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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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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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Therapies

Being ‘Bullied’ in the Therapy Room

Whilst naturally getting caught up in Jonah’s distress & pain (link) I had forgotten that the bully(ies) is(are) also in need of support – albeit from an angle that’s perhaps not immediately appreciated.  

The thoughts in this article come from a psychodynamic understanding of individuals’ psychology and from a systemic understanding of relationships through my practice as a counsellor/psychotherapist.

Why might a bully bully?

I’d suggest that bullying occurs due to the bully’s projected hatred/disgust of themselves.

As we are all people who need to be loved, cared for, taken care of etc, we don’t like to think of ourselves as being someone who is incapable of being loved.  Whilst some of us do have these thoughts, others avoid such torturous ideas through a process known as a psychological defence.  I’d suggest such a defence’s purpose might be:

make sure that I don’t know about something that would cause me great pain if I were to become aware of it.

Being an unconscious defensive process, the bully psyche would be using projection to help the bully avoid recognising himself as being the person “in need” of being bullied.  I mean ‘in need’ as being the bully’s psyche’s conclusion of what to do with the psychological pain the bully is carrying: destroy.

The bullying process continues whilst the bully’s defence continues to successfully keep the bully from recognising that it is himself he’s attacking through bullying.

I’d suggest this is why, anecdotally at least, it’s said that bullying parents create bullying children – the pain is passed down from parent to child … as is the way to deal with it.

So, bullying is taking place and now we have two people participating in the bullying:  the bully (the initiating participant) and the bullied (the unwilling participant). The two have entered into a psychologically torturous relationship.

This relationship is why I suggest that both participants in the bullying are in need of help: the bullied because he (probably) didn’t see it coming, and the bully to help him understand (and then deal with) his own pain.

Like a hook-and-eye closure, both participants have something that makes the bullying relationship succeed; both are contributed (at some level) something to the bullying relationship. The bully contributes something so that he gets to avoid his own pain, and the bullied contributes something for the distress to take root.  The bullied acts out the distress that the bully causes (and which may also be the distress that the bully himself is hoping to dispose of – psychologically he’s done it successfully by physical means).

Psychological “Bullying” of the Therapist.

Therapists in the therapy room can also find themselves bullied – but it’s those who work with unconscious processes (psychoanalysts, psychotherapists & psychodynamic counsellors for example) that will struggle use understand their experience of the bullying process (sometimes a very subtle process, not clearly an attack or bullying) to empathically help the bully come to understand what they’re not aware of doing.

Whilst there won’t be physical torture (discharged by the boundaries & contracting at the start of the therapy), through unconscious processes called projective-identification and counter-transference, the therapist can find himself under various forms of mental and emotional attack.

Attack through unconscious processes.

Over my decade+ of work I have found myself:-

  • Feeling as if I were going to be physically harmed by a client.
  • Have vomited after a client’s session.
  • Being continually contradicted, put right, getting the impression I rarely get things right, but the client still comes to sessions.
  • Felt attracted to a client that I would not normally have been attracted to, then shortly afterwards feeling rejected (though I have not acted out the attraction).
  • Felt inadequate to a client, no matter how I tried to be helpful.
  • Whilst listening to a client tell me how wonderful things are in his life, I have felt utter rage and and a sparkling, tingling, need-to-do-something feeling in my arms and wrists.

Just a tiny set of examples – and you may notice how often the word ‘feel’ crops up in these examples where I’ve ‘felt’ that I’m coming off worse as part of the therapy work.

Plus – I’d like to reiterate that these responses, whilst very much in my conscious experience, are hypothetically in response to unconscious material being received from the client.  The client isn’t sitting there consciously sending me “be sick” thoughts.

Part of my responsibility as a psychodynamic therapist is to struggle to understand what sort of responses I’m privately having with a client.  It is not my usual practice to reveal my responses (my counter-transference) directly – although this can be appropriate too (an article for another time).  Instead, I will work privately on understanding my responses, my feelings, so that I might gain an understanding of them in the context of the patient.

If I am feeling as if I were going to be physically harmed by a client, perhaps I am receiving an unconscious communication from the patient – something being communicated about the very real alert about harm. 

Sometimes de-attributing ownership of my feelings/thoughts can be helpful:  re-framing my fear that instead of thinking…

‘I’m afraid that my client is going to harm me’ 

…I re-frame this into something like:

‘someone is afraid that someone is going to harm someone’.

This can lead me into wondering if my client is in fear of being harmed by someone – someone else, themselves, me?

Preparing to share an interpretation.

When I’m ready to offer an interpretation of my counter-transference, I find Winnicott‘s ‘spatula’ concept helpful.  Donald Winnicott, worked as a paediatrician (and later a psychotherapist) the 1920s to 1970s.  He found that when he offered a tongue-depressor (‘spatula’) to a child and allowed the child to discover the spatula for itself, the child would invest more play into the spatula than if Winnicott had indicated the spatula to the child. 

