Silent Clients - Passive Resistance Or Alexithymia?

2024 Author: Harry Day | [email protected]. Last modified: 2023-12-17 15:43

Phil is the owner of a truly Nordic character, the word "stoic" suits him best. He suffers in silence. As befits a real man. No tears, no complaints. Sad eyes like a beaten dog, and a dull voice, as if he needs to change the battery.

Phil became depressed and desperate because his wife left him, taking the children with her. The prospect of psychotherapy does not cause him much enthusiasm, but he hopes that in this way it will be possible to convince his wife of the seriousness of his intentions to change. As for himself, he does not believe in the possibility of change. At the same time, the wife declared with all certainty that she could no longer live with a cold and insensitive person. Phil himself explains: “She claims that I’m empty inside. No feelings, at least I don't know about them. She may be right."

Although Phil really wants help, he doesn't know what to do or who to turn to. This kind of insecurity is very typical for people who do not have access to their feelings. In addition, Phil, who is not prone to introspection, has no idea how a client should behave in the process of psychotherapy. He is laconic and believes that talking is a waste of time. When asked what he's thinking, Phil shrugs. When asked to share his experiences, he replies: “My wife left me,” and looks at me expectantly, as if I should go and bring her back.

- Did your wife leave you?

- Yeah.

- Could you tell us more about this?

- There is nothing to tell. A week ago I returned from work and saw that she was gone. Together with children.

- How do you feel about this?

“She shouldn't have done that without first talking to me.

- You seem to be angry.

- Anger does not bring good to a person. I just think she should go home.

Naturally, it was easier for such a person to work at the cognitive level. That is how we spent some time with him, while our sessions on his part resembled a game of silence: it was mainly me who spoke. In particular, the conversation was about the practical aspects of living alone, about what to say to family and friends, about how to deal with insomnia. At the beginning of each session, Phil asked me a single question, expecting me to answer it within an hour. He himself remained silent. Explaining this by the fact that he has nothing to say.

“Fine,” I said one day, hoping to get rid of him. - I see no reason for us to meet again.

However, according to Phil, with the refusal of psychotherapy, he lost the last chance to return his wife, in any case, he was firmly convinced of this. No, he will attend sessions until his wife decides what to do. It remains to determine what we will do with him at this time.

Each session was a real challenge for me. Even if Phil intended to keep the conversation going, he didn't know how to do it. Thus, the responsibility for what was happening was completely on me. I dabbled a little, making incendiary speeches on all sorts of topics and trying to spark at least a spark of interest in him. We discussed fishing and hunting (which I know nothing about); sometimes it was possible to translate speech into his feelings and inner sensations (which was given to him with difficulty). One way or another, we spent another hour together, then he straightened up and, as if preparing to take another dose of bitter medicine, made an appointment.

I wanted to believe that Phil would get some benefit from our conversations, even if his wife never came back to him. Six months later, he became less withdrawn, and I expanded my knowledge of hunting and fishing. In the end, he arranged his life, deciding to get a new wife who will love him for who he is, or, in any case, will agree to live with him.

Phil was different from most taciturn clients in that his behavior was not based on resistance. He sincerely sought to cooperate with me, but did not know how to come to him and what it was. … There are, of course, other clients who are silent because they do not want to play by our rules.

Customers tend to be silent for a variety of reasons. For some, the idea of a stranger interfering with their personal lives is intolerable, while the only way to remain in control of the situation (at least they think so) is to control their words and behavior. Other clients are silent, because they do not know what to talk about, they need time to get their bearings and understand what the therapist wants from them. There are also those who express passive aggression, shy away from communication, trying to punish the therapist or influence his behavior.

Children and adolescents use silence more often and more skillfully than others as a weapon in psychotherapy. So, Marshall had to work with a 10-year-old boy, who was especially virtuoso avoiding communication with a psychotherapist, while resorting to various methods: he showed detachment, indifference and contempt for all the therapist's efforts. Because the child was excellent at ignoring questions, he was asked to serve as the prototype for the ideal difficult client. According to Marshall, if children want to be like this boy, to the chagrin of their therapists, they should only give the answers listed below to any question.

- I do not know.

- Sometimes.

- I do not care.

- It seems.

- Something like.

- I do not remember.

-Yes.

- No.

- Something like that.

- I forgot.

- Irrelevant.

Of course, if a psychotherapist with a client manages to turn rigid communication patterns into a game, while establishing clear rules, they may well laugh at themselves and destroy some of the barriers that exist between them in order to move on to the study of problematic issues.

