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The word rapport comes from French rapporter and it literally means to bring something to change. If we focus on communication between two people, it alludes to the fact that what one person sends to another, the latter returns it. In simpler words, rapport refers to the bond between two or more human beings, to the psychological and emotional harmony that is needed so that changes can occur in one of the parties.
Rapport is one of the most important issues in therapy and one that is often overlooked. It is estimated that a high percentage of success in psychological treatments is due to a good therapeutic alliance or good rapport between therapist and patient.
The school, the prior psychological evaluation or the techniques implemented during the course of treatment are extremely important in order to cure the patient. However, No less important is establishing a good relationship with him, so that he fully trusts us and feels motivated to face the treatment.
Everything else is useless if we don’t have feeling with our patient, since this will have a negative impact on the rest of the variables: the person will stop attending therapy, will not commit to the tasks between sessions, will not be motivated to achieve change and will not trust what we propose or indicate. as strategies.
Therefore, When we talk about therapeutic rapport we are referring to mutual understanding, the attitude of collaboration and the empathy necessary for two people to address a problem. common and achieve the desired objectives. It is such a relevant therapeutic element that today it is already taught to future therapists in universities and there are even specialized courses designed to train different professionals, especially health professionals, who will have to deal with another person who has a problem that It is necessary to solve it collaboratively.
Origins of rapport
The therapeutic alliance or rapport was developed throughout the 20th century. Already the well-known psychoanalyst Freud, in his 1912 work The Dynamics of Transfer, raised the need for the analyst to have an interest and understanding attitude towards his patient: The goal with this “strategy” was for the healthiest part of it to establish a positive relationship with the analyst.
Freud, in his early writings, defined the patient’s affection for the therapist as a beneficial and positive way of transfer. Let us remember that for psychoanalysis, transference is the psychic function through which the client transfers his unconscious thoughts and emotions to another person, in this case the therapist.
This transference aspect promoted trust, acceptance and credibility in the therapist’s interpretations, as we have explained previously. However, it was later seen that it was not the transfer understood as such that generated that trust and climate of mutual collaboration between professional and client, since sometimes misunderstandings could arise in the relationship and this was not, in any case, positive. .
It was Zetzel who then distinguished between transference and therapeutic alliance, suggesting that the alliance was the non-neurotic part of the relationship, which made insight or assimilation of therapeutic changes possible.
Later, the concept of rapport or alliance was incorporated by the majority of therapeutic schools, distancing itself from the reading of transference provided by the psychoanalytic context. According to Rogers, father of the humanistic school along with Abraham Maslow, special attention must be paid to the quality of the therapist-patient relationship. Rogers then proposed three fundamental characteristics that the therapist should possess: authenticity, unconditional acceptance of the patient, and empathic understanding.
According to this author, the probability of therapeutic progress would depend less on the personality of the therapist and his attitudes than on the way in which these are experienced by the patient in the therapeutic relationship. For this interpretation to be positive, it is essential that he feels understood (that there is empathy) and accepted without conditions.
Subsequently, Bordin, in the 70s, will describe the common characteristics that must exist in the therapeutic relationship in all schools. This author identified three components that make up rapport: agreement on tasks, positive bond, and agreement on objectives.
Techniques to generate good rapport
The two fundamental pillars on which rapport is currently based are trust and fluid communication.. When we talk about fluid communication we do not mean that it must be symmetrical, but rather the important thing is that therapist and client understand each other at all levels: verbal and non-verbal.
Communication, in reality, should be asymmetrical, where the patient intervenes much more than the therapist. Some techniques that have been proven effective in establishing good rapport are:
Active listening
It is a simple technique a prioribut that on many occasions it is difficult for us to carry out. It is about listening to what the patient has to tell us without interrupting himwith the predisposition of not making any value judgment, but showing through gestures and expressions that we are at his side, listening carefully, understanding what he wants to convey to us and empathizing with his emotions.
Warmth
For good rapport to exist, it is extremely important that the therapist be warm with his client.. A professional can know many techniques and have a lot of knowledge and have a lot of experience. However, if you are not warm with your patient, all this will not help much.
