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Paralinguistic Communication in the Therapeutic Relationship

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Paralinguistic Communication in the Therapeutic Relationship Archives of Psychiatry and Psychotherapy, 2012; 1 : 49–54 Paralinguistic communication in the therapeutic relationship Wiesław Sikorski Summary The author, on the basis of literature and his professional therapeutic experience, describes the mean- ing of vocal signals in diagnosing patients’ problems and improving communication during a therapeutic dialogue. In the article the author also shows the influence of voice vocal features on evoking many non- specific therapeutic factors as well as accelerating the insight and overworking process. The great im- portance of metasignals, i.e. information concerning emotions hidden in patient’s utterance has been no- ticed. A therapist is able to recognize them by careful listening to all vocal signals, particularly to: speech rhythm, voice height and verbal intensifiers. The author indicates that vocal signals themselves may often influence the content of transmission and give a lot of reliable information about patients. Patients’ reactions on a therapist’s behaviour are high- ly influenced by the reception and evaluation of his/her vocal signals. Therefore, a therapist should more thoroughly analyse voice features present at a therapeutic interaction and become their conscious send- er and recipient. voice signals / therapeutic relation INTRODUCTION el; the way in which the words can be uttered, acts on these two planes. Therefore, the paralin- Paralinguistic communication – also called guistic messages may provide additional infor- paraverbal or proto-language communication mation about how much the extra-verbal mes- – includes vocal, but extra-verbal aspects of sage is honest, and to what extent it is distort- communication properties, such as voice pow- ed. The therapist, when interpreting parallel fea- er (volume), the rate of speaking, variations, er- tures of voice, accompanying the speech content rors and other distortions of speech fluency, set- of a patient, with his „body language”, can better ting or level of voice, and its quality. „Paralan- predict the consistency or its lack in the simul- guage”, which is not fully a verbal or extra-ver- taneously transmitted content, in both – verbal bal message, at the same time, tries to „register” and non-verbal channels. It can also determine communication on various levels, and therefore which of these two channels is currently leading, seems to complement well the signals at the sub- and thus which is the one, you can rely on more. ject (verbal) and the emotional (non-verbal) lev- Since, for example, when a patient in his uttered words, more strongly emphasizes the issues that Wiesław Sikorski: Institute of Pedagogical Sciences, Depart- are important for him, he manifests a high atten- ment of Social communication, Opole University, 48 Oleska Str., 45-052 Opole, Poland. correspondence address: Wiesław Sikor- tion to the tone of voice, its volume, speed and ski, Institute of Pedagogical Sciences, Department of Social com- clarity of speech, then it must be assumed that munication, Opole University, 48 Oleska Str., 45-052 Opole, Poland. the information transferred by the subject plane E-mail: [email protected] (content) are quite reliable. In a situation, how- This article has not been aided by any grant. ever, when the verbal utterance is dominated by 50 Wiesław Sikorski different non-language sounds (without verbal know, or at the beginning of a psychothera- content), such as sighs, groans, munching and peutic session); grunting, it is more reliable connected in terms – non-verbally (for instance, when the sentence: of communication that the signals may be sent at „You have lost your mind” is accompanied by an emotional (relational) plane. In the first case, vocal signals in the form of a friendly smile or the patient is focusing heavily on the fact that his a humorous tone [2]. words were the most expressive; somehow he is not able to a similar extent to take care of his Meta-communication contained in vocal sig- „body language”. In the second case, however, nals is the main subject of analyses and discus- the occurring sounds which characterize some sions included in this paper. difficulty in expressing something in words, ac- tivate other media channels, including the ones which cover the relational plane (facial expres- META-COMMUNICATION AND THE PROCESS OF sions, gestures, posture) most [1]. THERAPY The following two hidden layers of meaning META-COMMUNICATION IN PSYCHOTHERAPY can be found in the messages formulated by the therapist and patient: it is the transfer of specif- The starting point for the discussion about the ic words, and the second - meta-communication importance of diagnostic and vocal communica- - which is a message referring to emotions. Ac- tion signals must be undoubtedly the reference cording to P. Watzlawick, J.H. Weakland and R. to the