ABSTRACT
In the clinical setting, "silence" is generally taken to mean, literally, "a lack of verbal communication". This chapter attempts to refutes that view and indeed to demonstrate that "silence" is neither silent nor challenging, but rather a very loud and meaningful communication. A dilemma is a state of uncertainty or perplexity, especially when requiring a choice between equally unfavourable or unpromising options. In the absence of verbal conversation, author choose to use the concept of "musing" - the process of calm, quiet, curious contemplation. The clinician might talk with a parent about what Sarah may be experiencing and in the meantime observe Sarah's responses to this conversation. There is no attempt to get responses from Sarah; rather the clinician stays with the moment, notes her "communications", considers them, and responds gently, empathically, and non-judgementally. What family and clinicians believe to be supportive and helpful, she experiences as coercive and persecuting.
