chapter  9
19 Pages

The Therapist Speaks

Interpretations provide many of the explicit forms of a therapist's communications. Nonetheless effective interpersonal communication requires a foundation of implicit forms of exchanges. If the most careful process notes of a session are compared with a tape recording, striking differences appear. The process notes, whether written during the session or from memory afterward, will reveal the therapist's speaking an average of 5 to 12 times. The tape will reveal the many ums, uh-huhs, and ohs that considerably increase the number of therapist speech elements. The process notes will portray the interchange as patient speaks, followed by therapist speaks, followed by patient, and so on. A tape recording will convey the pauses between speakers that are long and awkward, a "pulling teeth" type of exchange; or short pauses and staccato statements, a heated exchange often with interruptions of one another; or a slow, deliberate, thoughtful type of easy comfortable rhythm. More important, if the flow of mutual exchanges changes, a tape recording helps to identify the moment in the session when the change occurred. If the session is videotaped and therapist and patient are viewed on a split screen, the facial expressions add a further dimension to the

affective concordance or discordance taking place. Additionally a completely out-of-awareness gestural communication becomes evident as shared body tensions or relaxed parallel hand-to-face scratches add to the mutuality of the exchanges, or animation of face and gesture of one and that expressionless face and gesture of the other provides evidence that although the two are talking to one another, their affective connection is poor.