ABSTRACT: Therapists' use of dynamic facial expressions and proximity during interactions with older adults can increase rapport and improve client performance. The purpose of this pilot study was to examine music therapy students' (n = 6) and professional music therapists' (n = 4) use of facial expression and proximity during song leading with older adults. Therapists and students were either videotaped or observed leading interventions, and factors relating to facial expression and proximity were analyzed. Professional music therapists varied their facial expressions during significantly more intervals than students, χ^sup 2^ (1, 44) = 5.81, p < .05. Graphic analysis of proximity data indicated that professionals and students approached clients at similar rates, but students spent more time moving away and maintaining distant positions. Thus, professionals maintained close proximity to clients longer than students. Additional research is needed to determine the clinical relevance of music therapists' nonverbal behavior.
Music therapists use nonverbal means of communication with clients in conjunction with musical and verbal ones. Amir (1999) concluded, following her qualitative investigation, that musical and verbal interventions have their "own unique meaning and power" (p. 173). Other researchers have investigated the amount of time occupied by musical and verbal aspects in music therapy (Darrow, Johnson, Ghetti, & Achey, 2001; Wolfe, O'Connell, & Epps, 1998). Wolfe et al. (1998) found the mean percentage of time in sessions occupied by music and music therapist's verbalizations were nearly equivalent during group sessions. By contrast, student music therapists spent more time engaged in verbal rather than musical behaviors across individual and group sessions with varied clientele (Darrow et al., 2001). There is a paucity of systematic research investigating the use of nonverbal behaviors by music therapists during clinical intervention. Therefore, the current review of literature and pilot study were undertaken.
Research has been conducted on nonverbal behavior in areas relevant to music therapy. Research indicated that through nonverbal behaviors, especially facial expression, gestures, and proximity, health care providers influence communication and increase understanding (Ambady, Koo, Rosenthal, & Winograd, 2002; Buller & Street, 1992; Caris-Verhallen, de Gruijter, Kerkstra, & Sensing, 1999; Caris-Verhallen, Kerkstra, & Sensing, 1999). Nonverbal behavior is often used to establish rapport with others and improve or enhance communication in our daily social interactions (Tickle-Degnen & Rosenthal, 1992). Furthermore, a patient's satisfaction with his/ her treatment was a result of the health care worker's nonverbal behaviors (Griffith, Wilson, Langer, & Haist, 2003). Conversely, therapists can decrease a client's treatment outcome by remaining seated or failing to smile at a client (Ambady et al., 2002). Though there is an extensive repertoire of nonverbal behavior, facial expression is recognized as one of the more common forms of nonverbal communication.
Facial Expression and the Effects of Aging
Researchers have investigated the role of facial expressions in communication and the effects of positive facial expressions (Ambady et al., 2002; Blairy, Herrera, & Hess, 1999; Frank, Ekman, & Friesen, 1993). Frank et al. (1993) found that the physical differences in enjoyment smiles, defined as spontaneous smiles, versus nonenjoyment smiles, defined as those that are forced or posed, were observable and even influenced others' perceptions. Those who evinced enjoyment smiles were seen as more positive and seemed more expressive, natural, outgoing, sociable, relaxed, and pleasant than when they evinced nonenjoyment smiles. Researchers found that smiling positively resulted in trust among strangers; they also found that facial features affected cooperation, regardless of smiles (Scharlemann, Eckel, Kacelnik, & Wilson, 2001). …