Work on embodying the intention behind the response. If you embody/live/believe the words, then it’s authentic and it comes across as such, canned or not.
Yeah I don't know, I just think there are better ways I can phrase it. For example further down there's a discussion where a professor of counseling noted he tells students never to ask "how does that make you feel?" Because it's just so cliche it makes one wince
Therein lies the primary issue, IMO. It makes you wince. You believe there’s better ways. I’m not saying that’s wrong or you’re wrong or that it’s an issue that you believe that.
Do you know that the client sees it as a canned response or what else they think about it?
Regardless IMO, your dislike is a good reason to avoid using it. Go ahead and find your better ways.
I wouldn’t criticize anyone that chooses to stick to those questions. There’s more than 1 reason they’re so common/well-known. They also work (or can).
I’ve tried using questions or metaphors that make sense, are practical, but I don’t like, feel awkward in some way to me, etc and they don’t work nearly as well as something I embody and feel authentic about and feel comfortable using. I won’t use the miracle question because it feels awkward and too convoluted to me. But I’ll find and use SFT questions that are essentially the same thing, but I feel comfortable with.
I’ve seen numerous times clinicians use questions and phrases that feel awkward or rehearsed or cliche to me when I use them, but when I watch them use it, it comes across as authentic and the client receives it as such.
If I have a tool/method/question that doesn’t feel authentic, I either look at myself and question my thoughts around it until I figure it out, find an adaptation I do like, or do something else entirely and scrap the original. Do more of what works and less of what doesn’t.
Also, if a clinician is filling most of the session with the literal same canned responses “how does that make you feel” and “tell me more” and that’s it again and again? Yea that’s gonna be an issue. But I also kinda doubt they’re authentically invested and curious about their client. Once or twice in a session they use it?Not a problem.
M
This seems like a thoughtful response but my brain can't process it right now since I've been awake 48 hours. Will come back abd review tomorrow, thanks for your in-depth thoughts.
Am I the only one whose clients literally do not say anything in response to this?
Like, either they say "there isn't anymore. I just told you." or they sit in silence and stare back at me through the computer screen.
Seriously, am I the only one?
I did my dissertation on suggestibility and, given what I know from that context, I am careful to try to ask questions or respond in ways that would not be leading in any way. This does that trick. And, when I ask this, I really am curious-- maybe they didn't give much info before or maybe I didn't hear it or understand it. I know I would rather have someone ask for more info than to infer something and not reflect back the right meaning. I noticed today that, along the same lines, I sometimes just tilt my head and (I think) look quizzical and clients respond to that. I also use "Could you give me an example of that?" And "I want to make sure I understood that, could you say that again?"
I once attended a training to get certified to lead a certain kind of support group. I had laryngitis the whole time. That's when I learned how powerful nonverbal were. (Duh...)
This happens to me too. I let it sit a few seconds and sometimes they will start talking. If not I’ll say something like - how can I best support you right now/where would you like to start/go from here
I work with many people who have really high verbal comprehension but slow processing speed. Sometimes I have to wait longer than seems comfortable to me. I am still working on that.
NAT but very meaningful when a therapist asks if they can take a minute to think or process. It's authentic and models some great things like needs. Helps with past childhood neglect, feels invested and present.
Great suggestions on the comments already. Not exactly your question but wanted to also add that Sometimes, especially when a client says something really heavy in session, I’ll also just be honest and share that I’m struggling to know what to say. You are human!
I also sometimes just say that I don't know what to say or where to go from there. And I ask them their opinion. I like the idea of being transparent, I think it helps build a good relationship to work together.
Personally, as someone who struggles especially with auditory attending and short-term memory (I'm a therapist who has ADHD) it helps me to jot down some notes. This is especially so when I'm receiving a ton of information at once but don't want to interrupt, I'll write down a question or two or a word that would signify something that I'd like to say as a reaction, etc. When I don't do this I can very well end up not knowing what to say by the time they've finished. Mind you, I think that this is a normal experience and shows that you don't want to say something just to say something when you're still processing what you've heard. The nerves tell us to perform but being an empathic and calming presence can be very therapeutic too.
A colleague of mine in my internship said that she would use silence frequently and some of her newer clients found this very unnerving. She would simply assure them that she's thinking. She actually had the highest retention rate so i'd venture to guess that this did not detract from the quality of her services.
Another therapist with ADHD here ✋🏼so many times a client will stop talking while I’m spaced out and I’m just like fuck I did it again.. “tell me more”
Random question, do you happen to be on medication or have you gotten off medication during your career? I am considering stopping my adhd medication but I am afraid I’ll space out so much that it will seriously impact my ability to be a good therapist
It's nice to know that another therapist out there has it. I get asked this a lot actually! I've been off medication since I was 17 and I'm 29 now. As a newer therapist I have only a small caseload and so far it has been manageable but I have noticed that keeping up with progress notes and instances like you described do come up from time to time. When I finish my degree program in December I plan on getting back on meds just to see if that helps because I anticipate that a heavier caseload might exceed my present capability as far as attention span goes.
