RX Patient Tools
Use these quick guides before reading the article, or return to them when you need help preparing questions for a doctor.
While we often consider verbal and nonverbal communication as distinct or even in opposition to each other, they are, in fact, closely entangled.
Verbal communication is explicit and nonverbal implicit. The latter makes up as much as 90% of communication and includes how spoken language is delivered, along with postures, movements, gestures, and even changes in breathing (Westland, 2015).
When a client enters the room with dropped shoulders or a lively gait, we should take note as therapists. Communication begins as they walk in.
This article explores nonverbal communication – the counselor’s and the client’s – and introduces techniques, worksheets, and other resources to help identify, read, and use these powerful cues.
Addressing Nonverbal Communication in Counseling
Communication is crucial to all aspects of our lives, especially communication in therapy and counseling, where sharing thoughts and feelings is essential. The essence of communication involves (Rogers, Whitaker, Edmondson, & Peach, 2020):
- A means for conveying a message (spoken language, written words, intonation, gesture, body language, etc.)
- Decoding the message (whether heard, seen, or read)
- Responding or replying based on the interaction (perhaps a nod, vocal response, or an action)
In therapy and beyond, there are five ways communication can occur between counselors and clients (Nelson-Jones, 2005):
- Verbal
Via words; for example, “This has been difficult for you.” - Vocal
Through our voice, but not the words themselves (e.g., pitch, emphasis, speech rate, volume, and articulation). - Bodily
By the whole body, including eye contact, gestures, facial expression, posture, etc. - Touch
With a type of bodily communication, such as how soft or firm, and the part of the body that makes contact. - Taking action
Involving communication and messages outside of face-to-face, such as a follow-up note for a missed appointment.
This article focuses on the last four communication cues and techniques, which are often implicit and outside of awareness. They each require a degree of sophistication and experience gained through interacting with others (Rogers et al., 2020).
A List of Nonverbal Communication Cues
Nonverbal communication skills come in various forms and are typically unique to the personality and style of the individual.
Many are unconscious, making it easy to communicate the wrong messages or too much or too little information. Bodily communication cues include (Nelson-Jones, 2005):
- Facial expression
Facial expression is possibly the most important nonverbal communication. We can share a message of anger, surprise, disappointment, fear, or sadness simply through facial expressions, such as raised eyebrows or the shape of the mouth. - Gaze
How much and when we look at a speaker conveys a level of interest. As we talk, it can also provide us with details of our listener’s reactions to what we have said. - Eye contact
Eye contact is more direct than gaze; it conveys a great deal, including anger, interest, and even attraction. - Gestures
We can frame what we are saying or illustrate our points using physical movements. They may show emotion (e.g., using a pointed finger or a clenched fist) or add information to our words, illustrating a shape, size, or movement. - Posture
When we physically turn toward someone as they speak or lean forward, we convey interest; facing away or leaning backward can suggest a lack of interest or even boredom. Posture, such as sitting with legs and arms crossed tightly, may express being anxious or uptight. - Physical closeness
Our degree of comfort with physical closeness can vary depending on culture and connection with the other person. For example, the intimate zone (6–18 inches or 15–45 centimeters) may be reserved for close friends, relatives, or someone we are in a relationship. The social zone (4–12 feet or 1.2–3.65 meters) includes those who are less well known, and the public zone (over 12 feet or 3.65 meters) is for public gatherings. - Clothes
What you wear can communicate a great deal, including social and occupational standing, ethnicity, conformity, and gender identity. Different age and social groups may respond in various ways depending on the clothes we wear. - Grooming
Important information is conveyed by how we care for ourselves, such as being clean and tidy, styling hair, and removing/not removing body hair.
Many nonverbal cues are unconscious and require serious consideration to recognize.
5 Techniques and Methods for Your Session
“Heartfelt observing is staying subjectively engaged, in a kind of way, as we look at a client” (Westland, 2015, p. 71). We must remain close to the subjective experience and emotionally engaged with the client to capture the subtleties of nonverbal communication.
The following methods and communication techniques help ensure nonverbal and verbal messages are more clearly understood.
Being present
Staying present and remaining self-aware are crucial for reading clients’ nonverbal communication cues.
Meditation and mindfulness can help, as can practicing and reflecting on observation skills.
Learn to be in the room with your thoughts, with your awareness focused on the client. Put aside following a fixed agenda, offering advice, or attempting to find a solution. Instead, choose to be present and show understanding and eagerness to get to know your client (Westland, 2015).
Focusing on the nonverbal
Picking up on nonverbal cues requires moving “back and forth between focusing on the client and then ourselves” (Westland, 2015, p. 150). We must maintain awareness of how the client speaks and hear what their body is telling us.
Breathing slowly and with purpose can ease our sympathetic nervous system (Nestor, 2020); talking calmly and taking pauses may allow us to see more subtle phenomena in clients.
Look for small signs, such as a tear forming in the corner of the eye or tremor in the voice; become aware of your inner experience; and allow it to open up the nonverbal dialogue.
