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10 The Linguist APRIL/MAY www.iol.org.uk FEATURES non-manual features. There might also be disparity between the facial expression and the intensity of the sign.' In a session with a hearing therapist and a hearing client, the two may be facing each other (so the holding or breaking of gaze may be significant) or the client may be on a couch with the therapist behind her, so that gaze plays no immediate part. This is clearly not possible in a BSL-mediated session, where client and therapist must always have each other in view (and, as Pauline notes, where good lighting is crucial – the dim 'mood lighting' that can enhance other settings actually hampers therapy in BSL). However, while gaze is vital, it can prove problematic if sustained when the client is struggling to continue with the session. Pauline reports that one client asked her to turn away when they felt particularly distressed, which effectively halted the session. Suzanne agrees that avoidance of eye contact often signals an area that is uncomfortable or painful for the client. However, Pauline adds that initially uncomfortable reactions from clients – such as returning her gaze defiantly, laughing, or signing fear or confusion – can act as a springboard: 'Demonstrating my own comfort and acceptance in silence seems to help the client to stay with whatever feeling is coming up,' she says. 'Growing comfort with eye contact in silence usually signals a positive shift for the client.' Talking – and listening A monolingual therapist pays attention not only to what the monolingual client is saying but also to how they are saying it, with paralinguistic features, such as pace and volume of speech, eye-contact and body language, equally important. That dual focus of attention is multiplied when more than one language is involved, with the therapist also attending to factors such as forms of address and shifts between languages. The BSL therapist must be able to focus on the whole body while also following the client's lip patterns and signing in a very specific area of the body. 8 Complex listening or attending skills are just as vital an ingredient as the actual talking in a 'talking cure' – and where more than one language is involved, those skills are more demanding and complex still. Notes 1 www.britannica.com/EBchecked/topic/ 79009/Josef-Breuer 2 www.mentalhealth.org.uk/help-information/ mental-health-a-z/T/talking-therapies/ 3 I follow the Mental Health Foundation's practice of using 'therapy' and 'therapist' as shorthand for the full range of approaches and professionals in this area 4 See, eg, Chung, A, 2007, 'Daring to be Different. An exploration of cross-cultural counselling' in Therapy Today, 18 (4); and Jimenez, J P, 2004, 'Between the Confusion of Tongues or the Gift of Tongues: Or working as a psychoanalyst in a foreign language' in International Journal of Psychoanalysis, 85 5 www.mothertongue.org.uk/ 6 Costa, B, 2010, 'Mother Tongue or Non-Native Language? Learning from conversations with bilingual/multilingual therapists about working with clients who do not share their native language' in Ethnicity and Inequalities in Health and Social Care, 3 (1) 7 Dewaele J M & Costa, B, 2013, 'Multilingual clients' experience of psychotherapy' in Language and Psychoanalysis, 1 (2) 8 For more information, see Corker, M, 1995, Counselling. The Deaf Challenge, Jessica "To avoid a feeling they may well want to use the more 'remote' foreign language to create a distance" difficult area, but Suzanne and Pauline agree that plenty of other indicators suggest emotional arousal. Suzanne comments, 'Body language and facial expressions will indicate when a client has moved into a different [emotional] area: for example, if a Deaf person becomes angry in a session, their signing could become more animated, with their facial expression indicating that the predominant emotion is anger, not excitement, or body language may become closed, signalling that the client has moved somewhere uncomfortable or difficult.' Pauline expands on these linguistic and paralinguistic indicators: 'Signing may become very small or very large, speed up or slow down, become hesitant with [the client's] fingers wiggling, cheeks puffing out and lips pursing as they fight the urge to sign something revealing.' Other clues to the client's internal state may include 'head movements and breathing patterns, shrinking or closing off of the body, turning away, head dropping or tilting back, nose-rubbing, jaw- tightening, hiding their hands, stamping a foot or involuntary repetitive movements, particularly of hands or feet.' Coming face to face All therapists – and in particular those trained in certain theoretical models – are mindful of all aspects of body language as a means of expressing emotions, but a BSL therapist has to focus on the client's entire body while still directing attention to both the face and the all-important signing space to register the full import of what is being signed. As Pauline notes: 'It's important for the [BSL] therapist to understand that a range of emotions may all have the same sign but that the meaning is changed by the intensity, speed or repetition of the sign, alongside © ISTOCKPHOTO