As every good clinician knows, diving into deep discussions without first establishing rapport is a sure-fire way to derail the therapeutic process.
It can also increase client attrition.
In contrast, establishing rapport at the outset helps to calm clients while promoting confidence in the clinician. This type of therapeutic engagement involves “establishing a mutually trusting and respectful helping relationship” (Miller & Rollnick, 2013, p. 47).
This article will highlight various aspects of rapport, including what it means, why it’s important, and how to engage in it. Excellent tools, resources, and examples are also included. So, now that we’ve broken the ice, let’s take a more in-depth look at rapport and why it’s such an integral aspect of the therapist–client relationship.
Before you continue, we thought you might like to download our three Positive Psychology Exercises for free. These science-based exercises will explore fundamental aspects of positive psychology including strengths, values, and self-compassion, and will give you the tools to enhance the wellbeing of your clients, students, or employees.
This Article Contains:
- What Is Rapport in Psychology and Coaching?
- 3 Examples of Good Rapport in Counseling
- Is Rapport Important in the Therapeutic Relationship?
- How to Build Rapport With Clients
- 14 Tips for Developing Trust and Empathy
- Fostering Rapport: 10 Questions to Ask Patients
- Helpful Tools From PositivePsychology.com
- A Take-Home Message
What Is Rapport in Psychology and Coaching?
Defined as “the ability to connect with others in a way that creates a climate of trust and understanding” (Zakaria & Musta’amal, 2014, p. 2), establishing client rapport is the therapist’s first objective (Leach, 2005).
Rapport is a relationship in which the clinician simply clicks with the client (Reiman, 2007), and it is a continuous process that must be nurtured during each session. Ultimately, the goal of the therapist is to establish a therapeutic alliance (Horvath & Greenberg, 1989), which is aided by various aspects of the therapist’s behavior, such as language, facial expression, body language, warmth, etc.
Given that the client is exposing vulnerability by sharing their innermost secrets, feelings, and fears, it is only right that the counselor acts in a way that supports a collaborative and trusting client relationship.
Trust and rapport are the connective tissue for gaining and maintaining healthy relationships.
Susan C. Young, 2017
3 Examples of Good Rapport in Counseling
The following three vignettes describe challenging counseling situations in which rapport is extremely important.
They demonstrate the therapist’s ability to take in the client’s concerns and feelings, and respond in ways that enhance the therapeutic process.
Andrew is a middle-aged man experiencing a high level of anxiety. At the urging of his wife, he finally decided to attend therapy. He has never been to therapy and has always considered “shrinks” to be clinical and unfeeling.
He is also worried that they will see into his deepest fears and regrets, which makes him incredibly nervous. Andrew has always believed that seeking therapy makes a person weak, and he is especially worried about others finding out what he tells the therapist.
Andrew’s therapist greets him with warmth and friendliness, while offering him a beverage. She makes excellent eye contact and speaks in a soothing voice. She breaks the ice by making small talk about the beautiful weather outside, briefly mentioning her tulip garden and lack of green thumb.
These comments help to humanize her, while offering Andrew some time to calm down. The therapist discusses his right to privacy and confidentiality, which eases Andrew’s mind.
She also talks to him about how common anxiety symptoms are and that there is no shame in seeking help. The therapist’s approach and discussion of stigma and privacy concerns help Andrew to feel more relaxed and trusting, and ultimately to open up about his feelings.
Maggie is a 32-year-old woman who has been experiencing major relationship problems. She isn’t getting along with her coworkers or her boyfriend. She believes others are to blame for her issues and becomes defensive if these ideas are challenged.
She doesn’t want to go to therapy, as it has never helped before. Plus, she really doesn’t trust psychologists. But Maggie decides to attend counseling out of fear of losing her job. She presents with her arms crossed and a clearly distrustful and irritable demeanor.
Maggie’s therapist greets her with a kind smile as he escorts her into his colorful, comfy office. He offers her something to drink as he asks her if she had a pleasant weekend.
Maggie’s irritable responses are evident to the therapist, who is careful to speak in a nonjudgmental, understanding way. As she explains all the “crap she has to deal with each day,” the therapist uses a lot reflective listening, paraphrasing, and open-ended probes for information (e.g., “Sounds like that argument with your boss was really frustrating for you” and “Can you tell me a little more about what that was like for you?”).
Her therapist’s style exudes competence combined with an engaging and supportive approach, which enhances Maggie’s confidence in his skills while minimizing distrust.
