feelings, thoughts, questions, memories, concerns, perhaps somatic symptoms (physical sensations due to emotions)?

Is there really nothing going on in silence; that it’s a waste of time?

Use of Silence in Counselling.

When the client is silent in a counselling session, as the counsellor I’m busy working.

I’m still listening…

  • Listening to the quality of the silence; is the client thinking… or blank…
  • Listening to if the client working or waiting (for me to speak?)
  • Listening to myself & how I’m responding to the silence (counter-transference).
  • Listening for unconscious communication.

For example: if the client is telling me that silence equate to “nothing” or a form of “worthlessness”, this may be an opening to hold a conversation about what “nothing”/”worthlessness” means to the client (i.e. the client’s unconscious has find a way to communicate to me something about its concern around the topic of silence and what it may symbolise for the client).

Silence – whilst it may be understood to the client to represent a waste of time, it’s an opportunity for the counsellor to invite a conversation between the both about the concern.

Comments below 😉

 

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Telling the Client what they Don’t want to Hear

Clients come into counselling often due to some form of conflict (which some of us call the “Presenting Problem”).

The conflict may appear obvious (“My partner doesn’t like this about me…”), or the conflict may be at a deeper, as-yet-not-understood level (“I don’t seem to have any friends…”).

When I listen to a client tell their story ~ no matter if it’s at the beginning or during the work ~ I’m not just listening to the words of the story, I’m also listening to my internal responses to the story. I’m listening to how my emotions are reacting to the story, I’m paying attention to if my body is responding to the story. In addition to listening with my ears, I’m “listening” to how everything else apart from my ears is receiving the client’s story.

In other words, as a psychodynamic counsellor I’m paying attention to my counter-transference.

How does counter-transference help?

Some counsellors’ approach is to pay attention (only) to the client’s story, reflecting back (summarising, paraphrasing) portions of the story so that the client may gain some benefit from feeling understood. There is merit and rationale to such an approach.

However, by paying attention to how I am responding at different levels to the story, I’m later able to invite the client to go to a deeper level of understanding. To go deeper in understanding parts of the story that the client is not (yet) consciously aware of. I use the word “invite” quite intentionally, as invitations may be declined as well as accepted.

Counter-transference – an analogy.

For those who are unfamiliar with a counter-transference experience, I might describe the different parts of me that are responding to the story (my “counter-transference response”) as being like when a tuning fork is placed on a surface. Without the surface, the tuning fork makes nearly-no audible sound when it is thumped into life. But, when a thumped-tuning fork is placed upon a surface, the tuning fork begins to be heard quite clearly. In a way, to use counter-transference in counselling, the client is a tuning fork, I am a surface upon which the client touches, and I help the client to notice the client’s “sound” previously not heard by him… until he “touched” me.

 

Distinguishing Counter-transference from Personal Material.

In the past, I have heard some other counsellors express:

…the anger I felt was the client’s, not mine.

The counsellor is saying that they felt angry (whilst working with the client) but that the anger did not belong to the counsellor; they are saying that it was the client’s anger they were feeling (in Melanie Klein terms: the anger had been “split-off” and, through projective-identification, the anger had been dismissed from the client and “placed” within the counsellor).

…except (in this example) this form of explanation seems to dismiss the counsellor’s own role within the therapeutic alliance. Almost: “that’s his anger, nowt to do with me, guv!”.

It is my position, as a psychodynamic counsellor, that I must have something previously established within my mind that is available to resonate with the client’s (unconscious) material. So, tuning fork-like, the client’s stuff and my stuff combine to produce a “note” that, to my mind and/or body, seems to “sound” to me like anger.

Again, continuing with the example of anger, my struggle when I notice such feelings within me (and that the client appears not to be expressing or feeling) needs some thought:

  • could this anger that I’m feeling be my anger, and mine alone?
  • could this anger that I’m feeling be resonating with the client’s anger (counter-transference)?
  • a little from column A, a little from column B?

 

Feeding back the counter-transference.

Having received different shades of the client’s story: verbal (conscious), counter-transference / projective-identification (unconscious) , how might I use all of this together to assist the client.

Various authors have written about different approaches.

  • Some are subtle (eg a Donald Winnicott-style of leaving a spatula to be discovered):

…you say that women don’t find you attractive, but I imaging that some women do.

