The foundation of counselling and psychotherapy is communication. The American Psychological Association (APA) Dictionary of Psychology (2022) defines psychotherapy as "any psychological service provided by a trained professional that primarily uses forms of communication and interaction to assess, diagnose and treat dysfunctional emotional reactions, ways of thinking and behavior patterns." The historical image of psychotherapy, largely from the influence of Freud and psychoanalytic thought, is a patient on a couch being asked to share insights from the trained psychotherapist. A contemporary image of psychotherapy is two people talking to each other, which is often referred to as talk therapy. However, talk therapy does not completely encapsulate all the various aspects of communication involved.Communication is multifaceted, consisting of verbal, paraverbal, nonverbal and extra-linguistic components (Del Giacco et al., 2019).Whilst there are numerous communication channels in psychotherapy, the primary mode of interaction for most therapists is in talking and listening. A less common approach to psychotherapy has been the use of written communication in psychotherapy (Farber, 1953).In 1953, Farber discussed becoming deaf during his practice of psychiatry and his modification of treatment through asking patients to write to him and him responding verbally.