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Communication in Psychoanalysis
R E G I N A P A L L Y, M.D.
How a person speaks says as much, if not more, than what they
say. Nonverbal cues, such as facial expression, posture and tone
of voice are part of all interpersonal relatedness. Nonverbal cues
not only express emotion, but also regulate the body physiology,
emotions and behaviors between individuals. The homeostatic
regulatory mechanisms and affective exchanges between mother
and infant proceed nonverbally. Neuroscience data now indicates
these same nonverbal mechanisms occur between adults to
facilitate attachment, regulate affect and physiology and to
provide a sense of being understood. The impact of nonverbal
cues is mediated by circuits involving limbic structures in the
brain which activate nonverbal cues along with changes in
hormone levels, neurotransmitters and the autonomic nervous
system. Clinical vignettes are used to illustrate how nonverbal
cues function in the analytic treatment setting to shape both
transference and countertransference phenomena. Since
nonverbal mechanisms can be activated without conscious
awareness, neither patient nor analysand may be directly aware
of their impact. Analysts must pay attention to their own
feelings, behaviors and body sensations as indirect indicators
of the affective state and meanings of the patient.
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state that activates social relatedness between the mourner and others
(Averill, 1968).
Infants and Caretakers Activate
Nonverbal Responses in One Another
From the moment of birth, the mother and infant engage in distinct
patterns of nonverbal interaction, involving olfactory, tactile, auditory,
visual, and motor systems. As verbal capacities develop, what has
been learned nonverbally is integrated with linguistic systems.
Nonverbal systems that begin in infancy also continue their own lines
of development into more mature forms of nonverbal relatedness
between adults. I will briefly summarize a few motherinfant
nonverbal interactions that continue to be important even in adult
adult interactions.
Smell and Touch
While not as yet readily applicable to analytic work with adults, smell
and touch are the earliest modalities of nonverbal communication
and deserve comment. The odor of her breast milk is perhaps the
most fundamental nonverbal communication a mother directs to her
infant (Leon, 1992). By 6 weeks of age, breast milk odor stimulates
the infant to orient toward the breast and make sucking movements.
Communication through odor ensures that the baby will be able to
find the breast even in the dark.
Touch serves as an integral ingredient of physiologic regulation
of the infant. (for a complete review see Barnard and Brazelton, 1990).
Skin to skin touch increases feeding and weight gain in premature
infants and prevents the profound physiologic and behavioral changes
which accompany maternal separation. Touch promotes the
attachment bond. Anxiously attached children frequently have
mothers who show an aversion to close body contact.
Activation of the Nurturant Response
Infant nonverbal cues activate the nurturant response in caretakers,
a constellation of attentional focus, feelings, and behaviors. Bowlby
(1958) identifies that infant sucking, clinging, grasping, crying, and
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Facial Expression
Many aspects of nonverbal communication are the result of activity
in the autonomic nervous system (ANS): pallor, flushing, sweating,
tears, labored breathing, and shaky voice. Experiments by Ekman
(1990, 1993) indicate that facial expressions of emotion are linked
with specific ANS responses for six basic emotionsanger, fear,
sadness, disgust, happiness, and surprise. In the directed task
Ekman instructs subjects how to contract the muscles of their face to
create the facial expression of each of the 6 emotions. When subjects
voluntarily contract their facial muscles in the pattern associated with
one of these emotions, a high percentage of people actually feel the
emotion. In the lived experience task, subjects are asked to imagine
a situation in which they would feel each emotion. The patterns of
ANS activity that distinguish among emotions are: heart rate increases
with anger/fear/sadness and decreases with disgust; skin conductance
is significantly larger with fear and disgust than with happiness and
surprise; finger temperature increases with anger and decreases with
fear. The more an individual can reproduce the correct facial expression,
the more likely that individual is to show a distinct ANS pattern.
When a person either voluntarily or for unconscious defensive
purposes masks the facial expression of emotion, although they do
not show the usual facial display, individual contractions of facial
muscles and ANS changes can still be detected (Ekman, 1993). Other
nonverbal channels, such as voice, can continue to express the facially
suppressed emotion. People easily suppress verbal expression
(Harrigan et al., 1996). Facial expression is harder to suppress and
vocal qualities the hardest to suppress. When signals of emotion are
discrepant, people are more likely to rely on facial expression and
vocal qualities, rather than on what a person says.