…suggesting that the counsellor is feeling an attraction to the client, but is not stating this overtly. The “spatula” technique is to place something (such as a verbal intervention) in front of the client for him to “pick up” and play with as he sees fit, or to not notice it or to even actively ignore it. It’s up to the client to decide what they make of the counsellor’s intervention (the “spatula”) – see Spatula Game

 

  • Some are more overt (e.g. Karen Maroda – relational style psychotherapy):

…you say that you’re feeling happier today, and you’ve asked me how I am, so I’d have to say that I can’t understand why I’m feeling furious; quite differently to you. Shall we talk about this difference?

…the counsellor has stated different feelings to the client, and is inviting both of them to wonder about the difference (possibly the counsellor is capturing a split-off emotion from the client).

 

  • Some are positively challenging (e.g. Habib Davanloo – Intensive Short-term Dynamic Psychotherapy)

… you keep saying “I don’t know” to my questions, but I think you really do know, otherwise you wouldn’t be sitting in front of me waiting for me to tell you what you already know.

…suggesting that the counsellor is inviting the client to address a defence (denial?) by challenging a real experience between them both.

 

My own approach to using counter-transference varies between these examples depending on such factors as:-

  • The strength of the therapeutic alliance (early days I may take the subtle approach, later days I may take more overt approaches).
  • If I unsure that what I am experiencing may be more counter-transference or more my own personal material. This would be a discussion to go into supervision.
  • If the client has made an overt request to learn about their behaviour and impact upon me. I no longer entirely hold to the psychoanalytical tradition of saying nothing about myself (at least in the context of the therapeutic alliance).
  • How active are the client’s defences. Use of Patrick Casement’s internal supervision & trial identification concepts can be useful here.

… a deciding factor can be: can the client “digest” this “food” that I’m offering (and if he “spits it out”, what might he and I do with the regurgitation).

And even that (the regurgitation) is grist for the mill; worthy of a conversation:-

You asked me to tell you how I experienced what you’re telling me; when I did, you rejected the experience. What do you think may be happening between us just now?

 

When the client won’t hear…

A supervisor once suggested I offer an intervention to a client, and I responded: “But I’ve already said this”. Her response was: “What makes you think you offer it only the once?!”

The point of this exchange was that in counselling (we hope that) the client is growing, and at later times may hear what he has been unable to hear before (or heard in a different way to before).

So, when I offer back a counter-transference-informed intervention, the likelihood (being that the intervention is formed from unconscious material) is that the client may not be ready to hear it if my delivery it too early or misjudged. And that’s OK.  An inability (or a refusal) to hear may be import to keep the material “outside of the consciousness” right now. Should such a rejection occur, I’ll consider whether to look at the rejection or shelve the intervention for a later stage, and may not make this decision by myself; each client’s needs and each therapeutic alliance will be different.

The client may not wish to receive back that which they’ve dismissed into me (for safe keeping, perhaps).

 


 

In short, counter-transference is a process which a psychodynamic counsellor may use to help a client understand parts of themselves that, through their internal defences, they are unable to consciously appreciate.

The choice in technique of counter-transference interpretation will depend on any combination of the counsellor’s skills & empathy, the therapeutic alliance between counsellor and client, the client’s (in)ability to tolerate what they hear, and the counsellor’s respect that sometimes the client does not want to hear what they have just been told.

 

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About Counselling

Why I charge the full fee for DNA’d sessions.

Different therapists will each have a different rationale for their counselling session fees, and what they do when a client does not appear for an arranged session,

With respect to a client not appearing for a session with me (giving no warning): I charge the full fee for that session (and charge a half-fee for sessions cancelled with notice).  This arrangement is put in writing at the beginning of the clinical work so that the client is informed.

Now, you may think that the absent client aught not to pay for a session that they do not/could not attend.   After all, the client was not actually there for that session.

But… I was still there for the session… the whole of it… and I stayed there with the absent client

Read on for a more full rationale that informs my approach for missed/DNA sessions…

Paying the full fee for sessions not attended.

In a client’s absence, I will still be working during the session:-

  • I will sit in the room with the client’s empty chair.

     Sometimes a cigar is just a cigar.

…apparently Sigmund Freud said this… but other sources say he didn’t 😉

What this phrase means that sometimes therapists who work with the unconscious may interpret evidence… when actually the interpretation is a bit of a miss and a literal understanding may be more appropriate.

Freud’s attributed quotation, above, is referring to how the cigar may be interpreted to represent (say) a penis. Sometimes this interpretation may be accurate (the man who always takes out a very large cigar from the box may be compensating for the small penis… or whatever the “penis” represents for him: lack power, potency, etc.) and sometimes the interpretation may not be accurate (the man simply likes large cigars).

So, baring this in mind…

 

  • I will contemplate my responses to the client’s absence (otherwise called “counter-transference”).

As human beings, we often effect other human beings.

