The word rapport derives from the French rapporter and literally means “to give something back”. If we apply it to the sphere of communication between two people, it refers to the fact that an individual returns to another what he has sent him. In simple terms, rapport is the bond between two or more human beings, the psychological and emotional harmony necessary for an “exchange” between the parties to take place.
The approach, prior psychological assessment or techniques used in the course of treatment are extremely important for patient care. It is equally important that a good relationship is established between therapist and patient, which induces the latter to fully trust the therapist and feel motivated to undertake a therapeutic path with them.
Methods and techniques are of little use if there is no feeling with the patient. The lack of harmony and compatibility can negatively affect the rest of the variables involved: the patient may decide to abandon the therapy, may not take the objectives of the sessions seriously, may not feel motivated to change and be wary of the strategies proposed or indicated.
When we talk about therapeutic relationship, therefore, we refer to the mutual understanding, collaboration and empathy necessary for two people to solve a common problem together and achieve the desired goals. It is such an important element that it is present in university programs for the training of future therapists and in specialized courses for healthcare professionals. It is particularly essential for all professionals whose work involves interacting with patients and solving problems through collaboration.
Origins of the rapport
The rapport or therapeutic alliance is a method that has developed since the twentieth century. Already Freud, in his 1912 text Dynamics of Translation, underlines the need for the analyst’s interest in his patient and the importance of demonstrating an understanding attitude towards him: the objective of this strategy was that the part ” sana ”of the patient established a positive relationship with the analyst.
Freud, in his early works, defines the patient’s affection towards his analyst as a positive form of translation. For psychoanalysis, translation (or transference) is the psychological process by which an individual transfers his unconscious thoughts and emotions to another person, in this case the therapist.
This projection should foster trust in the therapist and lead the patient, as already mentioned, to accept the latter’s interpretations. Subsequently, it was found that it was not the translation process itself that generated that ideal climate of trust and collaboration between patient and analyst, given that on many occasions the relationship was compromised by misunderstandings that in no way led to positive outcomes.
Subsequently, the concept of rapport is adopted by most schools of psychotherapy, which progressively move away from the concept of translation introduced by psychoanalysis. According to Rogers, founder together with Abraham Maslow of humanistic psychology, particular attention must be paid to the quality of the therapist-patient relationship. Rogers states that the psychologist must possess three fundamental characteristics: authenticity, unconditional acceptance towards the patient and empathic understanding.
According to the author, the possibility of therapeutic success would depend not so much on the personality of the psychologist and his attitude, as on the way in which these elements are perceived by the patient within the therapeutic relationship. For the interpretation to be positive, the patient must feel understood (therefore that there is empathy) and accepted unconditionally.
In the 1970s, Bordin defined the characteristics of the therapeutic alliance or rapport that must be common to any therapeutic approach. The author identifies three essential components in the therapist-patient relationship: agreeing on goals, agreeing on individual tasks and establishing a positive bond.
Techniques for good rapport
The key points on which the relationship must be based are trust and fluidity in communication. In stating that communication must be “fluid”, we do not mean “equivalent” but rather capable of generating understanding between the parties on several levels, both verbal and non-verbal.
In reality, communication must be asymmetrical: it is good for the patient to intervene in it much more than the psychologist. Now let’s see some techniques that have proved effective in establishing a good rapport.
It is a seemingly simple technique, but possibly very difficult to do. It consists in listening to what the patient wants to tell without interrupting it, keeping a strong predisposition not to formulate any kind of judgment, but at the same time showing participation through gestures and expressions. The psychologist must listen carefully to the patient trying to perceive what he wants to communicate and interpret his emotions.
In order for a good rapport to exist, the psychologist must be warm and cordial with his patient. A professional psychologist may know many techniques and have a lot of experience behind him, but if he is not friendly with his patient, everything else is of little use.
In the absence of this fundamental characteristic there is the risk that the patient does not trust his psychologist and does not open completely, so that a lot of information is lost because it is withheld.
Furthermore, the lack of trust negatively affects the patient’s commitment to carry out the therapy: it increases the predisposition not to follow the specific tasks prescribed outside the sessions.
Putting ourselves in the shoes of the person in front of us is essential if we want to help them. For the psychologist it should not be relevant if the patient suffers from an emotional disorder or if he is a delinquent: in the relationship between the two parties it is necessary that the psychologist sees the world with the patient’s eyes, without necessarily having to share feelings or believe that his actions are correct. Only through empathy is it possible to gain the patient’s trust and, consequently, to help him.
As already mentioned, for the success of the therapy the patient must trust his psychologist and feel comfortable during the sessions. To gain the patient’s trust, beyond what has been listed so far, we must be credible.
The patient must perceive that we are professional, competent and with a solid background and that if by chance we were not updated on some topic, we would undoubtedly do everything possible to find answers to his questions, even with the help of another professional or taking care to fill in the gaps we have regarding that aspect in particular. In doing so, the patient will truly trust and trust in our ability to help him.
It is important to underline the common interests that psychologist and patient share. In particular, it is necessary to focus the patient’s attention on the fact that the achievement of the predetermined therapeutic goal is also of interest to the psychologist. However, it is important to try not to go off topic by finding points in common that have nothing to do with the goal of the therapy. Wandering around is equivalent to wasting precious time in sessions to the point that the relationship ceases to be asymmetrical, which is not recommended for the outcome of the therapy.
Consistency between verbal and non-verbal language
We must be careful in communicating with the patient as it can happen that we contradict through gestures or with a simple expression what is declared in words. The coherence between verbal language and non-verbal language is fundamental in the psychologist-patient relationship: without it we would not have the possibility of creating the climate of trust and collaboration on which we have insisted so much.
It must be borne in mind that it is imperative, as Rogers states, to show ourselves authentic and genuine with our patient. We must always pay attention to the form in which we express ourselves, keep cordiality and empathy alive and not generate inconsistencies between verbal and non-verbal language in the interaction with our patient.
What if the feeling is not there?
Although the techniques presented so far may appear simple and intuitive, it is not at all easy to put them into practice correctly when we interface with the patient: the psychologist himself is a human being, with his values, his attitudes, his emotions … all characteristics that often must be excluded from the sessions.
Beyond the commitment, however, it may happen that a good relationship is not established with the patient, and in this case one should not feel disappointed. As in any informal relationship, it can happen that there is no feeling between two people , so in the therapist-patient relationship, despite the shared commitment, it can happen that there is a lack of harmony.
In this case, the most sensible and honest thing to do is to refer the patient to another professional with the hope that with the latter he will establish a better therapeutic alliance, and can progress in his personal growth path. Thus, neither the psychologist nor the patient will have wasted time and will both be able to dedicate themselves to achieving their goals.
Rogers, C. (1987). Client Centered Therapy. Joints publisher.
Freud, A. (1936). The ego and defense mechanisms. Psycho. Joints publisher