Yawning: Analytic and Therapeutic Considerations

A thirteen-year-old patient is presented, to demonstrate how the active analysis of nonverbal expressive behavior, in this case yawning, was of value in understanding and treating a youngster who, because he was so withdrawn, would not otherwise have been amenable to the standard one-to-one psychotherapeutic approach. In discussing the clinical material, the literature concerning nonverbal expressive reactions, particularly in respect to yawning, is reviewed. In the process the psychogenetic, dynamic, structural, energic, and adaptive aspects of yawning are described. It is the author's opinion that only by focusing on specific non verbal reaction such as yawning can the unwieldy task of ,naking some meaningful statement about a manifestation as protean as the nonverbal in therapy occur. boy's presence was responsible for his wins or losses. This may partly explain Ray's belief, which emerged in therapy, that he could exercise magical powers simply by passively existing. After approximately two years of treatment, the boy's initial therapist decided that given Ray's rejecting mother and disturbed father, nothing more could be done unless Ray were removed from the parental home. As staff psychiatrist at the Jewish Child Care Association, which subsequently became responsible for Ray's care, I started to see the boy on a twice-a-week basis, six months after he was placed at a small group residence. The new course of treatment following placement did not begin auspiciously. Ray was not happy about having to live apart from his mother. Session after session, he sat silently staring and yawning. Rather than agree with Ray that nothing was worth talking about, and rather than discuss reports of his continual failure in many areas outside the therapy (something that had been done by others, resulting in further lowering of his already lowered selfesteem), I simply described Ray's immediate nonverbal behavior to him. In response to this, Ray, somewhat annoyed, spoke of how he felt he was always being unjustly criticized for everything he did. I tried to point out that I was not criticizing him but merely making "observations." I only partially succeeded in convincing Ray of my sincerity because, in actuality, I had been mildly disconcerted by his extreme passivity. At about this time I began to receive information that outside therapy, Ray had begun to improve in his ability to more actively enjoy himself. Within the treatment, with continuing feedback about his behavior, Ray now became increasingly somnolent and withdrawn-making it almost impossible for him to follow the simplest conversation. Yawning during sessions became more and more pronounced and, in keeping with a decision to comment upon whatever the patient brought to sessions, yawning at this point became the major focus of the therapy. Ray at first insisted that yawning was in no way significant. Although continuing to yawn, he did perk up a bit when I evidenced real interest in what he was doing. Ray then admitted to feeling more relaxed when he yawned. He also explained that yawning was a way of influencing the person at whom the yawn was directed. The infectious nature of the reflex was seen to be an important aspect of its dynamic. This formulation was an outgrowth of Ray's own hesitant associations (increasingly verbal in nature) about what he was doing. The patient said he was troubled since he noted that I also yawned. He did not know whether it was he who influenced me or vice versa. Passive dependency was seen to be linked with a concern about being controlled or controlling others. Pursuing this theme, Ray beamed when he announced that he would like to dominate me, that is, put me to sleep; but felt that he, of all people, could never influence anyone. Because his social withdrawal and boredom had always been experienced by others as a psychological null factor, this underlying fantasy of dominating other people had never been made explicit. This clarification allowed therapist and patient to understand how passive-dependent states may screen very active fantasies of omnipotent effectiveness. Further analysis of yawning proved to be a rich source of information about the complexity of his passive-active strivings. Ray mentioned that he was puzzled by the fact that he could not make any noise when he yawned. I speculated that early in life, perhaps when he was very young, he either did not want to hear a certain sound or was severely reprimanded for making noise. Following this comment, the patient was amused to find that not only could he vocalize when yawning, but that he had become more verbal in his communications outside the therapeutic setting as well. It could not be verified whether the psychogenetic reconstruction had been accurate; nonetheless, Ray remembered that his mother had always been impatient of any of the verbal demands he made. It was easy to see why Ray was so taciturn. The analysis of his yawning made his passivity more understandable. The patient claimed at this time that his therapist must be a mind-reader. Ray also believed that he could read and control the therapist's mind. He was convinced that he yawned because I was thinking he would. He was also convinced that by thinking sleepy thoughts, he could force me to yawn. His preoccupation with mind-reading, with thought and behavior control, was clearly involved in his compulsive yawning. The patient was encouraged to describe all the nonverbal cues that initiated yawning, and he gradually became aware that he had generally made interpersonal exchanges more magical than they really were. The magic depended on the unconscious nature of Ray's subliminal awareness of people's nonverbal