Rapport Building Lecture PDF

Rapport Building  What is an intake? An “intake” is the first major encounter between the professional(s) and the individual(s) seeking services. Any psychological intervention must have a starting point, any therapy relationship must have a first moment, and any assessment process must hav...

Rapport Building  What is an intake? An “intake” is the first major encounter between the professional(s) and the individual(s) seeking services. Any psychological intervention must have a starting point, any therapy relationship must have a first moment, and any assessment process must have an initiation—the intake is such a juncture. “Intake” has for centuries referred to the process of an interviewer taking in the client and their story. Intake is the first substantial interaction of the persons involved in a professional mental health service. Intakes must involve two tasks: building rapport and collecting data.  How does one build rapport? To build rapport with a client is to establish a positive therapeutic bond. This connection with the patient is sometimes called rapport, therapeutic alliance, working relationship, empathetic relationship, or other such terms indicating that there is trust, warmth, respect, and care exuded between the parties involved. Rapport does not necessarily mean that the clinician and patient like one another, that they would be friends outside the therapy setting, or that they share various identity characteristics. Rather, rapport is a special harmony shared by two or more people willing to authentically engage with one another, to work hard toward mutual goals, to interact with vulnerability and rawness, and to feel a sense of commitment to one another. How is this achieved?  Empathy vs. Sympathy  Empathy is the ability to put yourself in another person’s shoes. This allows you to understand the feelings of others as if they were yours.  Sympathy indicates feeling bad for someone even if you can’t understand what they’re going through. This allows you to recognize the feelings of others but not understand them as if they were yours.  Empathy is a stronger, deeper emotion vs. sympathy.  With sympathy, the relationship between your feelings and another’s isn’t equal. You might feel sorrow for someone, but you don’t personally understand their feelings or haven’t had the same experience. However, with empathy, the relationship is equal. You understand another’s feelings as if they were yours. https://blog.inkforall.com/sympathy-vs-empathy  Empathy vs. Sympathy  Phrases That Show You Empathize With Someone:  I’ve felt that way before  I know exactly what you mean  I totally get you  I know exactly how you feel  I had a similar experience  I know what you’re going through  Phrases That Show You Sympathize With Someone:  I’m sorry for your loss  I can’t imagine what you must be going through  I’m sorry this happened to you  I’m sorry that you feel this way  I really feel bad for you https://blog.inkforall.com/sympathy-vs-empathy  1. Clinical attitude for rapport An appropriate clinical attitude or therapeutic mindset is important to adopt prior to beginning an intake. Mental health professionals should generally be open-minded inquisitive individuals who enjoy connecting with others, care deeply about humanity, find value in exploring peoples’ lived experiences, and wish to help spur growth, healing, or other important changes in those they treat. If one can show up to the intake ready to offer their sincere human self, with a genuine interest in the client, rapport is already a relatively likely outcome.  1. Clinical attitude for rapport Therefore, part of the clinical attitude is to arrive at the intake with:  Calm poise  Unburdened mind  Having taken care of oneself prior to attempting to care for others. Especially in challenging circumstances (e.g., increasing institutional demands, understaffing, working through a pandemic, facing burnout).  1. Clinical attitude for rapport Other aspects of the clinical attitude which foster rapport include an awareness of what the client is experiencing in the intake itself. Patients arriving for their first psychotherapy visit are facing a daunting set of tasks:  To describe themselves openly and accurately  Offer vulnerability to a complete stranger  Discuss personal topics often of a heavy nature And to do all this whilst evaluating whether they might wish to return and see this clinician again in the future.  1. Clinical attitude for rapport Clients are asked to face their demons with an audience present—this is not easy. And so, the intake clinician who recognizes all this, empathizes with the helpee’s situation, and responds appropriately—with an attitude of respect for the special role they are given—is taking steps toward healthy rapport. Be warm, polite, curious, professional, and human. Be accepting of the client, exactly as they are, while also joining them in hope for change.  1. Clinical attitude for rapport An effective clinical attitude also includes a client-centered perspective.  For example, it can be easy for therapists to see a score on a distress screener above a certain cutoff and then head into the intake session mentally geared toward a discussion about that particular phenomenon (e.g., depression) when in fact the intake might be much more beneficial if the client is allowed to steer toward topics of their greatest concern.  Client-centeredness in the intake naturally allows the client to have a voice in the goals and direction of the conversation, thus aiding rapport.  1. Clinical attitude for rapport There are many barriers to effective interviewing which can be especially salient at the intake stage:  It is easy for therapists—especially early career folks—to be thrown of course by their own thoughts during the interview.  Clinicians can be distracted internally by self-criticism (e.g., “I didn’t word that question very well”).  Imposter feelings (e.g., “I’m not good enough to be doing this”)  Supervisory concerns (e.g., “I need this to go well for the upcoming video review with my mentor”).  