This article first appeared in the July/August 2004 issue.
Every day, in offices around the world, psychotherapists and clients exchange tens of thousands of words in the often-frustrating attempt to make the therapeutic conversation come alive. But in the midst of all the verbal meanderings, what’s often missing is the sense of being fully engaged and focused. Therapy can too easily become reduced to two talking heads spinning out tales, ignoring the intense sense of life that can emerge when we tap into our immediate, body-centered experience.
While most communication takes place outside of the verbal sphere, many therapists have little knowledge of how to bring nonverbal, present-moment experience into their work. Yet with a few basic principles and methods, many of them drawn from Hakomi Experiential Psychotherapy and the work of Ronald Kurtz, therapists can help clients orient themselves in a different way, enhancing both the intensity and the effectiveness of psychotherapy.
The vast undercurrent of our experience is only partly and imperfectly reflected in our verbal expression. In fact, we communicate our inner states and our implicit beliefs and models of the world most clearly in many nonverbal ways–through gesture, posture, pace, tension or relaxation of the muscles, and other subtle, somatic events. To work with the present-moment experience of clients, therapists must first be able to pay attention to these signals. This can be difficult for many of us who’ve been well trained to pay attention to the content of the client’s story.
But it’s equally or more important to notice the storyteller and not just the story. For instance, if Sam narrows his eyes when Jennifer speaks about his alcohol consumption, he’s having some kind of internal experience, the outward sign of which we can notice. Not only do we notice this, but so does Jennifer, and she has a reaction to it. By the time they start putting any of this into words, a tremendous amount of communication has occurred in the session and in their relationship, and has been revealed nonverbally.
As therapists, we can notice and attend to these outward signs of internal experience. One way to accomplish this is to keep asking ourselves, “What’s the client doing right now? How are they doing it? What experience are they having as they do it? The client may be looking down, squirming in her seat, or being very still, for instance. He may be talking with great emotion or in a very cognitive way. She may be blaming, attacking, or defending herself. Each of these is an indicator of an internal experience as well as a set of beliefs and models of the world that underlie a client’s behavior. For instance, if Jeff tends to speak rapidly, he may be feeling rushed and desperate inside, and he may have a model of the world in which there’s no time for him or it’s not okay to rest. His pace is the outward manifestation of his internal experience and core beliefs.
Here’s a partial list of physical signals that are helpful to track in exploring a client’s inner state:
- Voice—How much or how little emotion does it contain? Is it strong or weak, loud or quiet? Is it similar to or different from the partner’s?
- Body—What’s the body’s position? What images does it evoke? What’s the relationship between the partners’ bodies: close or far, leaning toward each other or away?
- Movement—Is it relaxed or active, jerky or smooth, controlled or spontaneous? Is it similar to or different from the partner’s?
- Gestures—Are they repetitive? What’s their quality: aggressive, abrupt, gentle?
- Posture—Is it rigid, collapsed, threatening, overgrounded, ready to spring into action, expressive?
- Eyes—Do they look at the partner or look away? Are they lackluster or lively, pleading, scared, defiant, or threatening?
- Muscle tension and relaxation—Notice the patterns of tension or relaxation and when they change.
- Verbal pace and tonal quality—Is speech pace fast, slow, or variable? Is the tone even, harsh, melodic, monotonic, soft?
Tracking orients the therapist to the present moment. In contrast, contacting–the act of reflecting back to clients their present experience–helps them shift their attention to the here and now and begin the process of deepening their awareness of their experiential selves. It also lets clients know that the therapist is connected with them; even simple contact statements can make clients feel deeply held and seen.
Contacting is different from mirroring back to clients the content of what they say: it’s the process of joining with their nonverbal communication and what it reveals about their unconscious processes. Contact statements let clients know that you’re aware of their internal world and that you’re noticing their communications on many levels. This is an intimate act. For instance, if a tear rolls down a client’s cheek, you might gently say, “Sad, huh?” This has a different effect than saying, “How are you feeling?” Psychotherapists are often trained to ask the clients questions about their experience, as opposed to noticing what’s actually unfolding in front of them. But questions such as this, while a staple of therapeutic interviewing, often do little to further a therapeutic alliance; they require analysis on clients’ part and can signal to them that we’re either unconscious or inattentive. Why ask if they’re already communicating to you nonverbally? By contrast, when we reflect back their experience in the spirit of transparency, compassion, and curiosity, clients typically feel more joined with and attended to.
Effective contact statements have several key features:
- They’re simple–if you speak in a complicated way, you’ll engage a more cognitive part of the client’s brain, and the experiential element will be lost.
- They have an inquisitive tone–since you’re not trying to force your personal impressions down the client’s throat, your statement should indicate flexibility by the inflection in your voice.
- They focus on how clients are behaving, in addition to what they’re saying. The qualities with which a person walks, talks, shakes hands, or gestures provide important information on how they’re internally constructed.
- They’re supportive of whatever experience is present.
- They convey the therapist’s curiosity, acceptance, and enthusiasm for the unfolding of the client’s experience.
- Their form is a flexible statement, rather than a question.
Here are some examples of how contact statements can be used to build a therapeutic alliance:
Posture: “You look like you’re ready to spring out of your seat.” “Looking down, huh?”