Expanding your awareness of the nonverbal
As you observe the client’s nonverbal communication, ask yourself the following questions to gain greater self-knowledge and self-awareness (modified from Westland, 2015):
- What am I sensing in my body?
- What am I feeling?
- What am I imagining?
- What am I thinking?
Without trying to rationalize, accept the answers as information about your client. Use it to gain deep insight.
Recognizing the form of speech
We all have different ways of speaking; as a therapist, you must learn your clients’. Listening in a low-key way to the content of the words they are saying makes it possible to listen more closely to the way the clients are speaking.
It takes practice, but it soon becomes possible to listen to the content of what is said and the form, potentially picking up on messages not present in the spoken word.
Considering style of speech
Speech styles may show avoidance strategies, early attachment styles, or the client protecting themselves; they can include the following (Westland, 2015):
- Talking in one note
A monotone or flat speech that lacks emphasis can indicate an insecure-avoidant attachment history. - Talking on the horizontal
Similar to ‘one note,’ the client may do a lot of talking to fill the space, yet there is little depth to what is said. - Enticing and enthralling
The client is skilled at telling engaging stories while keeping the listener from making personal connections. This style is not easily associated with an early attachment style. - Runaway train
There are no pauses for reflection or thought, but instead a cascade of words. This fast momentum, sometimes spoken at high pitch, suggests a “clinging-expressive” character style. - Talking without resolution
While expressive, the client talks without a sense of settlement or outcome, leaving the therapist feeling ‘overfed.’ It can indicate a disorganized-insecure attachment past.
There are many and varied styles of speaking. Getting to know the client involves recognizing their style/s and whether they are used to avoid sharing; style can tell more of a story than intended.
5 Worksheets & Games for Helping Clients
Good communication skills from both the therapist and client are essential for helping clients reach their goals.
Sharing information thoroughly and clearly relies on skillful awareness of your own and others’ nonverbal skills.
The following worksheets can be completed by the therapist or client to improve nonverbal skills and awareness.
Matching Nonverbal and Verbal Communication to Client Needs
Developing cultural competence – awareness of another’s gender, ethnicity, (dis)ability, and language – can help with all forms of communication, including nonverbal. This can be especially important when the other person’s background differs considerably from ours (Rogers et al., 2020).
The Matching Nonverbal With Verbal Communication worksheet examines a recent engagement (with a client or by the client), your attitude toward them, and whether your verbal and nonverbal communication are congruent.
Bodily Communication Competence Using SOLER
Nonverbal skills can be taught but benefit most from practice. The SOLER acronym (Egan, 2007) encourages practicing nonverbal communication in a culturally competent manner (Rogers et al., 2020).
Use the Bodily Communication Competence Using SOLER worksheet to reflect on your bodily communication during a recent meeting and consider the improvements you could make in the future.
Reflect on the nonverbal messages you were sending. Consider how you could change them and improve communication from now on.
Learning to Recognize Nonverbal Cues
Nonverbal cues can be difficult to spot; they require concentration, focus, commitment, and practice. Reviewing our own and others’ conversations can be helpful.
Watch an interview video or any other conversation, or mentally replay a consultation or meeting, and use the Learning to Recognize Nonverbal Cues checklist to hone your communication skills.
Nonverbal Mood Spotting Game
Communication games played in groups or pairs can be an ideal way to practice using and spotting nonverbal cues.
The Nonverbal Mood Spotting Game is a fun way to engage children or adults in using their nonverbal spotting and communication skills as they attempt to convey and guess moods.
Interpreting Body Language
Much of our body language is unconscious. We may not be aware of what we are communicating through our posture, gestures, and facial expression or think about the cues we use to recognize others’ feelings.
The Interpreting Body Language worksheet is great for children and adults to consider how they might use body language to convey a series of feelings.
Assessing Nonverbal Communication: A Questionnaire
Self-assessment and receiving feedback can be helpful and insightful ways to identify how to improve nonverbal communication.
The Assessing Your Nonverbal Communication worksheet can be completed by yourself and others to assess how successful you are at nonverbal communication and identify areas for improvement (modified from Nelson-Jones, 2005).
Assess your own and others’ feedback and see what changes you could make to your nonverbal behavior while remaining relaxed and focused on the client.
3 Best AAC Apps for Children With Autism
Children with severe speech and language problems benefit from using communication methods other than talking. The following augmentative and alternative communication (AAC) apps can be helpful.
Proloquo2Go
Proloquo2Go is an AAC and text-to-speech app with a database of over 10,000 words customizable to the user’s needs. The child uses symbols and text to create natural-sounding speech or phrases and sentences they can use for email, Facebook, and Twitter.
Find the app in the Apple App Store.
QuickTalk AAC
This AAC app uses pairs of buttons to select words and phrases for reproduction through a high-quality text-to-speech voice.
This app is easy to set up, and a profile can be created in a matter of minutes.
Find the app in the Apple App Store.
