THE SKILL OF MAINTAINING PAUSES IN THE MODE OF PSYCHOTHERAPY ONLINE VIDEO

2024 Author: Harry Day | [email protected]. Last modified: 2024-01-31 14:10

Conversation without pauses is not capable of giving birth to anything. It takes time for the fruit to ripen. A. Maurois

It is difficult to overestimate the use of pause as a means of psychotherapy. Its importance in the psychotherapy of clients was paid much attention to by Karl Rogers, who emphasized that the ability to withstand a pause is one of the most important professional skills of a practitioner.

During Rogers' visit to the USSR in 1986, during one of the lectures from the audience, the question was asked: "Why do you keep pause for so long?" The answer was something like: “The pause belongs to the client. During the pause, the most important thing happens, at this time a decision can come, an insight can occur. I have no right to take this chance from the client."

R. Kociunas speaks about “pauses of silence” and the need to understand the value of silence, “to be sensitive to various meanings of silence, in general to silence”, and skillfully use pauses and silence as a psychotherapeutic technique. Silence can be valuable because it "increases emotional understanding, provides an opportunity for the client to" dive "into himself and explore his feelings, attitudes, values, behavior …".

“The similarity between prayer and psychotherapy is that on the surface both of them are words, words, words, but the top of both is silence, listening, reverent silence, in which the voice of the other and the Other appears” (F. Vasilyuk)

Indeed, it is in silence, and not in the process of verbalization, that healing transformations take place in the human psyche: the experience of enlightenment, mourning, repentance, forgiveness, etc.

The presence of pauses in psychotherapy creates a sense of leisurely and thoughtfulness of what is happening. The therapist's haste to ask questions or comment on what the client is saying is almost never therapeutically effective. The pause emphasizes the significance of what was said, the need to comprehend, understand and feel. The result of the mutual pause is the client gaining a new sense of community. The therapist should pause after any statement by the client other than those directly related to the question. A pause makes it possible to supplement what has already been said, correct, clarify. Thanks to the pause, it is possible to avoid a situation where the therapist and the client enter into competition with each other in the right to insert a word, to say something. The opportunity to speak in psychotherapy is provided, first of all, to the client, and then at the moment when it is the therapist's turn to speak, he will be listened to with particular attention.

“Silence, you are the bestFrom everything I've heard”(B. Pasternak)

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The best (most accurate) answer can only come from the client himself, from within, and the therapist must maintain a pause on the client's side, which is most often fruitful. It is up to the therapist to wait patiently with interest to see what happens next. Pauses give the client an opportunity to explore their inner fears, and also contribute to the growth of the ability to distinguish between the objects of their feelings and perceptions, including their "I", parts of their experience and the relationship between them. Often, a pause provides an opportunity to follow the client's process of finding the right words (a suitable metaphor) in order to bring them in line with their feelings. Finding words or metaphors that exactly match the internally felt meaning of the moment help the client to experience the feeling more fully. It is during the pause that the client comes to discover an unexpected and positive aspect of the self-image.

The content of the pause can be heard (more precisely, sensuously perceptible) in some cases both clearer and fuller. Minutes of silence are often felt to be more meaningful, deeper and more fulfilling. During the pause, a certain internal flow of feeling, an internal process of experience, is released and revived. During the pauses, the client does a large-scale internal work in which the therapist must take an active part and try to influence the quality of this process. Jendlin calls this type of interaction “subverbal”, which does not mean rejection of verbal therapy, but rather is a way of entering a wider and deeper process of experience that occurs in every person at any given moment and within which psychotherapy is actually carried out. Words, Gendlin writes, no matter how accurate and appropriate, are only messages that surface on the surface, emanating from the processes of experience, only symbolization of experience.

Most clients who seek psychotherapy expect that help will come from a strong, authoritative figure of the therapist and are ready to follow the recommendations and wishes of the therapist, denounced in words, words, words … on his own he was not as serious and responsible in relation to the client as desired, but if the latter is internally passive, and the therapist does not see and does not take this into account in his actions, then such a “work” will hardly have any meaning. A therapist who implements the medical model of the "doctor-patient" relationship, where the patient is a passive recipient of the therapist's therapeutic actions, leads to unproductive conversations, and besides this, to the emergence of unspoken "obligations" of the therapist to the client - to unnecessary and therefore false responsibility of the therapist for the result, which actually depends to a large extent on the efforts of the client himself.

