Client Observation Skills

A man , aged twenty-five, is brought into the staff room of a communuty psychiatric clinic. His
face is gaunt, his eyes are dull, his shoulders hunch, his hands scratch the back of his neck almost
constantly, his shirt is partially unbuttoned, and his shoes are untied. Immediately on entering,
he slumps into a chair and continues to scratch the back of his neck. The staff psychiatrist,
psychologist, and social worker sit before him. One asks him why he is at the clinic. He continues
to look at the floor and answers in a dull monotone: “sad… so sad… so sad…” Further questioning
brings no further data, only the words “sad… so sad… so sad…” sometimes given slowly and
deliberately; other times in an agitated, rushed fashion.

The Young man above shows signs of Deep depression. He lacks intencionality, which was
presented in Chapter I as a central goal of the theraoy process. The first aspect of intentionality
was defined as the ability to generate a máximum number of words, thoughts, and behaviors to
communicate with self and others in a given culture. The task of the therapist is to help free this
man for intentional, creative responding. While the methods and theories of coun….

A woman of seventeen visits a street clinic in a large city. She is neat and well kept and strides
briskly into the corner cubicle where a volunteer peer counselor waits. After an initial friendly
Exchange of Greetings, her voice becomes tight and tense as she talks about her lover’s
impotence and lack of interest in her. Her body becomes increasingly rigid as she states, “I love
him so much, Why won’t he respond to me? I’ve donde everything for him. I bring home the
money; I clean the apartment. What more can I do?” She breaks down into tears.

This woman presents a fairly “Normal” problema of interpersonal relationships, yet the
structure of her difficulties is close to those of the depressed patient in the psychiatric clinic.
She, too, is frozen into repetitive patterns and is unable to créate new verbal and nonverbal
behaviors to respond to and direct her present situation. Again, the task of the counselor is to
assist her in creating new answers alternative behaviors, and taking intentional control of her
own life.

THE SILENT LANGUAGE OF THE INTERVIEW

If our goal lis to facilitate the personal and social development of the depressed man or the
woman facing difficulty with her lover’s impotence, we seek to enter their world and understand
how they function in it. One of the first and most important dimensions is understanding and
noting their nonverbal behavior.

Counseling consists of verbal and nonverbal interactions. Nonverbal communication and body
language are foundations on which the language of counseling and therapy are based.
Nonverbal language funtions at three significant levels:

1. Definition and condition of the interaction: for example, timing of sesión, place,
arrangement of affice, clothes, and so forth define what is important, much of what will
be said in that context, and the power relationship between two individuals.
2. Information flow: for example, often specific information passes in the form of
nonverbal communication, but more often nonverbal communication modifies the
meaning and places emphasis on verbal content.
3. Interpretation: each culture and each individual has significantly different patterns of
meaning in nonverbal language. What means one thing to you may mean something
totally different to someone else.
These three points comprise the major findings of extensive research in nonverbal
communication summarized by Harper, Wiens, and Matarazzo (1978).

Extensive work in listening skills revealed that standard middle – class patterns of direct eye
contact, forward trunk lean, and a médium vocal tone may be most inapropriate with some
clients. When you are working with an extremely distressed individual, such as the Young man
in the example or someone talking about a delicate issue, direct eye contact may temporarily be
harmful to the interaction. Avoiding the eyes of the person talking about a difficult topic may be
wise at times.

What nonverbals should you focus on as you begin to study client behavior? While there are
many ways to organize nonverbal behavior, it often proves helpful to begin with concepts that
are already familiar to you. Attending behavior has been presented as a suggested way of your
interacting with a client. The same four central dimensions of attending behavior provide a
usefull map for noting client nonverbals.

Eye Contact. Given cultural differences, it is still important to note when and in what context
the individual breaks eye contact. It is the shift of the pattern of eye movements that gives a
clue to what is going on in the client’s mind. Difficult issues tend to cause eye contact breaks.
The Young woman at the introduction of this chapter for example, may break eye contact when
talking about impotence but not when she talks about her caring for her lover. This may be a
sign of a real desire to maintain the relationship. However, precise meanings of changes in
nonverbal behavior or eye contact require more tan single observations, or you may make
critical interpretative errors. Some clients fear certain topics (for example, sex, hostility, child
abuse) and will avert their eyes when these tipics appear on the horizon. Each client and client
culture is different.

