Nonverbal Communication

Key Learning Objectives

Below are some examples based on two very different personalities. There are numerous other preferences that various different personalities may have. The examples and questions below are provided for the purpose of bringing awareness to the various aspects of nonverbal communication with patients.

And as there are no ready recipes when it comes to human interaction, all of the following 12 components of nonverbal communication are summarized by questions to ask to ourselves, rather than ready answers on how to act in a specific situation.


1. Spatial Positioning

  • Tornike doesn’t like being in the room with lots of people
  • He tries not to get close to them
  • He is also trying not to be in the centre of the room.
  • He prefers to be closer to walls, or in a corner
  • Tina likes to be among many people in the room
  • She tries to be in the centre of the room
  • She likes to be where spots the most action
  • She chooses spot to be well-seen by most of the people
  • Do I have the chance to offer various different spatial positioning options for the patients like Tornike and Tina?
  • Is my room set/designed to enable different positioning?
  • Will Tornike and Tina each be able to find and choose the spatial positioning that suits that most?
  • Where should I choose to position myself in case of such patient as Tornike / Natalie?

2. Personal Space

  • Tornike doesn’t like when someone is standing really close
  • He needs more personal space
  • He leans back or steps back as he is uncomfortable
  • He likes when people respect his personal space
  • Tina likes to talk with people from a close distance
  • When she speaks she’s approaching closer
  • She likes when the other person is close to her
  • For her being close means more attention
  • How can I guess the personal space requirement for various patients?
  • What should I do if I have to perform a necessary medical manipulation that requires breaking the patients personal space?
  • How can I gently indicate to a patient that it’s all right to adapt/change personal space as per his/her requirement?

3. Gestures

  • Tornike doesn’t use much gestures himself and he doesn’t like when the other person is using hands when speaking
  • He only uses gestures in rare and extreme cases to emphasize certain categorical demand/requirement of his
  • For him gestures are often sign of an aggression
  • He may even be puzzled with the other person nodding
  • Tina uses gestures a lot and she is expecting the same from the other person
  • If the other person doesn’t use gestures Tina often thinks she is not being understood or that the other person doesn’t agree with her
  • For her use of hands while speaking is a sign of attention and engagement in the conversation
  • For her it’s natural to nod her head and use her hands throughout the interaction
  • What should I do if my own use of gestures is different from the patient? Should I perhaps join Tina is using hands while articulating messages? Should I try to avoid using hands at all with Tornike?
  • Am I paying attention to the position of my hands while speaking? Are my palms facing upwards and/or am I showing my palms while talking with a patient?
  • Should I be nodding my head while listening to the patient? Or perhaps I should be careful not to imply unintended consent with my nodding on the topics that a patient is communicating?

4. Posture

  • Tornike tries to sit the way that he is not taking too much space
  • He is often leaning slightly backwards, as if trying to create some additional space for him
  • Tornike is often crossing her hands or hiding hands in the pockets.
  • He doesn’t like turning towards the other person with full body, instead his upper body may be turned to the speaker but the lower body may be pointing to a side.
  • Tina tries to create maximum comfort for her in space
  • She is often leaning towards the speaker, or sometimes she’s putting her hands in front to further decrease the distance with the speaker
  • She likes to face the other person and often her full body posture is also reflecting that
  • Would Tornike and Tina each find a place in my room to be comfortable in accordance to their preferences?
  • How should I adapt my own posture when meeting Tornike or Tina?
  • What are some of the physical barriers / separators (if any) that are between me and the patient when speaking?
  • Should I try to talk about some sensitive topics while not facing and opposing the patient but being next to him/her – shoulder to shoulder – as if walking together?

5. Manner of Talking

  • Tornike doesn’t like changing his tone while speaking, so he is often monotonic
  • He doesn’t like talking loud
  • He also doesn’t like when the other person is talking fast – he prefers a slower, calm tempo/pace
  • Tina tries to be expressive when talking she often changes her tone to emphasize various messages
  • She doesn’t like monotonic speech and therefore finds it difficult to listen to someone who is not changing the tone when talking
  • She prefers to talk fast and loud and this is also what she likes in other speakers
  • How much time do I have to identify the manner of talking that he/she prefers?
  • Should I shift to the patient’s manner of talking or should I remain at my style?
  • If the patient’s manner of talking is monotonic should I speak the same way?
  • What to do if I have a lot to share to a patient but he or she prefers slower pace of communication?

6. Vocal Sounds

  • Tornike doesn’t like when he is listened actively with sounds like “hmmm”, “ahaa”, “mmmmm”, etc – he doesn’t like to be given cues with such vocal sounds
  • He prefers to be listened quietly and be let to speak to the end and only then have the reaction to whatever he spoke
  • He also doesn’t like any sighing, giggling, or any other vocal sounds while talking so he himself also doesn’t provide any vocal sounds as cues.
  • Tina doesn’t like any communication where she doesn’t feel immediate reaction from the other person
  • She often uses various sounds like “oh”, “eew”, etc to express her emotions while communicating
  • As she speaks she often checks if the other person is with her via the vocal sounds from them.
  • What does it mean to listen actively and what are some of the vocal sounds I am currently using?
  • How much difference would the vocal sounds or complete absence of those make when speaking with Tornike? What about Tina?
  • Should I be more expressive and use of vocal sounds with patient like Tina?

