Some hypotheses about hesitations and their
nonverbal expression in family therapy practice
Peter Robera
When people seek therapy they have stories to tell. In the course of the
therapeutic conversation the clients continually make selections about
what they want to tell, and what they want to keep silent. In this article the
author focuses on the border zone between the said and the not-yet-said,
and proposes three hypotheses about the clienťs hesitations about speaking
in the family therapy session. In these hypotheses `hesitation' is used as
a metaphor to give meaning to some nonverbal utterances of clients in
such a way that space is opened up in a respectful way for as-yet untold
stories. I suggest that it is fruitful to think of certain nonverbal utterances
of the clients as hesitations to proceed with the conversation, and to use
these nonverbal utterances, in the line of Tom Andersen's thinking
(1995), as a starting point for a respectful dialogue with the family about
the good reasons they might have not to speak. Not only can this open up
space for as-yet unspoken stories, it can also help the therapist to establish
a collaborative therapeutic relationship with the family. These ideas are
illustrated with several case studies.
Introduction
When people seek therapy they have stories to tell. However, in
therapeutic conversations there are also stories that are not told.
Some stories are not told because the clients do not consider them
to be relevant to the concerns that bring them to therapy. Other
stories may be relevant but difficult to tell, for instance, because
clients judge that the context of the conversation is too unsafe to
tell their stories, especially their most vulnerable stories, their
stories of doubt and guilt, shame and pain. Rogers et al. (1999)
recognize a range of unspoken stories: `From the unsaid (what is
simply not said or missing), to the unsayable (what is difficult to say
but may be implied through negation, revision, evasion, or silence),
 2002 The Association for Family Therapy and Systemic Practice
 The Association for Family Therapy 2002. Published by Blackwell Publishers, 108 Cowley
Road, Oxford, OX4 1JF, UK and 350 Main Street, Malden, MA 02148, USA.
Journal of Family Therapy (2002) 24: 187­204
0163­4445
a Clinical psychologist and family therapist, Feelings & Context, Troyentenhoflaan,
87 B-2600 Antwerp, Belgium. E-mail: peter.rober@skynet.be
to the unspeakable (what points to a knowledge that is dangerous or
taboo)' (pp. 91­92). Griffith and Griffith (1994) state that in the
course of the conversation clients decide which stories to tell and
which to hold in silence: clients `constantly guard against expressing
stories that can safely be told only within private, inner dialogues'
(Griffith and Griffith, 1994: 40). This process of selection surfaces
whenever clients hesitate about speaking in the session. A hesitation
may be expressed, not only in prolonged silence, but also in nonverbal
signs from the client: a glance, a sigh, a pause in the flow of
the conversation, shifting in the chair and so on. Often these are just
fleeting nonverbal signs that might pass unnoticed if the therapist
does not pay close attention. Such moments of hesitation are important
however, since they are moments of evaluation in which the
client weighs the safety of the conversational context against the
vulnerability of the story she is about to unfold.1
In this article I will reflect on the importance of the clienťs hesitations
to speak in the family therapy session as an important tool for the
therapist in opening up space for untold stories. I will propose three
hypotheses that have been useful to me in my work with families:
1 Clients express their hesitations about telling a story mainly in
nonverbal ways.
2 When clients hesitate they have good reasons to hesitate. Their hesitations
often reflect important stories that have not yet been told.
3 In family sessions children are often the ones who express these
hesitations because they are the most sensitive to possible dangers
for the family.
The purpose of this article is to give an account of the constructive
contribution these hypotheses can make to family therapeutic practice,
in particular in creating opportunities for establishing a collaborative
therapeutic relationship with the clients and in helping to
open up space for stories that have not yet been told.
Stories and conversations
Anderson and Goolishian (1988) maintain that it is the therapisťs
task to listen to the clienťs stories and to help to open up space for
188 Peter Rober
 2002 The Association for Family Therapy and Systemic Practice
1 Although I would prefer to write in gender neutral terms, for the sake of readability
the client and the therapist are referred to by the feminine pronoun instead
of the clumsy `he or she' and `his or her'. No gender discrimination is intended.
the not-yet-said, or, in other words, for the stories that have not yet
been told. However, the relationship between the said and the notyet-said
is not a simple one. Instead, it is a complex, dynamic relationship
where what is said can be understood only in the context
of what is not said (Rogers et al., 1999), and where what is said
reveals and conceals at the same time (Lakoff and Johnson, 1980;
Billig, 1997). In this article I want to focus on the border zone
between what is said and what is not-yet-said. Indeed, although the
clienťs talk may be impulsive at certain moments during the
conversation, there are also moments of reflection in which she
pauses and selects what she will say next, and what she will leave
unspoken.
The Vansteen family
I was talking with a family in which the father, Kurt had a severe heart
attack some months ago, and nearly died. Since that moment he felt like
an old man and he was scared to live. The mother, Nancy, told me the
story about the changes the heart attack brought in the family. She also
mentioned how it had affected their only son, Sid.