Nonverbal Responses Integrate Emotion and Reason
Damasio (1994) affirms that body changes are an integral part of
emotion. Serving as a form of communication to oneself, the body
changes play a crucial role in reason and adaptive problem solving.
A brief schematic version of emotional processing is given to illustrate
these points.
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Matching
Humans automatically and unconsciously match the nonverbal cues
of others (Basch, 1988; Beebe and Lachmann, 1988). Since nonverbal
communication is linked with ANS changes, matching recreates the
physiology of one individual in the other person, facilitating knowing
what another is feeling and intending. The link between nonverbal
responses and body physiology, coupled with the fact that individuals
match each others nonverbal cues may be one mechanism by which,
not only infants and adults, but also adult dyads, can regulate each
others physiology and behavior during affective exchanges.
Nonverbal Cues Link Biologic Systems Between Individuals
Studies with animals and humans, infants as well as adults, suggest
that behavioral and visceral nonverbal signals link individuals
psychologically via mechanisms that link their biology. Hofer (1984,
1996a, b) integrates his own research with rats and that of others
with animals and humans in a model for understanding how the
biobehavioral interactions of mother and infant are internalized as
object representations and continue to operate in interpersonal
interactions between adults.
The mother regulates the infants behavior and physiology,
including activity level, hormones, sleepwake cycle, heart rate, and
body temperature. When the infant is separated from the mother, this
triggers characteristic infant separation responses as a result of the
loss of the mothers regulatory function. The most characteristic
mammalian response to separation is the infant distress cry. Other
physiologic and behavioral responses to separation include decreased
activity to the point of quiescence, ignoring food but increased
nonnutritive sucking, decreased investigation of new stimuli,
decreased body temperature, decreased heart rate, and increased
corticosteroids. If the mother is nearby, she will respond to the distress
cry by searching and retrieving her infant and engaging in comforting
behaviors (which, in rats, include licking and nursing) that return
the infant to physiologic regulation and stimulate the cessation of
crying. Regulatory mechanisms are mediated by neurotransmitters
such as GABA-benzodiazapines, opiates, and serotonin. For example,
benzodiazapine agonists decrease the distress cry upon separation,
and benzodiazapine antagonists increase the distress cry.
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I feel you are trying to force me to see the world as you do, to
literally feel inside my body the same kinds of intense responses
your body has in your rage and disgust toward the legal profession.
Perhaps only if I actually feel as you do will you feel supported and
understood. This helped the patient better understand that he
alienates people with his wish to literally create disgust and rage in
them, rather than to simply accept their ability to understand his
painful feelings.
Another set of interactions with this patient occurred in which he
made me feel awkward and confused. He quizzed me about current
events and asked, Whats your opinion? He would say, I know
its not allowed but perhaps we could talk better over lunch. I tried
to understand the meaning of these behaviors, and to explore them
in terms of transference themes related to anger. Since his comments
made me feel awkward and unsure of what level to respond to, I
asked whether he was aware of wanting me to feel confused or
uncomfortable in some way. He was annoyed that I considered any
meaning beyond his wanting to know me better. Continuing to explore
my own reaction, I realized I felt caught off-guard and startled. When
I shared this with him, he explained he needed to connect to the real
me. My off-guard reactions of startle made me behave with
characteristic body movements and facial expression, which he then
described to me. He knew when I behaved this way, it was my
automatic, uncensored response, even as I am trying to carefully
choose my words. The automatic, spontaneous behaviors that I was
completely unaware of and therefore did not hide from him was what
he sought as a means to be close with me. As a result of this, we were
able to further understand his beliefs that no one really wanted to be
close with him and how hard it was to feel that what people say are
signs of their closeness with him. It was by the process of our mutual
awareness of my nonverbal response that both he and I identified the
meaning of our interaction.
Discussion
Nonverbal behaviors and visceral responses unconsciously shape
language, and language unconsciously shapes nonverbal responses
(LeDoux, 1995). I have focused on the nonverbal in isolation, only
to tease apart the role it plays in interpersonal interaction.
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