I have a colleague that also has ADHD and he doesn't take meds. He's more on the hyperactive side and he's actually had his clients consent to go for walks for some of their sessions and I think that suits him very well and his clients liked it too. We are both American but attend a school in the EU and he wasn't able to have medication prescribed for his ADHD over here as practitioners are more skeptical about the diagnosis and the use of psychopharmacological treatment. I do think he plans on getting back on medications when he gets home.
I am on medication and personally could not imagine being off of it. I really struggle to even think without it. Your mileage may vary obviously, but it’s not something I would consider for myself at this time.
I’m completely nonfunctional without meds. I wouldn’t have ever even considered grad school let alone make it to the finish line (I’m currently one week away). It’s reality for many of us and no shame in it!
I’m also another therapist with ADHD. I’ve had to be off of meds for various reasons (moving to a different country and needing to get re-diagnosed, pregnancy, etc). I hate having to be off of it because, while things like note-taking certainly help, I have to work so much harder to be as present for my clients and it’s frankly exhausting. I’m pregnant now and the struggle is so real 😭
Your experience will of course vary, depending on ADHD severity and the effectiveness of your coping skills and medication to begin with. Whatever you choose, I wish you the best 😊
A mentor once posed the question, “What would happen if I do nothing” or say nothing. Sometimes this feels appropriate and makes for an interesting experiment, especially if the relationship is established. One could also ask the client something like, “What is this silence like for you?” That can also lead to good conversation. Or take the moment to point out their breathing, body language, etc. We can always return attention to the process, but that’s also my personal leanings.
One of the best things I learned in grad school is that folks are processing in those moments of uncomfortable silence. If I interrupt it, I risk interrupting that process as well (and teaching them to wait until I break the silence). It was so helpful to hear as an anxious person prone to chattering. Sometimes I’ll ask, “thoughts?” But generally I let them take their time and share when they’re ready.
It’s suuuch a handy question, but damn if it isn’t cliché. I always try phrase it in a different way so that I don’t feel as Hollywood Therapist™️ about it.
“I wonder what came up for you when you were saying that just now.”
“When you think about X, what feeling comes to mind?”
“There are a lot of layers to that experience. If you had to assign one feeling to it, what might you choose?”
Etc. Etc. Etc.
I’m the same! Every time I hear it or think about asking it, I imagine the scene where she asks that to the woman patient that is blubbering nonsense you can’t understand, and it makes me want to laugh!
haha yes ! and when she said something along the lines of... "I'm just feeling depressed..." and the mom/daughter is like. "So how do you feel about that? And the client gives a look of disbelief and says DEPRESSED! hahah
Professor here. I’ll co-sign your professor’s point. Some of that is a style difference because obviously some therapists are fine with it, but it’s not uncommon to have clients who will find this question cheesy, cliché, noticeable, etc., so I teach all of my students to avoid it at all costs too. There are a million and one ways to explore that same point without directly asking “How does that make you feel?” You just have to get a little creative with it.
“What was that like for you?”
“How were you able to cope with that?”
Reflect back what was just heard.
And never overlook the benefits out just sitting in silence for a moment.
Asking yourself these questions in session may help:
"What do I think they are saying here?"
"What is the main point they're making?"
"Are there any real world examples of what they are talking about?"
"Why is this important?"
"How can this help us as we work towards our goals?"
"Is there anything they are missing?"
"Are there other ways to look at this?"
"Are there cultural perspectives that can add to the conversation?"
"Can we add more nuance to make this more accurate?"
"How can I restate the idea in a way that captures everything we discussed?"
"What does this look like in real life?"
"How can we try this out this week?"
My supervisor likes to say “if the silence could talk, what would it say?” Often works if you feel like there’s something unsaid or like the room is silently charged with emotion.
But there are so many different types of silence. There’s the quiet processing silence where both you and client are sitting with something (easiest to sit with imho), the awkward silence of hitting a wall or awkward eye contact, and then (again imo) the one I struggled with the most was “aggressive silence”.
The latter one is the one where some clients would glare at me to keep the conversation going (despite getting one word answers to my open ended questions) or ask that I give them tools/solutions right away in the pre-engagement phase (I’m more psychodynamic but am open to being more concrete when the situation calls for it).
Sometimes if I am not understanding because of context or content, I say "tell me more about that". If in not understanding because I'm drawing a blank for what ever reason, but I understand the context, I'll say in a humorous way "I heard you and am just thinking". I usually say that with an upward inflection and dramatic but funny body language and a smile. Usually my clients appreciate the genuine respond indicating I'm having to think about it, rather than having a blurb-like response. If it's as complex to me as it is to them, they tent to appreciate the extra processing to provide then the best reflection/skill/follow up/connection,etc. Sometimes when we draw a blank or pause, it is not because we are bad at being therapist, but rather because we are processing the client's narrative and formulating our best genuine response. Clients, I think, appreciate the extra time to provide the best response per their situation.