Something we might say something like “he made me so angry” – and what we mean by putting it this way is that one person effected anger in the other.

It works a little bit like a dance (an actual one… two… three… physical dance): if you pull me towards you then I’ll feel that pull; your action resulted in my reaction.

It’s similar with emotions.

If I sit there and contemplate my emotions around the client’s absence (my “reaction”), this might help me understand what might be the client’s part in the dance (the client’s “action”).

Do I feel angry at this absence? Abandoned?

Am I feeling relieved? Was this following a difficult session?

Am I puzzled? Was I expecting this?

This pondering about my emotions can help me begin to appreciate maybe what the client’s “pull” on me may be asking of me… begging me… to understand. Something that, maybe, the client’s conscious mind cannot tell me.

 

  • I will ponder about what the absence might be (called unconscious communication).

Sometimes a DNA (“Did Not Attend”) might be about communicating something that could not be said in words.

Thinking this over can assist me in understanding a little about what might be happening for the client unconsciously (e.g. something that the client cannot put to me verbally, or if the client might be acting something out that wishes to be understood by someone).

Maybe the client became angry with something I said in the last session, but the client can’t tell me.

Maybe the client and I are going at a pace that’s too much for the client, but the client hasn’t been able to say “I want to slow down”.

 

  • I will look over my case notes.

It can be useful to read my notes from the day we started up to today’s session. Maybe there’s something I’ve not seen or have not been looking at since it appeared on the first day.

Perhaps the day of the absence is significant: could be an anniversary that’s important to the client, for example.

Maybe there’s a pattern forming with the client’s absence that the client and I have not paid attention to before.

  • From time to time, I’ll check my email & telephone messages…

… to see if the client has left a message for me about their absence or late arrival. Sometimes a cigar…

 

What I won’t do during a client’s session time…

  • I won’t telephone the client / chase them up.

Unlike some other therapists, I won’t telephone the client asking them where they are.

Behind my rationale for this is

(1) It’s likely that both of us already know that they’re not here.

(2) It’s true that the client might have forgotten about the session – but telephoning them during the session time isn’t going to change that.

(3) I believe telephoning during a session time can risk being quite persecutory or shaming.  It also breaks a boundary (that during this time we work in the room together). Telephoning goes contrary to my approach to unconscious communication (if a part of the client is needed to tell me something important by an absence, my approach is to understand/respond to the communication, not react to it).

 

  • I won’t email you/write a letter to the client.

 … for similar reasons to the item above.  I may draft some thoughts for inclusion in an email or a letter as part of trying to understand an absence, but I will leave the writing/sending to after the session.

So, in short, whilst you might not be present for your session, your session is still happening in your absence, and I’m still working for you.

Boundaries help us identify conversations to be had.

Setting boundaries help us – the client and I – to identify when a boundary has been stepped over.  Without boundaries being there, we cannot know when a boundary has been transgressed.

Transgressions are an invitation to conversation.

Whilst I may say that “if you miss a session without giving notice, I will charge for that session”, I’m also saying that this is open to a conversation too.

There will be exceptions to boundaries – and we can talk about those as they happen.

Boundaries aren’t meant to punish (although some of our childhood experiences will tell a different story); in counselling they’re there for safety, for containment and to help the counselling work.

Clearly, I may never receive the session fee for a client who has abandoned the work. If the client has left our counselling relationship they will have their own views and perspective about their absence, and we can’t talk about it of course (the client won’t be coming to see me any longer). So even through the client got a full session in their absence, I will be at a financial deficit and may well have to absorb that loss (rather than repeated chase up for it). It’s my position that containing this “loss” is an appropriate approach.

Reading Bion and Winnicott are helpful authors for a more detailed resource for my approach who are interested in learning more.

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About Counselling Articles

Absorbing People’s Emotions

This article from The Mind Unleashed talks about how to prevent yourself from absorbing other people’s emotions: http://themindunleashed.org/2014/06/stop-absorbing-peoples-emotions.html

Those of us therapists who include notions of counter-transference & projective identification/introjection in our therapy work actually make use of clients’ emotional affects upon us…

psychodynamic therapists use these phenomena to effect change in the client. We digest what unconscious emotional signals we “receive” from client (or what of our own emotional makeup may be triggered by the client’s story), try to understand it, then offer it (discretely) back to the client if the client is able tolerate it (and postpone further offers if the client rejects it).

This way of working comes from theoretical works published by Melanie Klein, Wilfred Bion, Donald Winnicott and others.

But – with the more skilled therapists – as a client you’d not be aware of this process going on, other than maybe noticing just how much your therapist seems to “get” you.