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Effective clinical interaction with patients and clients draws upon the same cues and skills necessary for successful interaction in daily life. However, interacting with individuals with health conditions that reduce facial expressivity (such as facial paralysis, autism, cerebral palsy, or Parkinson’s disease) requires additional skill and awareness because typical heuristics may lead to mistakes reading emotions when interacting with these individuals. This chapter will introduce important concepts related to person perception that can inform effective clinical interactions with individuals with reduced emotional expressivity, particularly in the face, with a focus on biases that may arise when interacting with individuals with expressive conditions and strategies to address those biases. In the words of biologist Adams A. Wilkins: “The human face is highly distinctive not only in its set of physical features compared to our animal cousins, but also in being the most expressive face of any creature on Earth, and as such it plays a crucial part in our social existence.”1 The clinical encounter is a specialized social interaction that is of great importance to personal and population health. The information in this chapter not only pertains to interactions with clients with reduced facial expressiveness. It is also useful during clinical encounters with clients without expressive disorders because people tend to use the same heuristics when interacting with a variety of other people. Regardless of whether the client has a health condition that affects facial expressivity, clinicians must be cognizant of the critical role the face plays in the effectiveness of clinical decision making and the outcomes of the encounter.
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As a normal part of interactions, people make social judgments about others. For example, a clinician might want to determine if a new client seems like a reliable reporter and capable of adhering to recommended treatments. We use information from others, like if they are smiling or not, or if they are talkative or quiet, to form our first impressions of them. Sometimes these first impressions may be correct and other times they may not be. For example, we might assume someone is competent and through our interaction discover that they are successfully managing their chronic health condition, or we might find out that a person who seemed competent is not adhering to treatment or does not understand their condition. Some of the challenges of effective clinical encounters are determining which information to use when forming impressions of clients, and then determining if impressions of clients are correct. Accurate impressions are critical to establishing a working alliance between client and clinician for developing an effective treatment plan that promotes adherence and healthy outcomes.2
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Research has identified different channels, or different methods, that individuals use to read emotions and form first impressions in clinical encounters and daily life. Verbal cues refer to the content of speech (e.g., someone saying that they are happy). Nonverbal cues include information such as facial expressions, gestures, posture, ...