When discovered for itself, the child might invest in the spatula becoming an aeroplane, a giraffe, a car … or just something that could be held in the hand and waggled a lot! 

When I offer an interpretation of my counter-transference to a client, I allow the client to try and discover the interpretation-meaning for himself (and if he takes no interest I wont force the issue).  I might say something like this:

Y’know, I’m a bit puzzled by something;  you see whilst I experience a man who seems perfectly capable to take part in the world, you’re effective, you take charge, you get things sorted out, I’m still left with this puzzling sense sometimes of someone who’s… I’m not sure … maybe concerned of being harmed himself?  …of being vigilant for attack sort-of-thing?

(I’m aware that my style can sometimes come across a little like stage spiritualists perform: ‘I have the name John – does anyone here have someone called John in their lives…?’ – and perhaps we are using a similar psychological technique of laying out something for someone to discover for themselves).

As I offer my interpretation, as I’m offering my ‘spatula’ to this client, I’m trying to allow him enough space so that he might pick it up and play with it himself.  If my counter-transference is accurate (my sense of feeling afraid of being harmed) then the client may invest in what I have just said and flesh it out.  If my counter-transference is not accurate (or I have just hit an area that the client is not ready to go into just yet) then the client may tell me he doesn’t know what I mean, making no investment in the interpretation at all.

In offering to understand the sometimes-terrible experiences that I will get from some clients, I’m working to get to a place where I can invite the client into be curious about what they might be responsible for.  Usually this will be in the context of the problems that they are talking about in therapy – and sometimes what I have to say challenges the client’s beliefs.  I try and do this with empathy … and without necessarily telling them how I am being impacted upon (we’re here to understand the process, more than we are to watch the content).  At the same time, because I’m challenging the client’s defence when I do this, the client may wish to strengthen the defence and not wish to take responsibility for their unconscious part in this interaction.  This will be OK. 

But often I find I have allowed a client’s door to be opened a little further and more details about the client’s reasons-for-being-in-therapy come out.  All this from working to understand the impact a client sometimes may have upon me.

In Closing.

Bullying has purpose. 

When we’re faced with bullying we quickly recognise the pain that the bullied are suffering and our attention is pulled towards those who are suffering (incidentally, also neatly turning our attention away from the pain that the bully may be projecting outwards too – neatly falling in line with the bully’s unconscious intention).

I’d offer you the thought that the bully is in great need help and understanding too.

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FAQ

What if I Miss a Counselling Session?

Missed sessions happen from time to time. Sometimes you cannot attend due to appointment clashes, sometimes a situation occurs that makes attending impossible, sometimes you might just simply have forgotten that we had an appointment.

If you need to cancel attending a session: simply contact me to let me know.  If we have an ongoing weekly agreement for counselling, or you are a member of a group, your next session will be available for you next week as usual.

Missed appointments & Fees.

If you miss a session without notice, your next planned session will still be available for you the following week (excluding any vacation or planned absences that either you or I have previously discussed & agreed upon, for up to a maximum of two missed sessions).  This is because of our contract to meet weekly.

Concerning fees, we will already have discussed this policy during our initial meetings:

  • The full session fee is payable if you cancel the session within forty-eight hours of the appointment time, or if you do not attend your session having given no prior notice of your absence. 
  • Half the session fee is payable if you cancel the session with more than 48 hours notice.
  • No fee is charged for the first four sessions that coincide with your planned holidays.
  • No fee is charged for my absences – planned or otherwise.
  • Bank holidays are not charged.

Unusual exceptions will be discussed in session.

Being Late for a Session.

If you are going to be late for a session, please try and come anyway.  For a planned session, I will always stay at our meeting location for the full session.  When you arrive we’ll make use of what time is available, though cannot extend the session time due to the next person’s appointment.

It might be helpful if you leave me a voice or email message if you’re going to be late but are on your way (I check both services before sessions – and during a session time if an expected-client does not appear without prior notice).

Repeated absences/lateness.

If you find you are repeatedly cancelling, or missing sessions, it will be worth us having a conversation about what might be happening for you (anxiety, needing to end counselling, feeling that the counselling is not holding you well etc).  This behaviour might be an unconscious communication that we both might find helpful to talk through with an air of interest and curiosity.

DNA.

For clients who stop attending sessions and don’t tell me what’s happening (Does Not Attend, or “DNA”) – I will reserve your session for up to two missed appointments.  Afterwards, if I still have not heard from you, I will not reserve your session day & time and release it to become available for someone else.  I will also let you know that this is happening.

You can always contact me again to resume sessions in the future by contacting me.