Rapport

Rapport Building

There are three main areas where rapport can be built

Personal
Behavioral

Cultural

Personal Rapport

A patient’s beliefs about themselves and the world must be totally accepted. “You must assume that what the patient is saying is true and then try to imagine what it could be true of”. Then, you can build on their model of the world to help them move themselves on to a more empowering belief. If you undermine their beliefs by not accepting them then they have only two choices

Not accept what you say and so mistrust your judgment

Accept what you say and have their own confidence undermined

Neither of these options is acceptable or useful

Behavioral Rapport

Match all the nuances of behavior that a patient exhibits. Generally you would start out with a slight time delay, perhaps of a few seconds, then gradually close the gap. This is known as pacing. When your movements start to synchronize you can then you can start to lead the patient. If done carefully you will notice that they will start to copy you. This is the strongest state of rapport.

You can’t do this with all behavior because there are distinct differences between talking and listening body language that must not be compromised. You simply copy the behavior they used when they were talking, when you talk. Eye contact is an important example of this.

The two main techniques are mirroring and matching

Mirroring You copy the patient’s visible behavior as if you were in a mirror. If they glance to their right you glance to your left.

Matching You can copy the patient’s behavior exactly. If they move their left hand then you move your left hand.

Cross Matching You do not have to match the exact movement. For example you could match a patient’s hand movements to your tapping foot, or a facial expression to a hand gesture.

1. Macro behavior The larger picture. The conscious behavior they are exhibiting. Matching or mirroring these will be obvious consciously to the patient. This may be useful in psychiatric cases where normal perceptions are altered to an extent that any overt matching of behavior would not be considered unusual by the patient and may in fact be welcomed. This is what Erickson considered meeting the patient in their world

2. Micro behavior

The smaller details. The expressions, movements, habits, and vocal traits. Matching or mirroring these will not be apparent to the patient.

PHYSIOLOGICAL

Posture

Gesture

Facial expression & blinking

Breathing. Matching breathing is an important skill and very powerful. This alone is probably the most effective skill that you can develop.

TONAL

Voice. The aim is to copy as much as you can without obviously mimicking the patient. Only really for use during the pre talk. Obviously your actual induction and therapy voice will be different.

Tone (pitch). You should try to raise or lower your tone to match them.

Tempo (speed). Speak at a similar pace.

Timbre (quality). If they have a resonant voice, then try to copy them. If they have a nasal quality then you can adapt your own voice a little.

Volume (loudness). If they speak softly, you speak softly.

LANGUAGE

Predicates

Key words. You copy their most common vocabulary.

Common experiences & associations – identify and discuss common ground to reinforce your similarity.

Content chunks – Use sentences of similar length and speak for roughly the same length of time that the patient does.

Cultural Rapport

Obviously you can’t match somebody’s culture but you can demonstrate your understanding and appreciation of your patient’s culture. This could be through demonstrating your knowledge, showing or respecting certain behavior or your use of specific language common to that culture.

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