Then she said: `Next week there will be another medical check up of
Kurť, and glanced sideways at her husband. Then she fell silent. The
silence lasted for perhaps one or two seconds, but it somehow felt to me
that Nancy hesitated to proceed with the telling of her story.
As happened in this session, it is not uncommon that a client makes
a pause in the conversation as she hesitates to speak. Tom Andersen
(1995) states that, at moments in which the client pauses, she seems
to shift between outer conversation and inner conversation. The
silence then is the expression of an inner reflection in which the
client searches for the best way to express herself (Andersen, 1995).
At the same time this pause also creates a space in which the client,
in her inner conversation (Rober, 1999), decides which story she
will tell, and which story she will, at least for now, hold in silence
(Griffith and Griffith, 1994). The client asks herself: `Will I tell this,
to this therapist, at this moment in the session?' In that sense, such
a pause may be seen as a hesitation to speak.
As is illustrated in the example of Kurt, Nancy and Sid, a hesitation
is often expressed in a nonverbal way. This may be understood
if a hesitation is conceptualized as a compromise between two
movements: the movement towards speaking, and the movement
Hesitations: their nonverbal expression 189
 2002 The Association for Family Therapy and Systemic Practice
that holds back the words. The compromise is a nonverbal expression.
Nonverbal expressions are sometimes very subtle and might
pass unnoticed if the therapist does not pay close attention. Paying
close attention to nonverbal signs used to be self-evident in family
therapy, but ever since narrative metaphors like story and conversation
were used as an epistemological foundation for clinical work,
the importance of nonverbal communication risks being underestimated
in family therapy. Indeed, the use of narrative metaphors as
`metaphors to live by' (Lakoff and Johnson, 1980) seems to invite
therapists to focus their attention on `words', `voices' and `talk'. As
a consequence, they limit their field of study to what is being said,
and the nonverbals are left in obscurity.
Nonverbals obscured
Perhaps this deserves some additional explanation. The concept
of `metaphor to live by' was originally described by Lakoff and
Johnson (1980). Primarily on the basis of linguistic evidence,
Lakoff and Johnson stated that metaphors are not mere poetical
or rhetorical decoration but a part of our language that affects
the way we perceive, think and act. Furthermore, they talked of
metaphorical systematicity. By this concept they mean that a
metaphor always highlights an aspect of our experience, and
leaves something else in obscurity. In family therapy the
metaphor `system', for instance, highlights the interaction
between the family members, but it obscures the randomness of
family events and the extent to which system analysis involves
observer subjectivity (Rosenblatt, 1994). Another example: the
cybernetic metaphor, on the one hand, helps us see circularity
and feedback loops in family life, but on the other hand, it
obscures personal responsibility and power inequality. In this way
every metaphor highlights some part of our experience, and
leaves another in the dark.
If we accept these ideas of Lakoff and Johnson (1980), it is justifiable
to ask the question: What might narrative metaphors (text,
stories, conversations . . .) leave in obscurity when we use them as an
epistemological foundation for a collaborative family therapy?
Minuchin (1998) tried to answer this question in an article entitled
`Where is the family in narrative family therapy?', and he stated that
the use of narrative metaphors in family therapy obscures the
family:
190 Peter Rober
 2002 The Association for Family Therapy and Systemic Practice
Narrative therapy has moved away from systemic principles in order to
highlight context and culture, but there is something paradoxical in this
movement. In the process, theorists seem to have misplaced the family that
prominent, intermediate locus of context and culture within which
people live.
(p. 403)
Reading through the collaborative literature, it seems that another
aspect of the family therapy practice may be obscured within a
narrative paradigm: the importance of nonverbal communication.
It is striking that in the literature of the collaborative therapies (e.g.
White and Epston, 1990; de Shazer, 1994; Freedman and Combs,
1996; Zimmerman and Dickerson, 1996; Anderson, 1997) nonverbal
behaviour is barely mentioned. For instance, in If Problems
Talked: Narrative Therapy In Action (1996), Zimmerman and
Dickerson's wonderful and courageous book on narrative therapy,
`talk' is omnipresent, and the authors never mention nonverbal
communication. Even in the chapter on narrative therapy with children,
entitled `Just let children talk', they never mention the importance
of nonverbal communication in working with children and
they only give examples of stories which children tell verbally. This
illustrates how narrative metaphors tend to focus our attention on
verbal behaviour (the story the clients tell), and may cause us to
underestimate the importance of nonverbal behaviour (the story
the clients show). This is clearly the case in Steve de Shazer's book
Words Were Originally Magic, in which de Shazer favours the text,
which he defines as `what is actually saiď (de Shazer, 1994: 75). He
seems very suspicious of considering nonverbal communication as
meaningful or useful. This is evident, for instance, in his comments
on a case study of Nathan Ackerman. When Ackerman saw a grin of
the son as a sign of disagreement with the father, de Shazer
comments, `But where does Ackerman get this idea that the son
disagrees? Certainly not from anything said so far' (de Shazer, 1994:
69). He writes that therapists `just got to listen to what the client
says' (p.109).