He also helps her to feel validated by respecting her opinions, and his positive attitude increases Maggie’s own optimism about feeling better. Lastly, he does not use psychological jargon, which could exacerbate her feelings of defensiveness around therapy. With plenty of time and patience, Maggie can benefit from her therapy sessions.
Jeremy is a teenager who has become increasingly withdrawn. His grades have gotten worse lately, and he either sulks around the house or hibernates in his room. Jeremy’s parents are worried about him and have taken him to see a counselor, which really irritates him as he has issues with authority. He slumps in his chair, barely responding to questions with more than a shrug.
Jeremy’s therapist is familiar with adolescent issues. She greets him warmly and does not speak to him as if he were a child. She carefully explains privacy laws related to therapy with minors, which reassures Jeremy that (aside from concerns regarding risks of potential harm to himself or others) his parents won’t be informed of anything he shares during therapy.
She also describes the collaborative nature of therapy and how the two of them will work as a team to determine the therapeutic process and goals. Although Jeremy is reticent, his therapist is patient, never pushing him to speak and allowing plenty of time for pauses. She is nonjudgmental and uses positive affirmations when Jeremy shares difficult feelings.
It doesn’t happen overnight, but Jeremy is receptive to the therapist’s approach, feeling respected, truly heard, and confident in the therapist’s expertise. Eventually, Jeremy realizes that seeing a therapist won’t get him in any trouble and that it even feels good to talk to someone who understands him.
Is Rapport Important in the Therapeutic Relationship?
While research examining the impact of rapport within the counseling field is lacking (Leach, 2005), studies do support a positive association between rapport and therapeutic benefits.
Here are five examples:
- Establishing a “partnership and mutual collaboration between therapist and client,” (Horvath, Del Re, Flückiger, & Symonds, 2011, p. 11) requires building trust and rapport. Meta-analysis findings indicate that a strong therapeutic alliance is predictive of desirable treatment outcomes (Horvath et al., 2011).
- Joe, Simpson, Dansereau, and Rowan-Szal (2001) examined the link between drug abuse outcomes and rapport among individuals treated in a methadone clinic. A lower degree of rapport was related to greater cocaine use and criminal behavior.
- Kasarabada, Hser, Boles, and Huang (2002) conducted a prospective longitudinal study investigating the link between clients’ perceptions of their counselors and treatment outcomes. The results indicated that positive perceptions of counselors were associated with significantly longer stays in treatment and better psychiatric outcomes. Among the counselor qualities that predicted treatment retention were trust, empathy, genuineness, openness, and nurturance.
- Harwood and Eyberg (2004) examined verbal behaviors among therapists while engaging in parent–child interaction therapy. The researchers found that supportive therapist verbalizations predicted greater treatment success.
- According to a comprehensive review by Keijsers, Schaap, and Hoogduin (2000), among the factors related to positive treatment outcomes among Cognitive-Behavioral Therapists were empathy, genuineness, warmth, and positive regard.
How to Build Rapport With Clients
Clearly, rapport building is an essential ingredient of a quality therapeutic relationship, but how does the clinician get there?
In her book, The Art of Connection: 8 Ways to Enrich Rapport & Kinship for Positive Impact, Susan Young (2017) describes the following ways to shine a positive light on others:
- Maintain a sense of calm rather than acting with defensiveness.
- Solicit the other person’s opinion.
- Be patient.
- Allow the client to appear smart and insightful.
- Avoid behavior that is humiliating to the other person, such as pointing out flaws.
- Put your own ego on the back burner.
- Practice concern for and awareness of the other person’s feelings.
- Find ways to make the other person feel at ease.
Along with Young’s (2017) suggestions, additional methods that help clinicians build rapport include:
- Use nonverbal cues that convey warmth and understanding.
- Break the ice with small talk.
- Integrate humor into the conversation as appropriate.
- Show empathy and compassion, especially when the client is distressed.
- Avoid being judgmental.
- Treat the client as a partner/collaborator in the treatment process.
- Foster the client’s sense of self-efficacy.
- Attend to the client’s nonverbal cues.
- Use reflective listening and paraphrasing.
- Engage in active listening so the client feels truly heard.
- Do not allow disruptions or distractions during sessions.
- Maintain a positive, enthusiastic, and supportive attitude.
- Use positive affirmations.
- Clarify client confidentiality and privacy rights.
- Ensure that the clinical environment is peaceful, private, and comfortable.
- Avoid technical jargon.
- Be flexible and open minded.
- Use open-ended questions to elicit further information.
