Non-verbal Language and Therapy1

NON-VERBAL LANGUAGE AND THERAPY

(PSYCHOTHERAPEUTIC PROCESSES ASSIGNMENT)

By: Muskaan Agarwal

Roll No: 21/936

MA (Applied Psychology), 1st year

Psychotherapeutic Prcoesses; AP20004A

Submitted to: Dr. S.P.K Jena

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NON-VERBAL LANGUAGE AND THERAPY

CONTENTS

1.0 Non-Verbal Communication And Psychotherapy (Introduction)

2.0 Non-Verbal Language In Psychotherapy

3.0 Consideration Of Non-Verbal Language By Therapist

 MOOD vs AFFECT: Congruent or Incongruent

 Factors To Be Considered For Non-Verbal Language In Therapy Setting

 Non-Verbal Behaviour Of Psychologist And Its Significance

4.0 Non-Verbal Behaviour As Diagnostic Criteria

5.0 Conclusion

6.0 References

1.0.NON-VERBAL COMMUNICATION AND PSYCHOTHERAPY

Therapeutic relationship is essential in the psychotherapy and is most successful when

therapist and client agree on a goal, repair ruptures and get client feedback (Angelis, 2019).

With the therapeutic relationship as essential as the treatment method, communication and

collaboration become increasingly valuable to the overall outcomes of therapy and

counseling (Angelis, 2019).

Wachtel (2011, p. ix) highlights the importance of communication in the therapeutic

technique and the need to “move from understanding the patient or client to putting that

understanding into words. An estimated 60 to 65 percent of interpersonal communication is

conveyed via nonverbal behaviors (Burgoon, Guerro and Floyd, 2009). Unfortunately, the
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emphasis in the clinical setting is disproportionately placed on verbal interactions(Philippot et

al, 2003).

Krausser (1958) mentions in his paper “Nonverbal communication: Notes on the visual

perception of human relations” that nonverbal forms of language fall into three distinct

categories:

1. Sign language includes all those forms of codification in· which words, numbers, and

punctuation signs have been supplanted by gestures; these vary from the

'monosyllabic' gesture of the hitchhiker to such complete systems as the language of

the deaf.

2. Action language embraces all movements that are not used exclusively as signals.

Such acts as walking and drinking, for instance, have a dual function; on the one

hand, they serve personal needs, and on the other, they constitute statements to those

who may perceive them.

3. Object language comprises all intentional and nonintentional display of material

things such as implements, machines, art objects, architectural structures, and last but

not least, the human body and whatever clothes it. The embodiment of letters in books

and on signs has a material substance, and this aspect of words also has to be

considered as object language

Although these various forms of nonverbal codification differ somewhat from each other,

they can nevertheless be considered together for comparison with verbal codifications.

2.0. NON-VERBAL LANGUAGE IN PSYCHOTHERAPY

Many nonverbal behaviors are unconscious and may represent a more accurate depiction of a

patient's attitude and emotional state. They can belie a patient's anxiety regarding a specific
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topic discussed in therapy despite verbal assertions that the subject is inconsequential and not

causing distress. It is critically important to consider a patient's nonverbal behaviors when

assessing risk of harm to self or others. Alternatively, nonverbal behaviors may shed light on

feelings of transference and countertransference between patient and physician.

“Nonverbal behavior exists in the interface between nature and culture” (Rimondini, 2011, p.

110). Its function in communication is to create meaning (Eaves & Leathers, 2018).

Nonverbal factors add to verbal communication by improving its accuracy and efficiency.

Feelings and emotions are often more fully and accurately revealed nonverbally (Eaves &

Leathers, 2018).

“When both speaking and listening, counselors, trainees, and clients disclose themselves

through how they create their bodily communication” (Nelson-Jones, 2005, p. 22).

The ability to understand an individual on a nonverbal level facilitates the strengthening of

bonds and therapeutic alliance, particularly when it complements conversations between

client and therapist. Another importance of nonverbal communication is in navigating social

occurrences and facilitating interactions within the society. As such, it remains a credible

source for insight in therapy. If a psychotherapist is attuned to his patient’s nonverbal cues,

while also listening to the words being spoken, he is more competent in providing accurate

solutions. These types of cues can help the counselor to recognize deeper emotional problems

that the patient may not be aware of. Somatic experiencing is an example where nonverbal

communication helps in therapy sessions. This form of therapy is designed to treat

traumatized patients, and it evaluates the body language and physical reactions of persons

undergoing treatment. Usually, a therapist will introduce a minimal amount of the traumatic

triggers, and then observe the nonverbal cues of his patient.

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Also, the body-mind psychotherapy requires that the therapist examines a patient’s breathing

patterns, sounds, and movements. This assessment helps to pinpoint counterproductive

behaviors; thus, the therapist can assist the individual to develop a new character that has

more positive effects.

The consideration of language development and the relationship or nonverbal to verbal

codifications sheds some light upon the shortcomings of psychotherapeutic methods. For

example, when a patient verbalizes his memories or relates his dreams, a psychologist who

attempts to reconstruct earlier events usually obtains a one-sided view. Those aspects that

lend themselves most readily to verbal treatment-names of persons and places, labels of

situations, and designations of stereotyped actions and unusual events--usually make up the

bulk of these accounts. Every good therapist eventually arrives at the inescapable conclusion

that verbal accounts cannot adequately represent analogically codified events and non-verbal

language comes into play.

