"You can't do affect with a still face"

A client recently pointed me in the direction of Diana Fosha and her work on trauma recovery. She comes from a psychoanalytic perspective which is very different than my own training and orientation, and I didn’t know anything about her so I went online and did a little digging. I read a little of her work and I saw that she has her own method called Accelerated Experiential Dynamic Psychotherapy (AEDP).

I really like to hear a therapist talk about their work. It is hard for me to take seriously the insights of a therapist who seems like a jerk, to whom I wouldn’t send a friend or loved one. Hearing the person talk gives me a sense of what it would be like to sit in a room with them as a client. I found this example.

She was warm and personable and very smart and it seemed clear that she spent a lot of time with actual clients and was not solely involved with research. I left the video on while I tidied up in the kitchen. At 7 and a half minutes she said something that made me put down the dishcloth, go over to my computer, and scan back and really listen. And then listen again. She was talking about therapist neutrality and she said: “You can’t do affect with a still face.”

There is a lot in this. Affect is the outward expression of emotion, both what a person says verbally about their mood and all the subtle clues we give off about how we are feeling. So right away she is talking about a therapist who isn’t only focussed on what I say about how I feel but on what I express about how I feel, unmediated by words. One of the limits of talk therapy is talking. It seems pretty evident that some stuff in our minds is harder to get at by talking. Most people have the experience of trying to share an experience with someone else and finding words are insufficient. Therapies that rely only on talk miss important dimensions of human experience. Unfortunately, many manualized therapies are very cognitively oriented, so they often leave out what is harder to articulate or even inarticulable. Psychoanalytic therapy is notoriously ‘talky’ as the client or analysand talks to the quiet, almost silent analyst and slowly, slowly moves to articulate what has been unarticulated, the realm of affect.

The still face is a reference to Ed Tronick’s work on attachment. Briefly, Tronick developed the still face experiment as a way of evoking attachment responses in infants by having the mother show no affect. The video can be hard to watch, so be warned.

Fosha is connecting the affectless parent in Tronick’s experiment to the neutral therapist who refuses to engage on an affective level with a client. This prompted me to think about when I do and don’t connect affectively with clients, when I allow myself to be an engaged, caring part of a two person system, and when and how I hold myself back. It can be hard, now that I am doing therapy remotely, showing concern, caring, warmth to a screen or sending positive regard through a telephone line. Watching this reminded me of how healing the presence of a caring, capable other can feel.

I work on a Mac. I know that when I look at my client’s face, I am not actually looking directly at them and I worry about deepening what can already feel like a gulf. But above my screen are the little round green light and round camera lens. We are so hardwired to find faces that if I squint my eyes, the two odd circles can look like a mismatched pair of eyes, my client’s real eyes, not their virtual eyes. That’s where I look sometimes when I particularly hope to pierce through the ether and isolation and send my client closeness, warmth and regard in the hopes of healing.

Face Power

A few times in my life, at moments of great emotional intensity, I have felt that I could not look at a particular person in the face. It was as if looking at them caused my eyes and mind to burn with a weird emotional fire so that I felt compelled, actually forced as though from outside my own self, to look away.  It seemed to me in those moments that I was experiencing both my own and the other person’s emotions and hearing their ideas, not as voices, but as an unshakable certainty about how they saw me. In a milder form, sometimes looking people in the face, particularly making eye contact, can cause me an itchy uncomfortable sensation, or a feeling of intimacy, or both. This isn’t psychosis. In fact, it isn’t even unusual; I see other people react in much the same way all the time. Reading and responding to a face for signals about another’s mental states is a powerful impulse in infants that is probably biological prompted and that we retain into adulthood.

The psychologist Simon Baron-Cohen writes about how most humans, from a very early age and as part of a biologically driven process, develop a complex series of perceptual and psychological tools for “mindreading;” understanding first that we and other people have all sorts of inner states and second, for making good guesses at what those inner states are and finally for understanding that different people will have different inner states. We have a powerful natural drive towards psychology. This is also sometimes called “mentalization.” Baron-Cohen makes the case that much of this is done through paying close attention to another’s facial expressions, particularly, the direction of the other person’s gaze.