De Shazer's neglect of the importance of nonverbal communication
may be understood against the background of his commitment
to post-structuralist philosophical ideas and his rejection of structuralist
thinking (de Shazer, 1994). Structuralists try to know the
world `as it really is', through detailed observation and interpretation.
Structuralist thinking is based on the ideas of the Swiss linguist
de Saussure who made a distinction between signifiant (signifier)
Hesitations: their nonverbal expression 191
 2002 The Association for Family Therapy and Systemic Practice
and signifié (signified). The signifiant is the word (for instance,
`dog'), and signifié is the concept to which the word refers (a pet
that barks and wags its tail). The signifiant and the signifié are linked
in an arbitrary way, but the link is fixed by cultural and linguistic
traditions. In this view meanings are expressed by means of a code.
The listener (or the scientist, the therapist, the reader and so on)
has to interpret the code to gain access to the underlying meaning.
De Shazer rejects the structuralist view that nonverbal behaviour
refers to some underlying meaning, which has to be decoded by an
expert. Instead he embraces a post-structuralist perspective inspired
by Derrida and Wittgenstein. He rejects the split between subject
(expert­therapist) and object (the family), and advocates a systemwide
co-operation that is deemed central to effective therapy (de
Shazer, 1991: 57). In line with this rejection of a structuralist
perspective, de Shazer focuses on solutions instead of on problems,
on the present instead of on the past, on exceptions instead of on
repeating patterns, on `what the client says' instead of on what is
unspoken.
Wordless is not worthless
However, not all collaborative therapists consider `what the client
says' as the only relevant focus for the family therapist in the therapeutic
conversation. Tom Andersen (1995), for instance, stresses
that the therapist not only has to listen to all the spoken, but also
has to see how it is uttered: `To hear is also to see', Andersen writes
(1995: 23). He gives an example of a father who sighs when he
speaks about his son's sadness. This was an invitation for Andersen
to start a conversation about sadness, and he asked: `When your son
is sad, is his sadness totally filled with sadness or are there other feelings
in his sadness?' The father says, `there's also anger.' Andersen
goes on and asks, `If your son's anger could speak, what would the
words be?' and so on. With these kinds of questions Andersen is not
searching for what the real meaning is behind or under the
expressed, as would a structuralist. Instead, he wants to understand
whaťs in the expression (Andersen, 1995). He focuses on the richness
of the nonverbal utterances and sees them as invitations for
further curious and respectful questioning.
When we return to the case of the Vansteen family we see that the
therapist, inspired by Tom Andersen's questions, took Nancy's
prolonged silence as a departure point of a respectful dialogue:
192 Peter Rober
 2002 The Association for Family Therapy and Systemic Practice
The Vansteen family (part 2):
I let the silence be for a moment and then I asked Nancy:
`If this silence could speak, what might the words be?'
`I don't know . . . I don't want to scare him. [She nods at Kurt] He is scared
as it is, and if I would tell about my fears. . . .'
`Are you afraid that he might become even more scared if you would tell
about your fear?'
`Yes.'
Sometimes hesitations to speak in therapy have been interpreted
as defences of the clients: the client resists the therapeutic
process by saying nothing. In that perspective silence is seen as an
absence: the absence of words. Other authors however have
stated, `Silence takes on many different shades and tones'
(Serani, 2000: 505): silence in therapy may mean many different
things to many different clients. Social constructionism has
taught us that meaning is not discovered in the intention of the
client. Rather it is created by a kind of negotiation in the
dialogue between the therapist and the client (Gergen, 1999). In
the case of the Vansteen family the meaning of Nancy's silence
was created by the silence on the one hand, and on the other
hand by the therapisťs response. The therapist did not view this
silence as an absence but as a presence: silence is full of unspoken
stories and reasons why they are kept unspoken. The therapist
considered Nancy's silence to be a reflection of her
hesitation to speak: there is something she wants to express, but
there is something that is holding back the words. He asked a
question about this silence: `If this silence could speak, what
would the words be?' Nancy's answer illustrates that she accepts
the therapisťs proposal that her silence was not empty. She
accepted that the therapisťs idea of the silence as a hesitation to
speak about her own fears made sense, and she made it clear that
she had good reason to hesitate: she did not want to scare her
husband more than necessary.
This simple example highlights the first hypothesis of this article:
The hesitation of a client to proceed in the conversation is often
expressed in nonverbal ways (for instance, silence). It also illustrates
the second hypothesis: Clients have good reasons to hesitate.
Sometimes speaking is dangerous (Griffith and Griffith, 1994), and
the speaker could hurt someone in the family or she could be hurt
herself.