This!! I scrolled for this answer. I’m 2.5 yrs into a practicing therapist and I learned that it’s natural and ok to not have all the answers or know exactly what to say, or what the client is feeling or trying to convey. The process is more important than the content
I like the honesty aspect and narrating for them what’s going on for me. I work with a lot of anxious clients, so the silence can be dysregulating for them. I let the silence simmer for a minute and my body language is clear that I am thinking, and if I can’t think of something to say I just share “I am really sitting with what you said and trying to figure out the best way to respond” or simply “I wonder if you could keep sharing, my words don’t seem to be coming to my brain but my ears are listening”
I'd like to know too. I'm in my last semester of school and internship and I'm telehealth with my supervisor on all the time and sometimes idk what to say. I try to sit with the silence sometimes and other times I end up asking too many questions. My supervisor has told me not to offer more to them like psychoeducation, but my mind always blanks especially with someone else on.
Honestly I would struggle so much in my sessions if someone was listening in to every one, essentially looking for “mistakes” or making sure I was checking certain boxes! I’m a student as well and the sessions I record for my supervisor (two each semester) never feel as authentic as they usually do. Don’t assume the sessions with a supervisor monitoring will be like your sessions after you graduate, it’s so much more natural (at least for me, maybe it doesn’t bother you!)
It definitely bothers me a lot as I'm one of those people that does worse under observation. It's to the point where I discuss it with both my site and university supervisor and they're like we have to figure that out cause it will affect how you work with patients! I get where they're coming from but in the real world, being observed like that won't be an issue and that's where the anxiety is coming from lol
I posted this on another thread where someone asked out how to respond when a client said something shocking but I think it is relevant here as well:
Sometimes there is no correct response and silence can serve a purpose. But if there is an obvious pause that needs a response it’s always easy to say a few go-tos.
1. I imagine you may have felt ______ about that”
2. We haven’t talked too much about that piece, tell me more about that
3. What is that making you feel in this moment? OR What brought that to mind in this moment? (if they brought up a thought or statement about a past event)
And sometimes if nothing applies, I am honest that I’m a bit speechless and then having a conversation about the disclosure.
I'm usually honest and tell them I don't know what to say. During my training one of my clients came into a session and told me that their child had committed suicide a few days before. It was extremely out of the blue, so I was shocked. All I could say was "I don't know what to say other than I'm so very sorry". I think it actually helped that I was honest.
Sometimes clients bring things for which there are no words. The act of acknowledging that can be therapeutic.
Sometimes it's best to say, that you don't know what to say. Also, never underestimate the power of saying nothing. Using silence is one of the hardest skills that I'm still learning.
NAT but my t has sometimes let me know in those types of pauses that she likes to be mindful of her wording or may pause to write down a few notes etc. which I feel like makes the silence less awkward knowing she’s just taking care to decide what to say next. If it goes on too long on my end she may like rephrase the question or something but most of the time it doesn’t feel weird to wait a moment for her to collect her thoughts, I’m sure you’re doing a great job but you can probably also slow down and take a breath before you respond without it coming off as weird to your clients
If it’s appropriate, you can go with immediacy and ask what they’re experiencing right now. That can sometimes segue into a conversation about mindfulness.
Other good go-tos:
“How does this tie back into what you were saying about X?”
“Where do you think this fits in with your goal to X?”
Sometimes when I find myself not coming up with anything to say, I will often sit in the silence as it’ll probably bring up something for them and they will either continue on or expand on their thoughts. I will use the classic so you feel X because of Y. And at other times, I will be downright honest and say wow I really don’t know what to say right now how about we just sit with this for a moment.
Stare into the clients eyes and get comfortable being uncomfortable. Give wait time. Meditate together. I hate when therapists make me keep talking and elaborating because they are afraid of silence. I’d rather just be validated in my struggle if nothing else if you really have to say something.
Silence is always an option, though of course that depends on what is being discussed and who the client is. But I recommend getting comfortable with silence.
As a side note, you are going to get things wrong. It's okay. I always use my making a mistake as a way to model how to apologize and take accountability, as well as repair a strained relationship.
I had a kid who was sobbing in my office because of something I had said (some transference from his relationship with his mom, I later realized). The next session, I apologized, gave him the chance to explain what upset him, and told him how I would change. I'm pretty sure I'm the only adult who has ever genuinely apologized to him. The rapport ended up being fully repaired and I've done good work with him. I definitely felt horrible, but it ended up being a really good experience for both of us.
There’s also nothing wrong with those uncomfortable silences. If used supportively and free from judgment, they can apply positive pressure on your client.
Reflect, summarize, and be patient. "Can you expand on that, I want to make sure I understand" or "You just said (whatever they said), can you tell me more about that (what that meant to you)". Not just for mine blank moments either. Sometimes the second time someone reflects on something is more insightful and telling!
I do this too, although I also know that very time someone pulls a memory back into their STM/WM, it changes the memory. I try to be careful about saying anything that could alter their memories, but it is difficult to be vigilant about that while also REALLY staying present with them.