Among all kinds of answers that can be heard from clients who are not inclined to talk, the therapist is more often perplexed by the answer like "I do not know." A special classification of possible reactions of a psychotherapist to a client was developed, who answers all questions “I don’t know”. I have subdivided therapeutic interventions from more passive to more active. From my point of view, you should achieve maximum results at the lowest cost. It is only when the simplest strategies fail that it is necessary to resort to more powerful methods of influence.

Therapist's reactions to a client who says “I don’t know”

1. Silence. Respond to silence with silence.

2. Reflection of content. "It is difficult for you to express in words what is happening to you."

3. Reflection of feelings. "You are really offended that you have to sit here and answer all sorts of questions."

4. Test lunge. "What does it mean to you not to know?"

5. Generalization of behavior. “I noticed that you often say“I don’t know”.”

6. Invitation to play. “Imagine that you know. Think carefully what it could be."

7. Confrontation. "It seems to me that you know a lot more than you are going to tell me now."

8. Self-disclosure. “It is difficult for me to work with you when you answer practically all questions“I don’t know”. It seems that you think that I know what is happening to you and do not need your help to understand it."

These are the most typical reactions of the therapist to clients who offer passive resistance. By and large, there are several other strategies that can be used to counteract the conspiracy of silence or excessive passivity.

9. New definition of behavior. “You have successfully managed to remain silent. Most people cannot compete with you."

10. Proclamation of a "silent" session. A prolonged silence is now considered an adequate response.

11. Prescribing silence. “I appreciate your ability to remain silent. This will make it easier for me when I have to discuss problems with your parents. I would like you to continue to remain silent, and I would not be upset that I know your opinion."

12. Structuring the session. “It looks like you have no suggestions about what to do during the sessions. Perhaps you will find it convenient if I ask you a few questions?"

13. Granting freedom. “I respect your desire to be quiet. I am ready to wait as long as necessary until you deem it necessary to start a conversation."

14. Suggestion to play. I’ll ask you a few questions that you don’t have to answer. Just nod your head or shrug your shoulders if you can't answer."

15. Use of non-verbal means of communication. "Since you seem to have a hard time keeping up a conversation, maybe draw a picture that reflects your feelings." Other options: discussing photos, listening to your favorite music, playing games, walking.

I am currently working with three teenagers who can rightfully be considered difficult because they refuse to talk to me. Parents insist on the need for psychotherapy, feeling their own guilt for having spawned such monsters, so once a week they throw me their offspring for brainwashing. All three boys are sullen and insolent. Each of them announced that he would come to me, but was not obliged to talk to me. “Great,” I replied, “what do you think we should do during the sessions?” I was proud of myself. I showed good will and joined the adolescents at the level at which they were able to function. One of the boys and I played cards - poker and kunken. He was not interested in other games. He answered only those questions that were related to the game. Another boy brought a ball with him, and we threw it to each other. He also didn't want to talk, but I convinced myself that we communicate with him productively on a non-verbal level. The third boy likes to walk with me to the pharmacy, where I buy him chips and cola. He mutters "thank you" to me and becomes unavailable again.

I have been working with each of these guys for several months now and have not noticed any pronounced changes in their behavior. Our communication is subject to a certain scenario, each of us knows what will happen next. Most surprisingly, parents of two boys report significant improvements in their home behavior and academic performance. Sometimes teenagers even show attention to their sisters. My parents consider me a magician and are interested in the methods of my work. I answer that these are professional secrets, but I think to myself: This is ridiculous. No confrontations or brilliant interpretations. I just play cards and go for walks. And they pay me for it too!

So, what are the possible reasons for the improvement in the condition of these children? Most likely, they feel sincere care on my part, they see that I am trying to help them. I strive to be as honest as possible, and they are confident that I will not tolerate any falsehood. I think they understand that it is in my power to bring them even more trouble if they refuse to cooperate with me at least minimally. Perhaps one day I will be useful to them too.

The process of not doing psychotherapy appears to be extremely difficult for those of us who strive for progress and change. At the same time passively resisting clients hardly react to direct interventions … Sometimes, when working with adolescents, the most effective psychotherapeutic technique is to temporarily suspend any therapeutic intervention so that the children do not feel cornered. I believe that it is a great misconception to think that progress in psychotherapy depends solely on our actions with you, sometimes success comes because the reluctant client is allowed to go his own way and at his own pace, instead of requiring him to meet our expectations.

Jeffrey A. Kottler. The compleat therapist. Compassionate therapy: Working with difficult clients. San Francisco: Jossey-Bass. 1991 (lyricist)

Harris, G. A. and Watkins, D. Counseling the involuntary and resistant client. American Correctional Association, 1987

Marshall, R. Resistant Interactions: Child, Family, and Psychotherapist. New York: Human Sciences. 1982.

Sack, R. T. Counseling Responses when Clients Say "I Don't Know." Journal of Mental Health. 1988.