8

Physically Communicate Good Intentions

Be solicitous in your approach to the patient, not with head thrown back [arrogantly] or hesitantly with lowered glance, but with head inclined slightly as the art demands.

—Ancient Greek medical text, fourth century BC¹

Some time ago, accompanying another physician in a hospital, I observed an interaction that still stands out in my mind. The patient was a woman in her thirties who had had a history of drug use. Marcie was being seen for a heart problem, which was not necessarily caused by her old drug habit (though probably wasn’t helped by it either). In recent years, she had been taking medications for her heart condition, and she had also been followed carefully by a team of doctors.

The cardiologist who was seeing Marcie that day assumed a physical stance that surprised me. He greeted her kindly in her hospital room, but as he spoke with her, he remained several feet away from where she lay in her bed. When he asked her whether she had been taking her medications regularly, his arms remained folded over his chest. “What dosage are you taking?” he asked. “How many times a day?” Marcie answered dutifully that she had been taking all of her daily medicines at home before the hospitalization, and he nodded, posing additional queries. His questioning was thorough, and he reiterated how her prescriptions were helping her heart. But his stance and crossed arms conveyed something he might not have intended. He doesn’t trust her answers, I thought. He thinks she’s lying.

I didn’t have the chance to discover after the encounter whether he really was concerned that she was exaggerating, but this physician’s nonverbal communication had introduced the thought to me, and I’m sure Marcie must have picked up on it, too. If she felt he doubted her, would she be more or less inclined to tell the truth? Would she be more or less willing to take his advice? I wasn’t so sure which way this would go. As the saying goes, “They may forget what you said, but they will never forget how you made them feel.”

THE IMPORTANCE OF NONVERBAL COMMUNICATION

Nonverbal communication conveys authenticity more effectively than words do. It’s good to know that a patient will forgive a poor choice of words if the caregiver takes a moment to pause and is present with authentic body language. Truth be told, I have said many stupid things that were quickly forgiven because my nonverbal communications were compassionate and superseded my words. Indeed, communication experts tell us that nonverbal cues carry more than four times the weight of verbal messages. Although the average person may command a vocabulary of 30,000–60,000 words, we humans rely on 750,000 nonverbal signals.² Not only that, scientists have found that we interpret nonverbal signals much more quickly and accurately than words.³ Because this kind of communication is so prevalent and significant, in order to make a meaningful connection, caregivers must attend to and practice gestures that create resonance with another person and will allow a meaningful conversation to evolve.

The way people walk, sit, smile, and even hold their bodies can convey innumerable unconscious messages that either prompt a conversation or stop it cold. Imagine the difference in attentiveness caregivers can telegraph by keeping their bodies still as compared to impatiently tapping a foot or twiddling a pen. In fact, investigations have shown that if physicians sit down and get on the same level as their patients, the latter perceive that their doctors have spent much more time with them than if they actually spent twice as much time, but were standing with a hand on the doorknob.⁴ They also perceived their doctor as more compassionate when they came down to their same body position.⁵

Research has even affirmed that simply the way people stand can have an effect on their body’s chemistry and how they face challenges. Psychologists Dana Carney, Amy J. C. Cuddy, and Andy J. Yap tested this by comparing participants they’d placed in assertive poses, the kind of nonverbal communication you’d see in the boardroom, with those taking submissive stances, the kind you’d see in a doctor’s waiting room. When they tested samples of the participants’ saliva, they found that stances of power raise the level of testosterone and ultimately increased risk-taking behaviors, while at the same time lowering the stress hormone cortisol.⁶ Their findings suggest that the way people hold themselves can change the way they feel and act, in part by influencing the hormones their bodies make. Certainly, posture can affect how people relate to one another.

Important silences, flushed or pale cheeks, abrupt changes of topic, or even momentary tears that are quickly blinked away are key indicators that all is not what it seems. If after asking a woman how many children she has, she answers joylessly, “Oh, two,” as she gulps and her face reddens, those nonverbal cues must be heeded and probed. This kind of attention renders caregivers active listeners who hear an unspoken problem.⁷ And, with patience and kindness, out may pour a tragic story of miscarriages and stillbirth or a child lost to illness or accident.

In this chapter, I present research about many aspects of nonverbal communication, including the effect of facial expression and direct eye contact, how posture can communicate good intentions, the power of touch, and the way gestures can reflect interest and affirmation. I also discuss techniques of posture, positioning, and mirroring that can help caregivers make a strong connection with the person they seek to help. Ultimately, they want to avoid showing the other person a “closed position,” such as crossed arms, unintentional displays of boredom, or frustration. They want their physical presence to say, I’m fully open to what you have to say. And they also want to comprehend what the other person is conveying with his body as well as his words.

