The Art of Nonverbal Communication in Practice : The Hearing Journal

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Nonverbal Communication

The Art of Nonverbal Communication in Practice

Hull, Raymond H. PhD

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The Hearing Journal 69(5):p 22,24, May 2016. | DOI: 10.1097/
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Nonverbal communication can be more powerful—and even more influential—than what we say with words, and can have a tremendous impact on our success as hearing health care professionals.

Experts in interpersonal communication have estimated that nonverbal communication constitutes approximately 70 percent of what is involved in communication. In other words, only about 30 percent of communication involves the actual words that we use. Placing the impact of nonverbal communication at 93 percent has been deemed a little high, however, so a safer level is thought to be around 80 percent—which is still quite an impressive figure. This means that only 20 percent of the impact of our communication is from the words that we use.

The nonverbal aspects of communication were undoubtedly an important part of relaying information when Homo sapiens began engaging in social behavior during prehistoric times. The nonverbal aspects of communication have been basic to survival since time began. Even Charles Darwin was involved in the study of nonverbal communication. In 1899, he published “The Expression of Emotions in Man and Animal,” in which he concluded that nonverbal communication was a primary “mode of delivery,” and placed verbal communication as simply an extension of the nonverbal form.

Thus, our body language, our facial expressions, our voice, and the way in which we present what we say to others are all extremely powerful. We must know how to present ourselves in a positive, constructive, nurturing way—our manner of presentation of ourselves.

Raymond H. Hull, PhD

Nonverbal communication takes a number of forms, from how we walk into the examination room where an interview with a new patient is to take place, to how we sit when communicating with others, and the gestures we use when we are talking. The following will give you suggestions on how nonverbal communication can have a positive or negative impact on our ability to interact communicatively with our patients, their families, and our colleagues.


What we call “the two-minute rule” is a critically important part of nonverbal communication. When we enter the examination room where we are to see a patient, or enter a boardroom for an interview for a new position, those in attendance will determine their appraisal of us within the first two minutes of our entering their space. This includes our manner of dress, how we enter the room, our eye contact, how we stand or sit, and our use of gestures when we speak. And that initial appraisal is difficult to erase.

Maintaining poise and calming bodily mannerisms will help to create a comforting atmosphere for those with whom you are communicating. If you act nervous when you enter the room, those in attendance will feel it and probably reflect it back on to you. It's contagious. They will be just as nervous as you are, and will probably not enjoy what you have to say.

Charles Spurgeon, one of the greatest communicators of the last century, often told his students, “When you talk about heaven, let your facial expression reflect joy and excitement. When you talk about hell, your normal facial expression will do!” What he was saying, in a rather humorous way, is that communication involves far more than just words—it involves our appearance, our poise, and our manner of presentation of ourselves to those with whom we are communicating.

We tend to reflect what we are feeling, and that feeling reflects onto those with whom we communicate. If we are feeling frustrated and angry, those who are listening to us may also tend to feel frustrated and angry along with us. If we are happy to be there, and express the joy of interacting with our listeners by our facial expressions and bodily mannerisms, those who are listening to us will tend to pick up on that joy and feel joyous in return.

Therefore, we sometimes need to make a mental adjustment—an attitude change—before we enter the room where we are to communicate with one of our patients. If we're not happy, we need to get happy. If we are nervous—well, being a little nervous can keep us on top of our game. Controlling it is the important part.


It is important to remember that we must maintain an appropriate distance when we are communicating with others—not too close, but yet not too far. Thirty inches is just about right—no more and no less. A while ago, I was speaking with my 17-year-old daughter, trying to get what I felt was an important bit of advice across to her. After I finished, I asked her if she understood what I had just said. After a slight pause, she said, in all seriousness, and with perfect eye contact, “Dad, you are standing in my social space.”

After all that I had just told her, that was her response! I realized then that I was standing closer to her than my usual distance, but was not aware that I was standing in her “social space.” So I apologized and stepped back at least one step. At that point, I again asked her if she understood what I had just told her. She admitted that she had absolutely no idea. The fact that I was standing in her social space took priority over hearing and comprehending anything I had just explained to her.