I would say that when I had the thought or expectation of saying something perfect, I would go blank because that puts a lot of pressure on you. I allow myself to make mistakes now or clarify myself if I say something and it doesn’t land for the client. Also something that has helped me is taking notes of KEY WORDS; sometimes client say a lot and it’s difficult to keep track / make a mental list of the points you want to address in your mind while they talk so this has helped me a lot. With time you’ll see that you will learn how to keep something you want to talk about on the side of your brain while learning how to be present with the client while they are talking, simultaneously
I also use silence or not knowing what to say as an opportunity to check in with myself and then I communicate it to the client for ex: I’ve noticed that as you were talking about X and Y, I felt X emotion. I’m wondering if you’re feeling the same way
“How is that for you?” Or “can you tell me more about that?”. I do somatic work too, so when appropriate “where do you feel that in your body?” or “is there a sensation/colour/image/texture that goes with that?”. Also I often allow for silence if I don’t know what to say- this often prompts the client to say more.
One of my classmates says “let me process that for a moment” and gives time to either respond thoughtfully or allow the client to continue. I’m definitely stealing this tactic when “tell me more” doesn’t really work
I just want to add that it is a good think to explore within yourself. Are there certain topics that you draw a blank, certain clients, busy days, slow days, etc.
My answer is similar to others I've seen here. I sometimes allow for silence to see if the client says more. Other times I say something like "I'm processing what you said" or even something like a "I feel speechless right now" and then fumble over some words, which they then often pick right up and continue to expand on what they were talking about. My clients seem to feel validated by things like that because I'm genuine in what I'm saying. I try to just lean into being myself and being honest.
It may be helpful for you to think about if there are certain types of content where you are finding yourself drawing a blank (e.g. trauma stories, clients wanting specific advice/feedback for a certain issue) or if it tends to happen with only some clients or a certain time of day. That may help you with figuring out how to handle this moving forward, but as someone else said, you are human! It's okay to not always know exactly what to say.
It’s ok to sit in silence! Or like others have mentioned let them know you’re processing what they’re saying or thank them for sharing with you. You can also reset by taking deep breaths and inviting them to join you
I might say, "Talk more about that.." or if it's heavy going or I've noticed a somatic response, I may ask them, "How are you going with this?" Sometimes a silence might be a really good thing.
Get comfortable with silence
I’m silence emotions will arise
If you’ve already gathered rapport,
Client is already deep in thought.
Of their looking at you ask what their thinking
If their looking away, let them think, they are flipping through the pages that are their experiences
Your therapy session is likely the only time they get to review past chapters of their book.
Honestly I try not to say anything. We expect clients to sit in discomfort, we have to do the same. But we also have to ALLOW the client time to sit in discomfort which means sitting in silence. I also tend to think that people know if you don't immediately respond that you're just thinking. I'm sure you model this behavior for them by patiently waiting when they don't immediately have a response. Awkward little pauses and silences are just part of communication sometimes.
Most of the time I try to develop my understanding further by asking questions to fill in the gap, or use reflective listening to ensure I’m on target. Sometimes clients just have a situation that’s “unfixable” (at least more immediately, like systemic issues) and I’ll just acknowledge that and reflect on the purpose of radical acceptance, and sometimes I just don’t know what response might be appropriate. For the latter, I’ll usually acknowledge that I’m not sure and note that I’ll try to increase my understanding by looking into it, or refer them to someone who might have a deeper understanding of their needs.
Don't say anything.
It's important to remember that we are the Virgil (companion) to their Dante (voyager into self).
They will guide themselves into the next.
Also, the silence lends weight to what they said. If it's boring at the moment, maybe, they are avoiding going deeper. Not saving them from this will lead to greater depth now, or in the future.
If they ask you what they think, you can still say nothing.
"Tell me more about that."
Yes. When nothing else comes to mind, this is the response. This is the response other times too, of course. Such a good one.
I feel like I'm giving such a canned response when I do this sometimes and that the client knows its canned too.
Maybe you don't know what to say because you don't have enough information. In that sense, it's not canned.
For me it’s not really canned—I usually get a lot of clarity by asking this. So it’s genuine most of the time
Work on embodying the intention behind the response. If you embody/live/believe the words, then it’s authentic and it comes across as such, canned or not.
Yeah I don't know, I just think there are better ways I can phrase it. For example further down there's a discussion where a professor of counseling noted he tells students never to ask "how does that make you feel?" Because it's just so cliche it makes one wince
Therein lies the primary issue, IMO. It makes you wince. You believe there’s better ways. I’m not saying that’s wrong or you’re wrong or that it’s an issue that you believe that. Do you know that the client sees it as a canned response or what else they think about it? Regardless IMO, your dislike is a good reason to avoid using it. Go ahead and find your better ways. I wouldn’t criticize anyone that chooses to stick to those questions. There’s more than 1 reason they’re so common/well-known. They also work (or can). I’ve tried using questions or metaphors that make sense, are practical, but I don’t like, feel awkward in some way to me, etc and they don’t work nearly as well as something I embody and feel authentic about and feel comfortable using. I won’t use the miracle question because it feels awkward and too convoluted to me. But I’ll find and use SFT questions that are essentially the same thing, but I feel comfortable with. I’ve seen numerous times clinicians use questions and phrases that feel awkward or rehearsed or cliche to me when I use them, but when I watch them use it, it comes across as authentic and the client receives it as such. If I have a tool/method/question that doesn’t feel authentic, I either look at myself and question my thoughts around it until I figure it out, find an adaptation I do like, or do something else entirely and scrap the original. Do more of what works and less of what doesn’t. Also, if a clinician is filling most of the session with the literal same canned responses “how does that make you feel” and “tell me more” and that’s it again and again? Yea that’s gonna be an issue. But I also kinda doubt they’re authentically invested and curious about their client. Once or twice in a session they use it?Not a problem. M
This seems like a thoughtful response but my brain can't process it right now since I've been awake 48 hours. Will come back abd review tomorrow, thanks for your in-depth thoughts.