But before I dive in, I want to explain some of the subtleties of nonverbal communication to watch for.

UNDERSTANDING WHAT WE’RE SEEING

It has been said that body language is the unspoken truth.⁸ But people must judge specific gestures in context. For instance, crossed arms could mean that an individual is being defensive, that he disagrees, or that he’s feeling insecure. But it can also mean that his arms are comfortable in this position, or maybe he’s cold. Caregivers must take into account what else is happening in an interaction to truly make sense of what they’re seeing.

This means that individual gestures are significant only when considered within the context of a person’s overall behavior. If verbal and nonverbal messages convey the same information, the communication is clear. A woman says she’s happy: Her eyes light up, she smiles broadly, and she walks with a springy step—no problem. But when she says, “I’m fine,” yet her sad eyes, shuffling gait, and drooping shoulders tell a different story, caregivers must pay attention to the latter. Even in the situation I observed at the hospital, although my colleague spoke kindly and sincerely to Marcie, because of his crossed arms and relative distance from her, I was unsure how his patient had received what he was saying. Unless nonverbal communications, words, and voice tone match, caregivers will be sending mixed messages that can confuse and ultimately distance them from the person they want to help.

Besides, individuals are quite adept at discerning what others really mean when they attempt to mask their feelings. People betray themselves with a thousand microscopic, unconscious clues. A finger to the side of the nose (Bill Clinton during the impeachment proceedings) or casting the eyes to the left if one is right-handed (is this why untrustworthy people are called “shifty” characters?) or speaking too loudly—can all indicate that someone is being less than truthful. Real emotions are likely to leak out despite one’s best efforts.

If caregivers try to deceive the person they wish to help, by telling him he looks terrific when their nonverbal cues indicate that they’re worried (being aware of the seriousness of the diagnosis), the patient is apt to mistrust them since he will resonate most strongly to the wrinkling forehead and downturned mouth, not to the words. Even if caregivers try to display a “brave front to cheer up someone,” the person will recognize the insincerity, which can easily break a connection. This is all the more valid if caregivers attempt to hide from someone the true gravity of his situation with statements such as “Oh, you’ll be fine” or “Next year, this will all seem like a bad dream.” Most people read what’s really going on . . . and others’ attempts to smooth over the rough edges only serves to make them feel more alone, potentially activating the nocebo effect—the harm that occurs when a negative mind-set can be damaging if the interaction is inauthentic.

Whenever appropriate, caregivers must be congruent in their messages, sending the same information with their words and bodies. But what do those bodies say? And what about the bodies of the people they are charged with helping? Although it’s impossible within the scope of this book to explore every nonverbal gesture, I will take a closer look at a few that can help caregivers make or ruin a good connection.

WHAT’S IN A FACE?

In The Winter’s Tale, Shakespeare wrote, “I saw his heart in his face.” When people first meet, they scan each other’s faces for about three seconds to learn what they can—which is a lot. Studies have suggested that the human face is capable of seven thousand expressions (some have calculated as many as ten thousand), and when people interact, every countenance they make conveys their innermost thoughts.⁹ When caregivers initiate a compassionate conversation, their interest and openness show first and foremost on their faces.

These expressions are understood the world over. Facial signs of pleasure, despair, and rage are no different among Australian aborigines than ranchers in Montana or fishermen in Norway.¹⁰ Charles Darwin made this observation as long ago as 1872, after having collected input from missionaries who worked with native populations, individuals who were hypnotized, babies, people who were blind at birth, and those with mental illnesses. At that time, he postulated that all humans convey particular emotions with the same expressions. For instance, they usually show surprise by raising their eyebrows. People who were born blind and who therefore couldn’t observe others, still raised their eyebrows when astonished.

A stony, nonexpressive face conveys that one is in command and powerful. Other facial expressions are the most immediately readable indicators that people are tender and nonjudgmental. As an extension of the pause, caregivers can relax any tension in their facial muscles to show they’re ready to be responsive and prepared to pay attention. When they smile kindly and genuinely in greeting another person, they begin to build a connection. But they must control their expressions beyond that first moment. A furrowed brow, scowl, or pursed lips, for instance, may suggest preoccupation with other issues, or that they are already applying prejudgments. Darting eyes may send the message that they’re waiting for something more to happen. A relaxed expression, however, says that they’ve dismissed other issues flitting through their minds. In addition, calmness in a facial expression says caregivers aren’t about to impose their own agenda on the conversation. They’re going to allow it to flow where it needs to go. With their faces, they’ve opened the opportunity for relatedness to begin.