Hesitations: their nonverbal expression 193
 2002 The Association for Family Therapy and Systemic Practice
Hesitations in the family session
John Byng-Hall described how a child can become a distance regulator
in the family (Byng-Hall, 1980, 1995): `The child monitors the
parents' relationship, ready to pull them together when they get too
distant or come between them when they get too close. Family therapists
know only too well the myriad ways in which children can be
involved in these maneuvers' (Byng-Hall, 1995: 185). In a similar
way children often become regulators of what is talked about in the
family therapy session by expressing hesitation to proceed with the
conversation. Indeed, in a family session hesitations are not always
expressed by the person speaking. Sometimes, while one family
member is telling a story, another family member (usually a child)
shows a nonverbal sign that may be understood as a hesitation to
proceed in the session. This is the third hypothesis of this article. It
is inspired by the work of Edith Tilmans-Ostyn (1999a) who talks
about the `brakes' of the family. She states that children through
their nonverbal behaviour often signal the dangers of conversational
exploration of certain themes during the session. It is as if the
chilďs nonverbal behaviour expresses a hesitation to proceed with
the conversation. When the child starts to make a noise or asks to
go to the toilet, or when the child distracts her parents and so on, it
is as if the child seeks ways to slow down or even stop the conversational
movement. In that sense, these utterances of the child may be
understood as nonverbal comments on the course of the conversation:
`This could be dangerous', `this goes too fasť, `this is not a safe
theme to talk abouť and so on. The following case example illustrates
this very clearly.
Case study of Tom
It was the first time that 8-year-old Tom and both his parents were together
in the same room since the parents had separated two years before. They
entered the room silently. They seemed cautious. Father sat down in the
chair on the right. Mother in the chair on the left. Tom sat in the middle.
I wondered in my inner conversation how he would feel, sitting between
his parents: Was he a bridge between them or was he a fence?
Tom was referred to me by his GP because of stomach aches. The
doctor had found no physical grounds for the pains, so he sent Tom and
his parents to me. We sat quietly at first and then we spoke about the
concern of the parents for Tom's mysterious pains. I felt uncomfortable
and I sensed that this talking was in some way a subtle fight between the
194 Peter Rober
 2002 The Association for Family Therapy and Systemic Practice
parents. They talked pleasantly, but they were reproaching each other all
the time. It was strange, because they did not look at each other as if they
had not yet noticed that the other was there too. Minute by minute I felt
the tension between the parents rise. I did not think that our conversation
would last an hour without there being an outburst of violence between
the parents. It seemed unavoidable. I wondered how Tom would be feeling,
and at that moment I saw that Tom was holding his stomach with both
his arms. `Is he in pain?' I asked myself. Then I looked at the parents to see
if they were alarmed too, but they were not.
Then father said to me: `Of course iťs up to you to find out what is
wrong with Tom.'
What could I say without taking sides? I wondered. I felt stuck between
both parents and I suddenly realized that this must be how Tom had been
feeling. I looked at Tom again, and now his face told me he was in pain,
so I asked him: `Are you in pain?'
He didn't say a word but nodded yes. I invited him to sit next to me and
to tell me about his pain. He stood up and came to sit down next to me.
`Can you tell me about your pain?' I asked him.
`It is better now,' Tom answered.
`Thaťs good,' I said, and I felt Tom's relief. I hypothesized that his
stomachache was probably an expression of the tension he was feeling,
sitting between his parents. I decided to ask him about it.
`Can you tell me the story your pain is trying to tell us?' I tried, but I
sensed that Tom would not be able to talk about it at that moment. And
indeed he didn't answer. So I again turned to the parents and we started
to talk about how difficult it was for them to be parents for Tom while separated.
I noticed that, at least for the moment, the tension between the
parents had gone. Both had been listening attentively to Tom and to me.
I made a mental note that Tom's stomach ache had at least attracted attention
to him, and in that way had avoided the possibility that the tension
between his parents would rise so much that it might erupt in violence.
As Tom's story illustrates, in some cases the symptom of a child manifests
itself in the session as a nonverbal behaviour that may be understood
as expressing a hesitation to proceed with the conversation. It
is as if Tom wanted the therapist to know that it would be dangerous
to proceed in the session because there was the possibility of an
aggressive outburst or a fight between his parents. The therapist
used Tom's nonverbal behaviour as a starting point for a dialogue.
This is often a useful way to open up space for untold stories. It is
important however that the therapist respects the tempo and vulnerability
of family members (Rober, 1998). Indeed, sometimes family
members show things in nonverbal ways before they, or other family
members, are ready to talk. This seemed to be the case with Tom's
Hesitations: their nonverbal expression 195
 2002 The Association for Family Therapy and Systemic Practice
stomach ache. The therapist initially thought that by mentioning the
stomach ache space could be opened up to talk about the unspoken
tension Tom was feeling during the conversation between his
parents. On second thoughts however, the therapist did not want to
pressure him to speak because he reflected that if Tom's stomach
spoke instead of his mouth, there would probably be a good reason
for that. It might be that, at least at this moment, it was too difficult
or too dangerous to put the story into words (Griffith and Griffith,
1994). In cases like this, it may be the best option for the therapist to
ignore the nonverbal utterance or to comment on it `with a tentative
uncertainty in order to help the family to become more sensitive to
things previously unnoticeď (Andersen, 1987: 420).