Remember, being too close can be bothersome to the one with whom we are communicating. On the other hand, if we are too far away, the listener may feel disenfranchised, and for the opposite reason, we lose ground in our effort to communicate.


Our posture can reveal to others things we did not intend to reveal. Our posture reveals what we are feeling. I am thinking here about meeting with a patient, interviews, or even a friendly conversation in the break room over coffee.

For example, while sitting and listening to what another person is telling us, leaning too far forward—with shoulders hunched, elbows on the table, our face cradled in our hands—indicates that we have already decided against what is being said. We're bored. Or we've stopped listening.

Leaning too far back in our chair with our hand covering our mouth may indicate hostility toward the speaker's ideas, or questioning their logic. We are withholding our remarks by covering our mouth.

I tell my audiences that if we are standing and listening to someone who is speaking to us, it is important to stand with feet approximately 18 inches apart. If our feet are too close together, it can appear that we are about ready to fall, or have assumed a ballet pose. If our feet are too far apart, it can appear that we are about to attack, fight, or are trying out for the football team. Feet kept about 18 inches apart gives the appearance of a comfortable stance—our feet are not too close together and not too far apart. The same stance is important when we are giving a presentation to an audience. It tends to give us an appearance of confidence, and shows that we feel comfortable being there.

In other words, what we are when we communicate with others—how we listen, how we appear, how we sit, how we stand when we are communicating—make up the “stuff” of communication. If we overlook any of those, communication may frequently simply not take place, or at least may be impaired.


Our arms, hands, legs, and feet reveal a great deal about how we are feeling in regard to what we are listening to as another person speaks to us. For example, arms folded across the chest, especially while standing, can indicate resistance. Playing with fingers and nails while sitting can indicate that we are not really listening to the other person. We are simply giving ourselves something to do until the other person finishes talking. Legs crossing and uncrossing, or heels or toes tapping, are all negative clues—perhaps that we are nervous, or that we are ready to leave.

Do not put your hands in your pockets, or have them clasped behind your back. Holding them in those positions causes us to appear that we are hiding something, or that we are bored. Our hands can be folded in front of us at the level of, or just below, our waist. This appearance indicates that we are listening openly, and we are interested in what our patient or their family member is saying to us. On the other hand, don't let your hands dangle at your sides. We tend to slouch when we hold them in that manner, and we take on the appearance of being tired.

Most importantly, never look at your watch, no matter how much you are tempted to. It is a definite signal that we have stopped communicating, and it is time to leave.

If you find yourself in a situation in which shaking hands with others is essential, it is very important that we control our handshake—make sure it is not limp or overly soft, nor overly firm as to cause pain. A “moist-clingy” handshake can repel people faster than one that is too firm. A handshake that denotes sincerity and genuineness is slightly firm, warm, and not overpowering. Placing your other hand over the hand of the person with whom you are shaking hands is appropriate on occasion, but can appear too personal to some people. Use it only when you feel that it is appropriate.


Our eye movements are important giveaways to what is going on in our minds. For example, lack of eye contact, or frequent glances to one side or the other, indicate serious disagreement, disinterest, extreme nervousness, or a thought-provoking “Why am I here?”

Eye contact is a very important part of interpersonal communication. Our eyes give us away. If we are talking to someone of the opposite sex, and as we are talking we are looking intently into the person's eyes, a sense of intimacy is established that we, or they, may not desire to have established. If our eyes stray below the other person's neck, however, we may appear to be looking at areas of the body that can make the person with whom we are speaking feel uncomfortable.

I tell my audiences—and we do some practice in this area—that the best area of the face to focus on while speaking to another person is the nose. When I am speaking to an audience, no matter how large or how small, I make eye contact with as many in the audience as I can by concentrating on their noses. By concentrating on the nose, it appears that we are concentrating only on that person and no one else. We aren't looking into the person's eyes, which may be too intimate, but we are concentrating on the person's face. It is a comfortable location for both of you, and it is what I do when I am talking with one of my patients.

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