Use Vocal Tones as a Container to Build Better Understanding

Alexandra Mitnick, LCSW

PACT Level 3 Therapist

Hmm. Oooh. Aaah. 

Writing a blogpost about the importance of using sounds as a technique or intervention within couples therapy is challenging. When I asked my colleagues for the best ways to describe these sounds, their replies varied: Motherese. Emotional prosody. Non-verbal bursts. These are all terms that describe non-linguistic sounds that rely on pitch, timbre, volume, stress patterns, and intonation to communicate emotion and attunement between client and therapist and, more importantly, between partners in a couple. Often, reverberations resemble those between mother and baby. The value of using these vocal tones to hold the couple within a container and move them closer toward secure functioning is potent and worth sharing.

The Importance of Vocal Tonalization     

The intention for the therapist in using sounds is two-fold. First, referencing Accelerated Experiential Dynamic Psychotherapy (AEDP), Diana Fosha tells us that by allowing our clients to deeply impact us — our heart, our breathing, our internal awareness — and communicating this through the use of empathic vocal sounds and vibrations, as mother does with baby, our clients have an authentic sense that they are not alone, that someone is tuned into their experience. Knowing that their experience deeply resonates within another, our clients' defenses can soften and move deeper into core emotion.

Additionally, the couple is not usually looking into our eyes as their PACT clinician, but into the eyes of their partner. So, one way for the individual in the couple to know how they’re impacting us as clinicians is through the sound of our voices — not our words but our sounds. In fact, using words themselves can sometimes be distracting, triggering, or cognitive. Using words may even move our clients back up into their heads and well-established childhood defenses.

Using non-linguistic vocalization or emotional prosody, focused on timbre, volume, and tone, is one way to help our clients regulate and transition into deeper physiological states. It is not always easy as clinicians to move from session to session being emotionally available and vulnerable, but when we can access this part of ourselves, the work tends to move deeper more quickly.

The second intention of using these vocal vibrations is to create a container to weave, stitch, and sculpt the couple together — to move them into a coordinated state of mutual resonance, co-regulation, and attunement. Below is a case study to exemplify this technique and an assessment of the case using PACT principles.

Case Study: Sculpting the Couple Toward Secure Functioning

John and Beth are a married, hetero-cisgender couple in their mid-50s. John is a measured, quiet avoidant-type (island) engineer of French-American descent. His parents were well-educated, performance-oriented, emotionally unavailable, and highly critical. They had high expectations for his academic and extracurricular endeavors while providing a low level of support. 

Beth is lively, chatty, and enthusiastic. A problem-solving matriarch of Persian-American descent, she works full-time in an HR tech job. Her parents were immigrants to the U.S., and thus were focused on being accepted as newcomers. As the only daughter among five sons, Beth was expected to be helpful, likeable, and supportive of her mom. Her parents were loving toward her as long as she was happy and easygoing. However, they did not hold space for her anger or sadness.

In session, John and Beth have difficulty connecting on a serious level, preferring to keep things light and superficial. Beth often talks for the both of them. She says she is eager to hear more about John’s feelings, saying she often doesn’t know what he is feeling. She usually speaks directly to me, despite regular encouragement to communicate directly with John. On few occasions, she slows down enough to listen to him but takes offense when he communicates that he, at times, feels shut down and unheard. This makes him apprehensive to communicate his deeper feelings with her.

As Beth begins to defend herself against what she perceives as accusations of her not listening, I gently interrupt to slow this down a bit. “John, please take Beth’s hands in yours.” They take a moment to shift their attention to my voice and my instruction.

They both seem a bit fearful to engage in hand-holding at this moment. John looks threatened and is heading into his shell. Beth looks offended and ready to set the record straight about her keen listening skills, both for my benefit and John’s. Eventually, they both take hands as instructed.

The Impact of Emotional Prosody

I use my voice to indicate I am feeling something stir inside of me, a deep slow “Mmm.” I see their defenses begin to soften. Their breathing begins to slow, and their eyes finally connect in recognition of their own safety. Again, like a vocal vibration, I make the sounds of attunement, a low gentle breathy, “Aaah, yees.” Tears well up in Beth’s eyes, and I make a soft low vibrating noise with my mouth closed. I am holding them here in this less-defended, more-available and regulated state, communicating to them that their presence and experience in this moment is important and modeling for their partner the value of being in this deepened state together.

Additionally in this moment, I have helped the couple shift physiologic states, from one of defense and high alert to one in which the nervous system can calm and they can be in a more grounded and open state of vulnerability and interest. Later in the session, Beth says that she feels afraid to do things wrong. She doesn’t like making mistakes and expects that if she does, she will be in trouble and judged negatively by John. When I asked what her tears were saying, she said they were tears in response to feeling seen. They were related to her grief about protecting herself from John for so many years. In her family of origin, she often felt like she was performing the sweet-girl role; if she kept everyone happy with her charm, she would never have to deal with their disappointment or her own real pain.

In turn, John realizes and communicates that he doesn’t speak up about his feelings of being overpowered  by her because he doesn’t want to make Beth feel bad. He is afraid that he might lose her if he shares his own vulnerability. Within his family of origin, emotions had no space or language. He was taught to “put your head down and work hard.” 

Within this moment, they both recognize the value of allowing themselves to drop their defensive shells and to move into this authentic state of being. In doing so, they both have a corrective emotional experience with one another. Beth doesn’t have to be good or right or sweet, and John doesn't have to swallow his uncomfortable scary feelings. In having this corrective emotional experience, both people feel better allowing their partner to witness their discomfort and pain and be there to hold each other in this place.

In this example, we can observe an important shift that took place. John needed Beth to drop into her own authentic pain, and Beth needed John to witness her experience. John also needed to feel safe in the connection — that Beth wouldn’t reject him if he had an experience that was different than hers.

This couple was not able to make this shift until they were each able to quiet themselves and their nervous systems, make physical contact, and hear the hum in my voice as empathic acceptance of the discomfort and threat they were each experiencing. I used my voice as a model of co-regulation. My voice held them in a tonal container intended to move them toward mutual resonance.

The Power of Bottom-Up Interventions

As PACT therapists, we use bottom-up interventions to bypass cognitive understanding, explicit memory, and the defense of intellectualization in order to have more access to implicit memory. That is, information remembered unconsciously and effortlessly. In the above example, I used voice tonalization and vibration, a bottom-up intervention, to quickly help each partner lower their arousal level and to access a part of themselves that did not exist in their consciousness or defensive structure. I helped them to be in a more receptive place, both for their own experience and their partner’s.

Bottom-up interventions move past the highly cerebral ways that our smart brains error-correct, plan, and sift through primitive information gathered from early childhood experiences. For example, helping John and Beth shift somato-affective states using vocal tones allowed each of them to bypass their early childhood conditioning and self-protection. They moved toward a fresher, more open state of being with one another. From this state, John and Beth were seeing each other as authentic beings, rather than projections of relationships from their past. 

Using empathic vocal sounds is a tool to indicate to our couples what we want from them and where we are heading. By using the power of vibrational tones, we show, not tell, our couples how deep affective resonance can sound. Our vibrational tones as therapists show couples what it feels like to have another receive you as you are. These tones indicate to the individual partners the value of revealing authentic pain. Being cared for in this way is often new and different and, as a result, quick and welcomed relief from familiar infancy and childhood experiences. 


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