He posits that the sub-skills of mindreading are developmental. If you have a watched a 15 month old go up and down stairs over and over and over again, you know the power of development. Human (and other animal) babies at a young age spend a lot of time looking at other’s eyes to assess where they are looking. Later children will point at an object that interests them to encourage another person to share attention, then look back to see that they are looking both of which are ways for children to develop an understanding of what is going on in another person’s mind. They seem to do this without being taught to do so. Early on, we have an innate urge to build mental tools for accessing another’s mind via their face.

In many ways Baron-Cohen’s model of mindreading is similar to John Bowlby and Mary Ainsworth’s model of attachment; the biological drive of infants to form a mutual connection with a caregiver. Both are biological drives of early childhood towards a social and psychological model of the world. It is interesting that Baron-Cohen doesn’t connect ‘mindreading’ with attachment since it seems that one of the early important functions of mindreading is being attuned with one’s caregiver. It would also help explain the intensity of emotional responses people have to facial cues from their partners in conflict; these are attachment responses.

When couples fight, I have observed a curious thing often happens. They often become very preoccupied with their partner’s state of mind. “Look, he’s so angry right now. Do you see how she’s thinking that I don’t do my share around the house?” Sometimes when people are talking about very hurtful experiences from their past, they will assume the voice of the person who hurt them and take on the voice of that person, mimicking it and amplifying its negative tone, its hurtful cadences, pausing to add in what the person was thinking when they said this. They also tend to exaggerate the facial expressions of the person. They particularly echo or exaggerate facial expressions that connote contempt.

Consider the eye roll. Holy smokes, can an eye roll ever escalate a conflict in couple or a family. The couple’s therapist and research psychologist John Gottman talks about the corrosive power of contempt deployed in arguments, usually expressed non-verbally such as an eye-roll, to poison a relationship. I suspect that there is something about the primal nature of face/mindreading and attachment processes that makes negative facial micro-expressions, particularly the eye-roll so dysregulating.

Partners are very good at reading one another’s non-verbal cues, particularly fast, involuntary facial expressions, or “micro-expressions” and most particularly their eyes. We have the idea that when we see these negative micro-expressions we are seeing the truest expression of our partner’s feelings about us. People believe that because these expressions are largely involuntary they have more weight than all the voluntary, willed behaviours of the other person, such as offering support or kindness. In this weird emotion-logic of arguments - ‘what is not willed is more true than what is done deliberately’ - the eye-roll has a special place because it is partially but only partially, involuntary, a silicon semiconductor of micro-expressions. A hurt partner can understand an eye-roll as both a willful act of cruelty and a revelation of a partner’s hidden contempt for them.

I once read a psychologist refer to “hypermentalization” meaning over-interpreting another’s mental states, particularly negative mental states. They went on to joke about “excrementalization;” meaning a shitty ability to read another’s mental states. That’s what we do when we are in a fight with our partner; we excrementalize. We tend to accurately see negative expressions that cross our partner’s face but completely miss or minimize expressions of neutral or positive mental states. If my partner thinks “I’d like to strangle him,” and that causes her to raise her eyebrow in a way which betrays her thought to me I don’t credit her for NOT SAYING a hurtful thing, for refraining from being nasty. If she then sincerely says, “I love you and I want to work things out” both in words and in facial expression, I will probably remain focussed on the eyebrow-raise as a true expression of her emotion and the rest as unimportant or even more destructive, as a lie.

If you understand from your partner’s look that they are pissed off or resentful of you, it may be useful to remember that your understanding of their expression may be very accurate, the product of a well-built and primal system for mindreading and checking on connection to the one you love. But it is almost certainly incomplete. When we are in conflict, with our attachment responses pumping and our mindreading on high alert for negative we see, correctly, that the glass is partially empty, and reject the 93% that is full. In that circumstance, force yourself to look for information that may disprove your idea about your partner.