Ignoring pauses, the desire to fill the silence that has arisen on the part of the therapist with unnecessary, and therefore unpromising questions, remarks or reasoning "rob" the possibility of free self-determination of the client. A therapist who manifests himself “abundantly” often leaves no free space for self-determination in front of his client, which only he can and should fill. By speaking for the client, the therapist deprives the client of choice; maintaining a pause and even a long silence confronts the client with a choice: to take place or not, to express himself or to refrain from it, to report something important about himself or not. A similar situation in the therapist's office correlates with the fact when the child was denied recognition of the experience of himself, in self-knowledge, considered him as something that does not belong to himself, as a result, such communication only strengthens the client's incongruence.

The pause "highlights" the main question that is the essence of the client's problem, and does not imply another answer to it, but the answer of the client himself, which creates for the latter a huge potential for self-disclosure and self-determination. All this makes the psychotherapeutic "charge" of such a conversation much greater than in the "genre" of an endless stream of words.

I will make a reservation that, of course, pauses, especially frequent and long ones, can be destructive for some clients and their use requires special care (for example, in cases of suicidal intentions, the self-concept that stopped very early in its development, feels the threat of destruction or decay, etc.) etc.), however, this is the subject of a separate discussion.

There is a type of clients (and there are quite a few of them) for whom pauses are difficult to bear. The pause that has arisen causes confusion and the immediately arising need to say at least something, just to fill it. The client speaks excitedly, looking for new and new topics, one thing is extremely clear from this - he with all his might clings to verbal interchange with a real interlocutor, so as not to be left alone with himself, with his inner world. Such clients experience a prolonged pause as a weakening of the connection with reality, while speaking - as a renewal of this connection. These are people with an inner emptiness who are able to feel "I am" only in direct contact with external reality - for example, in a verbal dialogue with a psychotherapist.

“Silence is freedom from being obsessed with progress” (K. Whitaker)

In my experience, the frequency and duration of pauses, as the therapeutic process develops from early to later stages, increases and becomes more intense and therapeutic, however, and verbalizations become more significant.

A pause comes when the client is confronted with something unclear, vague, unrecognizable, and not similar to familiar feelings or emotions. Experiencing something vague is significantly different from the usually experienced emotions when a person knows that they are experiencing anger, interest, or joy. This differs from the familiar “feelings”, however, what is felt in the “border zone” between the conscious and the unconscious is vague and unclear, and the person does not know how to describe and characterize it. The experienced in this "border zone" has its own, specific, unique quality, not described by universal categories (here I exclude alexithymic manifestations). The client may feel something that definitely helps him, although he cannot express it in words, but it does not matter. What is important is the sense of self, and the therapist does not need to know exactly what this something is.

It often happens that the client talks about his problem, but after a while (this time also, in my experience, varies, depending on the stage of psychotherapy, rapidly decreasing after passing the conditional milestone) he stops talking. Despite the fact that everything that could be said has already been said, it seems that the problem is more than what is said. This line is clearly felt, but it is not possible to clearly describe it, and there is no way to approach it. This is some kind of discomfort that creates the problem. Sometimes the client may feel like it's time to say something, because if you don't say anything, the discomfort increases. But in the process of speaking, the sensation that existed at the bodily level is lost. Sometimes for a long time in experiences it is not possible to distinguish such a facet, but more often it seems that this feeling simply remained unnoticed, because the person spoke too quickly and too much. It takes a pause to stay in direct contact with anything. Anxiety can arise, so clients tend to start talking as soon as possible, moving on to something else, jumping from topic to topic. At the same time, the speaker often remains outside, without plunging into himself. To be able to empathically understand such a client, it is necessary to understand the sources of his attitude to pauses in order to process the areas of conflict lurking in the background. We can deal with the fact that while the Self strives for permanent change through the integration of new experience, the tendency of self-actualization can, to a greater or lesser extent, violate this if it serves to preserve the Self, which is not able to recognize this experience, because … perceives it as too much of a threat. In this case, we are dealing with a splitting, a split in the trend of actualization, the result of which is the alienation of the individual from his experience and, thereby, from himself. Inconsistency arises when the organismic assessment of the experience of oneself is bypassed, and those conditions are recognized that retain their intrinsic value. The therapist must form hypotheses and ideas about how the situation of silence is perceived as threatening to such an extent that incongruent reactions represent an alternative to it, which guarantees comfort.

So, over time, the client becomes more and more congruent, free, a mobile Self is formed, ready for expansion, the ability to symbolize and integrate the incoming experience increases; he turns out to be capable of therapeutic silence alone with the therapist and with himself, the realization comes that the direct content of his statements is sometimes only a small part of the inner flow of experiences, the general meaning of which is inexpressible and always incommensurably greater than any verbally expressed content. Minutes of silence become valuable.