The successful communicative therapies for acute mental illness are designed to further

nonverbal expression and to stimulate the proximity receivers; among them are music

therapy, psychodrama, dancing, play and occupational therapy, and such treatment methods

as wet packs, continuous baths, and massage.

The need for analogic, nonverbal codificatios is expressed in the behavior of both manic-

depressives and schizophrenics who, during a psychotic episode, may reproduce movements

which accompanied earlier emotional experiences. In the process of recalling early memories,

a patient may suck his thumb or caress the arm of his chair; or he may, in the course of a

verbal account, gesticulate or make shaking, pulling, or poking gestures. Even more

informative are the primitive and uncoordinated movements of patients at the peak of severe

functional psychoses; such movements may be viewed as attempts to re-establish the infantile
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system of communication through action. It is as if these patients were trying to relive the

patterns of communication that were frustrating in early childhood, with the hope that this

time there will be another person who will understand and reply in nonverbal terms (Rusech,

1995)

3.0. CONSIDERATION OF NON-VERBAL LANGUAGE BY THERAPIST

All nonverbal behavior must be interpreted within context. Nonverbal cues cannot be

interpreted in a vacuum. No single behavior or gesture means the exact same thing in every

conceivable context. For example, consider the hand gesture of extending only the index and

middle fingers, spread apart in a V shape, while closing the rest of the hand. This might

signify a number, two. In the United States if the palm is facing the individual using this

gesture it signifies “victory” and if the palm is facing others it is identified as a symbol

meaning “peace.” In England, however, making the American “V for victory” sign is an

insult with sexual connotations. In London, displaying the American peace sign instead

represents victory.

First, a psychologist should take into consideration the environment in which an interaction is

taking place. During an initial interview, patients may seem anxious about talking to a

complete stranger about their problems or appear distracted as they take in the novelty of the

psychotherapist's office. Crossing one's arms across the chest might mean the patient is not

open to pursuing a particular avenue of exploration; however, in another case it might simply

be indicative of the office temperature being too cold for comfort.

Second, psychologist must consider a particular individual's typical presentation and usual

mental status examination. Some individuals are naturally more expressive in terms of

general animation, gestures, and affect. Others may carefully control and modulate their
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feelings. Certain cultures have different rules as to when it is acceptable to express a

particular emotion and to what degree. Third, it is helpful to look at nonverbal behaviors

globally rather than center on the minutiae. Instead of focusing on any one single gesture, it is

more effective and useful to accurately interpret several behaviors that occur simultaneously.

Finally, a psychologist must reflect on the interaction occurring between patient and

physician in real time. The psychologist's own nonverbal actions may in turn affect a patient's

behavior.

 MOOD Versus AFFECT: Incongruent or Congruent

Another aspect of the mental status examination involves comparison of a patient's stated

mood versus his or her perceivable affect. Nonverbal behavior is very similar. Sometimes the

facial expression, appearance, eye contact and body movements match the verbal expression

of the patient. On the other hand, the nonverbal behavior may send a contrary, or

incongruent, message relative to a patient's verbal communication. These inconsistencies may

represent the patient's unconscious feelings or unstated thoughts and require further

exploration in order to conduct effective psychotherapy. The inappropriate or blunted affect

and disorganized behavior often seen in patients with schizophrenia make it challenging for

the psychologist to accurately understand the patient's internal emotional experience.

Nonverbal behaviors can be of critical importance in identifying and evaluating the risk of

dangerousness to self or others. A patient who denies any history of self-injurious behavior

yet has multiple linear scars on his or her forearms would be considered at elevated risk for

future self-harm or accidental completed suicide. A patient who is upset about being

involuntarily admitted to the hospital may exhibit his or her anger through nonverbal

behavior. He or she may raise the volume of the voice, clench the jaw, and tighten the hands
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into fists. The psychologyst may recognize these as signs of agitation and take pre-emptive

action to prevent the situation from escalating. If the patient also has dilated pupils and

appears diaphoretic this may further warn the psychologist of an increased risk for impulsive

or violent behavior.

 FACTORS TO BE CONSIDERED FOR NON-VERBAL LANGUAGE IN

THERAPY SETTING

Nonverbal communication factors to consider include:

 Gaze – useful for coordinating speech and collecting feedback.

 Eye contact – crucial for showing interest and empathy.

 Posture – turning your body toward the speaker shows interest and engagement.

 Gestures – used to frame or illustrate what is being said or heard.

 Physical proximity – too close, and it can be awkward; too far, and a lack of

connection may be felt.

