body language non verbal communication ringwood psychologist

The Things People Do…

In psychotherapy, not all communication happens through talking alone. As one would expect, body language, facial expressions and tone all play a major role in getting messages across from one person to the other. In this blog I want to talk about some of the things – apart from talking – that people do in therapy: sitting, eating, drinking, taking medication, and answering calls and texts.

Where someone chooses to sit (if there is indeed an option for them to choose) and how people sit can often help me understand them and how they relate to others. In my current workplace I use different consultation rooms on different days. My “Monday room” has one armchair (mine) and then a big couch on the other side of the room on a bit of an angle. Without being overly “psychologist-y” and over-interpreting every minor detail, where people sit, can often tell me how ready they are to connect, or how safe they feel to be close. Most clients choose to sit on the side of the couch that is closest to me – as it makes for closer proximity, and maybe easier communication. So when someone decides to sit at the other end – especially when they burrow themselves into the corner of the couch – I do wonder if that says something about a bigger-than-usual need for safety, for communicating that they feel isolated, or that they find it uncomfortable to be “too close”. The same goes for people who come in too closely into the therapist’s personal space. This rarely happens with adults, but sometimes younger kids struggle with the idea of the personal bubble and can be quite up in one’s face! Again, this helps me understand something about the client better, in the case of say a 7 year old who comes in too close, it opens up lines of inquiry into their social ability to manage boundaries, or their way of alleviating anxiety, or their way of attaching to significant adults in their lives. Similarly, if an adult client chooses to kick off their shoes, or pull their legs up on the couch, or even sit or lie down on the floor, it is valuable information to help me get a better grasp on who this person is. Do these postures positively imply a sense of comfort and at-home-ness, or does it signify a stance of “I am different, I do things my own way”? Does it imply a lack of awareness of social convention? Or does it signify that that there is a proper awareness, but an actual choice in deciding to do things a bit differently to reflect something of the client being very comfortable in themselves and in the therapy room?

Similarly, I find it intriguing when people choose to eat while they are in their therapy session. Drinking coffee, tea or water is a stock standard procedure in most therapy hours, but bringing in lunch, dinner or snacks is a bit different. Again, I err on the side of caution not to over-interpret: often it is just a matter of pragmatism. If the client works full time, and only could grab an hour over lunch to come and see me, it would make sense that they bring their food with them.  Eating in the therapy hour probably also indicates a sense of familiarity or comfort. It could also be an attempt of the client to show me how busy they are – their only time to eat is in therapy! Could this be to elicit sympathy and care from me? The choice of meal can be interesting too. Does my client usually eat a salad for lunch, or did they specifically choose to bring a salad that day to show me how healthy their eating habits are? Similarly, if a client with diabetes pulls out donuts and chocolate bars, I also wonder about what they are trying to tell me without saying a word. That they march to their own beat, that they wouldn’t be told? Or that they are struggling so much that they don’t even care if their food can make them seriously unwell?

Rarely, a client might even bring in food for me! This may indicate, positively, that they want to share and that they are generous, but most of time it is actually a bit of a tricky situation with a lot of assumptions on the client’s side (e.g. that I like certain foods, that I don’t have allergies or very specific preferences, that I would be okay accepting food as a gift from a client, that I am okay with eating in front of others). It does also blur the boundaries, as we usually do eating-together with family and friends, rather than in professional relationships. I am usually hesitant to eat with a client, and depending on where in the therapeutic process we are, would either just thank them and then politely decline, or actually ask about what motivated them to bring me in a lunch too. If they interact in this way with me, chances are very good that they struggle with blurry boundaries or having assumptions in their other relationships too. Being able to analyse the meaning of the behaviours can be highly beneficial for the client to understand their own social interactions better.

When people take medication in session, I also wonder about the underlying message that they are trying to send me without using words. That they are really in severe pain? That no-one is noticing their pain or paying proper attention to it? That they need me to understand they are not exaggerating when they talk about their pain? Sometimes it is as simple as having to take certain medications at certain times, and that that time happens to fall within their session time. Most of the time though, I think there is a message of seeking nurturance and validation.

What to do when people take phone calls or answer texts in session? This is actually a very rare occurrence – and usually someone would say in advance in the beginning of the session that they are expecting a call from the doctor or the school. People tend to see their time with their therapist as special and focused, and 99% of clients will put their phones on silent for the session. The main emotional messages I get from people picking up random calls or answering texts in session is that they struggle with boundaries, tend to be in people-pleasing mode most of the time, and find it hard to prioritise their own needs. Alternatively, the motivation behind taking the call or text could be to let me into their world, so that I can see in real life what their conversations with others are like. I actually love the rare occasions when this happens – it gives me pure gold “here-and-now” material to work with therapeutically.    

When I make these mental observations in the therapy room, will I say it out loud? Well, it depends. Especially in the first few sessions, such an interpretative comment about someone’s choice of chair, or their eating, medication use and phone use in session will be too much and too confrontational. It may appear judgemental to comment on these behaviours prematurely, especially whilst trying to build rapport in the initial stages of therapy. These little titbits are earmarked in my mind though, to return to later, either to help me understand my client and their world better, or to actually address gently with the client at a later stage. Irvin Yalom writes beautifully about “striking when the iron is cold”- which means that it is often wiser to comment on such a behaviour once it is no longer there or changed. If, for example, a client tended to sit as far away from me as possible in the first 10 sessions, and then in session 11 and 12 sits in the chair that is closer, I can gently enquire as to what brought the shift – which may be a good segue into a discussion about feeling safe and managing boundaries. If I do choose to make an interpretive remark I will usually not do it as a statement but rather as a question. I might also ask them first what they think about it. It may sound something like this:

“I have noticed that in the first sessions of therapy you sat in the far corner of the couch, and today you have chosen to sit in this chair that is a bit closer. It could be that I am completely over-interpreting it, but I wonder if it is telling us something. What do you think?”

Often clients are very good to make their own interpretations, especially if asked to put on their “detective hats” or “psychologist hats”. If there is no solid response to a question like that, and they ask me what I think, I might say the following:

“I really am not sure, so am putting it out there as a question rather than a statement. Would you say it was completely random that you sat in one spot for the first ten sessions, and in the other one today? Or could it be that after having come here for some time, you now feel a bit safer to sit closer? And is this something you experience in your relationships outside of therapy as well?”

Similarly, if someone takes medication in session, I probably wouldn’t comment on it straightaway, but rather store it away on my mind to come back to later if themes of nurturance, or the world “not understanding (my) pain” come up. I might then gently enquire (asking rather than stating) if they sometimes feel they need to show people how much they hurt in order to be understood and validated, and then very gently check if they felt that way in the therapy room too. This is a subject which has to be handled with lots of diplomacy and “soft hands” – as I always want the client to feel that I am in their corner, and not judging them.

It is of the utmost importance not to elevate myself as an expert on what the client’s behaviour means. After all, I can be wrong, and many times when I have posed gentle questions, clients told me that they think I’ve got the wrong end of the stick! What a wonderful way to build rapport though, by thinking together about what certain behaviours might be telling us, searching for answers together. This also models that it is totally fine to not think about everything in the same way, and that the process and therapeutic relationship are ultimately the most important vehicles for change.

 

Lindie Oppermann
Psychologist
Felix & Sage Psychology

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