James M. Donovan - Paraverbal Communication in Psychotherapy: Beyond the Words

Paraverbal Communication in Psychotherapy

Paraverbal Communication in Psychotherapy

Beyond the Words

James M. Donovan, Kristin A. R. Osborn, Susan Rice

To Liz, Abbie, Brian and Bette, you have taught me so much about communication. I love you. Dad/Jim

To Jeremy and Isaiah, with gratitude and love, Kristin

To Chris and to Chris, my loves, Susan

In loving memory of Leigh McCullough

Contents

Three Paraverbal Puzzles

Take away the words and you find all the adornments that surround them. Body language, gestures, the story of the eyes.Gail Caldwell, Lets Take The Long Way Home (2010, p. 140)

Case #1Marvin and AnnDismissive Anger

One week ago, this professional Caucasian couple in their late 50s, married 30 years, both biologists, come for their sixth visit which, like the first five, does not get very far. Ann reports that Marvin is disputatious, negative, and often loses his temper with family members, with her, and with strangers. The prescription for an antidepressant and the sleep apnea intervention have helped him a little with self-regulation, but as our latest frustrating session nears its close, we still cannot grasp what makes him so truculent.

As is my wont, at the close of this session, I hand him a note on which I list the new learning of todays meeting for the couple to review, if they wish, before our next appointment.

Marvin: (loud, sharp, derogatory, almost insolent tone) Didnt I tell you these scraps of paper are of no use to me?

Jim: Im sorry I forgot. What would help you between meetings?

Marvin: (very loud, derisive inflection, glares at me) Nothing, I dont think you know what youre doing.

Jim: (calm, keeping eye contact) Funny Ive done this a long time. (neutral tone)

Marvin: (very loud, insulting edge now, leans forward, almost menacingly) Youre a fraud and a charlatan! (furious critical delivery)

Jim: (annoyed myself now, direct eye contact, more powerful inflection) Why would you return to someone so inept? (posing a paradox)

Marvin: My wife Ann thinks it helps. I think its useless, and youre useless. (dismissively)

Jim: (more neutrally) Its time to stop. Shall we keep the next appointment? What do you think?

Ann: Yes, lets. I think its valuable to me. Im at the end of my rope. (tone of despair)

Jim: Okay. (more optimistic inflection, more relaxed body posture) Ann gets up to leave; Marvin stalks after her. I sit dazed, feeling abused, angry, and a little frightened of Marvins sudden outburst. Why does he act with such virulence? Does this treatment have a future?

Case #2PatNo Words

Ive treated Pat, a 24-year-old white, single, male veterinary student for two years, weekly or bi-weekly. One day he begins to reminisce about his German shepherd dog from his teenage years. They were very close. When he did his homework, the dog often sat by. His pet seemed the only member of the family with whom Pat felt a bond. In the middle of his adolescence, the parents decided to move to a condo that would not accept large animals. They left the dog at the old house and returned to feed and walk him daily. Pat feels overwhelmed with guilt, convinced he should have stayed in the former home to care for his pal. The dog died a few months later.

I try to explain that adolescents have limited autonomy. When his parents refused his request, he had few options.

Pat, who formerly has taken a friendly and engaged tone with me, now glares and will not speak for the rest of this hour. Hes entirely mute for the next six sessions and will not respond to any of my questions or attempts to connect. I share my helplessness but still no response from Pat. During this period, he arrives and leaves on time but remains absolutely silent and looks down at his feet with a tight, apparently angry jaw. Im mostly confused but also a little worried that he might act self-destructively after he leaves the appointment, since hes obviously so upset. I do not sense any physical threat from him toward myself. The rage seems internal. What is my next move?

Case #3Pamela and FredA Smile

Pamela, a 55-year-old, white, college-educated, housewife, sculptress, and a quiet woman, arrives for perhaps her eighth monthly session with her 60-year-old husband Fred, a lawyer. They come so infrequently because they want check in appointments but not more intensive therapy. Theyre an economically successful couple with three adult daughters.

Ive not seen them in three months, this time, due to their vacation and to the bad weather. Little has changed; they seem moderately stalemated as usual. Fred wants more interaction and affection. Pamela feels more ambivalent about both but also committed to Fred. Her husband is the more talkative and quickly becomes frustrated when Pamela responds to him with only a few words. He asks her about her plans for the upcoming summer break.

Pamela: Im writing in my journal. I want to work on my sculpting and my exerciseand my relationshipsparticularly with you (a sweet, gentle smile crosses her lipsoften shes nearly expressionless but not now.)

Fred doesnt seem to notice this smile and does not respond to her. I point it out, then he too smiles broadly. We continue the meeting talking about activities that they could do together at their summer house, a discussion that has some animation. Both seem more relaxed and a little more mutually engaged.

After each appointment, I try to watch my couples, as they walk down the hall away from my office, to gauge the impact of the session on their body language. She departs, and he catches up to her and puts his right arm around her shoulder. She puts her left arm around his waist. He asks her, Are you doing this because Jims watching? I shout after them: This looks suspiciously like affection. Im turning into the waiting room now, and no ones observing anymore. What will the next session with Fred and Pamela bring?