Good reasons not to talk
Instead of focusing on the content of the unspoken story, I propose
that the therapist should invite family members to talk about the
good reasons (Tilmans-Ostyn, 1999a) they have not to tell the story.
The therapist might say: `I understand that you don't want to talk
about it now. Thaťs OK. But could you help me to understand what
makes it so difficult to talk about it now?', or `What do you fear
might happen?' These kinds of questions reflect a genuine respect
of the therapist who explicitly gives the clients the right to decide
for themselves whether or not they want to talk about something.
Furthermore, the therapist acknowledges that the clients have good
reasons for their decision not to tell the story, and she wants to try
to understand the importance of these good reasons. This respectful
and reserved approach often opens up space for other untold
stories that highlight the need clients have to try to protect themselves
by keeping certain stories silent. This is illustrated in the case
study of Elly and the hypodermic needle.
Case study of Elly and the hypodermic needle
A divorced mother, her 8-year-old daughter Elly and her 2-year-old son Art
came to family therapy because the mother was concerned about the
behavioural problems of her daughter. The mother also said that she
herself had been hospitalized with severe depression some months ago,
and she indicated that she also wanted some individual sessions for herself
to talk about her painful childhood. Her mother had died when she was 8
years old, and she had felt very lonely as a child.
196 Peter Rober
 2002 The Association for Family Therapy and Systemic Practice
At the end of the second session the mother suggested that Elly might
benefit if she could talk alone with a therapist about her father and how
she had missed him since their divorce. I turned to Elly and asked her what
she thought about the mother's suggestion. Elly shook her head. I asked
her if she could help me understand her gesture. Elly reluctantly said that
she did not want to talk about her father because it would make her feel
very sad. I said that if she did not want to talk about her father I would
respect that, but I added that if she wanted to change her mind and decide
she did want to talk about her father, she could. Elly nodded. Then I asked
the mother if she thought it was time for her to talk, without the children,
about her painful childhood as she had asked in the first session. The
mother said that indeed she wanted to talk about her childhood. It was
then that Elly stood up and playfully gave her mother an injection with a
toy hypodermic needle. The mother interrupted what she was saying and
said jokingly `Aw, you're hurting me!' We all looked at Elly.
When Elly gave the injection to her mother, my first thought was `this is
importanť. In my inner conversation I wondered if Elly perhaps wanted to
draw our attention away from the painful subject the mother was talking
about to the here-and-now that was less painful. Another hypothesis that
popped into my mind was that perhaps this was Elly's way of symbolically
helping her mother to feel less pain about her miserable childhood (the
injection being a pain-killer). Indeed, Elly had just said she did not want to
talk individually about issues that mattered to her because she would feel
too sad. Perhaps she thought her mother would be sad too when she
talked about her childhood.
I playfully asked Elly: `Do you want your mother to feel less pain?'
Elly smiled but said nothing. Then I told her about some of my reflections.
I told her that she had struck me as being a very helpful person and
that perhaps she thought it would be painful for her mother to talk alone,
and so she wanted to give her mother a pain-killer.
Elly answered that she didn't want her mother to talk with me alone
about her painful childhood.
I asked if she could help me to understand that. She remained silent. I
asked: `Do you think it will be too painful for her to talk about her childhood?'
She nodded yes.
The mother said to Elly: `But if I would talk about it, the pain would
eventually go away.'
Elly shook her head and said: `If you would talk about those painful
things, where would I have to stay?'
At first I was confused by Elly's remark. Then I realized that Elly was
probably referring to the three months that her mother had been hospitalized
with depression. Elly had to stay in a home during that period. I
asked her if she was afraid her mother might have to be hospitalized again
if she would speak about her painful childhood. She nodded yes.
Hesitations: their nonverbal expression 197
 2002 The Association for Family Therapy and Systemic Practice
Elly's affirmative answer acknowledges to the therapist that it made
sense to understand her playfully injecting her mother as a hesitation
to proceed with the conversation. Elly appeared to be very
sensitive of the dangers for her mother of talking individually with
the therapist as she feared that her mother might become
depressed again. These were Elly's good reasons to hesitate.
Hesitations at the beginning of therapy
Hesitations can often be observed, not only in the course of the
conversation, but also right at the beginning of the therapeutic
encounter, when therapist and client meet for the first time: for
instance, when the client is waiting in the waiting room or when she
is sitting in front of the therapist for the first time and is confronted
with her own intention to tell her story. She feels the vulnerability
of the stories she is about to unfold, and she wonders if the conversational
context will be safe enough: Will the therapist understand?
Will she laugh at me? Will she consider me crazy? Will I lose control
of my emotions? And so on. Clients seldom say these things out
loud, but still they hesitate, and the hesitation often shows in subtle,
nonverbal ways that are not easy to grasp. This is illustrated in the
case study of 25-year-old Liza, who came into therapy because she
had been abused as a child by her father.