- Use a soothing tone of voice.
- Never move too quickly, begin with ice breaking, and proceed at the client’s pace.
14 Tips for Developing Trust and Empathy
Carl Rogers believed that “true empathy is always free of any evaluative or diagnostic quality. The recipient perceives this with some surprise. ‘If I am not being judged, perhaps I am not so evil or abnormal as I have thought’” (Vincent, 2018, p. 167).
Rogers understood that by identifying with another person’s situation, the therapist elicits the client’s trust, which is crucial for motivating clients to change. These ideas are consistent with the substantive literature. In fact, empathetic listening skills are deemed to be essential components of evidence-based counselor training (Moyers & Miller, 2013).
There are a number of ways to enhance empathy and trust within the counseling context. For example, in a qualitative study in Australia, Phillip, Beel, and Machin (2020) examined methods that counselors use to build rapport during phone conversations with clients.
Based on their findings, the researchers reported the following recommendations for building trust and rapport during phone counseling:
- Empathize with the client’s emotional and cognitive frame of reference by drawing from their stories and manner of expression.
- Attend to the client’s paralanguage cues (e.g., volume, pitch, pauses, etc.).
- Use your own paralanguage as a way of moderating the client’s emotion.
- Use reflective responses and questions to clarify the client’s emotional and cognitive state.
- Mirror the client’s language, tone, and pace as a way of calming emotional clients.
In another qualitative study, Lynch (2012) investigated the key factors that produce successful therapeutic outcomes. Twelve interviews by licensed clinical social workers were analyzed for themes.
When asked “How do you show empathy toward your clients?” participants reported the following:
- Using appropriate eye contact and body language
- Using active listening techniques and reflecting language
- Being genuine, present, and mindful during sessions
- Focusing more on listening than speaking
- Using self-disclosure as appropriate
- Validating the client’s feelings
In a third qualitative study, open-ended interviews were conducted with female clients in order to explore client perceptions of empathic listening (Myers, 2000). Participants reported the following counselor behaviors as important for experiencing an empathic bond with the therapist:
- Expressing nonjudgmental acceptance
- Listening carefully, which includes remembering details
- Providing feedback via paraphrasing, questioning, and summarizing
Fostering Rapport: 10 Questions to Ask Patients
Asking the right questions is important for putting the client at ease while also eliciting key information.
Here are 10 examples of rapport-boosting questions:
- How are you doing today?
This basic question is essential for initiating the therapist–client meeting. In addition to showing interest in the client, it may reveal a lot about the client’s mood.
- Did you find the office okay? Do you live in this neighborhood? Where did you grow up?
While many of us dislike small talk, it is of great value when it comes to rapport building during therapy. Clients, especially new ones, are often anxious. Breaking the ice with simple small talk helps them to ease into counseling. It also makes the counselor seem more friendly and relatable.
- What brings you here?
This question helps to set the stage as far as the client’s perceived problems. While it will be further unpacked during the therapeutic process, the client’s initial thoughts about what’s going on in their life often reveal important information.
- Have you been to therapy before? If so, what was your impression of it?
This question helps the therapist to gauge aspects of the client’s therapy history that will inform them of how best to proceed.
- What was it you didn’t like about your prior experience?
Treatment resistance is a key obstacle to effective therapy. Determining prior barriers will enable the counselor to act in a way that promotes retention. For example, if the client disliked the prior therapist’s client-centered approach, the current clinician may opt for a more directive style.
- What might have made your prior therapy experience better?
Again, this question helps the therapist to create an optimal experience for the client by incorporating the qualities they would most appreciate.
- Tell me about yourself.
This open-ended prompt often elicits a wealth of information about how the client sees themselves and the impetus for attending therapy. It also helps to build rapport before getting into more detailed questions.
- What do you consider your greatest strengths?
Along with learning about the client’s degree of self-efficacy and self-esteem, this question is useful for creating treatment approaches and goals.
- What are the primary areas you would like to focus on during therapy?
Therapy is a collaborative process, and this question helps the client to feel like a valued partner in the therapy process.
- How do you hope to see yourself in the future?
Along with providing important treatment goal information for the therapist, this question also enables the client to visualize themselves in a positive light, which is a great way to enhance motivation.
Helpful Tools From PositivePsychology.com
We have several useful resources throughout our blog for building rapport with clients. To get you started, take a look at the following further reading and free worksheets.
- Listening Accurately Worksheet
This handout presents five simple steps to facilitate accurate listening and can be used to help establish communication norms at the beginning of a coaching relationship.
