Nonverbal Communication In Psychotherapy Essay, Research Paper

According to Stedman’s Medical Dictionary, (1994) psychotherapy is defined as the treatment of emotional, behavioral, personality, and psychiatric disorders based primarily upon verbal or nonverbal communication with the patient. This definition shows that nonverbal communication is a primary part in psychotherapy. In a process where diagnosis and treatment is primarily through communication, and with seventy percent of all communication estimated to be through nonverbal methods (Anderson, 1999), nonverbal communication plays a significant role in diagnosing and treating patients, as well as in establishing the client/therapist relationship. Nonverbal communication is so important to the therapeutic process that some practitioners argue that psychotherapy can not legitimately be conducted over the internet, because the lack of nonverbal communication can lead to misunderstandings and miscommunications without nonverbal cues to modulate the context of the conversation. (Childress, 1998).Nonverbal communication important to counselors include the client s posture, body movements, gestures, facial expressions, voice related behavior such as pauses, tone, silences, and pitch, and physical characteristics and grooming. It is also important to be able to observe the client s physiological responses. (Egan, 1998) Cues such as respiration rate, perspiration, blushing, paleness and pupil dilation can provide important data about underlying emotions, which may or may not be verbally expressed. Nonverbal communication is said to be the language of emotions (Carkhuff, 1980) and nonverbal communication in a clinical setting can modify a patient s verbal communication, giving the therapist further insight into the patient s true emotions. It can mirror spoken communication to underscore the client s statements or emphasize their feelings. At the same time, nonverbal communication that is in contrast to the client s verbal communication can negate or deny the patient s verbal expressions and expose their true emotions. In addition, Hill and Stephany (1990) found that a decrease in nonverbal communication style can be a signal of a negative reaction by the client while horizontal and vertical head movements can be indicative of a positive reaction of the client. According to Egan (1998), it is important for therapists to take all communication in context and use an integrated approach, balancing verbal and nonverbal communication. Egan (1998) also notes that some patients can be highly skilled in the use of nonverbal cues and may try to seduce or mislead the clinician with their use of nonverbal communication Nonverbal communication can also aid in diagnosing a patient’s psychopathology. Diagnostic criteria for psychological disorders is listed in the American Psychiatric Association s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, or DSM-IV. Many diagnosis rely almost totally on nonverbal behavior such as obsessive compulsive disorder, attention deficit disorder, and trichotillomania the constant twirling and pulling out of one s hair. Depression has a well-documented nonverbal communication pattern including less expressive facial expression, reduced eye contact, sad affect, long pauses, and silences, and reduced movements. A diagnosis of schizophrenia would take into account nonverbal behavior such as flat affect, grimacing, rigidity, and inappropriate laughter. A patient with anxiety might display pacing, hand wringing, frequent posture shifts and reduced eye contact. Psychopaths in a therapeutic setting show more forward lean, eye contact, and hand gestures, but fewer smiles. (Hull, Harrigan & Rosenthal, 1995) Several studies have also identified specific nonverbal styles that can help identify Type A personalities. Type A s have been shown to be more hostile, vigilant, display rapid and/or explosive speech, and short speech latencies. Visible tension, rapid body movements, and frequent changes of facial expression have also been noted in Type A. These nonverbal patterns are so well documented that they have been incorporated into several diagnostic instruments for Type A personality. (Hull, Harrigan & Rosenthal, 1995) While therapists may use a patient s nonverbal cues in diagnosing a patient, patients use the therapist s nonverbal communication to assess their competency. (Egan, 1998, Hull, Harrigan & Rosenthal, 1995, Ivey, 1971, Grace, 1995) Clients perceive therapists as more empathic and effective when they employ smiling, head nodding, eye contact and gestures when speaking. Their clients also rated therapists who used these same behaviors as more attractive, persuasive, and competent. (Hull, Harrigan & Rosenthal, 1995, Grace, 1995)

Attention is central to establishing a relationship between the client and therapist. Skinner found that the attention of others is a reinforcing behavior and can be used to either reinforce current behavior or facilitate a behavior change. Bandura noted that the therapist controls the patient by nonverbal expressions of approval or disapproval when the client s behavior is concurrent with or contrary to the established goals of the therapy. (Egan, 1998)Attending behavior such as eye contact, relaxed and attentive posture and verbal following were found to be important in establishing a relationship with the client. (Ivey, 1971) Eye contact should not be constant, fixed or staring, but natural. Relaxed posture is important, because if a therapist is tense, the therapist will find it difficult to focus on the client. In verbal following, the therapist must use turn yielding cues to respond to the last statement or a previous statement with a question or comment that does not introduce a new topic. When a therapist attends to the patient s comments without introducing new information, the patient is much more likely to reveal more of himself. Attention is a great reinforcer to the client to keep talking. (Ivey, 1971) Hasse (1989) found that clients are more attuned to the therapists nonverbal signals during the first part of a therapy session, but that their decoding of these signals diminish as they become more emotionally involved or aroused during the session. For this reason, clinicians need to be aware of their nonverbal communications from the beginning of the session. This is especially true when working with culturally diverse patients and counselors need to be aware of the cultural differences in nonverbal communication when dealing with clients of other ethnicities. While most Caucasians are comfortable with a proximity of four feet in a counseling session, Latin Americans, Africans, Black Americans, South Americans, Indonesians, Arabs and French are more comfortable with a much closer proximity and may be offended if the therapist moves back. While many people give more positive reports of people who smile, in some Asian cultures smiling may be a sign of weakness, possibly indicating embarrassment, shyness, or discomfort. Japanese and Chinese consider restraint of emotions such as anger, sadness, happiness, and love to be signs of wisdom and maturity. (Sue, 1990) A clinician that is not aware of these differences risks offending their client, as well as misinterpreting nonverbal communications. Eye contact can also cause misunderstanding among different cultures. Japanese and Mexican Americans see avoidance of eye contact as a sign of respect and Navajos see eye contact as hostile and use as much peripheral vision as possible. The clinician could interpret this avoidant behavior as rudeness, inattentiveness, shyness, or lack of intelligence if they were not aware of the cultural differences. Black Americans have many nonverbal behaviors that a counselor might construe as boredom, sulleness, resistance, or just being uncooperative. While White Americans maintain eye contact with the speaker about 80% of the time, Black Americans maintain 80% eye contact while speaking and frequently the listener may be doing something else while listening. Furthermore, Black Americans may not show other types of attending behavior such as head nods, feeling that their presence and proximity is enough to indicate listening. (Sue, 1990) Minorities seem to be more attuned to nonverbal communication than others (Sue, 1990) and it is important that the clinician be aware of his or her body language and whether or not it is displaying any biases. Clinicians uneducated in cross-cultural communication may not be able to establish rapport with a culturally diverse patient, which could end in premature termination of therapy (Ivey, 1971) This research has shown that nonverbal communicationis extremely important in psychotherapy. Nonverbal signals can validate or invalidate a client s statements as well as aid in diagnosis. Nonverbal communication plays an important role in the patient accepting the therapist as competent and interested. The therapist s attending behavior helps in establishing the therapeutic relationship and encourages a client to keep sharing. When working with other cultures, counselors must not only be aware of cultural differences in nonverbal communication styles, but must be aware of their own nonverbal communication and how it may transmit their biases to the client. Clearly, all psychotherapists need to have training in nonverbal communications.