Case study of Liza
When Liza entered the consultation room at the beginning of the first
session I felt a vague uneasiness. This uneasiness did not pass. At first I
could not put my finger on it. I wondered what was wrong. I told myself to
take some distance and to focus on my inner conversation. It was not what
she said that made me uneasy, rather it was how she said it. Her answers
were rather brief. She looked very tense. I also noticed that she looked away
and made no eye contact. I reflected that she looked irritated, and that
made me feel that she did not trust me. I reflected that, although we had
not met before, perhaps she was angry with me. Perhaps it was something I
had said that had hurt her or perhaps it was something else. Perhaps she
was just tense, as some people are at the beginning of a therapy.
I asked Liza if she was feeling tense.
At first she was silent, but then she said that it was not easy for her to
come to therapy.
`Can you help me understand that?' I asked.
Liza answered that she had been thinking about going into therapy for
198 Peter Rober
 2002 The Association for Family Therapy and Systemic Practice
a long time, but she had always postponed it: `Even just now, while I was
sitting in the waiting room, I contemplated walking out again,' she added.
I again asked her if she could help me understand.
Then she told me the following story: `My father has abused me the first
time when I was 4 or 5 years old. He came to my room at night when everyone
in the family was asleep, and he raped me. Afterwards he said to me
that I should never talk about it, because it was our secret and if I would
talk he would have to go to gaol. So I did not talk about it but the following
nights he came again, and every time he raped me. One night I had
wetted my bed. When father came and he noticed the bed was wet, he got
angry with me, and he called me a filthy, dirty slut, but he did not rape me.
So I had found a way to protect myself against him. Since that night I
wetted my bed every night.
Soon my mother noticed I was wetting my bed. So she talked to the GP
and he referred us to a therapist. When my mother told me we would go
to a therapist, I felt my hopes rising. Maybe now there would come an end
to the pain, the fear and the shame. In the first session however I noticed
that the therapist was only concerned in finding a solution for my bedwetting.
He did not seem at all interested in the family relations or in the
how and why of the bed-wetting. I have to admit that in some way that was
a relief, because I feared the confrontation with my father. At the same
time I was very angry with the therapist, not only because he did not notice
that there was more to it than just bed-wetting, but also because he was
searching for a solution for the bed-wetting and he did not seem to notice
that he was going to take away the only protection I had against my father.
So I sabotaged the solutions he proposed, and I also swore I would
never trust a therapist again.'
Liza's story moved me very much. I thanked her for sharing her story
with me. Then we started talking about trust and about how she could
protect herself from being hurt again by a therapist.
Liza's story about her childhood experiences can teach us a lot
about the importance of nonverbal communication (in this case:
her symptom, bed-wetting) in family therapy practice. It shows that
nonverbal behaviours of children often touch upon unspoken
stories in the family. The nonverbal behaviour seemed the best way
of saying what could not be said, since talking was forbidden and
unsafe (Griffith and Griffith, 1994). The fact that little Liza's
nonverbal signs were not taken seriously, nor understood by the
family therapist, was very disappointing for her. Furthermore, her
hesitation (fearing the confrontation with her father), which was
expressed in her sabotaging the therapy, was also left unspoken. It
is likely that the therapist has experienced her as a difficult, resistant
child.
Hesitations: their nonverbal expression 199
 2002 The Association for Family Therapy and Systemic Practice
The session of the adult Liza with the therapist highlights the
importance of taking nonverbally expressed hesitations at the
beginning of a therapy seriously, since they usually refer to important
personal stories that have not been told before. As in Liza's
case, hesitations at the beginning of a therapy often refer to earlier
unpleasant or even traumatic experiences with therapy (TilmansOstyn,
1999a). These negative experiences with therapy can make a
client feel extra sensitive and vulnerable. Opening up space for
these stories maximizes the chances that this new therapeutic
encounter will be collaborative and fruitful, not only because it
gives the therapist the opportunity to be extra careful about the
sensitive spots of the client, but also because she can make space for
something new by ensuring that the negative experiences will not
be repeated in this new therapeutic process (Tilmans-Ostyn,
1999a). The telling of the story of the negative experiences sometimes
suffices for clients to reassure them that the experience will
not be repeated. By telling the story, the new therapeutic process
becomes differentiated from the old one, and space is opened up
for new experiences.
Sometimes, however, it is not enough for clients to just tell the
story to be freed from their preoccupation with past experiences. In
those cases, the therapist can discuss with other family members
what could reassure them that the same bad thing will not happen
again when they risk themselves in a new therapeutic process. As is
illustrated in the next case study, the dialogue about this question
can give clues about what is needed for the client to feel safe in the
therapeutic dialogue.
Case study of Sam and the proclamation of martial law
A family came to therapy because 12-year-old son Sam ran away from
home. When the police found him he claimed that he had been
kidnapped. The police did not believe his story and brought him back to
his parents. They also contacted the school psychologist. The school
psychologist talked with Sam but, because Sam mentioned family problems,
he referred Sam and his family to me.
In the first session Sam was silent. He didn't want to talk. I asked him if
he could help me understand his silence. Sam looked at his father and
kept silent. I said: `Sam, I'm not sure, but I got the impression that you
don't want to talk. Thaťs OK. You don't have to talk.'