However, paying attention to facial expressions can be particularly challenging in today’s electronic environment. If caregivers are buried in their smartphones, or even just stop to check e-mails and texts during a conversation, they’ve taken their eyes and attention off the other person’s face—and thereby broken the connection. Moreover, when inputting information on patients’ computerized records, physicians and others on a medical team devote much of their attention to the screen, not to the people they’re helping. That to which we give attention grows! So it behooves caregivers to become mindful of how their bodies convey their intentions and concerns.

The Eyes

One of my medical students failed an exam during which students interviewed mock patients to see how well they communicated, showed empathy, and developed trust. As he spoke with an older patient, Tom stubbornly avoided making eye contact. In his culture (Hmong), as in many others, it is a sign of disrespect to look an elder in the eye. But Tom’s evaluation was based on the unspoken rules of our culture, and his demeanor was found to be deficient. According to the Western way of thinking, averting the eyes indicates a lack of connection and empathy. Thus, maybe inappropriately, Tom was judged to be lacking empathy. I worked with him on this aspect of nonverbal communication, retraining how he had been conditioned as a child, and eventually he passed this test. I’m happy to say that he became a successful resident.

Eye contact is quite complex and a key element of nonverbal communication. Forty different eyebrow positions express human feelings, as do twenty-three eyelid positions. (Imagine the many permutations that exist if we multiply these numbers together.) People can enhance a good connection when they maintain eye contact about 60–70 percent of the time. But that’s just the average. If caregivers are good listeners, they make eye contact 80 percent of the time, but need only do so 40 percent if they’re the one doing the talking. Indeed, frequent eye contact conveys sincerity. Ninety percent of the gaze focuses on the triangle created by the eyes and mouth.¹¹

Where people place their gaze is also important. Rolling the eyes upward is unsettling and can indicate disinterest¹² or contempt. Downcast eyes can convey sadness or shame. If the person one wishes to help doesn’t maintain eye contact but rather looks down or away, she may be shy or depressed, or she may be rejecting the caregiver or what he is saying. The eyes of anxious or stressed people involuntarily blink more often than those who are not so upset. Although the former may make eye contact as often as people who are less stressed, they hold the gaze for less time. This is especially true of people who are depressed. They maintain eye contact only 25 percent as long as people who are not depressed. At the same time, as Tom, my Hmong student, learned the hard way, those whom caregivers want to help may interpret minimal eye contact as a sign of stress or a negative response.

Even the pupils in the eyes matter. When they dilate, they indicate that people are seeing or experiencing something pleasurable, which they want to take in. The pupil dilates to let in more light, more of what they want to see. Conversely, when the pupils contract, it means people are dealing with some unpleasantness that they’d rather shut out. These reactions are entirely unconscious, yet they can still help caregivers understand someone’s frame of mind. Indeed, this is why poker players wear sunglasses when they’re at the table. The shades keep the other players from seeing the subtle pupil dilation that might reveal the winning hand.

As small a gesture as it may be, caregivers can convey many feelings with their eyes, including caring and compassion. In our culture, meeting another person’s gaze and being willing to maintain eye contact (but not staring, which indicates hostility) begins building trust. It may seem merely like a pleasantry, as simple as greeting an individual by name, but in fact, these are acts that people remember.¹³

The Smile

Along with eye contact, smiles also convey what people are thinking. A smile reinforces friendliness, disarms a difficult situation, and promotes peace and safety—all to the good. I mentioned smiling kindly upon greeting someone, but often people also smile when they’re uneasy or even anxious. Ethnologist Frans de Waal explains in Peacemaking among Primates that young rhesus monkeys grin when they’re feeling threatened. “In social situations,” de Waal writes, “the grin signals submission and fear; it is the most reliable indicator of low status among rhesus monkeys. In other species, such as humans and apes, this facial expression has evolved into the smile, a sign of appeasement and affiliation, although an element of nervousness remains.”¹⁴ Think of the third-grade teacher yelling, “And wipe that grin off your face!” after she finished reprimanding a student.