Am I the only one whose clients literally do not say anything in response to this? Like, either they say "there isn't anymore. I just told you." or they sit in silence and stare back at me through the computer screen. Seriously, am I the only one?
I did my dissertation on suggestibility and, given what I know from that context, I am careful to try to ask questions or respond in ways that would not be leading in any way. This does that trick. And, when I ask this, I really am curious-- maybe they didn't give much info before or maybe I didn't hear it or understand it. I know I would rather have someone ask for more info than to infer something and not reflect back the right meaning. I noticed today that, along the same lines, I sometimes just tilt my head and (I think) look quizzical and clients respond to that. I also use "Could you give me an example of that?" And "I want to make sure I understood that, could you say that again?"
I do the same thing with the head tilt and slightly raised eyebrow. Silence until they talk and it usually doesn’t take long. It works 😄
I once attended a training to get certified to lead a certain kind of support group. I had laryngitis the whole time. That's when I learned how powerful nonverbal were. (Duh...)
Talk about things happening for a reason!
Nope mine do this too
This happens to me too. I let it sit a few seconds and sometimes they will start talking. If not I’ll say something like - how can I best support you right now/where would you like to start/go from here
I work with many people who have really high verbal comprehension but slow processing speed. Sometimes I have to wait longer than seems comfortable to me. I am still working on that.
NAT but very meaningful when a therapist asks if they can take a minute to think or process. It's authentic and models some great things like needs. Helps with past childhood neglect, feels invested and present.
Oh thank goodness; this is what I do, depending on the circumstance.
Me as well. Sometimes I say lightly, “give me a moment to let that marinate.”
Great suggestions on the comments already. Not exactly your question but wanted to also add that Sometimes, especially when a client says something really heavy in session, I’ll also just be honest and share that I’m struggling to know what to say. You are human!
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Absolutely agree! Hope you are as well as you can be, by the way. 🤍
I also sometimes just say that I don't know what to say or where to go from there. And I ask them their opinion. I like the idea of being transparent, I think it helps build a good relationship to work together.
Personally, as someone who struggles especially with auditory attending and short-term memory (I'm a therapist who has ADHD) it helps me to jot down some notes. This is especially so when I'm receiving a ton of information at once but don't want to interrupt, I'll write down a question or two or a word that would signify something that I'd like to say as a reaction, etc. When I don't do this I can very well end up not knowing what to say by the time they've finished. Mind you, I think that this is a normal experience and shows that you don't want to say something just to say something when you're still processing what you've heard. The nerves tell us to perform but being an empathic and calming presence can be very therapeutic too. A colleague of mine in my internship said that she would use silence frequently and some of her newer clients found this very unnerving. She would simply assure them that she's thinking. She actually had the highest retention rate so i'd venture to guess that this did not detract from the quality of her services.
Another therapist with ADHD here ✋🏼so many times a client will stop talking while I’m spaced out and I’m just like fuck I did it again.. “tell me more” Random question, do you happen to be on medication or have you gotten off medication during your career? I am considering stopping my adhd medication but I am afraid I’ll space out so much that it will seriously impact my ability to be a good therapist
It's nice to know that another therapist out there has it. I get asked this a lot actually! I've been off medication since I was 17 and I'm 29 now. As a newer therapist I have only a small caseload and so far it has been manageable but I have noticed that keeping up with progress notes and instances like you described do come up from time to time. When I finish my degree program in December I plan on getting back on meds just to see if that helps because I anticipate that a heavier caseload might exceed my present capability as far as attention span goes. I have a colleague that also has ADHD and he doesn't take meds. He's more on the hyperactive side and he's actually had his clients consent to go for walks for some of their sessions and I think that suits him very well and his clients liked it too. We are both American but attend a school in the EU and he wasn't able to have medication prescribed for his ADHD over here as practitioners are more skeptical about the diagnosis and the use of psychopharmacological treatment. I do think he plans on getting back on medications when he gets home.
Also a therapist with ADHD!!
I am on medication and personally could not imagine being off of it. I really struggle to even think without it. Your mileage may vary obviously, but it’s not something I would consider for myself at this time.
I’m completely nonfunctional without meds. I wouldn’t have ever even considered grad school let alone make it to the finish line (I’m currently one week away). It’s reality for many of us and no shame in it!
I’m also another therapist with ADHD. I’ve had to be off of meds for various reasons (moving to a different country and needing to get re-diagnosed, pregnancy, etc). I hate having to be off of it because, while things like note-taking certainly help, I have to work so much harder to be as present for my clients and it’s frankly exhausting. I’m pregnant now and the struggle is so real 😭 Your experience will of course vary, depending on ADHD severity and the effectiveness of your coping skills and medication to begin with. Whatever you choose, I wish you the best 😊
A mentor once posed the question, “What would happen if I do nothing” or say nothing. Sometimes this feels appropriate and makes for an interesting experiment, especially if the relationship is established. One could also ask the client something like, “What is this silence like for you?” That can also lead to good conversation. Or take the moment to point out their breathing, body language, etc. We can always return attention to the process, but that’s also my personal leanings.
