Communication Skills for People With Facial Paralysis

Hands with expressive phrases written on them

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If you have facial paralysis, expressing yourself confidently can be challenging. There's a lack of representation and public awareness of facial paralysis, which can lead others to make inaccurate assumptions.

I've written about the need to eliminate stigma at the societal level. However, while social change is imperative, it can take time and people with facial paralysis need support and tools to navigate social life now.

After years of conducting a communication skills program, Express Yourself, for the Moebius Syndrome Foundation, Facial Palsy UK, Facial Paralysis and Bell’s Palsy Foundation, and the Moebius Syndrome Association in Denmark, this post summarizes my key tips. Express Yourself is a communication skills program for teenagers and adults with facial paralysis from any cause, including Moebius syndrome, Bell’s palsy, multiple sclerosis, and more. People with other types of facial differences, especially those that may disrupt facial expressions or speech, could benefit as well. The program draws from my expertise as a social psychologist who studies and has facial paralysis. Initial evidence suggests Express Yourself could increase expressivity and rapport during social interactions.

Humans have a variety of ways to express themselves, and they naturally vary in their levels of expression based on factors like gender and culture. We'll discuss seven types of expressive diversity and how they relate to facial paralysis.

1. Facial Expression

People without facial paralysis are accustomed to looking to the face as a rich source of information about how a person is feeling. With facial paralysis, your ability to form facial expressions may be limited. When you first meet new people, they may not understand that you have facial paralysis or what it is.

However, people have many ways to express themselves other than the face, making up a collection of skills I call alternative expression. Research shows that people who were born with facial paralysis use more alternative expressions than those who more recently acquired it. Using alternative expressions helps people with facial paralysis communicate emotion and creates positive first impressions.

Let’s explore the many other ways you can express yourself.

2. Verbal Communication

Written, spoken, or signed language can be one of the most clear and unambiguous ways to express yourself. Many people with facial paralysis are excellent writers, bloggers, novelists, and poets, and I suspect this is because writing gives people control over how they express themselves.

Some people with facial paralysis also have challenges speaking clearly. Sometimes you might feel shy or embarrassed of the way you talk, so you might talk too quietly. It is important to talk loudly enough so that others can hear and understand you, and so that you appear confident.

What should you do if someone has trouble understanding you? Be patient and repeat yourself a little more slowly. Write it down if you need to. Some people with facial paralysis may find augmentative or alternative communication or sign to be helpful alternatives to speech. Everyone has the right to be understood!

3. Voice

We also use our voice for nonverbal communication. Vocal tone is very expressive. To illustrate the power of tone of voice, try saying the sentence, “I start a new job tomorrow” in a happy way, then a sad way, then a fearful way. The same sentence spoken with different intonation can mean very different things.

4. Gesture

Using gestures is a great way to be animated. They can clarify and emphasize speech, so they may be especially helpful in getting your point across to people whose speech may be unclear. But be careful. Most gestures are culture-dependent. For example, while a thumbs-up expresses positivity or agreement in the West, it is an insult in certain countries.

5. Posture

Notice how you are sitting. What does it say about you? Sitting or standing up straight with your head held high makes you look and feel confident. Squaring your shoulders with the person you are addressing communicates focused attention and respect, letting them know that you are interested.

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6. Eye Contact

Eye contact functions as a way to indicate interest and confidence. In general, people tend to view those who make appropriate eye contact as likable and competent.

Sometimes people with facial paralysis feel uncomfortable with eye contact because of shame about how they look. Since people with facial paralysis are already at risk of being viewed as less likable and intelligent, making an effort to build eye contact can help upend those misconceptions.

If eye contact is challenging for you, practicing can help you feel more comfortable over time. A classic trick is to look at the bridge of someone’s nose if you're uncomfortable looking them in the eye. People can’t tell the difference. You can also practice making eye contact with someone who is close to you.

You don’t have to engage someone in a staring contest. The average person maintains eye contact for about 3-4 seconds, slowly glances to the side or other parts of the face, and then looks back. We tend to make more eye contact when listening to someone speak than when speaking. If there is a break in the conversation, glance away, unless you would like to take a turn, in which case signal that by making eye contact and beginning to speak.

People typically regulate conversations with facial expressions in addition to other communication skills such as eye contact, head nods, and saying “uh huh”. People with facial paralysis can show interest and engagement with these other communication modalities.

It can also be challenging to indicate when you have something to say because people are accustomed to facial expressions that indicate turn-taking behavior. You can communicate that you’d like to take a turn by making eye contact with the person who is speaking and raising your finger gently to indicate you’d like to make a point.

This information about eye contact comes with a caveat: It applies to Western culture. Research finds cross-cultural differences in what is viewed as appropriate for eye contact. Generally, people from Western cultures prefer more eye contact, while those from Eastern countries prefer less. In fact, in some Eastern cultures, direct eye contact, especially toward people who have more status than you, can be perceived as rude.

7. Style

We make choices about how to present ourselves every day. What we wear on a date is very different from what we would wear to a job interview.

People may also choose to style themselves to align with an identity they hold, for example, a sports fan, or an indie kid. Clothes, hairstyles, accessories, and makeup, if you choose to use them, all send strong messages about your personality.

Sometimes people with facial paralysis may feel shame about their appearance, and hoping not to draw attention to themselves, or feel like “Why bother,” they do not put much effort into their appearance.

Everyone deserves self-care. What do you like about the way you look? What can you do to highlight it? What can you wear to express your identity?

Just as some women use "power dressing" as a way to subvert sexism in the workplace, some people with facial paralysis may dress in sophisticated clothes to assert competence or develop a flamboyant style to convey confidence. You can wear “conversation pieces," such as an interesting scarf, T-shirt, shoes, purse, or jewelry.

Several people with facial paralysis have mentioned selecting bold glasses that serve multiple functions: improving vision, protecting eyes with a weak blink from debris and wind, and adding character and symmetry to the face.

These are just a few examples of ways to express who you truly are. Not all will work for you or for a particular situation. Try out different tools, make them your own, and practice.

Lastly, a message to people without facial paralysis: You can make a big difference as an ally. Remember to pay attention to expressive diversity, and the many ways people express themselves. Learn how to reduce stigma and facilitate social interaction for people with facial paralysis.