When Therapists Should Disregard Body Language

Source: Flickr: Masks by Linda Rain, C.C. by 2.o

When I was teaching psychotherapy techniques to psychiatry residents and psychology interns, one piece of advice I gave them ran counter to the advice most frequently given by other supervisors. I told them that when doing therapy with patients with personality disorders, to pay more attention to the words that the patient verbalizes than to their non-verbal expressions and body language.

Body Language vs. Verbal Language

In general, body language is, in fact, usually more important than what a person says in determining how they really feel or what they really believe. This is true because, biologically, non-verbal communication evolved in our species long before language did, and became a primary representation of what is going on inside of us.

So why do I give trainees the opposite advice? The fact that non-verbal behavior conveys more, and more accurate, information to another person than verbal behavior is precisely the point. I believe people who have personality disorders are often playing roles. In a sense, they are acting. These people have developed a false self or persona that is one of the various roles I have described in prior posts (savior, avenger, go-between, spoiler, defective, loser, monster, covert caretaker, etc.).

In order to do this most effectively, one has to be a good actor, and therefore hide one’s true self—one’s actual beliefs and feelings which are not part of the act. Because role players have to be convincing, they are purposely giving off the wrong impression with their body language. How do they know to do that? Probably through trial and error.

Method Acting in Everyday Life

Method acting is a technique taught in theater schools in which actors learn how to start to really believe that they are the characters they portray and try to forget about who they really are. They can remain in character even between takes. Of course, at some level, they know they are not the character. When it comes to dysfunctional family roles, average people have been practicing this skill for most of their lives and are really good at it.

Why do they become such good actors? The simple explanation is that for them, playing their role as well as possible seems to be nearly a matter of life or death. Not playing the role leads to a form of existential terror called groundlessness.

A person nonetheless does have the power to go ahead and exhibit their true selves in spite of this, but in dysfunctional families, doing so is terrifying. One of the things I learned in dealing with people with borderline personality disorder is that, whenever they feel that what they are doing is not working, that is when they start to self-injure (cutting or burning themselves).

Ambiguous Language

So what about their verbal behavior? Shouldn’t that also be misleading for the same reasons? Well, yes it is. But there is a peculiarity of language that leads to my second piece of advice to beginning therapists: whenever patients say something that is a little ambiguous—when there is more than one way to interpret it—I tell them to at least think about the less obvious one. This is also the secret to solving a crossword puzzle, in which a lot of the clues can be interpreted in a bunch of different ways to throw solvers off.

For example, the mother of a nurse yelled at her, “I can’t believe you talk to doctors that way!” The nurse was far more outspoken than most people in her situation and, often surprisingly, got away with it. Of course, the nurse interpreted the mother’s remark as a criticism because of the mother’s tone of voice. But the words themselves contain no value judgment at all. I think the mother actually admired her daughter for being outspoken because she couldn’t be herself, but could not admit it.

I think the nurse also knew this because she was, in fact, acting out successfully in that regard, and the mother was living vicariously through her. The reason the nurse got upset when Mom yelled at her was because the mother was now seemingly upset with her for doing the very thing that the mother seemed to want her to do in the first place. The ambiguity in the words Mom chose can give a therapist clues as to what Mom's real feelings are.