Silences in Psychotherapy: An Integrative Meta-Analytic Research Review

There is research evidence, from both qualitative and quantitative studies, that silences in psychotherapy have established associations with good and poor outcomes that include and extend beyond symptom measures to processes such as insight, symbolization, and disengagement. Research also has demonstrated that therapists attend to clients' silences, seeking to comprehend the processes therein and intentionally support productive silent processes. This chapter synthesizes this research and examines features of silence processes to provide psychotherapists with the skills to differentiate the functions of both productive and obstructive forms of pausing. It includes a review of 33 quantitative and qualitative studies on silences in individual psychotherapy (from 309 clients and 209 therapists). Our qualitative and integrative meta-analytic evidence indicated that it enhanced their ability to intervene responsively and enhance therapy outcomes when psychotherapists' responded strategically to the specific functions of silences. We consider research limitations, training implications, and therapeutic practices based on the research evidence. Clinical Impact Statement Question: This integrative meta-analysis provides clinical guidance by reviewing the extant research literature on the functions of and clinical responses to moments of silence in therapy. Findings: Findings indicate that silent processes in psychotherapy (e.g., productive processing, disengaged withdrawal) have established associations with good and poor outcomes and that therapists seek to respond differentially to silent processes but may find this task challenging. Meaning: When psychotherapists could identify the specific function inherent in silent processes, they could intervene responsively to enhance therapy outcomes. Next Steps: Incorporating training to support therapists to better identify types of silences routinely may better equip them to facilitate productive silence moments and to intervene when silences are obstructive to the change process.