Authentic (or Duchenne) smiles are controlled by major facial muscles that connect to the corners of the mouth (the zygomaticus major) and the area encircling the eyes (the orbicularis oculi). According to Guillaume Benjamin Amand Duchenne, the French neurologist who first published these discoveries in 1862, when these eye muscles contract, the cheeks lift, the skin under the lower eyelids puckers, and wrinkles appear at the outer corners of the eyes.¹⁵ This is a genuine smile. However, at a party or other social gathering, individuals can (and often do) fashion their mouths into a broad, fake smile at will, even if they’re feeling unhappy or angry. Indeed, in our culture, people—especially those who are depressed or sad—will hide their true feelings by smiling. When observed sharply, one might detect a false smile because the eyebrows, eyes, and forehead don’t move much. That’s where to look to really understand a person’s emotional state.

The crinkling of the muscles around the eyes (creating crow’s feet) when people truly smile is unconscious and is hard to be willed into existence. Most people can distinguish a false from a genuine smile. The latter lights up the face and eyes, indicating enjoyment, while the former shows mostly on the mouth and is more likely to be perceived as an attempt at deception.¹⁶ Before considering Botox injections to erase crow’s feet, people should remember that those wrinkles inform others of their sincerity and genuine pleasure. Without them, faces appear too plastic and are unable to convey one’s true emotional state.

Delivering bad news may render clinicians anxious. However, softening the blow with a false smile can send a mixed message that’s both confusing and off-putting. So it’s helpful for caregivers to be mindful of their smiles if they find themselves in this difficult situation. Otherwise, the connection they’re trying so hard to build may rupture for reasons that may feel mysterious to them.

HAND AND ARM GESTURES

People may begin an encounter with a handshake, which in bygone times revealed a weaponless hand, and remains in many cultures a sign of respect and mutual agreement. A compassionate handshake generally involves a firm grip that conveys confidence (one’s own self-respect will reflect back to the individual) but isn’t arrogantly strong or overbearing. It’s softened with kind eyes. A tender addition to the handshake may be a touch with the left hand on the other person’s right elbow or covering their right hand with one’s left during the encounter. These signals of warmth at the right moment can be as welcoming as a smile. The dominant person usually takes the top position during a handshake. If caregivers want the client to feel more confident, it’s easy to roll their hand under so that the client’s hand is on top. But ideally both hands are equally vertical.

Caregivers should observe the resting hands of the person they want to help. If they lay limp and floppy in her lap, she may be sad or have low self-esteem. Fidgetiness or grasping behaviors can show anxiety, as can shakiness or twitching. The white-knuckles of a clenched fist can conceal anxiety or anger. But palms turned up and out can denote warmth and openness.¹⁷

The patient may use her hands to indicate that she wants to interject her ideas into a conversation. To do so, she may create a steeple in front of her face by touching the tips of her fingers to each other. Steepling suggests that she has something important to say and can signify self-assurance. Or she may raise her hand or simply an index finger slightly to indicate that she wants to speak. On the other hand, if she places that same finger on her lips (as if to say, “Shh!”), she may be trying to keep her ideas to herself. In that case, a caregiver may want to probe a bit further to see what’s on her mind, or he may wish to explain himself more clearly.¹⁸

If someone has folded her arms, she may be signaling a “closed” attitude. In effect, her arms are creating a physical barrier to the situation or information she’s receiving. People also use this stance when they’re bored or expectant or are braced for displeasure. Some people say of crossed arms, “I just do it because it’s comfortable.” But as was evident in the conversation between Marcie and her physician, this nonverbal cue can also communicate I am not fully open to what you have to say. However, if a person’s arms are so tightly crossed that she seems to be hugging herself, she may be feeling insecure or sad and could benefit from being comforted.

POSITION

When people are seated, they signal their interest and engagement by sitting tall and leaning just a little bit forward. On the other hand, leaning back can make them seem less interested and even complacent. Sitting rigidly erect indicates tension—also not the best position to take when making a connection. And too much of a forward angle can seem aggressive—as if someone were encroaching in an overbearing way. Personal space differs by culture. In the United States, it is two to three feet—basically an arm’s length. For others it is much tighter. Caregivers should not move closer to someone than what’s acceptable until they’re invited into the other person’s space, even when seated.

In addition, when caregivers initiate a compassionate conversation, they must make sure they are positioned at a similar level to the person they’re caring for. Seating arrangements that place one person higher than the other can suggest the presence of hierarchy or privilege and can instantly be off-putting. For instance, if a doctor is standing, conducting the conversation while looking down on a patient who is sitting or stretched out on an examination table, the patient may feel diminished. It’s hardly a way to make a person feel empowered.

