Dissertations and Theses
Date of Award
2024
Document Type
Dissertation
Department
Psychology
First Advisor
Sasha Rudenstine
Keywords
Nonverbal Behavior, Virtual Therapy, Working Alliance, Therapeutic Engagement
Abstract
The individual (intrapsychic) and dyadic (interpersonal) implications of nonverbal behavior have kindled interest among psychologists for decades. Many researchers and clinicians have studied nonverbal communication in the context of attachment and moment-to-moment interactions between parent and infant (Stern, 1977; Beebe et al., 2000). Theorists have also explored nonverbal behavior in the clinical setting as a dynamic relational dimension co-created by patient and therapist (Freedman and Lavendar, 1995). Although the extant literature highlights how nonverbal communication can inform psychotherapy outcome (e.g., by fostering empathy and building rapport), the topic of therapist engagement with patient nonverbal behavior—specifically, how these interactions serve as a mechanism of change—remains open for interpretation. The growing popularity of and access to virtual therapy, especially in the wake of COVID-19, has also fueled interest in this topic. Though initial reactions from clinicians highlighted a fear of losing nonverbal cues with the transition to remote therapy, research findings suggest that the difference lies less in frequency than in the types and methods of therapeutic engagement (Markowitz et al., 2021; Lin & Anderson, 2023).
In the present study, 13 short-term (20 sessions) alliance-focused adult psychotherapy treatments were analyzed using both quantitative and qualitative methods. Videotaped psychotherapy session data was coded for moments of therapist engagement with patient nonverbal behavior. Six categories of nonverbal behavior emerged: (1) body movements, (2) facial expression, (3) eye contact/gaze, (4) touch, (5) vocal cues (“paraverbal”), and (6) atmospheric. Three types of therapist engagement with patient nonverbal behavior were documented: nonverbal (e.g., mirroring), verbal, and simultaneous verbal plus nonverbal engagement. Quantitative self-report measures of working alliance and general psychological functioning were also collected to compare the frequencies of therapist engagement with patient nonverbal behavior in remote and in-person psychotherapy and to better understand the role of these interactions in the psychotherapeutic process. Overall, total therapist engagements with patient nonverbal behavior were higher for the in-person treatments when compared to the remote treatments. The frequency of therapist engagements with patient nonverbals did not predict patient-rated working alliance scores at the session level but did correlate positively with changes (e.g., improvements) in overall mental health functioning. Treatment modality did not predict changes in either of these scores. Qualitative analyses of three cases studies revealed notable variations in the frequency, function, and effectiveness of therapist engagement with patient nonverbal behavior. Implications for training and supervision are discussed, including how these interactions can help to communicate empathetic attunement, regulate affect, and integrate unprocessed or unformulated experiences into conscious awareness.
Recommended Citation
Sheriwn, Elliana, "Therapist Engagement with Patient Nonverbal Behavior: Exploring these Interactions as a Mechanism of Change in Virtual and In-Person Short-Term Psychotherapy" (2024). CUNY Academic Works.
https://academicworks.cuny.edu/cc_etds_theses/1329
