Actions Speak Louder Than Words

One of the greatest lessons that I’ve learned which I try to impart upon my patients is that actions speak louder than words every time. This applies whether we are discussing another person in the patient’s life or the patient herself. In other words, one can deceive themselves and others, either intentionally or not, but if we pay attention to an individual’s behavior, we get a much clearer picture of what is really going on. The unconscious is incredibly powerful and one’s behaviors cannot help but betray one’s true sentiments. We can train ourselves to pay more attention and become better attuned to the non-verbal cues that are being expressed.

These non-verbal cues include subtle facial expressions and body postures as well as more obvious behavioral patterns such as perpetual lateness and cancellations, continued inaction, or repeated substance use. I encourage my patients to “turn off the volume” and pay attention to the non-verbal signals they pick up on from others, rather than the words they are being told. One patient who is having problems in her marriage is continually frustrated and upset when her husband says he wants to fight for their relationship but his actions indicate otherwise. This spouse has taken little to no steps to start individual or couples therapy, has not done anything to improve his health through diet and exercise, continues to drink alcohol excessively, and does very little to help out with the household chores. Another patient often arrives for her appointment ten to twenty minutes late or cancels a day before and asks to wait until the following week to meet. Yet another patient consistently arrives for his appointment thirty minutes early yet “forgets” to pay his co-payment every other week. Therapists have learned to track these behavioral patterns, for they provide a wealth of information about the individual’s unconscious motivations.

I caution my patients not to interpret the behaviors of others. We may hypothesize about what the non-verbal behavior tells us, but we are not mind-readers and we cannot know with certainty the meaning of these behaviors. For instance, the patient who is consistently late for her appointments may be unconsciously expressing anger toward me and/or may be acting on her fears about accessing painful emotions in therapy by attempting to regulate the amount of contact we have to ensure that she not come in contact with these feelings.

Interpreting another’s behavior can lead to confusion, anger, and faulty assumptions; simply paying attention to what the patterns of behavior are is safer, as it is almost always non-disputable. If I point out to the female patient above that she frequently arrives to her sessions late or cancels her therapy appointments, this data is merely observable fact that is indisputable. If I interpret the meaning of this behavior as an expression of the patient’s anger toward me, then I have crossed into the murky territory of attempting to guess the reasons for her behavior. The patient may disagree with my interpretation and a therapeutic rift may occur or my deductions may be incorrect. I caution my patients to stick to the observable behaviors without interpreting the meaning of said behaviors. By strengthening our ability to “mute” another’s words and tune into behaviors, we can develop our ability to accurately pay attention to the incredibly powerful non-verbal communications that are being expressed before our eyes.

The Role of Meditation Practice In Psychotherapy

In recent years I have begun implementing meditation practice during the first ten minutes of a session with some of my patients. The choice whether to meditate or not is always at the discretion of the patient. The purpose of such practice is to help bring awareness to one’s internal world in the present moment. This encompasses improving one’s attunement to emotions and physical sensations that can be detected in the body. I have found that many people are initially uncomfortable being with themselves in the here-and-now, and thus they flee being in the present and resort to living in the past or future, allowing their thoughts to distract them from what is right before them.

Most people do not need my help accessing their thoughts; they can fairly readily identify what they are thinking. It can be a different matter when they are trying to identify what they are feeling. When an emotion is intensely felt, it is likelier that the individual will notice it and be able to describe it. One is more apt to recognize that she is enraged than to recognize that she is mildly annoyed. But if we believe that all people have thoughts, feelings, and physical sensations at every moment, whether we are aware of it or not, then we can begin to see how difficult it can be for many people to access feelings when felt to a lesser degree. This concept that people have thoughts, feelings, and physical sensations at every moment is similar to breathing. Once an individual is encouraged to focus on his breathing, he usually can do so easily. We are all breathing at every moment but often we are not paying attention to our breathing. The same applies for thoughts, feelings, and physical sensations. Some people may find identifying and accessing physical sensations challenging. Still more may struggle to identify and stay with their feelings. Trauma survivors in particular may struggle in this way, given that one of the ways they learned to cope with the trauma they experienced was to numb themselves and dissociate from their internal world. This serves a protective function. As adults many of these individuals have difficulty knowing what they are experiencing when it comes to emotions and physical sensations.

Meditation seems to assist people in building their awareness of what is happening internally. Furthermore, it can help people learn to stay in the present moment and tolerate inhabiting their own internal world without feeling threatened by unpleasant emotions. I’ve witnessed people who initially had trouble sitting still because they were so anxious learn to relax into a ten minute meditation practice and open themselves up to the present. With most patients we start and end the meditation practice with four deep breathing inhalations and exhalations. This seems to help people relax and prepare themselves for the meditation. During the meditation itself, patients are instructed to focus on something simple, such as their breath, that they can keep returning to when their minds start to wander. They simply can notice and be curious about the thought that distracted them and then return to their breathing. With some patients, it is preferred to scan the body from head to toe during the meditation as a way to tune into what is happening internally. By conducting a body scan, one might become aware of tension and other physical sensations that are being held in various body parts. Another option is to draw one’s awareness to the sounds around them, both near and far. I invite my patients to focus on their breathing or to do a body scan, however, because these are ways to increase awareness of one’s internal space, whereas sound brings the individual to something that exists outside of them. Over time, most patients tell me that they have found that the meditation helps them be more aware of what is going on inside them, both with emotions and with physical sensations, and these skills can transfer to the their lives apart from the meditation. For the purpose of developing these skills during psychotherapy, I find that the term “awareness building” rather than “meditation” may be a better fit. People can get confused by what is meant by meditation practice. When we agree that we are working on improving their awareness of their feelings and body sensations, they can best understand how such practice can be of value to them. After the ten minutes, I find it useful to briefly discuss how the patient experienced the exercise and what she became aware of during the time. I also attend to whether starting with this practice has a positive shift for the remainder of the session and can help the patient feel more present and connected to me while engaged in the therapeutic endeavor.