Gestures: To a woman gesturing near her husband: “Your hand pushes him away.”
Verbal pacing: To someone who’s speaking very rapidly: “You feel rushed inside, huh?”
Eyes: To a husband who isn’t looking at his wife: “It’s hard to look at her when you say that.”
Dynamics of presence: “Your energy level went up as hers went down.”
Voice quality: “There’s a slight pleading quality in your voice as you say that.”
Verbal tics: “You end every few sentences with ‘You know.'”
Hesitance: “It’s hard to talk about this, huh?” “You’re not saying much.”
Defensive maneuvers: “You just crossed your arms and turned away.” “Holding back your tears, huh?”
Some therapists are concerned that naming clients’ experience deprives them of the opportunity to name it themselves. I’ve found that this is no more true than the idea that reflecting back the content of what people say deprives them of the ability to talk about their lives.
Once you’ve noticed the physical aspects of your client’s experience and contacted it, the next step is to allow that experience to unfold toward core material. When a client is immersed in her experience, she has the opportunity to bypass the usual responses and defenses and explore, in a more visceral fashion, the concepts and attitudes that underlie her perceptions, behavior, and feelings. Therapy moves from the head to the viscera.
For instance, if a client is tightening her jaw when her husband talks about his commitment to his job, the therapist might first contact the feeling state by gently saying, “Angry, huh?” or “Looks like you’re feeling frustrated” or “Clenching your jaw, huh?” Next, to help immerse the client in the experience, you might say, “Just let yourself stay with that anger. Let’s invite it to be here.” Then you can ask the client to explore some aspect of her experience. In this case, you might say, “Notice where you feel the anger in your body?” or “What words go with that anger, what images or memories are there?” or “What’s familiar about that feeling?”
As therapists, we often feel that we’re responsible for knowing what comes next in a session, and for interpreting the internal world of the client. But, just as a flower has intrinsic knowledge of how to bloom and the skin has intrinsic knowledge of how to heal, the psyche has an innate intelligence that, given the right conditions, will unfold in a healing direction. We just need to assist clients in staying with their experience more deeply while it unfolds.
Mindfulness is a basic tool that helps clients to notice usually ignored levels of their experience and explores how their core beliefs and attitudes organize their worlds. It refers to the state of self-observation in which the normal trancelike consciousness through which we perceive our lives is replaced by present-moment attention. At the heart of mindfulness is a willingness to notice one’s present experience without judgment or any effort to make changes.
Al was mad at Susie. As he complained to her about how poorly she listened to him, she became increasingly defensive. I watched and listened for a minute, noticing her hands contract and her eyes look away, as well the increased volume and tone of desperation in his voice. I interrupted them and contacted her by saying, “Susie, it looks like it’s hard to hear what Al is saying. Can we slow things down and have him just say one sentence and you can notice what begins to happen inside when you listen to him? Notice any sensations, feelings, memories, images, anything that comes up automatically.” I then had Al distill his complaint into one sentence and deliver it when Susie said she was ready. This time, instead of being defensive and counterattacking, she said, “I feel guilty.” I asked her to stay with this by being mindful of her feelings of guilt. Then memories came up of her parents, who controlled her through their disappointment. None of this would have come to consciousness without the application of mindfulness at this point.
To induce mindfulness, it’s crucial to first slow down internally yourself. You might then say to your client, “Take a moment to turn your attention inside. You can begin to notice what comes up all on its own when your partner looks at you that way, or when you hear that she’s unhappy with you. You might notice thoughts or feelings or sensations in your body, images, impulses, or memories. Nothing might happen, and that’s okay, too. No pressure. Just notice whatever naturally arises when we do this.” Then ask him to give you a report of what he discovers.
People are holographic. How they walk, talk, move, shake hands are all holographic fragments of how they’re psychologically organized in the larger arena of their lives. For instance, if you study how a woman crosses her arms when she faces her husband, how he speeds up or slows down as he addresses her, the little squinting of one partner’s eyes as the other turns away, the pleading rise of the eyebrows, you’re seeing a part of a larger pattern.
The possibilities for interventions using mindfulness are as limitless as your own creativity. Anything a client, couple, or family does or experiences can be studied in mindfulness. The prerequisites are creating a psychological container in your office that’s safe, interventions that are nonviolent, and asking clients to bring mindfulness to the table, so that their experience of their different actions can be explored in a nonjudgmental, compassionate fashion. But working in this way isn’t for the faint of heart. It requires that we come out from behind the protective cloaks of authority and proceed, hand in hand, with our clients on an adventure–the unfolding of the whole, conscious self. I invite you to join in this journey, not to the far reaches of the external world, but to the wonder and beauty of the internal world of present experience.
Photo by Willie Maldonado/Image Bank/Getty Images
Rob Fisher, MA, MFT, a certified Hakomi therapist and trainer, is an adjunct professor at John F. Kennedy University and at the California Institute of Integral Studies, on the faculty of Santa Barbara Graduate Institute, and a supervisor for the Shiluv Center in Israel. He‘s the author of Experiential Psychotherapy with Couples: A Guide for the Creative Pragmatist, along with numerous chapters and articles on the use of mindfulness in therapy.