Similarly, a parent who wants an honest answer from his teenager about whether drinking is taking place at parties would do well to sit down with the teen face-to-face. Having a conversation on the same physical plane doesn’t make the father and child peers—there’s still an imbalance of responsibility and authority—but the physical position helps ease a dynamic of blamefulness and defensiveness, enabling a more productive conversation to ensue.

TOUCH

Some experts in nonverbal communication consider touch to be the master sense—underlying all others. Think about it. We taste something when it touches our tongue, hear something when sound waves touch our ear drums, and see something when images touch our retinas. Indeed, touch has been called the most influential nonverbal communicator of all.¹⁹ It can change the meaning of words almost instantly, even if the utterances seem unimportant.

Beneath awareness, the skin can send and receive information that is quite important. One research study showed that waitresses who touched their customers for less than a second on the shoulder or hand when returning change or the credit card slip received larger tips than those who refrained from physical contact with their customers.²⁰ In another investigation, students whom college librarians grazed briefly on the hand at checkout rated the quality of the library much more highly than a control group that received no such touch.²¹ And many studies of preterm babies in the NICU who are held skin to skin on their parents’ chests and gently stroked clearly establish that these infants need fewer interventions, recover much more quickly from the effects of their prematurity, and leave the hospital sooner.²²

When touch is included in the medical encounter, patients perceive their appointments as longer and more positive than they actually are. If I’m in a hurry and the situation does not demand a long visit, I will still try to incorporate touch into the therapeutic ritual. This is why the physical exam is so important, even if I feel the presenting complaint doesn’t warrant it.

While other cultures may condone frequent cheek kissing, hand-holding, and hugging, in the United States there are many unspoken rules about when and where to make contact. Touch communicates a wide spectrum of feelings from antagonism and anger to comfort and love, and the same behavior can have many meanings depending on its context, duration, and intensity; the toucher’s intent; and where on the body the contact occurs. For instance, it would be perfectly acceptable for a mother to tuck in her young son’s shirttails, but she would be awfully upset if a stranger attempted to tidy him up in this way.

Many professionals touch the people with whom they interact every single day—say a nurse or manicurist or dental hygienist. This has been called “cold touch” since in most instances, not much emotion is conveyed. These individuals are simply doing their jobs, which involve physical contact. Shaking a colleague’s hand or tapping a woman on the arm to indicate that her purse has opened or that the bank teller is ready to receive her is called social-polite touching. People do this all the time with acquaintances. It’s relatively anonymous, in contrast to touch that indicates friendship and warmth. That’s when a person puts an arm around a friend, hugs, or otherwise physically reassures someone close to them. The most intense kinds of touch involve intimacy and love—caressing, kissing, holding, cuddling. These behaviors soothe, bring comfort, and elicit the release of oxytocin.

As a physician, I am required to touch my patients, palpating an abdomen or feeling around the throat for the thyroid gland, for example, when I perform a physical. But I also consciously touch them when I listen to their heart. In one hand, I hold the stethoscope to their chest, but I place the other on their back, creating a type of hug. This is much more than just listening to the heart. I am taking them into my hands and conveying that I am there to support and care for them.

If caregivers are not in an intimate relationship with someone but still want to offer a reassuring or comforting touch while helping them, the safest spots are on the outside edges of their body: the back, shoulder, outside of the arm or leg (when seated). And although helpers may believe that everyone needs a hug, it’s important to note that hugs don’t always heal. Some people feel uncomfortable with close physical contact. Pushing it on them can undermine trust and connection. Or they may have some medical reason that would obviate a squeeze. I learned this the hard way when I hugged a colleague who, it turns out, had severe arthritis in her shoulders. My friendly embrace caused her undue pain. It’s best to learn about the person’s unique situation and ask if it’s all right to hug before making a move.

MIRRORING

When synchronizing two engines, one changes its speed to come into rhythm with the other. The same can be true of the brain. Perhaps due to mirror neurons, two people can fall into step with each other, mimicking each other’s feelings and nonverbal signs. Not all of this is unconscious. “Body mirroring” is a behavior that can be learned. In fact, many business books provide chapters on how and when to do this. Everyone from the CEO to salespeople are familiar with using their bodies to win over potential clients. I can assure you that drug reps are quite adept at this. The idea is to take on the other person’s nonverbal communication—without calling attention to the gestures—in order to convey respect and establish trust.

