This technique is most useful with silent patients. Silence should never be used with over-talkative patients, because letting them talk continuously would not allow the interviewer to control the interview. This difficult type of communication, when used correctly, can indicate interest and support. Silence on the part of the patient can be related to hostility, shyness, or embarrassment. The interviewer should remain silent, maintaining direct eye contact and attentiveness. The interviewer may lean forward and even nod. After no more than 2 minutes of silence, the interviewer may say,

What are you thinking about?'' ' 'You were saying ...?'' ''These things are hard to talk about.'' ''You were about to say ...?''

If the patient remains silent, another method of sustaining the interview must be chosen.

The interviewer must use silence when the patient becomes overwhelmed by emotion. This act allows the patient to release some of the tension evoked by the history and indicates to the patient that it is acceptable to cry. Handing the patient a box of tissues is a supportive gesture. It is inappropriate for the interviewer to say, ''Don't cry'' or ''Pull yourself together,'' because these statements imply that the patient is wasting the interviewer's time or that it is shameful to show emotions.

It is important to use silence correctly. An interviewer who remains silent, becomes fidgety, reviews notes, or makes a facial expression of evaluation will inhibit the patient. The patient may perceive the frequent use of silence by the interviewer as aloofness or a lack of knowledge.

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