Body Language. The vast array of body gestures, motions, and expressions cannot be detailed
here. Clearly, they vary from culture to culture- witness the West- ern style of saying “No” bye
shaking the head sideways and the Russian style of saying the same thing by shaking the head
up and down. Different groups ascribe different meanings to the same gesture, and you will also
find each client has unique patterns.

The body language of the depressed Young man discussed earlier illustrates many characteristics
of the clinical manifestations of depression: por eye contact, hunched shoulders, hands in
constant movement, monotone voice, and a physical appearance of “not caring”. These aspects
of nonverbal comunication are easy to observe. But the Young woman’s more subtle rigidity
may require more careful observation in order to note a specific individual nonverbal style.

The most usefull type of body language, however, is the shift or change in body posture. The
client may be sitting naturally and then, for no apparent reason, closet he arms, sit back in the
chair, or cross the legs. Often these seemingly irrelevant shifts are indicative of conflicto in the
person. What is being said and what is being felt may not be same thing.

Vocal Tone and Speech Rate. A person’s vocal tone and speech rate can say as much about
people’s states of being, particularly their emotional state, as the words they speak. Loudness
and softness on certain topics may be important clues to the strength of feelings. A fast speech
rate is often associated with nervousness and hyperactivity, while a slow speech rate may be
associated with lethargy and depression. As in eye contact and body language, sudden voice
changes around certain topics of discussion should be noted. Vocal tone is an indication of the
degree of warmth. The voice is an instrument that conveys many subjective feelings and
emotions.

Topic Jumps. Changes and shifts in topic are clues that your client has something else on his or
her mind. You may enter a serious discussion of the woman’s feelings toward her impotent lover
and suddenly find she is talking about something totally different, perhaps problems on her jobo
r maybe even the weather. Your ability to note a client’s topic jumps and cope with them is
critical to your success as a helper. Complicating this is the fact that sometimes it is wise to
suport clients in their changes of topic, as a temporary shift to a less difficult topic may help
develop trust and allow you to return to the central issue in more depth at a later time.

The depressed client at the beginning of this chapter has, as is typical of many depressives, only
one topic… himself and his depression. Your task with this type of patient may well be to change
the topic and introduce new concepts for discusión. You will find many of your clients quite
adept and skillful at controlling what is talked about in the interview.

Ultimately, your skill as a therapist and counselor will rest on your ability to “control” the topic
and discussion flow. While you want to “walk with” the client and understand their view of the
world, it is important to remember that most clients come to therapy in the hope that their
worldview will be changed toward a more positive direction. The Word “control” is used
deliberately here as it brings out a difficult and complex issue. Control can be manipulative and
anethical.

However, if the client controls all conversation in the sesión, your ability to produce change may
be impaired. It may be usefull to think of control in the interview as a joint issue of both
counselor and client. In the long run, clients must regain control of their own lives and, as such
overcontrol on your part is not desired.

Mirroing Nonverbal Behavior. One route toward balanced control of verbal and nonverbal
behavior is the deliberate mirroring of your client’s behavior. You will sometimes find yourself
aware of nonverbal behavior that simply doesn’t make sense to you, and you may feel awkward
and distant from the client. One route toward understanding the other person is to consciously
imitate or mirror nonverbal behavior for a brief time. If you attend carefully to your own body
once you asume a mirroring position, you will find that changes in the client’s movement actually
produce stimulation or desire to move in your own body. These “electrical potentials” may be
noted through mirroring and produce an even higher level of empathy.

Examination of films and videotapes reveals fascinating patterns of nonverbal communication.

In a successful, smoothly flowing interview, movement complementarity or movement
symmetry often occurs between counselor and client. Movement complementarity is
represented by a “passing” of movement back and forth between client and counselor. The
client may pause in the middle of a sentence, the counselor nods and the client finishes the
sentence. Movenments between counselor and client pass back and forth in rhythm.

Movement symmetry is exciting to view. Counselor and client unconsciously have assumed the
same physical posture: their eye contact is usually direct; their hands and feet may move in
unison as if they were dancing or following a programmed script. Movement symmetry can be
achieved in a beginning fashion by deliberately assuming the posture of the client. This mirroring
of nonverbal behavior often brings the therapist to a closer and more complete understanding
the client.
The lack of complementarity and symmetry is also something to observe.

The counselor may say something and the client’s head may jerk noticeably in the opposite
direction. When dissynchronous body movements occur between counselor and client, the
interview is often on the wrong track. A solid knowledge and awareness of body language is
necessary to consistently observe this type of behavior.

