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. (PsycInfo Database Record (c) 2023 APA, all rights reserved).