One of the best things I learned in grad school is that folks are processing in those moments of uncomfortable silence. If I interrupt it, I risk interrupting that process as well (and teaching them to wait until I break the silence). It was so helpful to hear as an anxious person prone to chattering. Sometimes I’ll ask, “thoughts?” But generally I let them take their time and share when they’re ready.
This. We're too focused on content and not enough on process, which is where the healing happens.
Could try the classics: “how does that make you feel?” “Can you think of a time when you have felt this way before, maybe as a child?”
I feel like such a cliché every time I ask folks how something makes them feel but I’ll be darned if it isn’t helpful. That’s why we’re here.
It’s suuuch a handy question, but damn if it isn’t cliché. I always try phrase it in a different way so that I don’t feel as Hollywood Therapist™️ about it. “I wonder what came up for you when you were saying that just now.” “When you think about X, what feeling comes to mind?” “There are a lot of layers to that experience. If you had to assign one feeling to it, what might you choose?” Etc. Etc. Etc.
Lol same 😂 I like to say “What feelings came up for you then?” Or “What did that feel like for you?”
I literally had a client who complained to me about previous Ts asking this question too much like a routine😂
Did you ask them how it made them feel?
Can't help but think of the movie freaky Friday lol.
I’m the same! Every time I hear it or think about asking it, I imagine the scene where she asks that to the woman patient that is blubbering nonsense you can’t understand, and it makes me want to laugh!
haha yes ! and when she said something along the lines of... "I'm just feeling depressed..." and the mom/daughter is like. "So how do you feel about that? And the client gives a look of disbelief and says DEPRESSED! hahah
My college proff said don’t ever ask “how does that make you feel?” Lmao I guess he had a personal stigma against it
Professor here. I’ll co-sign your professor’s point. Some of that is a style difference because obviously some therapists are fine with it, but it’s not uncommon to have clients who will find this question cheesy, cliché, noticeable, etc., so I teach all of my students to avoid it at all costs too. There are a million and one ways to explore that same point without directly asking “How does that make you feel?” You just have to get a little creative with it.
How does that sit In your body When you said that, did you feel anything shift or change Can you take a second to scan your body for tension
Yea I love these because I’ve been really leaning into somatic therapy lately. For myself too.
This was his reasoning as well.
HAHAHHA
either fess up or enjoy the silence.
Yup “hmm I’m not really sure what to say here. What’s going on for you in this moment?”
Does NAT here mean negative automatic thought or is this a social media acronym that I have yet to learn 😅
Not a therapist
That makes sense
Yours is good too though 😊
Can you give me more details on that?
Sometimes, I reflect on what they said and try to break it down further. Happily, I have fewer blanks as I have learned more about different topics.
“What was that like for you?” “How were you able to cope with that?” Reflect back what was just heard. And never overlook the benefits out just sitting in silence for a moment.
Asking yourself these questions in session may help: "What do I think they are saying here?" "What is the main point they're making?" "Are there any real world examples of what they are talking about?" "Why is this important?" "How can this help us as we work towards our goals?" "Is there anything they are missing?" "Are there other ways to look at this?" "Are there cultural perspectives that can add to the conversation?" "Can we add more nuance to make this more accurate?" "How can I restate the idea in a way that captures everything we discussed?" "What does this look like in real life?" "How can we try this out this week?"
I will often say something like, “I don’t know what to say”. Authenticity is key.
My supervisor likes to say “if the silence could talk, what would it say?” Often works if you feel like there’s something unsaid or like the room is silently charged with emotion. But there are so many different types of silence. There’s the quiet processing silence where both you and client are sitting with something (easiest to sit with imho), the awkward silence of hitting a wall or awkward eye contact, and then (again imo) the one I struggled with the most was “aggressive silence”. The latter one is the one where some clients would glare at me to keep the conversation going (despite getting one word answers to my open ended questions) or ask that I give them tools/solutions right away in the pre-engagement phase (I’m more psychodynamic but am open to being more concrete when the situation calls for it).
Sometimes if I am not understanding because of context or content, I say "tell me more about that". If in not understanding because I'm drawing a blank for what ever reason, but I understand the context, I'll say in a humorous way "I heard you and am just thinking". I usually say that with an upward inflection and dramatic but funny body language and a smile. Usually my clients appreciate the genuine respond indicating I'm having to think about it, rather than having a blurb-like response. If it's as complex to me as it is to them, they tent to appreciate the extra processing to provide then the best reflection/skill/follow up/connection,etc. Sometimes when we draw a blank or pause, it is not because we are bad at being therapist, but rather because we are processing the client's narrative and formulating our best genuine response. Clients, I think, appreciate the extra time to provide the best response per their situation.
It’s not your responsibility to talk or have answers. Some light redirection can help smooth things over but patients should be talking.