studies of a famous group of researchers Fish [3] the therapeutic interactions without me- and therapists of Palo Alto. The people gath- ta-communication would create a chain of mu- ered in it, of a stature as P. Watzlawick, G. Bate- tual misunderstandings and conflicts. Any com- son and V. Satir, were one of the first to recog- ments, any discussion of the contentious state nize that the decisive role in the reading of the of affairs, any additional question about wheth- communicated content by a patient plays „me- er the words that had been heard were under- ta-communication framework”. According to stood correctly, comprise meta-communication. this assumption, the framework contains guid- The ability to invoke meta-communication in a ance on how the message can be interpreted. A situation of overt conflicts and disturbances of therapist is provided with clues, that allow him relations with patients belongs to the profession- systematize his perception and understand the al competence of the therapists. It is the base of meaning of words spoken by the patient. These all successful compromise. researchers have taken the trouble to determine Meta-announcements can cause difficulties at how these frames are clearly communicated. It any stage of therapy, starting from conclusion of was obvious that this must occur in some form a therapeutic contract, through the use of certain of „meta-communication.” In other words, they procedures (e.g., therapeutic interventions) and assumed that any information at the same time ending with the completion of therapy. Some- includes tips on how to understand it. In the times a seemingly clear and logical statement case of communication in the therapeutic rela- with a positive tinge, can, through an improper tionship (and also interpersonal) it suggests that meta-announcement, express a negative attitude. such clues can be expressed: For example, if a therapist at the time of the con- clusion of the „therapeutic contract” first utters – verbally (for example, by saying the sentence: the sentence, „I’m going to help you”, and then „I think you are crazy, but this is obviously s/he adds the verbal modifier „only”, at the same just a joke”); time stressing and uttering it with rising into- – contexts (for example the question: „How are nation, then an entirely different message aris- you?” may be understood differently if by the es. Now the words „I’m only going to help you” application of the same non-verbal means the take the form of a signal expressing an attack expression is uttered during a chance encoun- or a defensive attitude or a grudge. Moreover, ter in the street when meeting somebody you the use of such meta-announcements – especial- Archives of Psychiatry and Psychotherapy, 2012; 1: 49–54 Paralinguistic communication in the therapeutic relationship 51 ly demonstrating disapproval and anger – is not Pause and silence easy to neutralize. If the addressee of the meta- announcements formulated this way is a patient, According to the first pragmatic axiom of then the defence harmful, negative content, in- communication P. Watzlawick [4], which states cluded in them, can be even more difficult. An that „it is impossible not to communicate”, even additional problem is the fact that on the one short interruptions and moments of silence also hand the creation of such meta-announcements may communicate something. Many junior re- easily gets out of control, and on the other, the searchers of psychotherapy are so much afraid attack that is hidden in them is usually so subtle of silence that they begin to speak before they that often the sender (here: the therapist) is not can understand why the patient remains silent. aware of the harm caused to the recipient (here: Meanwhile, the cause of this silence may be that: the patient). Similarly, the addressee (here: the a) the patient is thinking intensely, b) s/he expe- patient) may often be unaware of this, how s/ riences strong emotions, c) s/he does not want he has been hurt. For example: a patient admits to talk or talk about what s/he is thinking, d) is that s/he often changes his/her therapists which concerned about the reaction of the therapist, e) are commented by the current clinician as fol- the patient is trying to get a grip, f) s/he is not lows: „Presumably, I’m not your last therapist”. able to choose the right words, g) s/he is con- The modifier „presumably” and the accent on cerned that the conversation will be overheard, the word „last” make that the message means: h) s/he is wondering whether to reveal what was „You are a psychotherapy addict” or „You lack up to that moment carefully hidden, kept in se- motivation to overcome the problems,” or even cret, etc. [5]. „The complaints are so serious that no therapist is able to help you”. A therapist, in formulating such a statement with good intentions, in order Voice characteristics and mental disorder to encourage the patient to work intensively on him/herself, obtained the opposite effect.
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