"Can silence be gold where the word-silver rules the ball?" (S. Rout)

Today, not only psychological counseling (problem-oriented), but also online video psychotherapy (using Skype, Viber, Messenger, and other programs) is rapidly gaining popularity. This is the closest way to the traditional way of working, as the face-to-face mode is preserved. However, he is more demanding on the quality of communication (compared to other options for psychological work in cyberspace), which is also directly related to the subject of the conversation. The novelty of the field of psychological services in cyberspace generates a lot of speculation, and research related to the effectiveness and description of the methods used in online psychotherapy is scarce.

We start our new path with good intentions, but we often get entangled in erroneous decisions and value conflicts, turning into a helpless helper. Sometimes we don't make the best choice; we make mistakes and find ourselves in the dead ends of our ambivalence and insecurity.

Obviously, the psychological space in the online video mode is created by a specific context and boundaries, while observance of three conditions (congruence, unconditional positive attitude, empathy), which contribute to the creation of a certain facilitating psychological climate, remains pivotal. It seems that the requirements for the professional competence of the online video therapist, which focus on the ability to establish close and intense therapeutic relationships, as well as the ability to work at different levels of symbolization, are increasing. Online video psychotherapy services require new benchmarks in relation to the limits that we encounter on the psychotherapeutic “journey”.

In online therapy, a pause, especially at the initial stages of therapy, can lead to misunderstandings and a break in communication. The pause that has arisen on the other side of the screen can easily excite, it seems long, unnatural, as if demanding to build your balance, to catch a feeling of support and safety in words. Clients, regardless of their psychological characteristics, in the initial phase of the therapeutic interaction react to the pause that has arisen with greater anxiety than it does in the immediate therapeutic setting. Sometimes clients are at a loss whether the silence is caused by the poor quality of the Internet, they ask if the therapist can hear them, the moment is lost. In the mode of video consultations, the therapist, rather than in the situation of therapy in the office, is faced with the intolerance of silence for himself, when not at all therapeutic expediency forces him to interrupt the prolonged pause. These are moments when silence is experienced as something that carries a threat, focusing all attention on it, highlighting its professional inconsistency. There is a desire to say at least something. Online video psychotherapy presents new challenges to our authenticity and our professional values. Congruence also means that the therapist does not always have to look his best, to give the impression of being always understanding, strong and wise. If the psychotherapist remains himself and opens himself, this frees him from various internal burdens, from falsehood and makes it possible to enter into as direct contact with another person as possible.

Online psychotherapy increases the requirements for the features of therapeutic expressiveness, which ensures that the pause is maintained and that the maximum effect is obtained from it. There are three features of the therapist's expressiveness that Gendlin described.

Unobtrusiveness. It is very important for the therapist to be able not to impose oneself; the therapist's behavior can be more active and at the same time less intrusive and less frightening of the client if the therapist expresses himself (his own feelings, ideas that occur in him), so that it is quite obvious that this statement is about himself or about the events taking place in his inner world at the moment. Thus, the therapist will be able to more openly share his thoughts and feelings, and at the same time will not impose anything on the client's mind. Acting in this spirit, he speaks from his own person, does not try to forcefully introduce anything into the space of the client's inner experience and does not mix the events that occur in it with the events that occur in the client.

A few seconds of internal self-observation. To genuinely respond to something that comes from within himself, the therapist must pay some attention to what is happening in himself. Living a few moments inside oneself leads to finding in oneself a certain response to the words and actions of the client, to what is happening between them, or to their silence. In a few moments of inner self-observation, one can detect a genuine reaction to the present moment. Several moments of internal self-observation almost always lead to two changes in the therapist's feelings: a) it becomes clearer that this feeling is something mine, and not something about him; b) it becomes much easier to share your feelings.

Unclouded simplicity. The ability to formulate the client's feelings and thoughts when the process of expressing them unfolds, and the therapist internally focuses mainly on the sensation that the client's actions cause.

The article presents a sketch of reflections on the experience of maintaining pauses, unfolding in the plane of the psychotherapeutic process in the online video mode, and an attempt to get closer to a deeper understanding of pauses in this format of psychotherapy.

Literature:

Gendlin Y. Subverbal communication and expressiveness of the therapist: development trends of client-centered psychotherapy

Gendlin Y. Focusing: A New Psychotherapeutic Method of Working with Experiences

Kochyunas R. Fundamentals of Family Counseling

Rogers K. The Client-Centered / Person-Centered Approach in Psychotherapy

Rogers K. Counseling and psychotherapy