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Wednesday, December 26, 2012

The Many Meanings of Silence

There are many meanings to silence.  After a very full Christmas day yesterday, at about 10:30 PM, I realized that, at least for a few minutes, there was complete silence.  It was a welcomed silence, the kind that you can relax into, close your eyes and take a deep breath.  

I spent part of Christmas day visiting my 92 year old mother, who has Alzheimer's and lives in a nursing home.  Whenever I've gone there, I've never experienced even a moment of silence in the place.  Nursing homes, like hospitals, are very structured environments where things are constantly going on to take care of the needs of the patients.

When I first began visiting my mother in the nursing home, I felt bombarded by the constant noise and activity:  TV sets blaring in residents' rooms and in the common room, nurses wheeling carts, the conversations among staff and patients, announcements on the public address system.  Combined with all the emotions involved with placing a close relative in a nursing home, even a well run nursing home with caring staff, the experience was an overwhelming blur at times.

Now, when I visit my mother, I have a more nuanced experience.  The noise and constant activity can still be overstimulating, but now that I know the staff and certain residents, the noise and activity are within a certain context that I've come to expect.  It's no longer overwhelming.

Although the nursing home is constantly buzzing with noise, there have been more and more moments recently where my mother is silent.  She always responds warmly initially when she sees me.  Sometimes, she knows I'm her daughter.  Other times, she thinks I'm her sister, a friend, her mother or a friendly nurse or social worker.  Whoever I am to her at the moment, I seem to be a benign presence.

There are times when she is full of questions about what's going on in my life, whoever she imagines I am at the moment, often asking the same questions over and over again.  I've become accustomed to this.  What's more challenging is when she retreats into her own world with a thousand mile stare and she becomes silent.  It's then that I'm most aware that the Alzheimer's is slowly progressing.  At those moments, I wonder where she goes, and there's a part of me that is concerned that she won't come back.    But then, she becomes aware of my presence again and begins asking questions and I'm relieved that she's somewhat more engaged again.

Silence in Psychotherapy Sessions
Silence in a psychotherapy session can have many different meanings, depending upon the particular client, therapist and their relationship.  Usually, I work in a dynamic and collaborative way.  Even so, there are times of meaningful silence in sessions.

A therapist needs to know her client well to understand the meaning that a particular client attributes to silence.  There are some clients who can't tolerate any kind of silence because it puts them in touch with the emotional void that's always there.  For other clients, it feels like a depriving experience that replicates an emotionally depriving childhood experience.

The classical psychoanalytic stance of neutrality, if there is such a thing, would be too depriving for these clients, especially at the beginning of treatment when the therapist and client are still forming a therapeutic relationship and the client is just beginning to develop trust.  For some of these clients, silence represents the stone cold anger they felt from a parent or the times they were left alone to take care of themselves emotionally and maybe even physically.

For those clients, too much silence, at that point in the treatment, is punishing, and a therapist needs to know this so that she can be an emotionally supportive presence in the room in ways that are meaningful to each client.  Over time, many of these clients, who might use constant talk as a way to ward off uncomfortable feelings during the early stages of treatment, learn to become more comfortable with moments of silence because it no longer feels depriving.

For other clients, especially clients who have developed a trusting relationship with the therapist, silence is a welcome respite.  Growing up, their household might have been filled with noise and chatter, no time to day dream or just to be.

Silence in the psychotherapy session for these clients can be a time to reflect or to feel therapeutically and emotionally "contained" by the therapist in ways they never felt  when they were growing up.  When treatment is going well, there is an interactive dynamic between clients and therapists that is especially  palpable in moments of silence.

A therapist needs to be attuned and develop an intuitive sense about the many meanings of silence for each client, which can change from one session to another.

I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist.  I work with individual adults and couples.

To find out more about me,vsit my website:  Josephine Ferraro, LCSW - NYC Psychotherapist

To set up a consultation, call me at (212) 726-1006.

photo credit: Easa Shamih (eEko) | P.h.o.t.o.g.r.a.p.h.y via photopin cc

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