Tired or Bored: When Your Therapist Yawns
A number of interesting articles on yawning appeared in the April issue of Neuroscience and Biobehavioral Reviews. In them the authors discussed the physiological and social aspects of yawning. There are many theories about the physiological reasons for yawning, such as;increasing oxygen to the brain when we are not breathing sufficiently, helping to cool down the brain to prepare for sleep, reducing physical arousal when we are tired, popping our ears to equalize air pressure. All of these and other physiological theories have not been proven, so scientists are still pretty much in the dark when it comes to understanding why we yawn. One thing they can all agree on, however, is that yawning is very contagious. When one-person yawns, chances are another person who is looking at them will also yawn. In following the contagion theory, scientists are now wondering if yawning is less about physiological reasons and more about social relationships. One hypothesis is that yawning is a form of communication - letting others know about our mental and physical state. Because it's so contagious it helps us to understand immediately what other people are feeling without having to guess, think about it or even use language.
One thing we all know about yawning, is that we tend to do more of it when we are tired or bored. So most people assume that when they see a person yawn one or both of these are occurring. So what is going on when your therapist yawns? Being a psychotherapist is not an easy job, although it may look otherwise to the untrained eye. Therapists sit with people who are anxious or depressed throughout their workday, which can take a psychological and physical toll on the therapist. If a therapist has seen six patients or more and you're their seventh appointment, there is a good chance a certain amount of fatigue has set in. When patients ask why I don't have evening hours I tell them, "You don't want to see me in the evening." What I am saying implicitly is that I am not at my best at night.
When I train psychology and counseling students, I often discuss how pacing is very important in managing the workday. For example, I have a long break between my morning patients and afternoon patients so I can invigorate myself with a nap or a walk or both. But even then, if I had a difficult night sleeping or just a particularly difficult day, I still may be more tired in the afternoon than normal. So fatigue is not out of the realm of possibilities for therapists, which can lead to yawning.
But there is a more powerful reason for a therapist to yawn with a patient, whether they are fatigued or not, and that is related to the state of mind of the patient. Neuroscientists have shown that our brains are wired to communicate with other brains. The study of mirror neurons has shown that our brains routinely communicate emotions and intentions without our needing to use language. I discuss how this works in detail in the article, "Is this me or you I am feeling". Mirror neurons are cells in our brain that pick up the emotions of others. When they are active, they not only trigger the same emotion centers in our brain (as the person we are observing), they activate the same muscles in our face and body, as if we were to mirror the same emotion as the person we are observing. This not helps us to understand the process of empathy (I feel your pain), but it also helps us understand why watching another person yawn makes us yawn in return.
So let's get back to yawning therapists. Typically, the patient comes into their session and starts to talk about what's on their mind. But what if the patient is really tired, but not aware of it? What if the patient if feeling bored about what they are talking about, but not aware of it? What if the patient does not want to talk about what's really on their mind, so they talk about something else instead - something safer and easier to talk about? What if the patient is emotionally disconnected and unaware of their state of mind altogether, but fills the time with material to be a "good patient?" If any of these situations are true it is very possible that the patient's disconnection, boredom or avoidance of their emotions will activate the therapist's mirror neurons, leading the therapist to feel disconnected, bored or beginning to avoid talking about important things. When I get bored or emotionally disconnected I feel tired. And that tired feeling can lead to a yawn. Let me tell you a story about a particular patient that will help you understand this process.
Not too long ago, when I was sitting with a patient who was talking about her day at work (it was an evening time slot, which I have since stopped working - I have learned that I am too vulnerable to mis-attunements with patients after 6PM). I was finding my thoughts drifting, thinking about my grocery store shopping list on my way home from work. After deciding that I wasn't ready to buy an iPad, I realized how much my mind was drifting away from the patient. In my early years of practice, I might have just refocused and maybe mildly criticize myself for not paying attention. But instead, I asked myself a question. Why am I drifting away? The answer to that question was sitting right in front of me.
