Some clients will talk your ear off. The moment you pick up the phone or step in
the door you learn to expect an onslaught of questions, queries, observations,
gossip, laments and explanations. It can
be hard to get a word in edgewise. We
learn a lot about these clients thanks to their willingness to share (or
over-share as the case may be). As
workers, we work over time to develop this verbosity into opportunities for meaningful
and constructive conversations.
With other clients the opposite is true. Getting a full sentence out of them may be
like pulling teeth. I have two such
clients right now, each with a very different basis for their (relative)
silence.
One is a relatively new client to me. She has a long history of schizophrenia and “non-responsiveness
to treatment”. Part of the problem is
that her mother speaks for her. So we
try to meet outside the house. Our
meeting tend to go along the same lines every time. I greet her, ask some general questions (what
have you been doing this week? Anything
good on tv? How do you like the weather?
etc) , try to bring up items from previous meetings, ask about plans. Sometimes there is a head nod in reply. Sometimes a quiet one or two word answer,
which may or may not be related to the question. Sometimes a moment of silence followed by “sorry,
what did you say?”
I can see that she’s struggling. She talks to the voices a lot more than she
does to me. Under her breath, so I can’t
quite hear. She pushes on her eyes,
opens and closes them repeatedly without looking at me. She puts her head up and down off the
table. She has a lot going on, and I do
get the impression that she’s trying to be present for our conversation while
all these other things are going on for her.
Slowly it’s getting better.
She is maybe getting used to me, will ask me questions sometimes, will
give me a few words more of response each time.
I’ve referred her to a new psychiatrist who I think (hope) might
progress where the last one stalled. I’m
working with her family on letting her speak for herself. We’ll see how it goes.
The other is a long-time client. We’ve worked together about 3 years. I’ve seen him through several ups and
downs. But the silence is a new
thing. It’s not even silence per se, but
quietness. I ask a question and he says
something in response but the volume knob must be turned to 1 because I can’t
hear. I ask him to repeat himself and he
may or may not. Several times I’ve
resorted to being blunt “I’d really like to talk to you, but I’m finding it
hard to hear what you say. Can you speak
up?” This goes nowhere. When I can hear him, I’m not sure I
understand the content. It’s tangential,
it’s rambling, the associations are loose, as they say.
It’s an important skill in the toolbox for every good
counsellor – being comfortable with silence.
We are often invading people’s private spaces, their homes, the personal
lives with our assessments and surveys and mandatory home visits. We discuss difficult and painful subject
matters. We inquire about things some
clients never may have spoken aloud to another person. Sometimes the reasons are unclear.
So what can I do in these situations? Show up.
Keep talking. Give them
space. Catch myself when I’m becoming
frustrated. I’ve got the luxury (ha!) of
working in a long-term program, so hopefully I can give them as much time,
space and talk as they need before we have to say we’re not getting any work
done so discharge becomes necessary.
Any other ways you can think of to support a client who is
having trouble communicating?