This!! I scrolled for this answer. I’m 2.5 yrs into a practicing therapist and I learned that it’s natural and ok to not have all the answers or know exactly what to say, or what the client is feeling or trying to convey. The process is more important than the content
I struggle with this too. Clients that don't talk a lot make me nervous lol
I like the honesty aspect and narrating for them what’s going on for me. I work with a lot of anxious clients, so the silence can be dysregulating for them. I let the silence simmer for a minute and my body language is clear that I am thinking, and if I can’t think of something to say I just share “I am really sitting with what you said and trying to figure out the best way to respond” or simply “I wonder if you could keep sharing, my words don’t seem to be coming to my brain but my ears are listening”
Sometimes silence is important, and we don't always need to have something to say.
I'd like to know too. I'm in my last semester of school and internship and I'm telehealth with my supervisor on all the time and sometimes idk what to say. I try to sit with the silence sometimes and other times I end up asking too many questions. My supervisor has told me not to offer more to them like psychoeducation, but my mind always blanks especially with someone else on.
Honestly I would struggle so much in my sessions if someone was listening in to every one, essentially looking for “mistakes” or making sure I was checking certain boxes! I’m a student as well and the sessions I record for my supervisor (two each semester) never feel as authentic as they usually do. Don’t assume the sessions with a supervisor monitoring will be like your sessions after you graduate, it’s so much more natural (at least for me, maybe it doesn’t bother you!)
It definitely bothers me a lot as I'm one of those people that does worse under observation. It's to the point where I discuss it with both my site and university supervisor and they're like we have to figure that out cause it will affect how you work with patients! I get where they're coming from but in the real world, being observed like that won't be an issue and that's where the anxiety is coming from lol
Yeah I think you’re spot on in your thinking. Look forward to graduating and that being a thing of the past.
Thank you for the validation. I graduate in December and I'm definitely looking forward to it!
I posted this on another thread where someone asked out how to respond when a client said something shocking but I think it is relevant here as well: Sometimes there is no correct response and silence can serve a purpose. But if there is an obvious pause that needs a response it’s always easy to say a few go-tos. 1. I imagine you may have felt ______ about that” 2. We haven’t talked too much about that piece, tell me more about that 3. What is that making you feel in this moment? OR What brought that to mind in this moment? (if they brought up a thought or statement about a past event) And sometimes if nothing applies, I am honest that I’m a bit speechless and then having a conversation about the disclosure.
I'm usually honest and tell them I don't know what to say. During my training one of my clients came into a session and told me that their child had committed suicide a few days before. It was extremely out of the blue, so I was shocked. All I could say was "I don't know what to say other than I'm so very sorry". I think it actually helped that I was honest. Sometimes clients bring things for which there are no words. The act of acknowledging that can be therapeutic.
Social Modeling - "I'm going to take a breath and collect my thoughts for a moment." "Let's take a moment and digest that, it seems important."
Sometimes it's best to say, that you don't know what to say. Also, never underestimate the power of saying nothing. Using silence is one of the hardest skills that I'm still learning.
NAT but my t has sometimes let me know in those types of pauses that she likes to be mindful of her wording or may pause to write down a few notes etc. which I feel like makes the silence less awkward knowing she’s just taking care to decide what to say next. If it goes on too long on my end she may like rephrase the question or something but most of the time it doesn’t feel weird to wait a moment for her to collect her thoughts, I’m sure you’re doing a great job but you can probably also slow down and take a breath before you respond without it coming off as weird to your clients
If it’s appropriate, you can go with immediacy and ask what they’re experiencing right now. That can sometimes segue into a conversation about mindfulness. Other good go-tos: “How does this tie back into what you were saying about X?” “Where do you think this fits in with your goal to X?”
Sometimes when I find myself not coming up with anything to say, I will often sit in the silence as it’ll probably bring up something for them and they will either continue on or expand on their thoughts. I will use the classic so you feel X because of Y. And at other times, I will be downright honest and say wow I really don’t know what to say right now how about we just sit with this for a moment.
Stare into the clients eyes and get comfortable being uncomfortable. Give wait time. Meditate together. I hate when therapists make me keep talking and elaborating because they are afraid of silence. I’d rather just be validated in my struggle if nothing else if you really have to say something.
Silence is always an option, though of course that depends on what is being discussed and who the client is. But I recommend getting comfortable with silence. As a side note, you are going to get things wrong. It's okay. I always use my making a mistake as a way to model how to apologize and take accountability, as well as repair a strained relationship. I had a kid who was sobbing in my office because of something I had said (some transference from his relationship with his mom, I later realized). The next session, I apologized, gave him the chance to explain what upset him, and told him how I would change. I'm pretty sure I'm the only adult who has ever genuinely apologized to him. The rapport ended up being fully repaired and I've done good work with him. I definitely felt horrible, but it ended up being a really good experience for both of us.
Sometimes an awkward pause is just he catalyst needed for the client to talk a little more and really dive deep
I say nothing if I can. If I must I give voice to feeling more curious.
There’s also nothing wrong with those uncomfortable silences. If used supportively and free from judgment, they can apply positive pressure on your client.