1. Clinical attitude for rapport  External/interpersonal blockages to the therapy process such as:  Defensiveness (e.g., “her story is making me sad, and I can’t let her see that”).  Overly focusing on test results (e.g., “their distress screener had a high anger score so I must focus on that even though they seem to want to discuss drinking”).  Authoritative needs to control (e.g., “I’m in charge so I’ll direct him in the conversation”).  The interviewer may even be too tired, too stressed, too caffeinated, or otherwise too uncomfortable to offer their best self. These and many other clinician-based barriers can each significantly dampen the likelihood of strong rapport developing during the intake.  2. Cultural humility for rapport A surefire way to erode potential for rapport is to approach the client with bias, stereotyping, prejudice, or outright discrimination, based on various aspects of their identity (e.g., sexual orientation, gender identity, social class, religion, nationality, race, ethnicity, ability). To work toward culturally-attuned rapport, interviewers ought to be open and accepting of the client’s identities and work toward an understanding of how those identities inform their lived experience, including within the therapy relationship itself.  2. Cultural humility for rapport Cultural humility is a sensitivity to identity factors which not only aims to maximize understanding while minimizing generalizations, but also goes further to recognize that the client is the expert of their own experience, and the practitioner is the learner.  2. Cultural humility for rapport Ecklund and Johnson (2007) provide guidance for enhancing cultural skills in intakes with children and families, building their recommendations around four themes:  Assess the client’s cultural identity  Investigate ways in which the client’s cultural background informs their explanations of their presenting problem  Become aware of the client’s psychosocial environment and how these factors impact functioning  2. Cultural humility for rapport Ecklund and Johnson (2007) provided examples of questions/prompts which could be used in an intake to highlight cultural issues and connect to the client’s identity, such as: “How does your family understand what is going on?” or “Who helps you? What activities/groups make it better?” and “Does the family experience oppression? How has it affected the child?” 3. Practical considerations for rapport The intake interview should start punctually and not vary too much from the anticipated length. The seating should be comfortable and age-appropriate. The room should be private and relatively distraction-free. The interviewer should arrive prepared with whatever materials necessary. The clinician’s relevant code of ethical conduct should be clearly followed. 3. Practical considerations for rapport One major practical consideration for building rapport is who conducts the intake:  Whenever possible, the intake clinician should be the same individual planned to provide the ongoing service.  This too may sound obvious, but in fact many agencies attempt to farm out the intake phase of care due likely to the fact that there is much information to absorb and often a great deal of paperwork. For instance, training centers often assign entry-level clinicians (e.g., first-year clinical graduate students) the task of conducting intake interviews, only to hand of the clients to more advanced trainees thereafter. 3. Practical considerations for rapport  Nielsen and colleagues (2009) found that so-called “discontinuity clients” (i.e., those seeing a different clinician for intake versus follow-up):  Were far more likely to end treatment prematurely  Showed slower therapeutic progress.  To disrupt or delay other aspects of psychotherapy including rapport-building. 3. Practical considerations for rapport Another practical consideration is how to view the purpose and scope of the intake. Some therapists take the stance that there are two distinct phases of therapy: assessment and intervention. The intake need not be treated as separate from therapy or some sort of pre-intervention effort. However, the intake is considered the beginning of the professional service. For instance, a case study by Iwakabe, Edlin, and Thoma (2021) showcases the profound potential for healing in even just the first session of psychotherapy when the intake is conducted well. Rapport as an art Rapport building is as much an art as a science. A practitioner must learn the behaviors required to build rapport such as eye-contact maintenance, body positioning, question delivery, head nodding, affect expression, etc.  Steady eye contact as affirming versus intimidating  Leaned-in posture as engaged versus invasive  Furrowed brow as inquisitive versus judgmental Topics and tactics of interview intake data What to ask, and how? The setting will dictate some of the topics, and the client will likely bring many topics to the conversation of their own volition, but there does ultimately rest some responsibility on the interviewer to ask the right questions. Topics and tactics of interview intake data Topics and tactics of interview intake data Instead of canned questions coming from the practitioner, the intake can become a conversation with spontaneity, helping put the client at ease along the way. Starting open-ended (e.g., “How are you?” “What brought you in?” “Tell me about yourself.” “How would you describe your life story?” “What goals and desires do you have for this therapy experience?”) and simply following the client’s lead from that point forward can often fill in the majority of the intake details without ever needing to refer back to a cheat-sheet. Topics and tactics of interview intake data An intake session conducted organically in this way, with conversation ebbing and flowing to new topics naturally, is often the best way to maximize both rapport building and data collection. Reference Pashak, T. J., & Heron, M. R. (2022). Build rapport and collect data: A teaching resource on the clinical interviewing intake. Discover Psychology, 2(1), 20.