Tuesday, April 12, 2016

When Silence Speaks

Emma settles into the chair across from me, takes a deep breath and speaks quietly, slowly, deliberately. She’s telling me about her week. Her son is excited about his softball team, her daughter is anxious about her upcoming school play, her husband is away on a business trip. “That makes it easier,” she says.

“It makes what easier?” I ask.

“His being gone. I know it’s terrible to feel like that and I know it’s not his fault, but it’s easier.”

“But what’s the ‘it’ that’s easier?”

There is a long, profound silence. Emma sits motionless. Although I’ve only seen Emma for a couple of months, I’ve become familiar with her stillness.  

“I’m trying to decide whether I should take the children out to dinner tonight,” she finally says. 

I’ve also become familiar with Emma’s tendency to avoid answering questions and to switch topics, often to something banal, almost as though there was nothing we had been discussing. 

“What just happened now, Emma?” I ask. “How did you get from it being easier when your husband’s gone to taking the kids out to dinner?”

“If I’m going to take the kids out to dinner, tonight would be a good night. Before he gets home.”

Yes, I think, but she still hasn’t addressed what makes it easier when he’s gone. I consider pushing, but find myself reluctant to do so.  

Another profound silence ensues. 

“Do you ever take vacations?” she asks suddenly.

“Yes, I do. Why do you ask? Do you feel anxious about my being gone?”

Another long silence. “No,” she says with a nervous laugh. “It would be easier. I wouldn’t have to think of what to say.”

“So it’s easier when your husband is gone and it would be easier when I’m gone.”


“Speaking is obviously very difficult for you, Emma. What happens when you sit in your silence? What are you thinking? What do you feel?” 


Emma’s silence, her non-responsiveness, her tendency to talk about apparently inane topics. None of it makes me angry. Sometimes bored, sometimes frustrated, but generally I hold myself still along with her. It’s like feeling frozen. Emma has told me a little about her background. She was the only child of a religious family who lived in the rural Midwest. Her father was extremely depressed, often unable to get himself to work for weeks at a time. Her mother was an angry, embittered woman who reached for the belt for any minor infraction.

“Emma, what about as a child? Was it difficult for you to speak then too?”

Another nervous laugh. And silence.

After a while I ask, “Can you say what you’ve been thinking during the last couple of minutes that you’ve been silent?”

After a while she responds, “They’re images.”

“Can you tell me what some of the images are?” I say gently.

“Cornfields. Sunflowers. My mother. It’s cold.”

I flash on a patient I saw years ago who, as a child, was punished by being left naked in the storm cellar. I wonder if Emma was similarly abused.

“Can you tell me about your mother, Emma?”

“She was mean. She hated me. She said I was the devil’s child, that she needed to beat the devil out of me.”

“What kinds of things did she beat you for?”

“Everything. Not getting up at exactly 6AM. Tracking mud in the house. Talking when she had one of her headaches. She always said her headaches were my fault. She never had headaches before I was born. That’s what she said.”

“You were terrified of her.”

She nods. 

“Did you ever feel angry with her?”


“You can feel angry with someone even if you don’t express it,” I say.

“She gets bigger.”

“I’m sorry?” I say, confused.

“The image. It gets bigger.”

“You’re saying that if you feel angry at your mother you see her image getting bigger?”

She nods.

“And you feel more frightened.”

She nods again.

“Is that what happens when you talk to me, Emma? Does the image of your mother get bigger, like you’re not supposed to be telling me things?”


“You know, Emma, you can always tell me to stop, that you’ve had enough. I’ll always respect your wishes. The last thing I want to do is be another abuser.”  

Silence. Then she says, “Maybe if it would be better if we didn’t go out to eat. It’s a school night. The children need to do homework.”

Although she can’t say it directly, Emma has clearly told me she’s had enough.


maxjustina said...

Silence can also be interpreted as Fear - that feeling that arose generally when you feel threatened by someone, especially over an extended period of time. Silence could also be interpreted and excess anger that make it difficult to speak to anyone about anything. Silence is used generally to plan the next step in relation to what is at hand.

The art of questioning the client by using few words could open an avenue for him or her to bring something to the fore, which could then be prodded by the couonsellor. Try not to allow the client to remain in silence. Do all in your power to being him or her to a point wherein the element of trust begins to raise its head and make the client breathe easire.

Linda Sherby PH.D., ABPP said...

