Therapeutic Approaches for Non-Verbal Clients

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Non-verbal client signing during therapy session

As a mental health provider, you are honored to work with a diverse variety of individuals. With different backgrounds, needs, and experiences, each person you work with teaches you something new and gives you a chance to become better at your craft while helping someone strengthen their skills. Most often, the therapeutic setting involves the exchange of dialogue. Verbal communication is frequently viewed as a pillar of mental health care because communication is how providers and their clients exchange thoughts, experiences, ideas, and feedback. But what happens when verbal communication is not an option?

Why Might a Client Be Non-Verbal?

Clients may be non-verbal for a wide number of reasons. Some of the most common include:

  • Non-Verbal Autism Spectrum Disorder (ASD) – According to the CDC, autism spectrum disorder is “a developmental disability caused by differences in the brain.” It is an umbrella term that covers many different developmental disabilities showing issues with social communication, interactions, repetitive behaviors, different ways of learning, paying attention, and more. Someone with ASD may be non-verbal for their entire life, a period in their life, or for intermittent periods in their life, depending on their unique symptoms, experiences, and circumstances.
  • Apraxia of Speech – Apraxia of speech is a motor speech disorder that makes it challenging to speak. As a child, the pathways that a brain uses to communicate messages to your muscles and mouth to talk and make noises do not work as they should – impacting speech. Adults can develop apraxia of speech after a brain injury, stroke, dementia, tumors, or brain disease. Depending on the severity of their apraxia, a client may have varying levels of difficulty speaking to their provider or may be completely non-verbal.
  • Aphasia – Aphasia is a disorder that impacts one’s ability to communicate – usually after a stroke or head injury. Someone with Aphasia may be non-verbal or may speak in short/incomplete sentences that do not make sense, confuse their words, speak unrecognizable words, and have trouble understanding others. They may also struggle to understand written language.
  • Selective Mutism/Traumatic Mutism – Selective mutism is a complex anxiety disorder in children/adolescents marked by their inability to speak in social settings. They often have a genuine fear of social interactions that causes them to go silent. This may apply to the therapeutic setting. A provider working with children may encounter a child that does not speak to them out of anxiety. This is different from traumatic mutism, which applies to all situations, not just social ones. Children may go completely non-verbal after experiencing something traumatic due to their inability to process that event.

While you may have clients that are unable to or have difficulty communicating verbally, the relationship can still thrive. As their provider, you need to implement non-verbal communication methods to help bridge the gap.

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What is Non-Verbal Communication?

Non-verbal communication is the “act of conveying information without the use of words.”  

Types of Non-Verbal Communication and Tips to Apply Them in Therapy

Body Language

  • Client: Even with verbal clients, body language can tell quite a bit. Pay attention to how your client is moving or positioning themselves to try and interpret their mood/emotions/feelings. Changes in body language can include posture, hand movements, and eye contact. For example, if their shoulders are tense, they’re hunched over, and their arms are crossed, they may be feeling nervous, reserved, or even frustrated. You can use body language to help your clients feel more at ease by making sure you remain relaxed, your arms stay uncrossed, and you don’t use rapid movements that could alarm them.
  • Movement – How are they moving in their space? Are they tapping their foot rapidly? They may be anxious. Opening their arms for a hug or a handshake? Then they may be open to the opportunity in front of them. Are they exploring the room around them? Then they may be curious.
  • Gestures – Pay attention to how your client is using their hands and arms to gesture around them. Are they pointing? They may want to show you something. Are they making a shape? They may be trying to describe something. You can try to repeat your client’s gestures to show that you understand what they’re communicating to you.
  • Paralanguage – Paralanguage is a type of speech that does not involve words but may involve intonation, pitch/speed, hesitation noises, gestures, and facial expressions. They are the vocal but nonverbal elements of communication by speech. A client may be using paralanguage to emphasize a point or communicate a feeling/emotion around an idea. For example, a non-verbal client may point emphatically at something they want to show you and say “ah!” to show you that it is important to them that you see.
  • Facial Expressions – Facial expressions can tell you a lot. A wrinkled brow can tell you when someone is perturbed. A teary eye can tell you when someone is upset or sad. A smile can tell you when someone is feeling joyful or happy. You may not need someone to use words to tell you how they feel if they can express it with their facial expressions. As therapists, you should try to maintain a calm and reassuring face when communicating with clients in a way that helps them know that you understand them.  
  • Eye Contact – Eye contact combined with facial expressions can tell a therapist everything they need to know about a client’s feelings. Fluttered eye contact with a worried brow and told you that someone might be nervous around you. Lack of eye contact can tell you that someone may not be ready to communicate with you. Constant eye contact can tell you that someone is listening to you. As their provider, you should always make eye contact with your clients when they’re communicating with you.
  • Touch – Also known as haptics, touch is a form of non-verbal communication that includes handshakes and high-fives in the therapeutic setting. For therapists working with children, it may be appropriate to give a high-five when completing an activity to communicate a good effort.

There are many ways to communicate with non-verbal clients and still have a thriving therapeutic relationship.

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