The Shifting Sound of Silence: A Constructivist Grounded Theory

Data on the use of silence from a therapist's perspective remain limited. This study aimed to develop an understanding of psychotherapists' use of silence in clinical settings. Practising psychotherapists were interviewed about their experiences of silence, and a constructivist grounded theory approach was adopted to arrive at a substantive theoretical understanding of psychotherapists' silence. A grounded theory analysis supported the construction of a theory conceptualised into four main categories: conditions (evolving disparity, rendering relationships and minding the gap), cornerstones (sensitising silence, productive comforting, productive discomforting and temperature gauging), consequences (deepening the treatment) and considerations (timing and silently experiencing). Silence is intersubjective and effective in clinical settings, and the results of the current study indicate that silence is powerful and ambiguous and is best used later in treatment when a strong therapeutic alliance is in place. Individual comfort and the needs of the client were found to be more significant than any single modality or theory. Silence is used to create a space in which treatment can be deepened through the presence of a therapist and mutual introspection. This study recommends a greater focus on a contemporary use of silence during the training and education of psychotherapists, and the importance of free association should be addressed earlier in clinician training. This theory requires further exploration of patients' experiences to establish their correspondence.



Implications for practice

This study developed a set of categories indicating how silence is employed by therapists in a clinical setting. Silence can be viewed as intersubjective, creating a space where treatment can be deepened by the presence of the therapist and mutual introspection.

When considering the use of silence, the individual comfort and needs of the client were found to be more significant than any single modality or theory.

The use of intentional silence in therapy is best utilised later in treatment when a strong therapeutic alliance has been established.

This study also highlights the need for training institutes to address the contemporary use of silence in therapy so that students can begin to experience and explore what silence may mean for them and their clients.