I paused and then I said: `Let me tell you a little story. Here, look at this
turtle. [I showed him a toy turtle] Whenever a turtle feels that it is unsafe
200 Peter Rober
 2002 The Association for Family Therapy and Systemic Practice
it retracts its head and its legs in its shield. [I showed him how the turtle
retracts its head and legs] In that way the turtle cannot be hurt. Thaťs the
way a turtle protects itself from being hurt. Now children don't have such
a shield. You know how children often protect themselves when it is not
safe? They don't say anything. They keep quiet and wait until it is over. So
when you are quiet like that, I am wondering if you are feeling unsafe, I
am wondering if you ever had the experience that something bad
happened after you talked about something?'
Sam again looked at his father and also at his mother. I got the impression
that Sam was interested in this kind of question. Then Sam took a
breath as if he was going to say something, but I interrupted him: `No, wait,
you don't have to answer me. Only answer me if you feel safe enough.'
Sam nodded. Then he said that he had felt safe to talk with the school
psychologist, but now, with his parents present, he didn't want to talk. We
talked about the difference between talking individually with a therapist
and talking with parents present in a family therapy. Soon it became clear
that Sam was concerned about his father who might become depressed
again if they talked. The parents explained that the father had been hospitalized
several times with severe depression. The father said that he himself
had been tense about going to a therapist because he was afraid that talking
might evoke his depression again: `I went to therapy once, but the
more I talked, the more I started to feel depressed again. So I didn't go to
therapy anymore,' he explained.
I asked them what would reassure them that the same thing would not
happen here in these family conversations.
Sam said: `If we would all be vigilant to see the first signs of the depression.'
`To watch for warning signs?' I asked.
Sam nodded.
Then I asked: `What would be the first warning signs that the depression
might creep up again on father?'
Sam and his parents talked about `not wanting to get up in the morning',
`feeling tired all the time', `talking less with us', `talking less positively
about himself', `no longer enjoying reading the newspaper', `not going
out fishing with his buddy', `sighing a loť, `drinking more'.
I took notes of these signs. I proposed to make a scale that would assess
these warning signs. At the beginning of every session the family members
would each score these items on a scale from 1 (no alert at all) to 10 (red
alert). Then I asked, if the scores to this assessment scale were to start to
be alarming (6 and higher), how should we react, what should we do?
`We proclaim martial law,' Sam exclaimed.
Everybody laughed.
We talked about what `martial law' might mean for this family and then
the family members decided that under `martial law' the sessions would
have to stop being very emotional and `deep', father would have to contact
Hesitations: their nonverbal expression 201
 2002 The Association for Family Therapy and Systemic Practice
his psychiatrist to talk about taking medication, he would also have to talk
to his wife about what bothered him, and he would have to think about
positive aspects of himself and the world around him and discuss it with his
family.
After the session I made a contract in which I clearly stipulated the
agreements we had reached. As agreed with the father, I also contacted
his psychiatrist to explain what we would be doing in the family therapy.
The next session everybody was given a copy of the contract, as well as a
copy of the assessment scale to score. This procedure made talking in the
family safer for everybody. It also helped the therapist to establish a therapeutic
relation of collaboration with the family. During the whole therapy
the assessment scale was scored and the alarm threshold was never
reached.
Discussion
In this article I have advocated that it is sometimes fruitful to think
about nonverbal utterances of clients as hesitations to proceed with
the conversation and to use these nonverbal utterances, in line with
Tom Andersen's thinking (1995), as a starting point for a respectful
dialogue with the family. It is important however to highlight that I
do not propose that the therapist should start to talk about her
hunches or suppositions about the clienťs untold stories. On the
contrary, I suggest that the therapist should be very respectful
towards the untold story, and that the dialogue should be focused
on the hesitations and the good reasons clients may have not to
speak. This genuinely respectful and reserved therapeutic approach
often creates a context in which clients feel safe to start to talk about
their more vulnerable stories. Furthermore, it also helps the therapist
to establish a collaborative therapeutic relationship with the
family.
In concluding, it may be important to acknowledge that,
although I hypothesized that clients often express their hesitation
in nonverbal ways, this does not mean that all hesitations are
expressed nonverbally. Sometimes clients just say, `I'm not sure I
want to talk about this because . . .'. Often, however, such a verbally
expressed hesitation is announced by nonverbal signs. Children are
usually the ones who express these hesitations nonverbally, because
they `bathe in the emotional climate of the family' (Tilmans-Ostyn,
1999b: 90). This gives the therapist the opportunity to invite the
child to become a consultant (Andolfi, 1995) in the therapeutic
conversation. The child hesitates and signals in a nonverbal way
202 Peter Rober
 2002 The Association for Family Therapy and Systemic Practice
possible dangers, and the therapist uses the chilďs nonverbal signs
as a starting point for further dialogue, not about the dangerous
theme, but about the hesitations and about the good reasons family
members have not to speak.
