Psychotherapists' passivity--a major training problem

A major problem encountered in the early psychotherapy training of psychiatric residents, psychologists, and social workers is the tendency for the student to take an inappropriately passive and silent role. Rather than actively engage patients in a therapeutic alliance, beginning students have the tendency to remain withdrawn and inarticulate. This often reaches extreme proportions and may later significantly block treatment progress. Clinical vignettes are presented to show the range and variety of hyperpassive behavior in psychotherapy training and the potential crippling and destructive effects on the treatment process. This is not to imply that there is no danger in excess activity on the part of the therapist. Indeed, not all silence need be destructive. However, detachment, withdrawal, and excess silence--attitudes often fostered by our training programs--can be markedly destructive to both patients and treatment. Psychodynamic factors causing this situation are reviewed. A variety of methods and strategies are recommended for dealing with it. If the supervisor remains alert, the problem can be significantly resolved before it interferes with treatment. In this way, the student will be helped to overcome one of the major ealry hurdles of training.