Process-oriented research is an important part of modern psychotherapeutic research. Nevertheless, there remains a long way to go in order to fully understand psychotherapeutic processes in the treatment of mental illness. In particular, the investigation of so-called therapeutic micro-processes, small but essential aspects of the patient – therapist interaction (especially facial micro-expressions), could bring promising insight into the mechanism of psychotherapy, as well as allow identification of specific factors essential to successful psychotherapy, regardless of the types of psychotherapeutic methods used.
Studies show that 60–80% of all communication (in treatment) is nonverbal (1, 2). Many nonverbal events are unconscious and often convey a patient’s emotional and psychological state in a way that verbal communication cannot (3). In any given interpersonal interaction, a great number and variety of facial expressions are normally present (4); unfortunately, many of the visible expressions in conversations of two or more people are often inauthentic and very consciously controlled. Micro-expressions, on the other hand, can neither be controlled nor be voluntarily displayed, and thus offer a truer view into the genuine feelings and emotions of a person. Discovered in the late 1960s by Paul Ekman, micro-expressions are defined as facial expressions of brief duration, lasting only for one-quarter to one-half of a second (5), and can be understood as either repressed or unconscious expression of emotion (2, 6). Ekman’s research led him differentiate and name seven universal or basic emotions, expressible in the form of micro-expressions: Happiness, Surprise, Anger, Sadness, Fear, Disgust, and Contempt. In the context of psychotherapeutic interactions, the fact that micro-expressions are signals perceived unconsciously and can influence the patient-therapist relationship dynamic makes their investigation worthwhile.
What’s more, therapy sessions with higher levels of nonverbal micro-affectivity have been rated as having more impact on patient outcome (7). If that is the case, it shows that common methods of analysis between cognition and affect might be incomplete, as they do not capture the speechless forms of affective expression. In addition, subconscious interaction patterns are implemented trough nonverbal signals. If the therapist is able to resist this relationship offer verbally as well as nonverbally, then pathological relationship patterns may be prevented, which in turn may increase the probability of successful treatment (8).
In this light, it seems promising to investigate the association between verbal psychotherapeutic interventions and the involuntary facial micro-expressions provoked by them (9), especially as it pertains to the working alliance, as this may allow us to better evaluate the effectiveness of certain interventions in therapeutic settings. Here below, we describe our novel method of how to measure and evaluate these micro-processes, with some preliminary findings obtained by applying them on a small sample study population.