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and adolescents are among the most proficient at employing silence as a weapon
in therapy. Marshall collaborated with one ten-year-old client who was especially
skilled at avoiding any interaction whatsoever through a variety of means
detachment, indifference, disengagement from anything the therapist might try.
Because this child was so brilliantly adept at ignoring questions, he was recruited
to help write a list of what it takes to be the most difficult client possible.
Marshall therefore suggested that if other children want to be like him and frustrate
their therapists, they should say only the following in response to any question:
I dont know! Of all the responses we get from the silent client, I dont know may be the most difficult of all. Sack has catalogued several of the most common ways a therapist might respond to a client who says I dont know to any query that is initiated. I have presented the therapeutic options in progressive order of how intrusive they might be. My assumption is that we try to do as little as possible to produce the greatest impact. Only when our most benign interventions fall on deaf ears should we resort to more potent strategies.
Ethics - Balancing
Power Options to the Client Response of I dont know.
Ethics - Balancing
Your Power by Doing Less
My need to do something. Well, even with all the training I have had and permission I have been given from supervisors I admire, I still feel the need to do something in my work. Cases in point: I am seeing three adolescents right now whom I would describe as difficult because they refuse to talk. Their parents insist they get help, feeling guilty about the monsters they believe they have created, so they drop them off at my office once a week for some brainwashing.
All three boys are defiant and surly. They have declared to me that they may have to come but they dont have to talk. Fine, I tell them, what, then, would you like to do with the time we have together? I feel proud of myself. I am being supportive, concentrating on being with them on any level at which they can function. With one boy, we play cards poker and gin rummy. He is not interested in learning any other games, and he will not respond to any question if it does not relate to the game. Another boy brings a ball and we play catch outside. He will not talk either, but I convince myself that on a metaphoric plane we are communicating on a deep level. The third boy walks with me to a drugstore where I buy him some chips and a Coke. He mumbles thank you and then promptly ignores me.
The real surprise. I have been seeing each of these boys for a period of months. I cannot see that their behavior when they are with me has changed at all. We have settled into a routine in which we know what is expected. The real surprise is that the parents of two of the boys claim there has been substantial improvement in their demeanor and school performance. Sometimes they are even nice to their sisters. The parents think I am some kind of magician and ask me what Ive been doing. "Trade secrets," I tell them. But I think to myself, "This is ridiculous. No fancy confrontations or brilliant interpretations. I just play cards and go for walks. I cant believe I get paid for this!"
So why are these kids possibly improving? It must be that they sense I really do care, that I am trying to help them. I try to be completely honest, and they know I will not tolerate any crap. I suppose they also realize that I am in a position to get them into even more trouble if they do not cooperate minimally. Maybe I will even be able to do them a favor someday.
act of not doing psychotherapy is difficult for those of us who are so attracted
to progress and change. Yet passively resistant clients do not respond too well
to direct intervention. And sometimes with adolescents, the best therapy is to
suspend any therapeutic activity temporarily so they do not feel so cornered.
I suppose it is awfully arrogant of us to believe that nothing much happens in
therapy unless we make it happen; some of our best work comes from allowing resistant
clients to move along at their own pace and speed without having to cater to our
Ethics CEU QUESTION
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