In Issue 7
the skill of attending to our clients as a core piece of the Active Listening process was introduced and included for illustration was this beautiful graphic of the Chinese character for listening. It summarises succinctly the details of WHAT we attend TO
when we actively listen:
Looking more closely, we use:
for attending to
| The verbal messages of our client
for attending to
| The non-verbal messages of our client
for attending to
| Resonances in our clients message
for attending to
| Our interpretations, interruptions and overall
When we think about the data we collect when we listen, usually the first thing that comes to mind is the words that we hear. While this is of course essential, we are all familiar with the expression 'Actions speak louder than words'.
In the process of fully understanding the communications of another human being, it is well established that we privilege non-verbal messages over verbal. So, for this first issue on attending, it made sense to start with a discussion about attending to our clients' non-verbal messages.
What are Non-Verbal Messages?
Often referred to broadly as 'Body Language', non-verbal messages may be considered in discernible parts.
Egan in 'The Skilled Helper'
defines these parts as:
How are non-verbal messages useful in Eating Behaviour Counselling?
1. Developing empathy
'Empathy is the ability to accurately perceive the lived experience of another; emotionally, cognitively and bodily and reflect that understanding back to the other'
- Bodily Behaviour - posture, movement and gestures
- Facial Expressions - self explanatory!
- Vocal Behaviour - tone of voice, speed of speaking, pausing, volume of speech
- Physiological Responses - often autonomic such as flushing, sweating or quickening of breath
- Physical Characteristics - including appearance and body size (need to be used cautiously!)
). Attending to our client's body language is essential to the development of empathy as it contributes vital information about our client's present moment experience.
2. Providing important information for our 'assessment' process
Remember, behaviour change is difficult. Our client's body language can give us all sorts of information about how they are experiencing that difficulty. Non-verbal messages in our client's communication can be useful for both confirming a verbal message and also conflicting with a verbal message. They can also be useful to give us data about preparedness for change, anxiety states and self awareness in our client.
3. Inviting our clients to have a body connection
When we attend to our client's body language we model acceptance of our client's body's messages. The power in the congruence of this action in eating behaviour counselling cannot be underestimated.
What does working with non-verbal messages sound like?
Just as there are infinite examples of what a client may say verbally in session to their Nutrition Counsellor, there are infinite possibilities of what a client may say non-verbally in session too. To grease the wheels of thinking about the usefulness of non-verbal messages in our client sessions, I will work with Egan's definitions (above) to demonstrate a couple of examples within these infinite possibilities:
Our client here may be experiencing overwhelm, shame or frustration with herself. Talking over the top of this is unlikely to be helpful as the client is certainly NOT saying to us 'I am receptive to you'. More likely what is being communicated is a need to hide.
We might appreciate this by going slower with our inquiry, softening our tone or empathising directly:
: 'I get a sense your eating yesterday is really hard to talk about, I can really see what a struggle it is to be revisiting all this just now'
Client: ' Yes I've never told anyone about my bingeing before. I hate it'
Dietitian: 'It takes courage to do this work............let's go a little slower....perhaps take a deep breath, invite yourself to relax a little'
(you might notice that Google Images doesn't offer a great line in 'subtle!')
Our client here is unlikely to be indicating she is 'ready for action'. Whilst we might be triggered to find a solution to her malaise or exhaustion, launching into a goal setting session or a well meaning 'pep talk' is unlikely to be effective at meeting her where she is at! Trusting that validation is key to our alliance with the client we might consider saying:
Dietitian: 'This week of change has been huge for you, I can see it has asked of you just about all you have'
Client: ' I'm done with it all. I'm not sure I can keep going'
Dietitian: 'You're ready to chuck in the towel'
Client: 'Yes.............(hesitates, tired) but no too.......I guess this means too much to give it all away'
Dietitian: 'I wonder what we could learn just now about what it is you might need to do to look after yourself during this process of change?'
'...(Sigh) ......As usual I over did it! I need to learn pace'
Let's consider some examples here that are congruent and conflictual.
Example 1 Congruent facial expression
We could say that our client here is exhibiting a genuine, relaxed smile. This might be an opportunity to hear more about 'the good' and strengthen her resources in the moment. Expanding on 'the good' is a great tool for building your client's authentic confidence from within their own experience.