However, once you learn to observe this type of mirroring, it can be a most valuable tool. If you
start noting the general pattern of body language of your client and deliberately asume the same
posture, you will find yourself in better synchrony and harmony with what client. Many scoff at
this suggestion, yet, if you try mirroring the body posture of the other, new understandings and
communication can develop. Do not use this tool manipulatively, use it to develop increased
awareness and new levels of insight.

THE PLACE WORDS AND LANGUAGE IN THE INTERVIEW

A peson’s worldview or map of reality is represented by both nonverbal and verbal sentences.
It is important to recognize that words and sentences form the core of most counseling and
psychotherapy approaches. This section provides an overview of how the language of the
interview may be examined to clarify the nature of the counseling process. We will first examine
how the gramatical structure of simple sentences tells us much about the counselor and the
client. We will then examine how the wording of more complex sentences gives an indication of
how the person thinks. Finally, we will examine the concept of Surface and Deep structure in
sentences and consider specific methods through which counselors can bring out the deeper
meanings underlying the issues brought by clients.

The Structure Of Sentences. The way people articulate or phrase sentences is an important clue
as to how they view the world. Consider the following sentence given by a woman in the early
stages of counseling:

HELPEE: My husband tells me what to do and I try to do it. But, I simply can’t respond.

HELPER: How would you like to respond to him?

HELPEE: He wants me to please him. I’d like to be able to do that.

In the above sentences, the woman puts herself as the object of the sentence in a passive role.
The counselor supports this passivity by asking her how she would like to respond to him. A
forward-moving, feminist therapist would most likely attempt to putt he client in the actor role
and in charge of her own life. For Example:

HELPER: Anne, what are your personal wishes and desires in this situation?
What do you want?
HELPEE: I’m really angry… so angry I sometimes just don’t want to do anything for hi mor with
him.

Putting the woman as the agento r actor changes her perception of the situation.
In the first example, the sentence structure of the counselor putt he client in a passive role and
reinforced old, ineffective behavior. In the second example, the sentence structure used by the
therapist places the client in a stronger, more assertive role and helps remove passive thinking
and acting. The woman who has complained about he difficulties with her lover has described
her situation via one set of sentences. The same situation could be described via many
alternatives.
For Example:

1. (Original statement) I love him so much. Why won’t he respond to me? I’ve donde
everything for him: I bring home the money; I clean the apartment. What more can I
do?
2. He won’t respond to me. He doesn’t respond to my attentions. He ignores me no matter
what I do. I better try harder.
3. I’m getting ripped off. I do all the work and he just lies around the house. It’s time I
kicked him out. Yes, I love him, but it isn’t worth it.

Whiler more alternative descriptions could be generated, these three are sufficient to ilustrate
the point. Clients come to counseling ssesions with key sentences describing their situationgs.
Often these sentences are routinized into standardized patterns. The task of the therapist is to
free the client to generate new sentences, as described in versión 2, it may be predicted that
the new sentences would be a result of sexit counseling that moved her from a partially passive,
partially assertive role to a completely passive, traditionally feminine carácter. Phyllis Chesler in
Women and Madness (1972) speaks passionately and articulately about how a predominantly
White male helping profession has served to keep women in subservient roles.

The third set of sentences place the Young woman in an assertive frame where she is making
her own decisions. She is the subject of her sentences and on the basis of these sentences i sable
to generate new nonverbal behaviors (specifically, throwing him out). The ways in which people
view themselves are revealed in their sentences.

Le tus imagine that you are driving along the Pennsylvania Turnpike and get off for lunch. On
your return to the Pike, the ticket that comes out of the machine is ripped and you have only
half of the ticket. What are you going to tell the collector when you get off the Turnpike at the
Ohio border?

1. The ticket ripped.

2. I ripped the ticket
3. The machine ripped the ticket
4. Something happened

The description of even such a small event can be a clue to the way a person views self and the
world. Each of the above sentences could be termed a true and accurate description of what
happened, but each sentence represent a different worldview. The first represents a descriptive
view in that the event is simply described; the second represents a person who takes
responsibility for the situation and may be an indication of inner directedness; the third
represent outward directedness or an “I didn’t do it” view; and the fourth represents a vague,
fatalistic, almost mystical view.

From sentence analysis, we may draw some important conclusions for the counseling process:
the Word used by a client or a therapist to describe an event may say more about the person
talking than about the event itself; the gramatical structure of sentences (subjects, verbs,
objects) is also an indication of personal worldvie. Counseling is a predominantly verbal process,
and systematic analysis of the language of counseling is assential to full understanding.