Silence in Therapy

Silence is Golden sometimes 2014-02-08 14.53.27

This blog is written to query a possible way forward for psychotherapeutic work. A chance to review a change, an alteration to the way of working as a Psychotherapist/Counsellor/Mental Health Practitioner. What if the clients we supported were co-worked with – in tandem with a colleague, not alone? What if we had a colleague in the room with us?

Together

October 2015 has been a month of developments for me as a counsellor, Forensic Mental Health Practitioner, Visiting Lecturer, blog writer, Trainer on the Knowledge and Understanding Framework for Personality Disorder and reader of Daring Greatly by Brené Brown.

Tandem Support

I had the good fortune of working alongside a colleague at one of the probation offices I support. I checked with both service users I was to provide counselling support with if I could bring another therapist into the room. Both clients affirmed that this would be okay. My colleague would observe the work in both appointments and where necessary add comment to the interactions.

Cancellation Policy

To be honest I wasn’t worried for myself or my colleague as we began our work, the client on the other hand I was nervous for. He was a new referral whom I had only met once previously for an assessment meeting. The probation officer warned us that he wasn’t in the mood for therapy or much of anything. I chose to acknowledge what the probation officer had said, and repeat their phrasing and emphasis on the clients mood. My response was to let the probation officer know that if the service user wanted to, he could leave at any point during the appointment. I then asked the service user if he were comfortable for us to proceed with my colleague in the room. I informed him that he had the right to cancel the appointment and leave  if the need arose.

A Beginning

The service user was a young man between the age of 18-24. He was dressed in multiple hoodies and a pair of loose fit jeans, was from an African Caribbean background and as his probation officer had stated was in a quiet seethingly angry mood. When asked if we could proceed with the appointment, he offered a terse and tight lipped response of ‘uh yeah.’ Putting his head first down then looking out of the window at passing traffic.

Silence of Withold

Much of the appointment was spent in silence. I began by setting out the parameters of the space, time of the meeting and confidentiality of our work together (context). When asked how I might be able to help. He resolutely told me that ‘You can’t help me! No-body can. I can barely help myself.’ When prompted by myself he added ‘Na, nothing man. I’ll be alright.’

There were moments where silence drew something out of him and then there were times where silence acted like a cloak in which he hid himself and appeared as if he was not going to come out from. My colleague MM appeared comfortable with this man’s disquiet. I was disquieted by the peek-a-boo game and my inability of providing anything more than space, time, an ability to mirror, paraphrase and offer small interpretations of what was happening for him in the space. (Was I good enough?!!)

The Obvious

Ultimately I felt that there were 2 break through moments during the silent conversation. I am a firm believer in that stating the obvious can help clarify difficult or frightening experiences ‘Nailing the cloud down’. The other is using humour to assist in lightening the mood and move the sense of discomfort on a little further. These two moments came after the service user said ‘I don’t care!’ a number of times and after I said ‘I imagined a large car chase scene where there were lots of car wheels screeching through London’s wet streets’. He laughed at the ridiculousness of this suggestion and said ‘It’s not that bad, nah nothing like that.’ I heard MM laugh quietly and the tenseness in the room gave just a little, enough for me to offer a question about caring and if I could be allowed to care for him. To carry his caring whilst he was busy worrying about the thing we were not talking about.

Success?

The appointment came to an end and I mentioned to the service user that I looked forward to our next appointment. He gave a response which intimated that he, if he made it to next week, would like to engage in a further appointment.

Myself and MM went to my office space and talked at length about the appointment and what it’s merits were. MM was complimentary about how we used the space. He, I, and MM the observer all shared an experience barely talking about one members concerns. What strikes me is that there was a parallel process occurring throughout the time as well. The service user spoke little, I on the other hand spoke for us both and MM said barely a word. I was compensating on some level for the lack in the room and attempting to fill space and time with usefulness (subconscious mechanisms going into hyper-drive). The parallel process was in the transaction of what we brought to witness in the room. Me attempting to support and assuage the young man’s mood to a different space/place. He dancing a line between not sharing or caring and then trusting the space investing some of his story and caring.

Supervision

Returning to my workspace we, MM and I, reflected on the 50 minutes we had in the room and talked about what had just happened from a number of perspectives. Traditional counselling supervision often happens within a number of different contexts including; place, time, environment, focus and attention and intention of the therapeutic appointment.

Skilled supervisors support their supervisees without ever meeting the person or person’s their supervisee speaks about. They have nothing but what their supervisee brings into the room. I like to bring all of the aspects of what has worked well, what did not work well or aspects of the work that I am confused with. Most of my supervisors are so good it is like they have been with me in the room all along seeing what I had not even begun to identify.

Collective Unconscious

Having a colleague in the room, brought something immediate and responsive to the work. It was almost like the collective unconscious in the room facilitated managing a difficulty and brought solutions that a 1 on 1 encounter may not have achieved. It is likely if I had worked with the service user alone some of the realisations would have been different but could have been just as supportive.

A Shift

The point I am wrestling with is could 2+1 meetings where there are 2 therapists in a room be an aspect of the work that is common rather than uncommon. The Speakmans work in a way that is similar to 2 therapists and a client. BACP and UKCP may have something to share on working as a triad however I felt that the learning was trifold as opposed to bifocal and that was immeasurably felt by all who encountered this session…