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- Look for leg and foot movements and physiological reactions. Leg and foot
movements are most subject to nonverbal leakage because we move them more
automatically, without conscious thought (Ekman and Friesen 2003 ). Very con-
trolled individuals often show emotions in their hands and feet (e.g., gripping
their hands together, tapping their foot) or in physiological behaviors such as
blushing, sweating, breathing (e.g., shallowly or rapidly), and blinking. - Notice frozen expressions (avoidance of showing emotion, poker face), masking
(replacing a felt emotion with another more appropriate one), minimizing
expressions (to make a feeling seem milder), and exaggerating an expression
(e.g., nodding the head vigorously and saying “uh-huh” when confused by the
information you present). - Nonverbal expression may be dependent upon age, gender, and/or culture (e.g.,
older patients’ facial expressions may be more difficult to read as they have a dimin-
ished blushing response, and wrinkling may mask subtle reactions; women may be
more likely than men to cry; and some cultures discourage public displays of emo-
tion). Furthermore, although research suggests recognition of emotions is a univer-
sal ability, accuracy may vary as a function of cultural background and exposure
(Elfenbein and Ambady 2002 ). Specifically, facial recognition generally is higher
when both parties are from the same “national, ethnic, or regional group” (Elfenbein
and Ambady 2002 , p. 203), although accuracy can be improved when one has
greater exposure to the cultural group. Additionally, research suggests members of
a majority group show less accurate judgements of minority group members’ facial
expressions, while minority group members are more accurate in their judgments
of majority group members’ expressions (Elfenbein and Ambady 2002 ). - Listen for incomplete sentences. Patients may trail off or shift to another sen-
tence/topic because what they are saying is emotionally charged. Ask patients to
finish incomplete sentences. - Watch for sudden shifts in behavior in any direction (moving from open posture
to closed posture, speaking more rapidly to more slowly, breathing more deeply
to more shallowly, etc.). For example, a patient may have a sudden shift in behav-
ior depending on the content of the session (presentation of risk information,
introduction of abortion as an option, etc.).
3.3 Effective Counselor Physical Attending Behaviors
There are five major domains of physical attending: face and eyes, body, voice,
distracting behaviors, and touch.
Face and Eyes
Effective attending with the face and eyes generally involves the use of occasional
head nods, smiling at appropriate times, and looking at the patient without staring. Be
careful, however, about nodding your head at times when patients are saying
3 Listening tofiPatients: Attending Skills