Find the app in the Google Play Store.
LetMeTalk
This free AAC app supports the creation of synthesized speech by forming images into phrases and sentences.
It contains over 9,000 images – or you can add new ones with the built-in camera – and supports several different languages.
Find the app in the Apple App Store.
Top 3 Books on the Topic
The following books are excellent resources for the theory and practice of good communication, particularly nonverbal communication.
1. Verbal and Non-Verbal Communication in Psychotherapy – Gill Westland
Experienced psychotherapist Gill Westland takes the reader on a journey through the key components of therapeutic interactions.
Along the way, she introduces the interrelationships between verbal and nonverbal communication and the mindfulness practices that can help ready the listener to receive both.
This fascinating and engaging book helps therapists and clients navigate the communication skills involved in embodied relating.
Find the book on Amazon.
- Hardcover Book
- Westland, Gill (Author)
- English (Publication Language)
- 320 Pages - 08/24/2015 (Publication Date) - W. W. Norton & Company (Publisher)
2. 21 Days of Effective Communication – Ian Tuhovsky
This valuable book, packed with everyday habits and exercises, can improve social intelligence and communication skills.
Erudite yet insightful, this is a practical guide for building meaningful and rewarding relationships at home, work, and beyond.
Find the book on Amazon.
- Tuhovsky, Ian (Author)
- English (Publication Language)
- 124 Pages - 07/02/2018 (Publication Date) - CreateSpace Independent Publishing Platform (Publisher)
3. Practical Counselling and Helping Skills – Richard Nelson-Jones
Richard Nelson-Jones’s book is an essential read for experienced or trainee counselors and therapists.
Nelson-Jones introduces counseling basics before diving deep into the practicalities of creating the right environment and therapeutic alliance for helping clients.
The author pays particular attention to understanding the communication needs of the client, whether shared verbally or nonverbally.
Find the book on Amazon.
- Used Book in Good Condition
- Nelson-Jones, Richard (Author)
- English (Publication Language)
- 528 Pages - 12/20/2013 (Publication Date) - SAGE Publications Ltd (Publisher)
Resources
Communication skills are essential to all areas of life, particularly in therapy; the therapist and client share verbal and nonverbal communication to understand the obstacles obscuring short- and long-term goals.
Why not download our free emotional intelligence tool pack, designed to improve awareness and understanding of each other’s needs, and try out the powerful tools contained within? Here are some examples:
- Building Emotional Awareness
Identifying and understanding emotions is vital for emotional intelligence and a prerequisite for excellent communication skills. - Decoding Emotions by Analyzing Speech, Body, and Face
Practice reading other people’s emotions by exploring three different decoding techniques.
Other free resources include:
- Effective Communication Reflection Worksheet
This is a practical guide for applying active listening techniques and validating its success. - Silent Connections
Try out nonverbal communication with this fun group therapy activity.
More extensive versions of the following tools are available with a subscription to the Positive Psychology Toolkit©, but they are described briefly below:
- Mindful Speaking
Mindfulness helps us speak the truth while remaining fully present and aware of what the other person is saying.
-
- Step one – Practice speaking mindfully, with intention, by slowing breathing and checking in with what you are about to say.
- Step two – Having spoken, pause and check in with yourself again. What did it feel like to say that? Did it come out as intended?
- Step three – Reflect on your feelings now and how the other person responded.
Try to implement mindful speech every day.
- 17 Positive Communication Exercises
If you’re looking for more science-based ways to help others communicate better, check out this collection of 17 validated positive communication tools for practitioners. Use them to help others improve their communication skills and form deeper and more positive relationships.
A Take-Home Message
Nonverbal communication is a powerful ally of verbal communication. Posture, gesture, tone, and vocal pitch can convey a great deal, consciously or unconsciously.
And yet, it requires skill. Nonverbal communication is easily overlooked or misunderstood. In therapy, this can be significant, leading to missed opportunities to better understand the client’s needs or build a solid therapeutic alliance.
Awareness of self and others is vital. Being present and fully engaged in the moment helps the listener’s observation skills and ability to soak up the intentions behind purposeful or unintentional misdirection.
By expanding awareness through education and practice, anyone can raise their ability to read nonverbal communication to the next level.
The worksheets and techniques in this article offer an opportunity to increase awareness of nonverbal skills and practice identifying them in real-world situations.
- Egan, G. (2007). The skilled helper: A client-centred approach. Thomson.
- Nelson-Jones, R. (2005). Practical counselling and helping skills. Sage.
- Nestor, J. (2020). Breath: The new science of a lost art. Penguin Books.
- Rogers, M., Whitaker, D., Edmondson, D., & Peach, D. (2020). Developing skills & knowledge for social work practice. SAGE.
- Tuhovsky, I. (2018). 21 Days of effective communication: Everyday habits and exercises to improve your communication skills and social intelligence. Author.
- Westland, G. (2015). Verbal and non-verbal communication in psychotherapy. W.W. Norton & Company.