Dietitian: 'I can hear some great progess and I can see how pleased you are about it too!
' Yes, this feels pretty good just now'
'Wonderful! Can you tell me some more about this feeling good?'
Client: 'I did what I set out to do. It was hard but this time I cracked it.
'Yes you did! I wonder, looking back over this week, what it was you did differently to help the change get over the line? What resources or knowledge did you draw on?
Example 2. Conflicting facial expressions.
Our client here is likely to be experiencing some trouble or internal conflict with what he is saying. The smile is forced and there is a mismatch with his eyes. If this client was telling us that he wasn't worried at all about his eating or his health we would be unlikely to believe him. Challenging this discrepancy is vital to keeping the conversation real and our assessment accurate.
Dietitian: 'Thanks Bob for sharing that. It's strange ......and correct me if I am wrong but......., I am hearing one thing as you talk and I am sensing another. ...mmmmmm.....my hunch is perhaps all is not as good for you as you say. Am I on the right track?
In Issue 5
on being real with our clients, I give another important example of this scenario very common in working with clients transitioning to the non-diet approach. Click here
for a quick revision to compliment this exploration of conflicting communication signals
A client launches into a fast rolling recall of their week's eating experiences. The data pours out, one event after the other hardly drawing breath and very hard to follow. You notice the tone becomes a little more shrill and volume a little louder - your client's vocal behaviour may be indicating a degree of anxiety and overwhelm. The invitation to the Nutrition Counsellor is to work with this anxiety to manage the session better
Dietitian: 'Wow Anish, there is a lot going on in all that. I can hear in your voice it must have been pretty messy for you this week.'
Anish: 'Yes, Messy is a good word for it!'
(Takes a deep breath and his body settles, shoulders and eyes soften)
Dietitian: 'Hmmm a deep breath - looks like you needed that'
(encouraging smile, reassuring tone).' I wonder Anish, to keep the messiness from taking over your session here - what would be the most important thing to focus on together slowly?'
A client, Susie, recovering from an eating disorder as agreed to check her weight in session with you. She has indicated she is fine with this and proceeds to stand on the scales. On returning to her seat you notice that her neck and upper chest has become quite flushed in large red patches. Her mouth is smiling, but a bit like Bob above, her eyes indicate something that pulls against the sense of ease she would like to portray. Physiologically her body is experiencing anxious arousal. Her body cannot betray her true experience. If you have a good engagement with Susie the conversation may proceed like this:
'Susie, I know you have reassured me that you are comfortable with checking your weight with me but I am noticing some signs in your body that tell me this is pretty tough for you'
Susie: 'No I'm really fine with it. I don't feel anything, really'
(slight strain in vocal tone)
'May I ask Susie is this something that happens in other situations for you.........it is hard to get in touch with how you are feeling in the moment?'
(little laugh) 'Yes it is actually. My psychologist is always talking to me about it.'
Dietitian: 'Would it have use to you, do you think, to mention this experience to her as well?'
'Yes OK, good idea'
: 'Susie I think for now how I'd like to work with this is to remind myself that I need be mindful of how we do things that might be stressful for you. How does that sound to you?'
Susie: 'Good Yep. Thanks for that'
A female client presents every session immaculately clothed with flawless make-up. In supervision you reflect on your sense of your client as being like a 'perfect china doll'. This further informs your understanding of your client's strive to be perfect at all times in all aspects of her life including her eating behaviours and food choices. You decide to debrief with Susie in her next session if she would be interested in trialling some spontaneous eating experiments and how she would consider this to be of benefit to her.
Some Caution with using Non-verbal Messaging
In a nutshell.....hold interpretations loosely and always check your impressions with your client or work with tentative suggestions. I also appreciate what Egan says here: 'The trick of course is to spot the messages in these behaviours without making too much or too little of them'
The body is sensitive. It registers every thought and feeling. Be tender with it.
No Soundtrack this issue. Instead I'd like to pay homage to a hero of my adolescence - Rik Mayall, who sadly passed away on June 9th 2014. Rik played 'Rick' the arrogant, self-absorbed, self-proclaimed 'people's poet' and anarchist in The Young Ones comedy series in the 1980s. He was the master of the 'I don't give a toss, you're stupid and everyone knows it' face. So perfect for this month's issue. Thanks Rik for all the laughs and making the puerile and grotesque so 'everyday'.