- 10 Ways to Build Trust in a Relationship
This article features a great deal of information aimed at enhancing trust in relationships, including between clients and clinicians. More specifically, the article includes tips for generating trust, such as utilizing effective communication skills, expressing empathy, and maintaining a calm demeanor. Trust-building activities for groups are also provided.
- 32+ Coaching Skills and Techniques for Life Coaches & Leaders
This article takes a comprehensive look at various rapport-building strategies used by coaches. In particular, the article covers motivational techniques, coaching models, online group coaching, and effective communication. Here, you’ll also find various book recommendations to further your coaching skills even more.
- Levels of Validation
This short self-assessment helps coaches and other helping professionals consider the level at which they typically validate the feelings and experiences of their clients, ranging from mindfully listening to radical genuineness.
- 17 Positive Psychology Exercises
If you’re looking for more science-based ways to help others enhance their wellbeing, this signature collection contains 17 validated positive psychology tools for practitioners. Use them to help others flourish and thrive.
A Take-Home Message
If counseling is a process of discovery and recovery, then grace is essential to help clients experience enough safety to explore the hidden places of their lives.
Mark R. McMinn
A powerful counselor–client bond is essential to support clients in realizing their treatment objectives.
It is seen as a first step and absolutely necessary to create a harmonious and trusting therapeutic relationship. In this space, a client can unpack their vulnerabilities and move toward healing.
By establishing trust, being authentic, and listening actively, the therapist can open the door to building quality rapport, which helps to enhance client motivation and compliance, and ultimately therapeutic success.
We hope you enjoyed reading this article. Don’t forget to download our three Positive Psychology Exercises for free.
- Harwood, M., & Eyberg, S. (2004). Therapist verbal behavior early in treatment: Relation to successful completion of parent-child interaction therapy. Journal of Clinical Child & Adolescent Psychology, 33, 601–612.
- Horvath, A., & Greenberg, L. (1989). Development and validation of the Working Alliance Inventory. Journal of Counseling Psychology, 36, 223–233.
- Horvath, A., Del Re, A., Flückiger, C., & Symonds, D. (2011). Alliance in individual psychotherapy. Psychotherapy, 48, 9–16.
- Joe, G., Simpson, D. D., Dansereau, D., & Rowan-Szal, G. A. (2001). Relationships between counseling rapport and drug abuse treatment outcomes. Psychiatry Services, 52(9), 1223–1229.
- Kasarabada, N., Hser, Y., Boles, S., & Huang, Y. (2002). Do patients’ perceptions of their counsellors influence outcomes of drug treatment? Journal of Substance Abuse Treatment, 23, 327–334.
- Keijsers, G., Schaap, C., & Hoogduin, C. (2000). The impact of interpersonal patient and therapist behavior on outcome in cognitive-behavioral therapy: A review of empirical studies. Behavior Modification, 24, 264–297.
- Leach, M. (2005). Rapport: A key to treatment success. Complementary Therapies in Clinical Practice, 11, 262–265.
- Lynch, M. M. (2012). Factors influencing successful psychotherapy outcomes (Master’s clinical research paper, St. Catherine University, Minnesota). Retrieved from https://sophia.stkate.edu/msw_papers/57
- McMinn, M. R. (n.d.). Retrieved May 21, 2021, from https://www.goodreads.com/author/quotes/87398.Mark_R_McMinn
- Miller, W., & Rollnick, S. (2013). Motivational interviewing: Helping people change. Guilford Press.
- Moyers, T., & Miller, W. (2013). Is low therapist empathy toxic? Psychology of Addictive Behaviors, 27, 878–884.
- Myers, S. (2000). Empathic listening: Reports on the experience of being heard. Journal of Humanistic Psychology, 40, 148–173.
- Phillip, K., Beel, N, & Machin, T. (2020). Understanding the cues and strategies counsellors use to develop rapport with clients through telephone counselling. Psychotherapy and Counselling Journal of Australia, 8, 1–9.
- Reiman, T. (2007). The power of body language: How to succeed in every business and social encounter. Pocket Books.
- Vincent, S. (2018). Being empathic: A companion for counsellors and therapists. CRC Press.
- Young, S. (2017). The art of connection: 8 Ways to enrich rapport & kinship for positive impact. ReNew You Ventures.
- Zakaria, R., & Musta’amal, A. (2014). Rapport building in qualitative research. 1st International Education Postgraduate Seminar Proceedings, 1.