We all know people who seem to have the magic touch when it comes to relating to others. They have a way of calming a tense situation and putting people at ease. They instantaneously connect with strangers on the bus or while waiting in line. Neighbors gather around them at the block party. Waiters squat down by their table to carry on animated conversations that have nothing to do with the menu. What makes people like and trust them so immediately? Are there specific behaviors common to exceptionally gifted therapists that we can study, practice, and cultivate? Luckily, the answer is yes.
Microbehaviors occur within fractions of a second, most of them not conscious to the sender or receiver, and some greatly contribute to inspiring feelings of safety, connection, and comfort. Let’s take a look at the subtle ways these emotional messages are transmitted.
Prosody consists of the timing, phrasing, emphasis, and intonation of words in a conversation, which all help convey aspects of emotional meaning and make our speech lively, convincing, and engaging. It’s conveyed by raising and lowering the pitch of voice, speeding up or slowing down the rhythm of our sentences, and varying the loudness of our words. Even the frequency of breathing within speech can convey a sense of urgency or calmness. The effective use of prosody creates a sense that you’re really following and getting what a person is saying. It’s also a feature of storytelling that keeps listeners interested and curious, holding their attention, and thereby organizing and calming their nervous system.
So how do you produce prosody when you speak? The most elemental model comes from the sounds a parent makes when talking to a four- or five-month-old baby. For example, imagine a father chatting with his baby while dressing her on the changing table. The “dialogue” goes something like this:
Father: (pulling the arm out of the baby’s pajama shirt) Where’s Bella’s arm? Ooooh, there it is! What a big girl you are. You’re getting so biiigggg.
Baby Bella: Ba!
Father: (in a high-pitched, excited tone) That’s right! Big! Who’s a big girl?
Bella: (making a gurgling, babbling noise with her lips): Brrrrrrrrrrrr.
Father: (putting the shirt over Bella’s head, speaking with increasing volume and inflection in his voice) Where’d you go? Where’d you go, Bella? (Pulls shirt to discover baby’s eyes.) Boo!
Bella: (looking momentarily startled, then smiling wide, wiggling her whole body, and squealing as she giggles)
Father: You’re so silly. You’re so silly. I got your tummy. (Leans down to blow raspberries on baby’s belly.) I got your belly!
Bella: (Kicks legs and lets out another, louder squeal.)
Father: You’re so funny, aren’t ya, little girl?
This parent–infant dialogue is the essential foundation for prosody in human beings. Humans use that voice instinctively while tending to babies because babies are biologically programmed to hear higher-pitched tones, which lilt up and down like the chirping of a flock of lively birds on a spring morning.
They capture the baby’s attention and make her calmer, more organized, and more amenable to the parents’ suggestions and handling.
Most successful therapists, regardless of theoretical orientation, make good use of their prosodic voice as an essential component of conveying empathy. But the true masters of prosody really stand out when you watch them in action. Daniel Hughes, developer of Dyadic Developmental Psychotherapy, is one such person. His captivating use of that sing-songy voice while matching his client’s rhythm is like witnessing the unfolding of a concert of flow and meaning-making.
In a conversation on video that I’ve watched many times, Hughes is sitting face to face, in close proximity to a mother who’s experiencing almost categorical rejection from her 12-year-old adopted daughter. Out of her underlying feelings of hopelessness and hurt, the mother has been hostile toward Hughes previously in the session. After a long back and forth of struggling to uncover the true pain the mother is so fearful of confronting, she finally begins to trust Hughes’s intentions and begins to reveal her deep suffering.
Adoptive mother: (leaning forward, face contorted in pain, gasping in short breaths and heaving as she speaks) I let this child into my heart.
Hughes: (in a pained, high-pitched yet encouraging whisper and gasp) Yeah.
Mother: I offered her everything a child could want! A loving home, a mother who’s interested in her, who wants to know what she feels, what her day was like!
Hughes: (sitting forward, matching her expression of pain) Yeah.