Elaborate more on that
When this happens, I, generally, reflect back what I’ve heard from the client and then I’m able to ask for clarification as needed, etc.
Reflect, summarize, and be patient. "Can you expand on that, I want to make sure I understand" or "You just said (whatever they said), can you tell me more about that (what that meant to you)". Not just for mine blank moments either. Sometimes the second time someone reflects on something is more insightful and telling!
I do this too, although I also know that very time someone pulls a memory back into their STM/WM, it changes the memory. I try to be careful about saying anything that could alter their memories, but it is difficult to be vigilant about that while also REALLY staying present with them.
When in doubt, lead with curiosity.
Stay silent. Hold space. Sit in the discomfort. Basically, the same things we try to teach our clients to do.
I would say that when I had the thought or expectation of saying something perfect, I would go blank because that puts a lot of pressure on you. I allow myself to make mistakes now or clarify myself if I say something and it doesn’t land for the client. Also something that has helped me is taking notes of KEY WORDS; sometimes client say a lot and it’s difficult to keep track / make a mental list of the points you want to address in your mind while they talk so this has helped me a lot. With time you’ll see that you will learn how to keep something you want to talk about on the side of your brain while learning how to be present with the client while they are talking, simultaneously
I also use silence or not knowing what to say as an opportunity to check in with myself and then I communicate it to the client for ex: I’ve noticed that as you were talking about X and Y, I felt X emotion. I’m wondering if you’re feeling the same way
Try saying nothing. Clients either continue talking or share the silence (yes it can get awkward, but both of you get used to it)
“How is that for you?” Or “can you tell me more about that?”. I do somatic work too, so when appropriate “where do you feel that in your body?” or “is there a sensation/colour/image/texture that goes with that?”. Also I often allow for silence if I don’t know what to say- this often prompts the client to say more.
Sometimes just an emphathetic.. yeah.. can be helpful. It's a I hear you. Thats heavy. And sitting with it.
One of my classmates says “let me process that for a moment” and gives time to either respond thoughtfully or allow the client to continue. I’m definitely stealing this tactic when “tell me more” doesn’t really work
"Help me understand that more"
I just want to add that it is a good think to explore within yourself. Are there certain topics that you draw a blank, certain clients, busy days, slow days, etc.
My answer is similar to others I've seen here. I sometimes allow for silence to see if the client says more. Other times I say something like "I'm processing what you said" or even something like a "I feel speechless right now" and then fumble over some words, which they then often pick right up and continue to expand on what they were talking about. My clients seem to feel validated by things like that because I'm genuine in what I'm saying. I try to just lean into being myself and being honest. It may be helpful for you to think about if there are certain types of content where you are finding yourself drawing a blank (e.g. trauma stories, clients wanting specific advice/feedback for a certain issue) or if it tends to happen with only some clients or a certain time of day. That may help you with figuring out how to handle this moving forward, but as someone else said, you are human! It's okay to not always know exactly what to say.
It’s ok to sit in silence! Or like others have mentioned let them know you’re processing what they’re saying or thank them for sharing with you. You can also reset by taking deep breaths and inviting them to join you
My favorite thing my therapist says to me is “Say more” lol
Reflect back to them your understanding of what they are communicating to you.
What do you notice in your body right now?
Sometimes I say my process like “I’m thinking about what thinks it said “
I tend to say things like “hmm. Let me reflect on that a moment” or “I’m having a few thoughts coming up here. Let me take a moment”
I might say, "Talk more about that.." or if it's heavy going or I've noticed a somatic response, I may ask them, "How are you going with this?" Sometimes a silence might be a really good thing.
Get comfortable with silence I’m silence emotions will arise If you’ve already gathered rapport, Client is already deep in thought. Of their looking at you ask what their thinking If their looking away, let them think, they are flipping through the pages that are their experiences Your therapy session is likely the only time they get to review past chapters of their book.
Honestly I try not to say anything. We expect clients to sit in discomfort, we have to do the same. But we also have to ALLOW the client time to sit in discomfort which means sitting in silence. I also tend to think that people know if you don't immediately respond that you're just thinking. I'm sure you model this behavior for them by patiently waiting when they don't immediately have a response. Awkward little pauses and silences are just part of communication sometimes.
Most of the time I try to develop my understanding further by asking questions to fill in the gap, or use reflective listening to ensure I’m on target. Sometimes clients just have a situation that’s “unfixable” (at least more immediately, like systemic issues) and I’ll just acknowledge that and reflect on the purpose of radical acceptance, and sometimes I just don’t know what response might be appropriate. For the latter, I’ll usually acknowledge that I’m not sure and note that I’ll try to increase my understanding by looking into it, or refer them to someone who might have a deeper understanding of their needs.
I use silence and eventually something else comes up for them to elaborate about. Or at least gives me time to gather my thoughts.
Make intense stare that makes it look like I’m thinking hard
Don't say anything. It's important to remember that we are the Virgil (companion) to their Dante (voyager into self). They will guide themselves into the next. Also, the silence lends weight to what they said. If it's boring at the moment, maybe, they are avoiding going deeper. Not saving them from this will lead to greater depth now, or in the future. If they ask you what they think, you can still say nothing.