Smile, You're a Therapist!

Why "neutral" might not be a therapist's best look.

Posted May 25, 2018

Deborah Cabaniss
Source: Deborah Cabaniss

OK, imagine this: You’re in therapy. You’re upset. You just had a fight with your mother/boyfriend/boss. You’re crying. You reach for a tissue. You look up at your therapist. You see a person looking at you who is neither happy nor sad. Just looking. Neutral. That’s the way therapists are supposed to look, right?

The idea of the “neutral analyst” is a concept that’s as old as psychoanalysis itself. Therapists are supposed to listen and not judge. As a psychiatrist and analyst, I was taught to listen empathically but not to side with any part of the patient. That’s called therapeutic neutrality. Here’s an example: if a married patient is unhappy and contemplating divorce, my job is to listen to the patient’s conflict, saying neither, “don’t go!” or “call a lawyer!” That makes sense and helps patients understand their inner feelings, wishes, and fears.

But does that translate to looking like the analysts in New Yorker cartoons, expressionless, with thin horizontal black lines where their mouths should be? Is a blank face the physiognomic equivalent of non-judgmental listening?

I thought about this last week while reading an interesting article in the Science Times about how people read emotion from faces. https://www.nytimes.com/2018/04/24/science/reading-neutral-faces.html. The investigators asked 99 children, age 9-12, to interpret the emotions represented in a series of faces. They found that while most of the children identified angry or happy faces well, children from what they called “high conflict” households had difficulty identifying neutral faces. They read something into them – seeing them as angrier or happier than they really were.

That article reminded me of something called the “Still Face” experiment, pioneered by “baby watcher” Edward Tronick, a psychologist who studies infants ("Effects of child abuse can last a lifetime: Watch the ‘still face’ experiment to see why," Washington Post, September 16, 2013). In the Still Face experiment, Tronick videotapes a mother interacting with her very young infant. First, mom is smiling and cooing at her baby – and then, according to Tronick’s instructions, she turns away and, when she turns back, has a completely neutral, non-interactive face. Her previously happy baby tries desperately to get some emotion from her mother – smiling, reaching – and when this fails, becomes completely dysregulated — hiccupping, drooling, screeching, arching her back and ultimately turning away. I show this every year to my psychotherapy students and they can barely watch. It’s really painful.

So, babies don’t like neutral faces, and children from high conflict households can’t read them. What about adults in therapy? Personally, I think it’s very disconcerting to talk to someone whose face shows no emotion. Are they interested? Bored? Irritated? Planning their shopping list? You can’t tell. While we don’t drool or hiccup when faced with a “still face,” we get pretty uncomfortable.  I have to imagine my patients feel that way, too.  

As a young therapist, I think I modeled myself after some idealized version of a blank-faced analyst. No more. Today, I smile, frown, laugh, and knit my brows in confusion. In short, I “show my cards” more. But even when I’m just listening, I pay attention to the corners of my mouth and try to turn them up. I’m not talking about a toothy grin, just something that’s unambiguously “not neutral.” Some of my patients will still read me wrong – but that should be because they do that with everyone, not because I’m not offering emotional clues.

What’s the take home? Therapists: Watching yourselves on video can really help. You may be surprised at how you look. Patients: There’s no rule that you have to face a blank slate session after session. New Yorker cartoonists will just have to turn their attention elsewhere.