Are Body Language and Tone Necessary for Therapy to Be Effective?

Now that purely text-based therapy has taken off and has a growing number of studies backing its efficacy, mental health professionals and researchers are debating whether psychotherapy needs body language and tone to produce results. To compare the effectiveness of texting therapy with other mediums, the psychological community needs to think about what treatment outcomes are most important. As the practice of therapy has evolved, so has its priorities.

For many decades psychotherapy had only one format: a therapist and client in a room. Despite the requirement for both parties to be in the same physical space — within viewing distance — the early days of mental health counseling did not utilize body language to its full potential. Many patients lay on a couch and faced in the opposite direction of their therapists. To act as a “blank screen,” practitioners of psychoanalysis participated minimally in sessions and encouraged their patients to speak as much as possible.

Sigmund Freud, the father of psychotherapy, believed people could be “cured” by making conscious their unconscious thoughts. The primary goal of psychoanalysis was to help patients have cathartic experiences that would provide insights into deeply rooted issues. Despite the lack of visual cues, this early form of therapy did work for some patients. It was valuable enough to become the foundation for modern approaches to psychotherapy.

As the field of psychotherapy advanced, there was increased focus on the relationship between therapist and client. This approach involved the counselor taking a more active role. Person-centered therapy [Rogerian therapy], for example, stressed the therapeutic relationship and argued it was essential to making progress. The stronger the bond between the two parties, the more robust the results would be. Like other humanistic approaches, Rogerian therapy had the goal of helping people reach their full potential.

There is a wealth of evidence that proves a high-quality therapeutic alliance increases the likelihood of positive outcomes in treatment. Body language and verbal cues are important factors that contribute to the development of this clinical relationship. People express roughly 60% of their communication using nonverbal behaviors. Vocal tone can help counselors detect underlying emotions and issues.

In recent years psychotherapy has shifted to an emphasis on reducing symptoms of mental illness and improving both mood and functioning. The increased use of data and technology has allowed mental health professionals to seek more tangible outcomes. Mental health assessments, for example, have helped clinicians and researchers use numerical scores to measure the impact of therapeutic approaches. Psychologists can prove the efficacy of a form of therapy if the treatment efficiently lowers scores related to unhappiness, lack of productivity, and suffering.

Ultimately what determines the effectiveness of therapy is how the treatment meets the goals clients are interested in achieving. If someone begins psychoanalytic sessions with the mission of discovering what subconscious issues are contributing to a maladaptive behavior, the therapy can succeed by unearthing the answer. For someone with crippling depression, treatment needs to improve functioning.

The dilemma is that people place varying degrees of importance on these outcomes, some of which are difficult to measure. Some clients want to rely on therapy to become more whole, actualized versions of themselves. Others simply want relief from psychic and emotional pain. Is it most essential for therapy to manage the impact of mental health issues, or to assist clients in reaching their potential as human beings?

Text-based therapy has been proven effective for reducing the prevalence of symptoms of certain mental health conditions, according to a study from Columbia University. It also has a record of improving functioning and overall mood. The medium established a sufficient therapeutic alliance score but not was quite as strong as that of traditional therapy. Despite this difference, texting therapy was as effective as traditional therapy in treating anxiety and depression. Video sessions — often available along with texting — can strengthen therapeutic relationships but are not necessary for successful care.

These results indicate therapy does not need body language and tone to be effective in treating several mental illnesses. Written communication is more than enough to significantly improve mood and functioning. For other outcomes, however, more research still needs to be conducted.

Researchers and psychologists have yet to thoroughly study the effects of many forms of psychotherapy — including text-based therapy — on factors other than symptom reduction. The field still needs to examine other results, including psychological insight, catharsis, actualization and more. Once mental health professionals define other measures of effectiveness for psychotherapy, texting therapy will have more opportunities to prove itself.