As we have explained before, the person will not be able to trust his therapist, he will not be completely open to him and, therefore, much information will not come to light. Furthermore, a lack of trust will have a direct impact on the patient’s degree of commitment to the therapy: low trust will increase the chances that the patient will not do the tasks that the therapist sends him/her outside of the consultation.
Let’s think that we are dealing with a person who is suffering from a vital or emotional problem, so coldness does not help at all. To promote the empathy and acceptance that Rogers talked about, you have to be warm.
Empathy
It is obvious that putting ourselves in the shoes of the person in front of us is essential if we want to help them. It doesn’t matter if our patient is a person who suffers from an affective disorder or is a criminal. If we are going to deal with him, We must see the world through their eyes, even if we do not share their feelings or believe that their actions are correct.. Only by being empathetic will we generate trust and be able to help the person.
Establish trust
As we have mentioned, for the future of therapy it is very positive that the patient feels confident and at ease when they attend therapy sessions. To generate trust, in addition to everything we just mentioned, we must be credible and also appear to be credible.
The person must perceive that we are professionals, that we are correctly trained and updated and that, if in any aspect this is not the case, we will do our best to respond to your request as soon as possible, either by referring us to another professional or by training ourselves in that specific aspect. In this way, the patient will trust that we will be able to help them.
Find common points
This point refers to the need to focus attention on common interests. In this case, to move towards the therapeutic objective that was initially proposed by the client.. It is important not to stray from the topic and end up talking about common points, but that have nothing to do with our objective. If we do so, we would lose time in the session and in the end the relationship would no longer be asymmetrical expert-client, something that is not recommended for therapy.
However, it doesn’t hurt to be flexible and create a relaxed atmosphere in the session where you can comment on something outside the objectives, but always be careful not to fall into what we just discussed.
Coherence between verbal and non-verbal language
Let’s try to be careful when communicating with our patient, since many times we say something that may be incoherent with our expression or our gestures. Coherence between verbal and non-verbal language is essential in the therapeutic relationship since without it, there would be no possibility of generating the climate of trust and collaboration that we have been talking about.
When there is a contradiction between what we say and our posture or expression, the latter prevails and is actually authentic, since non-verbal language works at a more unconscious level than verbal language.
Therefore, it is necessary, as Rogers said, that we show ourselves authentic or genuine with our patient. Always taking care of the forms and maintaining warmth, acceptance and empathy, but without generating inconsistencies between our verbal and non-verbal language when expressing ourselves to our patient.
What to do when this good feeling does not occur?
Although all these techniques may seem like common sense, the truth is that they are not easy to put into practice when facing a patient in consultation: the therapist is also a human being, with his own values, attitudes, emotions, etc. ., and many times they have to be left out of the therapy for the benefit of its progress.
Even with everything, It may happen that we do not generate a good relationship with the client and we should not feel disappointed because of it.. Just as in informal relationships it may happen that we do not have good feeling with someone, in the therapeutic relationship it can also happen to us, even if we make every effort to prevent it from happening.
In this case, The most honest and sensible thing is to refer the patient to another professional with whom they can develop a better therapeutic alliance. and can continue with your personal growth. In this way, neither of us wastes time and we focus on what really interests us: the patient’s recovery.
Rapport is not empathy
It is important not to confuse the phenomenon of rapport with what we know as empathy.. While the former is better understood as a process that occurs in a specific communicative dynamic, empathy is rather a set of psychological predispositions that occur in individuals, and that lead us to understand both how a person feels and thinks, even if we are not talking to her.
In practice, it is common for both notions to overlap (and of course, being an empathetic person helps establish rapport in a conversation), but it doesn’t have to happen that way.
The importance of rapport in the therapeutic bond
To conclude, we emphasize the importance of rapport within psychotherapy, since It is one of the processes that promote the creation of an adequate therapeutic bond.
This notion refers to the set of expectations, and dynamics of communication and support, that They make clear what the purpose of the therapy is and the relationship between the patient and the professional..
It’s about creating a conversational climate…
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