In their writings, collaborative therapists have not been paying
sufficient attention to the nonverbal behaviour of clients. This may
be understood against the background of their commitment to
post-structural and postmodernist philosophies, as well as their
suspicion of therapists' knowledge and power. The therapist is not
the expert, but the client is, collaborative therapists rightly state,
and the clienťs story is considered to be of central importance.
However, part of the clienťs story is told in nonverbal ways. Not
paying attention to nonverbal signs of the family members can leave
important stories untold. Genuinely listening to the clienťs story
means listening to the simultaneous presence of both what is said
and what is expressed nonverbally, and to the interplay between the
two. In that way, what is expressed nonverbally can become a door
that gives access to explore the complex layers of the family
members' experiences and understanding and, perhaps more
importantly, it can help to establish a fruitful collaborative therapeutic
relationship.
Acknowledgements
I thank Edith Tilmans-Ostyn (Université Catholique de Louvain,
Brussels, Belgium), Michael Seltzer (Oslo University College,
Norway), Craig Smith (San Diego State University, USA) and Tom
Strong (University of Calgary, Canada) for their valuable comments
on an earlier draft of this paper, as well as for their helpful sugges-
tions.
The central ideas of this article were first presented at the IFTA
Family Therapy World Congress in Oslo, Norway (June, 2000).
References
Andersen, T. (1987) The reflecting team. Family Process, 26: 415­428.
Andersen, T. (1995) Reflecting processes; acts of informing and forming: you can
borrow my eyes but you must not take them away from me! (pp. 11­37). In: S.
Friedman (ed.) The Reflecting Team in Action: Collaborative Practice in Family
Therapy. New York: Guilford Press.
Anderson, H. and Goolishian, H. (1988) Human systems as linguistic systems.
Family Process, 27: 371­393.
Hesitations: their nonverbal expression 203
 2002 The Association for Family Therapy and Systemic Practice
Anderson, H. (1997) Conversation, Language and Possibilities: A Postmodern Approach
to Therapy. New York: Basic Books.
Andolfi, M. (1995) The child as consultant. In M. Andolfi and R. Haber (eds) Please
Help Me with this Family. New York: Brunner/Mazel.
Billig, M. (1997) The dialogic unconsciousness: psychoanalysis, discursive psychology
and the nature of repression. British Journal of Social Psychology, 36: 139­159.
Byng-Hall, J. (1980) The symptom bearer as marital distance regulator: clinical
implications. Family Process, 19: 355­365.
Byng-Hall, J. (1995) Rewriting Family Scripts: Improvisation and Systems Change. New
York: Guilford Press.
de Shazer, S. (1991) Putting Difference to Work. New York: W. W. Norton.
de Shazer, S. (1994) Words Were Originally Magic. New York: W. W. Norton.
Freedman, J. and Combs, G. (1996) Narrative Therapy: The Social Construction of
Preferred Realities. New York: W. W. Norton.
Gergen, K. J. (1999) An Invitation to Social Construction. London: Sage.
Griffith, J. L. and Griffith, M. E. (1994) The Body Speaks: Therapeutic Dialogues for
Mind­Body Problems. New York: Basic Books.
Lakoff, G. and Johnson, M. (1980) Metaphors To Live By. Chicago, IL: University of
Chicago Press.
Minuchin, S. (1998) Where is the family in narrative family therapy? Journal of
Marital and Family Therapy, 24: 397­404.
Rober, P. (1998) Reflections on ways to create a safe therapeutic culture for children
in family therapy. Family Process, 37: 201­213.
Rober, P. (1999) The therapisťs inner conversation: some ideas about the self of
the therapist, therapeutic impasse and the process of reflection. Family Process,
38: 209­228.
Rogers, A. G., Casey, M. E., Ekert, J. Holland, J., Nakkula, V. and Sheinberg, N.
(1999) An interpretive poetics of languages of the unsayable (pp. 77­106). In
R. Josselson and A. Lieblich (eds) Making Meaning of Narratives. London: Sage.
Rosenblatt, P. C. (1994) Metaphors of Family Systems Theory: Toward New Constructions.
New York: Guilford Press.
Serani, D. (2000) Silence in the analytic space, resistance or reverie? Contemporary
Psychoanalysis, 36: 509­519.
Tilmans-Ostyn, E. (1999a) La Démarche vers le Thérapeute: de la plainte  la
demande (pp. 71­84). In E. Tilmans-Ostyn and M. Meynckens-Fourez (eds) Les
Ressources de la fratrie. Toulouse: Ers.
Tilmans-Ostyn, E. (1999b) Quand la Démarche Parentale vers la thérapie est
centrée sur un enfant (pp. 85­110). In E. Tilmans-Ostyn and M. MeynckensFourez
(eds) Les Ressources de la fratrie. Toulouse: Ers.
White, M. and Epston, D. (1990) Narrative Means To Therapeutic Ends. New York:
W. W. Norton.
Zimmerman, J. L. and Dickerson, V. C. (1996) If Problems Talked: Narrative Therapy
in Action. New York: Guilford Press.
204 Peter Rober
 2002 The Association for Family Therapy and Systemic Practice