A question which often emerges when I look with supervisees at transcripts of their therapy sessions with clients, is when to speak and when to remain silent. Whole supervisions can be dedicated to thinking about the impact of speaking or not speaking at certain moments, when one might think that it is the content of what is said that always matters most.

I have come to think of the process of sessions rather like entering the photographic dark room, where you wait for a photograph to develop.  One part of the picture might come into focus quicker than another and it might be enough to give a sense of what the whole picture might be.  When this happens it may be easier to think of when to speak and what to say. At other times however – often more common than not – we may arrive at the end of the session and feel only one small part has come into focus, there may be a pressure to speak, to say something meaningful, but we are not sure what to say.

Part of this dilemma I think is due to being integrative child psychotherapists.  We have to hold the balance between being expressive and more restrained in our therapeutic stance. As integrative therapists we position ourselves somewhere between the valuable heritage we have from our psychoanalytic colleagues, whom may be more familiar with a model of restraint and our relational and attachment based colleagues whom may favour a more expressive approach.  However, even that division is not straightforward as psychoanalysis itself sometimes seems divided in the literature between the more drive based, classical, one-person psychology models descended from Freud and those that are more intersubjective and interpersonal (Mitchell, S 2004 ).  Then there are the integrative approaches such as Mentalization, which come from the Freudian line of development (particularly Anna Freud) but very much see their therapeutic stance as expressive and openly empathic through ‘playing’ with ideas.  So where does this leave the integrative child psychotherapist, whom is trying to form their own integrative therapeutic stance and is drawing upon both more restrained and more expressive models?

It comes back to what is needed at this present moment. How is the session ‘developing’? What is seeking to emerge or come into focus but may need our careful presence?  How regulated is our client? How might they be experiencing silence? A more restrained approach may value the place of silence, particularly to see how the child uses it. Yet we need to hold this alongside being mindful of our knowledge of neuroscience, particularly of Porges’ work on the social engagement system. Is the level of restraint helping to bring or keep the social engagement system online? With a child with ASD they may value the silence and not having their sensory response system overloaded yet for another child – even with ASD- they may find the silence too persecutory and this may activate their stress response system sending their social engagement system offline.

It is therefore about attunement. If we really listen to our countertransference, if we first self-attune and listen to what is being registered within our body-brain-mind state and let that guide us we will be able to allow an attuned response to the other to emerge. This response may call for silence or few words, or it may call for an enlivened and energetic verbal response. Of course we have the additional resource of being able to use the arts and so our expressive response may not have to rely upon words, particularly if we feel they do not fully convey what we wish to express. This is the beauty of being of an integrative child psychotherapist. We have a model which can be flexible and responsive to the child and is always seeking the best way at that moment to make contact.

References

Mitchell, S (2004) Relationality: From Attachment to Intersubjectivity. Routledge

Porges, S (2017) The Pocket Guide to Polyvagal Theory. The Transformative Power of Feeling Safe. Norton