Mother: I want to help her—with anything! Anything at all! But she won’t let me! I would’ve given anything for my mom to want me like that!
Hughes: (Takes a deep breath, speaks with urgency, matching mother’s cadence.) Of course you would! (Repeats more softly.) Of course you would. You brought her in. You cared for her. You thought of everything you could to make her feel comfortable, to make her feel safe, to make her feel wanted. (Pauses, sighs, speaks in a quieter, slower voice.) You’re saying, Hey, I’m your mom.
Mother: (Pauses her crying, looks intently at him, sighs more deeply.) Yeah.
When I close my eyes and listen to this segment without the video, I can almost imagine Hughes holding the mother, rocking her back and forth as she’s experiencing her excruciating sense of rejection. His pitch, rhythm, and cadence conveys both empathy and comfort, and makes the mother calmer and more receptive to letting him in. It seems almost magical.
A second aspect of communication in the social engagement system is the use of facial expressions to elicit trust. Porges hypothesizes that there’s a “a face–heart connection” in the body, wherein the movements of the facial muscles regulate or change a person’s heart rate, serving to create either relaxation and openness or defensiveness. The facial expressions that evoke positive social states include having a genuine smile, a focused, curious look in your eyes, and a wide, smooth (unfurrowed) brow and forehead.
What do these facial states look like? Have a friend take a photo of your face while you conjure up different images of feeling states, such as your baby smiling at you, a reunion with a cherished friend, a moment when you received distressing news, or when you felt confused by some information that didn’t make sense to you. Then take a close look at your faces in these states and let yourself imagine which expressions you might use to create feelings of trust, and which might interfere with connecting with a client.
Eye Contact and Touch
As listeners, we tend to look in a sustained way at a speaker to show our interest and attention. But beyond that, what in your eyes lets people know you’re really listening? What produces bright eyes, rather than a dull look? One answer can be found in the difference between the meaning of the two words looking and gazing. Looking simply refers to the act of directing your eyes in a particular direction, whereas gazing refers to the act of looking at something in a steady way, usually for a longer time, and possibly with less blinking. The difference is difficult to explain but easy to distinguish if you’re the object of a listener’s gaze.
Finally, the therapeutic use of touch is a powerful signaler of safety when applied in an attuned way. Touch is usually prohibited between therapists and adult clients, but there’s a strong argument to be made for incorporating calming or reassuring touch when warranted. Done with permission and awareness of the client’s physiologic responses, a therapist can offer to gently press a client’s hand or place a hand on the client’s shoulder. Even approximating warm touch when direct contact isn’t appropriate can be effective. For example, preparing a warm mug of tea for clients to grasp on a cold day, having plush throw blankets of various textures available for them to hold or drape around their shoulders, or having various weighted pillows for them to clutch can provide tremendous comfort to calm and contain feelings of vulnerability.
I also try to establish the practice of shaking my clients’ hands before they leave. I do this with intention, trying to avoid the “let’s close this meeting” effect, but grasping with both hands and looking warmly in the eyes to solidify a sense of “let’s have this one last moment of connection to solidify the gains that we made.” It also signifies I’ll hold you in my mind until the next time we meet. I don’t do this with every client and not at every session, but I often try it if I sense that a consolidating touch will help the client walk out the door feeling more grounded.
The discovery of how we can best use the prosody of voice, eye contact, and gentle touch to affect social communication is a significant advancement in the field of psychotherapy and brain science. We’ve now moved past the point where we rely only on intuition to elicit trust and openness. And the good news is that when we lose the connection with our client, we can tap into the deep power of the social engagement system to find it again.
Dafna Lender, LCSW, is a certified trainer and supervisor in both Dyadic Developmental Psychotherapy (DDP) and Theraplay. She’s the program director of The Theraplay Institute in Evanston, IL, and provides Theraplay and DDP trainings and supervision in three languages.
This blog is excerpted from "Tuning into Attunement," by Dafna Lender. The full version is available in the January/February 2018 issue, Not Your Grandfather's Therapy: Meeting the Needs of Today's Clients.
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