Talk therapy is a form of treatment used for mental illnesses. It's often used in conjunction with other treatment but sometimes used by itself for less severe cases. While methodology, focuses, paradigms and tactics change from patient to patient, and even practitioner to practitioner, one thing stays the same: the practitioner's observation of body language. This analysis begins in the first mere milliseconds of the meeting. One observation commonly used by therapists is the client’s choice of seating. Where he or she sits can give the practitioner insight into the person’s willingness to be in therapy, comfortability in the room, demeanor, and even possible mental illnesses.
Part of where we sit is dictated by culture: in America, we generally try not to sit right next to people if possible. When getting on a bus with only five strangers on it, we as American are more likely to sit in an empty seat on an empty row, than taking a seat right next to a stranger. Western cultures like their personal space; we have a bubble around us and expect others to have this bubble as well. If a person breaks this bubble without invitation, it can be awkward, uncomfortable, and even concerning to the person whose personal space was invaded. When observing a person’s seating choice in a psychotherapeutic setting, the practitioner must be cautious to take this cultural norm into account, especially when meeting clients from a different culture.
For the sake of simplicity, let’s say two Americans are meeting for the first time in a therapeutic setting. There are one doctor and one patient. The patient, Becky, has requested a meeting to deal with her increasing anxiety. Where does she sit? Is she more likely to take the seat right next to the therapist to show that she is willing to work together, or the seat across the room just next to the door? Becky is clearly willing to be in therapy as she requested the meeting herself, but she is experiencing very high anxiety.
Becky will likely take the seat nearest the door and furthest from the doctor. If there is a pillow nearby, she may put it in her lap and hold it. She is not too close to the practitioner and is able to avert eye contact easily if she gets anxious. The pillow acts as a shield and source of comfort if she happens to feel attacked or invaded by the doctor’s questions. She also has a lot to look at and keep her mind semi-occupied: the doctor’s desk, his piles of notes and legal pads, the painting that hangs above his head, and even the bookshelf filled with his 100 favorite reads regarding psychotherapy. From her seat facing the doctor, she is also able to observe his body language, as much as he is her’s. This gives her a level of comfort and can also cue the doctor into some of the possible social origins of her anxiety.
A doctor once told me a story about the man who sat in his seat. He came into the practitioner’s office weekly, sometimes twice a week, and sat in the doctor’s chair every time. It is pretty common for a patient to stick to the seat they choose during the first meeting, but this man failed to notice that it was the doctor’s chair time after time. Despite the deep seat-print that scarred the doctor’s chair, his hot coffee sitting in its ring on the side table, and the legal pad and pen deliberately positioned next to the decade-old coffee stain, the patient was completely oblivious to these obvious social cues. The man was eventually diagnosed with narcissistic personality disorder, a common symptom of which is, “having an inability or unwillingness to recognize the needs and feelings of others.” This disorder comes with a host of indicators that suggest self-absorption and a failure to notice the boundaries and possessions of those around the individual. It literally took the man years to take himself out of his own head and notice that he was sitting in the doctor’s seat.
Everybody uses body language and social cues- in fact, research suggests 60-70 percent of our communication is nonverbal. A doctor’s ability to tune into these proxemics can lead to a strong clinician––patient relationship, a deep understanding of the patient’s anxieties, and even help find a diagnosis.