Hi Maxjustina,

Thank you for your comment.

I agree completely with what you said in your first paragraph and not so much with your thoughts in the second. This patient's silence is definitely related to both fear and anger - fear of the angry mother who exists in her head and fear of her own rage which she has had to suppress her entire life.

But I don't believe that "prodding" a patient such as this could ever be helpful, but would rather be experienced as another form of intrusion and abuse. I agree that sitting in silence for an extended period of time is also not helpful for someone like her, but there has to be a happy medium between pushing too hard and respecting what the patient does not feel safe enough to do. Although you may be correct that she needs to develop sufficient trust in me to be able to speak, she would still need to get beyond her fear of the internalized mother who she carries within her.

Thanks again for your thoughtful comment.


Unknown said...

Very sophisticated account Linda. Congrats on your writing skills. Re the patient you're obviously better quqalified than I am being from a youth work background to interpret the behaviour you describe. However (I'm sure you guessed there'd be a 'however' or something similar) the whole process is disturbingly subjective in interpretation. Which can make interesting 'copy' but less useful psychology (I nearly said 'analysis' before remembering my academic antipathy to all things Freudian). It all reminds me of my 'method'as a youth worker using subjectivity/sympathy/empathy etc and retrospectively achieving some results. I think. But shouldn't professionals like yourself be just a tad more scientific both in thinking and method? Then again if I'm a lone critical voice why should you I suppose. Take the money and be empathetic.

Linda Sherby PH.D., ABPP said...

Hi Allan,

First, thanks for your compliment on my writing skills. Good writing is extremely important to me, so I do appreciate your commenting on it.

Second, analysis has gone way beyond Freud these days. I am a psychoanalyst, but not a Freudian.

Third, no, I don't agree that skilled treatment should be more scientific. I think that experience, understanding, interpretation and, perhaps first and foremost, the complex relationship between patient and therapist is what is most curative.

And fourth, yes, I do get paid for my expertise, for my time, and for my dedication to my patients. But if I did this work primarily for the money, I would have given it up long ago. I have been doing treatment for over 40 years and I hope never, ever to stop.


Anonymous said...

Thank you for your interesting and thought-provoking writing. As a therapy patient, I have experienced often the struggle to speak in sessions and I appreciate that the reasons for patient silence can be complicated and bewildering to both participants. Aside from fear from previous abuse or abusers, or from the uncontrolled release of strong emotion (anger, humiliation, hurt, sorrow and unresolved grief, shame, etc.), I will mention another reason for silence probably not felt by the patient in this scenario as her mother was her abuser. In my experience, my abuser threatened to harm or kill my family if I spoke. In my childhood way of thinking, if someone (mother or other adult) had ASKED me what was happening, I would have been "freed" to speak because I would not have broken the abusers rule. I realized this difficult standoff was playing out in my therapy when I just wanted my therapist to ask me a question so as to allow me to speak. But that is not something a psychodynamic therapist is trained to do! I do appreciate, after leaving a therapist after a few years of silence and before realizing this dynamic, the delicate balancing act for a therapist in engaging the patient during these periods of silence.
I look forward to your future work. Thanks for your blog, Linda.

Sukanya said...

Very moving account Linda. I agree with you totally about the curative powers of the therapeutic alliance. An oft ignored aspect in the quest of method & protocol. While it is important to have a methodology & therapy plan it has to be built on a strong trusting relationship. Kudos to you for doing that.

On an another note, how difficult is it to change the scenarios etc to keep the identity of the client safe? Have any of your clients ever recognized themselves in your blog...that is assuming of course that it is available for them to read! Thank you.

Linda Sherby PH.D., ABPP said...

First, Anonymous, thank you very much for your comment. It sounds as you have dealt with a lot in your life and I do hope that you have been able to find some peace and fulfillment.

Second, mothers can be as abusive as fathers.

Third, it is definitely not true that psychodynamic therapists are trained not to ask questions. I ask lots of questions. And in this therapy scenario, my concern was not that I wasn't asking questions, but rather that the questions I were asking could be perceived as pushy and therefore abusive to the patient.

And fourth, although you might well have been freed to speak if someone had asked you what was wrong, that is often not the case. The prohibition of the abusive remains in one's mind and regardless of whether one is asked, the terror of speaking often remains powerful.

Thanks again for your input.


