How do Child and Adolescent Psychotherapists work with silent patients? An exploration of some meanings and functions of patient silence in sessions: An interpretative phenomenological analysis

This study explores the experience of child psychotherapists that work with the silent child. I conducted semi-structured interviews with a purposive sample of four child and adolescent psychoanalytic psychotherapists, and used interpretative phenomenological analysis (IPA) to examine the unique meaning that participants attribute to their work with the silent child. Four superordinate themes emerged from the data: formulations of the silent child—‘just different’; technique and cautious adaptation—'I needed to try something different’; the therapist’s feelings; and the tension between the need for support, and resistance to accessing it. This study aims to highlight the value of long-term work with the silent child, and strengthen understanding of the need for a mixed approach, which includes psychoanalytic technique and its cautious adaptation, to enliven the withdrawn child. As the first known qualitative study that investigates the experience of therapists working with silent patients, it reveals accounts of participants’ experiences that working with the silent patient can be a long and painful process, but that psychoanalytically trained child psychotherapists have a good foundation for work of this kind. The child psychotherapist’s skill of working with nonverbal communication based on infant observation is central, but flexibility is also required. A finding that was hitherto unexplored in the literature is the therapist’s feelings of shame when working with the silent patient, tied to a feeling of being deskilled and the apparent lack of progress, which leads to difficulties in accessing the necessary supervisory support. This study’s findings can be used for future research and can hopefully benefit the clinical practice of child psychotherapy with the silent child.