Table 1.

Suggestions and considerations for conducting psychotherapy with masks

General considerations

• Start an open dialogue with patients about the impact of masks on emotion expression and recognition to minimize nonverbal miscommunication

• Normalize the verbalization of emotions

• Encourage patients to ask questions about the therapist’s own emotional reactions

• Increase communication through body language

• Match nonverbal gestures and body language to the intended emotional expression

• Pay close attention to the patient's prosody

• Ask clarifying questions when unsure of the patient’s emotional state

• Use lower pitch, speak more loudly and more slowly, and eliminate background noise

• Be aware of individual differences

Reliance on the upper face for emotion recognition

• Can lead to confusion between emotions with similar upper face expression

• Can cause non-emotional upper face expressions to be confused with emotional expression

Eye contact

• Consider how increased eye contact may be perceived by the patient, depending on their culture or diagnosis

• Appreciate that some patients may have difficulty increasing their eye contact

Risks of increased upper facial expression

• Can convey emotion where none is intended

• Can lead to misperception of emotion