Linda Sherby PH.D., ABPP said...

Thanks for your comment, Sukanya.

Every once in a while I do a piece called My Blog. In that I explain that in my blog, while I am real, meaning that I try to present myself as the therapist I am, feeling what I think I'd be feeling and saying what I think I'd be saying. However, the "patients" in my blog are almost entirely fictionalized, just so that I am in no way compromising my patients' confidentiality.

That having been said, I obviously draw the "patients" from somewhere, whether that is an experience with a patient coming in late or an encounter with a stranger on a plane. But unless I have explicitly asked a patient to write about them in my blog, I never do so.

In my book, "Love and Loss in Life and in Treatment" I used a different technique. There some of the patients gave me their consent to use their material and other patients were composites of patients that I had seen over the years. So ages, occupations, sex, presenting problem, history, etc., all were changed. And in those instances no one recognized him or herself.

You might be interested in knowing that, not surprisingly, even patients who had given me permission to use their material, often had a powerful response when they read about themselves in the book.

Thanks again for your interest.


Anonymous said...

Dr. Sherby,
First, you were right to call me out on my statement regarding psychodynamically trained therapists. It was a generalization I should not have made.

Secondly, I was not abused by either my mother or my father, but I am not so insensitive as to suggest that abuse by a father should be compared to or is somehow worse than abuse by one's mother. I was trying (unsuccessfully) to convey, through example, another dynamic that might cause a therapy patient to be silent. In your vignette of Emma, she was reacting to you as though you were her mother (an abuser), or at least reacting with fear (and silence) that you could be like her mother (unpredictable, explosive, physically and emotionally violent). Even Emma's description of her mind's images were telling: Her mother "gets bigger." That is exactly what a child sees when an adult is coming toward them (to attack, as her mother so often did). Unlike a deer in the headlights, which may or may not know what is about to hit it, an abused child knows exactly who is about to hit him or her. So, yes, I agree that you, as a therapist with a patient with Emma's history, have a tough task: building trust, questioning to engage, determining Emma's capacity to tolerate exploration, helping her realize and understand the transference(s) etc. Emma's silence or her talking about inane topics may be not only a means of affect regulation but her way of testing the waters, so to speak, of your trustworthiness. Are you going to explode over nothing? Are you abusive? Or even, are you going to do nothing? Suppose you decide NOT to ask questions (as my previous therapist chose to do) and not to respond to Emma's seemingly inane topics. You remain silent and neutral and wait for Emma to lead the conversation to something you think is meaningful (and that may be a very long wait). Is that helpful? Is that going to allow Emma to build trust in you? Not in my experience. And your silence might even start to replicate for Emma the experience she might have had with her father as a non-abusing but uninvolved and non-protective parent/adult. Her reaction to THAT transference might be rage, or despair, or choosing to talk about (more) "nothing", or silence (because she thinks the therapist "doesn't really want to know"). So Emma may be balancing many strong transferential reactions and confusions of her own. And if a trauma patient such as Emma is new to the therapy experience and/or her therapist is less skilled or less experienced or just less relational, the result may be not just "not helpful" but actually re-traumatizing.

Lastly, I agree with your statement, "The prohibition of the abusive remains in one's mind and regardless of whether one is asked, the terror of speaking often remains powerful." I am reminded of the true story of a 13-year-old boy who had been kidnapped at an earlier age and held captive not far from his home. His captor eventually had such control over him, that he allowed him to go out in the city. The boy somehow remembered or learned the phone number of his mother and would call her at these times when he was allowed to go outside. But for a long time he was unable to speak or to tell her in any way who it was who was calling her. The mother started to suspect that it was her son, though he wouldn't or couldn't answer her questioning him. His silent calls did eventually lead to his being found and reunited with his mother. People questioned why the boy didn't just tell her or anyone where he was. Why didn't he just talk? I knew perfectly how it would feel to be holding that phone in silence. I suspect Emma would too. And I don't know this for sure, but I suspect it helped the boy that his mother, on the other end of the line, just kept asking.

Thanks again for your response and for sharing your writing.

Anonymous in Michigan

Linda Sherby PH.D., ABPP said...

I appreciate your comments, Anonymous, and agree with everything you said. The internal image getting bigger is definitely a child's experience of the "bigness" of the abusing parent.

And thank you for that story about the 13-year-old boy. It's very powerful and captures what we are both trying to communicate.