My patient was drifting from the issues she needed to talk about (her extreme loneliness and difficulty meeting others). My mirror neuron system was simulating her state of disconnect in me. I was feeling what she was feeling, or not feeling as it were in this case. At that very moment of awareness, I started to yawn. I couldn't stop it, although I did try. It was so contagious, she yawned right away (mirror neuronsat work). I felt quite embarrassed. She smiled as if to forgive me. Then she apologized for boring me.
At first I responded that she wasn't boring me, that it was long day. But I realized almost immediately that wasn't quite true. So I corrected myself and said, "I was feeling disconnected not bored." She asked me, "What's the difference?" I told her that when I am connected with my emotions I feel anything but bored; I feel energized and alert. I went on to say that I thought that she had been experiencing something, and that I was feeling it too. This led us to talk about how she was feeling guarded coming into the session, which led her to talk about things that weren't really important to her. From that minute on, there was nothing boring or disconnected about the session. We were back in sync, but this time, in a constructive way.
Unfortunately, there isn't an easy answer to the question, "Is the therapist bored or tired?" As Freud once said, "Sometimes a cigar is just a cigar." But sometimes it's not. Sometimes a yawn is a yawn, but sometimes not. The only way to really know is talk about it with each other. Of course, this can be true between partners as well as friends. If someone is emotionally disconnected,whether they are aware of it or not, the other person might begin to feel that disconnection (whether they are aware of it or not). And if so, a yawn may be the beginning of an interesting conversation that is anything but boring.
The Tired Therapist - Daniel Sonkin - Aug 9th 2011
Thanks for sharing your experience and your question.
I can't really say what your therapist was up to, but your hypotheses may be right on the mark. If you were very, very tired, it is certainly possible that your therapist was "feeling" your exhaustion and showing you in his behavior.
I am not the kind of therapist who is provocative in this way. I would just be inclined to say something to you like, "I am feeling very tired as we talk, I wonder why that is?" Hopefully it would open up a line of discussion that would be very productive.
Most importantly, when you have questions about what a therapist is asking you or doing, its important to be direct and ask the therapist why they are saying or doing something. The most robust predictor of positive outcome in psychotherapy is the therapist-patient relationship. Like all successful relationships, that involves honest and direct communication with each other. Reseach on therapy suggests that miscommunications are very common in therapeutic relationships (like all kinds of relationships), so clarification is necessary to make sure we understand each other.
Most importantly, I hope that your sleep problem resolved. There are programs around the country (eg, UCSF in San Francisco) that have sleep disorder clinics. Most therapists are not trained in this highly specialized area of treatment. So if your problem persists, I would recommend looking into one of these programs.
Thanks again for your comment.
Thanks, Kevin - Daniel Sonkin - Aug 9th 2011
Thanks for taking the time to comment, Kevin. I'll look up that Casement article that you mentioned.
Yawning - Kevin Friery - Jul 3rd 2011
Patrick Casement wrote a very elegant vignette about a piece of clientwork in this arena. I can't recall whether it was in "Learning From the Patient" or the follow-up "Further Learning....". He used it as a way of exploring projection, whether the client was expecting people to find her boring, (but expands on this in a better way than I am able here). I think it is a good addition to this excellent post...
Do therapists use yawning as a technique? - - Jul 1st 2011
I used to go to a psychotherapist who would yawn and stretch or look away from me constantly during our sessions. At the end he would look at the clock and say "God, you've been talking for an hour!" It seemed a little put on and since it was so socially inappropriate to be like that I assumed it was a technique but I wasn't really sure what he was looking for or how I was supposed to react. It felt weird trying to react to an act when all that was in my mind was "that's an act. I wonder what he's getting at"!
However, at the time I was seeing him, I was habitually staying awake for around 35 hours at a time on average 3 days a week. It was very severe insomnia and it went on for 18 months all in all. It's possible he was actually reacting to my exhaustion, I suppose, although I was probably pretty boring too! :-) I was feeling very disorientated and confused (mostly sleep deprivation, though) so I wasn't the best patient. I sort of just went off on hours of tangents because I couldn't focus on anything I was saying and I couldn't concentrate enough to work out the answer to any question he asked.
This was an interesting article, but I wonder whether you'd know what my therapist was trying to do? It did look very much like he was putting it on. It seemed he was overacting.