7. Person-to-Person Touch

  • Tornike considers any touch as a harsh invasion to his personal space
  • He doesn’t like to be touched during a conversation
  • He actually dislike any kind of touch even if the intention is to express empathy, friendly attitude, warmth, etc
  • Tina often expresses her attitude with a touch
  • She may sometimes touch the other person with her hand to express empathy, etc
  • For Tina a person to person touch is a natural part of communication and she may perceive people who dislike touch as aggressive and may think they are not friendly towards her
  • What are some social/moral/ethical/religious/cultural frames regarding person-to-person touch in various circles of the society that I may be interacting with?
  • Handshake is a touch too – So should I consider that aspect when greeting a patient perhaps?
  • What is the legislative/legal/SOP framework regulating patient/doctor touch in the jurisdiction that I am operating?

8. Intrapersonal Touch

  • Tornike often touches his hair, or ear or covers his chin and mouth when speaking
  • He often does these moves subconsciously and he can’t really control those
  • Tornike doesn’t really think much of such touches – he considers those as pure habits
  • Tina never touches her face while talking, but she has often noticed subconsciously rolling her long hair ends on her finger, especially if she is trying to focus on something or when she is nervous
  • She also has the habit of touching her chest with her palm to express or emphasize her emotions
  • Touching mouth – hiding or lying?
  • Touching ears – nervous?
  • Rolling/touching hair ends / correcting hair – nervous?
  • Touching a nose or lips – hiding?
  • Touching chin – thinking? not interested? or very interested?
  • Touching forehead – thinking? nervous? confused?
  • Touching the area between eyes and nose – tired? nervous?
  • How trustworthy is the research/science about intrapersonal touch? How safe it is to interpret all the above?

9. Facial Expression

  • Tornike doesn’t smile a lot
  • He often narrows his eyes and tilts head a bit when listening
  • When he is in his thoughts he may hide his lower lip behind his upper lip as if biting
  • Sometimes if he is genuinely interested in another person he raises both of his eyebrows in the show of approval and interest
  • Tina smiles a lot even at times when she feels anxious or worried
  • She has a habit of raising one eyebrow when she disagrees or doesn’t like something
  • Her cheeks will blush easily when she gets nervous
  • She doesn’t like to be stared at with unexpressive cold face
  • Think of at least three different facial expressions yourself and provide your opinion as to what they mean.

10. Eye Contact

  • Tornike doesn’t like when he is stared at – he often avoids direct eye contact
  • He prefers looking at some visual (screen, board, paper, etc) when talking with another person, rather than establishing an eye contact
  • For him an eye contact is very intimate
  • Tina cannot communicate without proper eye contact
  • She always tries to establish a direct eye contact
  • If the other person is avoiding contact with eyes then she doesn’t really trust that person
  • She always tried to maintain an eye contact for at least several seconds while interacting
  • Think about SOPs in your clinic/unit/work and identify some processes where you may be required to stop eye contact in order to do something else – i.e to use computer to enter specific information while talking with the patient, to use certain medical tools, etc. Can such distractions/interruptions be avoided/minimized to ensure we have our attention toward the patient?
  • How do you think therapists/psychologists are solving the puzzle of eye contact when they are meeting patents?
  • How to behave with children or adults who escape the direct eye contact?
  • Which visuals we may think of using to avoid “too much” eye contact so as not to lose their engagement and keep their attention?

11. Use of Objects

  • Tornike likes when they use visual when explaining something – such as a photo or a model
  • He is not good in using visuals himself but he like when other use those when delivering messages to him
  • For Tina it’s important to touch the model/visual – so she likes when she is allowed to do that
  • She likes the visuals that are more interactive rather than just a photo – as she enjoys “experiencing”, touching, using those, rather than only looking
  • Think of the objects/visuals you may be able to use to explain something – screens, models, photos, etc
  • How do you think the objects you possess at hand may influence the communication?
  • Should we consider drawing something on the whiteboard on on the paper together with the patient as an object/visual? How effective do you think such visuals are when created together with a patient?

12. Use of Own Body

  • Tornike considers it really rude to stretch or crack fingers, or to applause, etc when communicating
  • For him use of own body in such a manner is not appropriate at all
  • For Tina it’s natural to clap hands or express her emotions in some other forms with her body – she may even jump when she’s happy
  • She is never hesitant to use her body as she thinks is the best to express her emotions and she welcomes the same behavior by the others.
  • Think of various norms that affect use of one’s own body in various cultures. Think of the differences and similarities. What are some of the norms in your current social environment? How different are those from the environment in some other countries where you have lived/worked?

Task to Prepare

The task for the next session is for EVERY student in each team to choose one out of the twelve components of nonverbal communication discussed in this module and then to answer the questions that are asked at the end of each component description.

Each speaker will have very limited time of up to 2 minutes max to address the questions and provide examples or argument the answer as applicable.

For a student to receive a grade for this task, the class participation is required with camera/microphone turned on when presenting. Each student presenting should have ONE SLIDE prepare with his/her name on it and with his/her answer – brief bullet points are acceptable, no need for lengthy answers as the time doesn’t really allow that.

Looking forward to seeing you in class with your thoughts and answer on the questions raised above!