Exploring silence in short-term psychoanalytic psychotherapy with adolescents with depression

Psychotherapy process research is important in developing technique and enhancing clinical skills. Silence, as an aspect of child and adolescent psychoanalytic psychotherapy, has been a neglected area of research, despite it being acknowledged as an often challenging yet therapeutically useful aspect of the work. This study aims to explore silence in adolescent psychoanalytic psychotherapy, by studying the emergence of silence in therapy sessions. Three Short-Term Psychoanalytic Psychotherapies of adolescents with depression were used in the study, and silences occurring in six sessions of each therapy were coded, using the Pausing Inventory Categorization System (PICS). Findings showed that, in the three therapies sampled, almost one-third of session time was spent on average in silence, and most of this silence was coded as ‘obstructive’. Moreover, the amount of silence in every stage of therapy was different for each patient-therapist dyad. Follow-up interviews conducted with the adolescents were analysed using thematic analysis, and showed that the adolescents generally expressed negative feelings about silence in their therapy. Analysis suggests that the majority of the silence in these therapies related to conflict, which could be viewed as both an aspect of the developmental stage of adolescence, and a symptom of depression. These findings suggest that silences may not always be therapeutically productive in adolescent therapy, even if they are considered to be so in psychotherapy with adults, and so adaptations in therapeutic technique are required.