Ultimately, earning “respect” in sales gets someone to buy what salespeople are selling. But in the compassionate encounter, caregivers mirror nonverbal communication to put patients at ease and to show that they’re ready to meet them where they are. If the patient slouches, the caregiver might partially slouch, too. His slouch says, “I see you’re low, and I feel your pain.” When mirroring in this way, the caregiver’s body helps create resonance or rapport with the other person; it’s an important way to forge a connection.

Clinicians can also lead or guide with their own bodies to help someone open up and share valuable information. They start by mirroring a patient’s body language and developing trust with the eyes and subtle caring expressions on the face. Then, once the connection is started, they slowly unfold their bodies to a more open position in hopes that the other person will follow suit. Here is how this might work: If the patient is sitting in a closed position—for example, arms folded over the chest and legs crossed—the caregiver would imitate his stance. Next, the caregiver would model a more relaxed version of this position with loosely crossed arms and legs. This posture is less defensive and indicates availability. Then, the caregiver would uncross his or her legs entirely and lean forward to show engagement. Finally, the patient’s new openness would telegraph that he is comfortable and ready to share.

Nonverbal communication is not simply a mirror but part of an evolving yet subtle dance. Caregivers hope their bodies prompt in the speaker that fundamental instinct that, yes, the conversation feels right, and that any words yet to be spoken will be well received.

On the other hand, when the patient moves in such a way that he disrupts the mirrored position, he may be indicating discomfort, disagreement, or a sense of betrayal that he can’t (or won’t) put into words. If caregivers notice this disconnect, it would be wise to address what might have prompted it.

HOW TO TELL WHETHER SOMEONE IS LYING

Other nonverbal behavior communicates that an individual is shading the truth or outright lying. For instance, I might ask a patient whether he is ready to stop smoking. He may tell me that he is, but his nonverbal cues indicate to me that he isn’t. I can deduce this even before he answers because he has used what’s called the respiratory avoidance response. He coughs as if to clear something from his throat even though there’s nothing there. This behavior generally suggests that he is uncomfortable with what he’s saying.

Or he may put his finger to his nose the way Johnny Carson, one of the early hosts of The Tonight Show, used to do before telling a risqué joke. This is not the vigorous rub a person would use to scratch an itchy nose but a few gentle strokes or flicks. Some experts believe this is “a reflection of the fact that a split is being forced between inner thoughts and outward action.”²³ As mentioned earlier, while Bill Clinton testified before a grand jury, he touched his nose infrequently when he was truthful, but he did so twenty-six times when he lied.²⁴ Someone who tugs an earlobe, scratches the side of his neck, rubs one eye, blinks to excess, or smiles for too long (most natural smiles last only four or five seconds) can also be stifling his emotions or shading the truth.

If caregivers notice these behaviors accompanying a “Fine!” in answer to their question, “How are you doing?” they can follow up with an open-ended comment such as “Really?” or “Tell me more.”

PUTTING IT ALL TOGETHER

A patient’s first contact with his or her caregivers is key. It is where the patient will perceive whom the caregivers are and whether they will be a good fit. The interactions following that first impression will provide the patient with information needed to confirm his or her intuition.

Additional strategies may help make the right first impression—one that can lead to a strong connection. For instance, caregivers should read the patient’s energy and react in a way that shows respect. If someone engages, they should convey a message through the eyes that they are available and have their full attention. If appropriate, caregivers can also touch the patient in some way. This is generally a handshake, but it may also be a gentle touch on the shoulder. They should mirror the patient’s body language and then slowly lead him or her to an open and trusting position, as indicated above.

The pause should be utilized appropriately if caregivers note an emotion that warrants further exploration. For instance, if a patient’s eyes slightly well up when asked about marriage, caregivers should stop, show concern, and gently pursue the emotion with a question such as “When I asked about your relationship, I saw that a tear came to your eye” [. . . Pause] or “If that one tear could speak, what would it want to say?” In this regard, it’s important to watch for consistency between body language and words. If there is a disparity, gently explore further.

If a patient doesn’t participate in the therapeutic dance (he or she doesn’t partake in mirroring, for instance), caregivers should not force the issue, as this will upset the individual. Rather, with words and nonverbal cues, they can show caring, and perhaps the person will be more open the next time they meet.

When someone is willing to partake in the dance of connection, enjoy it! This is one of the most rewarding interactions caregivers can have. And once two people connect, it creates a chemical reaction. Both are transformed!