What You're Probably Missing in Therapy

In therapy, it's important to notice the storyteller, not just the story. As therapists, we can notice and attend to outward signs of internal experience. The client may be looking down, squirming in her seat, or being very still, for instance. 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.

What You're Probably Missing in Therapy

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.

Tracking

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?

Contacting

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.

Immersing

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.

***

This blog is excerpted from "A Different Kind of Presence," by Rob Fisher. The full version is available in the July/August 2004 issue, The Body in Psychotherapy: How Far Do We Want to Go?

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