 Clothes and personal grooming – appearing professional is vital, but so too is being

able to connect, especially with a young person or group

 Facial expression – Facial expression is one of the more straightforward nonverbal

behaviors to identify and interpret, and is also one of the most studied elements of

nonverbal communication. Ekman and Friesen identified several facial expressions of

emotion that are relatively similar and easily identifiable across cultures. The six

classic emotions that are recognized and understood by members of most cultures are

surprise, fear, disgust, anger, happiness, and sadness. (Ekman and Friesen, 1975).
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Ekman and Friesen later developed a facial atlas that catalogs every facial muscle and

its role in each of these emotional states. This information is the basis of an encoding

system used to classify facial expressions for research purposes (FACS vs F.A.C.E,

2010) In clinical use, being able to recognize and differentiate between similar

expressions (e.g., fear and sadness or disgust and anger) is important when treating

alexithymic patients who have difficulty articulating their feeling state. The study of

facial expression has been further refined in order to detect emotional “leakage” via

very subtle “microexpressions” or fleeting, involuntary, nonverbal facial indicators of

an emotion that someone attempts to conceal by voluntarily displaying another

affective state (FACS vs F.A.C.E, 2010).

 NON-VERBAL BEHAVIOUR OF PSYCHOLOGIST AND ITS SIGNIFICANCE

Nonverbal behaviors of the psychologist greatly impact the dialogue in psychotherapy. Just

as the psychologist is observing the patient in the office, the patient is observing the

psychologist. Nonverbal behavior plays a significant role in establishing the therapeutic

alliance in any patient-physician interaction. In psychotherapy settings, it is critically

important to the formation of rapport between the patient and psychologist.

Rapport is the essential groundwork that must be laid between both parties in order for them

to continue building a strong therapeutic alliance in which to work together toward mutual

goals. Rapport is influenced by three nonverbal behavior elements: attentiveness, positivity-

negativity, and coordination (Tickle-Dengen, Gavett, 2003)

Attentiveness.
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Attentiveness refers to each individual's capability for focusing attention on the interaction

occurring between the patient and psychologist in the here and now. (Tickle-Dengen, Gavett,

2003). Clearly if a patient feels the psychologist is distracted or uninterested in what he or she

is saying, this undermines rapport.

The psychologist can display interest in the patient by giving undivided attention to the

conversation at hand and encourage further communication with nonverbal behaviors such as

making eye contact and nodding.

Positivity-negativity.

Positivity-negativity refers to how interacting individuals are responding to each another.

(Tickle-Dengen, Gavett, 2003). Are they enjoying one another's company and showing this

through nonverbal behaviors such as smiling, laughing, leaning forward in their chairs, and

adopting open postures? Or are they uncomfortable with one another and displaying

indifference or hostility and creating physical distance or barriers between one another?

Coordination.

Coordination refers to the similarity in the nonverbal behavior of the patient and

psychologist. (Tickle-Dengen, Gavett, 2003). This can be conceptualized by thinking about

how one person mirrors another's behavior. Examples include making eye contact at the same

moment, returning a smile, or adopting and changing position in tandem with the patient.

4.0. NON-VERBAL BEHAVIOUR AS DIAGNOSTIC CRITERIA

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The initial mental status exam can provide valuable information about a patient and begins

when a new patient is first seen in the waiting area. However, it takes time to accurately

identify a particular individual's baseline.

Once in the interview room, there are a number of observable, nonverbal behaviors that

produce information about the patient. One should take notice of where the patient chooses to

sit, posture during the interview, whether eye contact is maintained, and how the patient

reacts to interpretations beyond simple verbal acknowledgment. Over time, the psychologist

becomes attuned to the patient's baseline appearance, attitude, and behavior. Some of these

nonverbal behaviors may point the psychologist in the direction of a specific diagnosis are as

follows (APA. 2000):

a. Autistic disorder: Marked impairment in eye-to-eye gaze, facial expression, and

body postures; gestures stereotyped; repetitive motor mannerisms

b. Attention deficit hyperactivity disorder: Does not appear to listen when spoken to,

easily distractible, fidgeting, inability to remain seated

c. Substance intoxication or withdrawal states: Conjunctival injection with cannabis

intoxication; miosis in opiate intoxication; and lacrimation, rhinorrhea, and

yawning in opiate withdrawal

d. Schizophrenia: Flat affect, poor eye contact, avolition (negative symptoms),

disheveled appearance, unpredictable agitation, rigid or bizarre postures

(grossly disorganized or catatonic behaviors)

e. Major depressive disorder: Psychomotor agitation or retardation restricted or

blunted, dysphoric affect, tearfulness

f. Posttraumatic stress disorder: Hypervigilance, exaggerated startle response,

restricted range of affect

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5.0 CONCLUSION

Nonverbal behavior contributes significantly to all interpersonal communication but

unfortunately is often only a peripheral area of focus in the psychotherapeutic setting. While

listening carefully to the patient is obviously a fundamental aspect of psychotherapy, there

may be additional diagnostic and therapeutic information to be gained from watching the

nonverbal behaviors expressed by a patient. Nonverbal signals can alert a psychologist to

important affective states that may otherwise be overlooked or denied. They can also help

identify how comfortable a patient is with a given topic of discussion. This information can

then be used to guide the psychotherapy in a manner that is tolerable and therapeutic for the

patient. Being aware of our own nonverbal behavior and how it may impact interactions with

patients is central to improving our ability to establish rapport and maintain a strong

therapeutic alliance.

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