Rapport in Clinical Settings

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Introduction

Background Information

Rapport is the emotional experience of high-quality interactions. An example of rapport is when someone opens up to a friend about their problems, and then the friend listens attentively offers validation and respect for the person’s feelings, which allows them to feel safe and open up more. Rapport is feeling understood, safe, and valued by the other person. Building rapport is a skill that must be learned to successfully work with others in many settings, including healthcare providers, educators, and business professionals. Clinical settings require a particular type of rapport building called "therapeutic rapport" (Therrien et al., 2021). To establish therapeutic rapport, you need to focus on attunement which helps the patient feel safe and confident about discussing difficult issues. Attunement is listening empathically to build trust and demonstrate attentiveness, which builds confidence in the provider’s ability not only to listen but also to care for their patient’s needs. These factors allow rapport building, which is a necessary component of effective health care.

It is important to note that rapport is best established between individuals when the same demographics are present in both the individual and the other person. For this dynamic of reciprocity to exist, it is best if both parties have similar cultural, organizational and societal experiences. This can be achieved through shared interaction with the same social groups, economic status and educational level (Sauerland et al., 2018). To establish therapeutic rapport in clinical settings between healthcare providers and patients, one needs to understand the characteristics of therapeutic rapport, which include trust, safety, vulnerability and confidentiality.

Trust allows for risk-taking by the patient and a greater ability to disclose personal information. Safety is achieved through the patient’s sense of assurance that the provider is safe and will not judge them when disclosing personal information. Patients also feel safer sharing with their providers when mutual trust between them. Vulnerability, which defines the ability to open up to a patient, allows the patient to open up more and be seen as having more potential. For this to occur, one needs to demonstrate attentiveness which demonstrates genuine care for a person’s needs and well-being (English et al., 2022). Lastly, confidentiality is established when the patient has confidence in their healthcare provider that what they are sharing with them will not be used against them negatively.

Theories of Rapport Creation in Clinical Settings

There are four theories of rapport in clinical settings that demonstrate how healthcare providers can achieve rapport with their patients. The four theories are Social Exchange Theory, Reciprocity Theory, Situationism Theory, and High Touch Low Touch Approach. Social Exchange Theory explains why people establish relationships with others (Dang et al., 2017). This theory suggests that humans seek to gain rewards from others; this process is called positive reciprocity, which can be achieved through cooperation, altruism, or gratitude. Social exchange theory would explain that a doctor’s kindness towards a patient would elicit positive behaviour from the patient (Therrien et al., 2021). In addition, doctors should be careful not to provide too much help because patients may become dependent on these services; this phenomenon is referred to as negative reciprocity. According to the High Touch Low Touch Approach, the doctor should provide treatment and establish strong personal relationships with his or her patient. The doctor would be able to help more by being sensitive to the patient’s needs; this could be done through interactions, physical contact, and talking about the weather.

The Reciprocity Theory suggests that humans are motivated to maintain appropriate relationships with others. In this theory, the amount of cooperation that a person receives is based on their intentions, the amount of help they give, and the form of help given. The doctor can call more attention to his or her presence by changing his or her attitude towards patients, making them more likely to be helpful (Sauerland et al., 2018). Doctors can also decrease their help level by interacting with patients in a non-cooperative fashion. The Situationism Theory suggests that people feel happy when involved in situations where their behaviour can influence the outcomes. This theory suggests that doctors who help their patients perform more successfully in stressful situations will increase the likelihood of positive outcomes for the patients (English et al., 2022). In addition, doctors should be aware of these patients’ needs and avoid giving unnecessary advice that does not fit their situation because this could cause negative reactions from patients.

Benefits and Methods of Rapport Creation

There are many benefits to building rapport with clients that include the satisfaction of needs, client and family active involvement, and a higher rate of improvement. The best methods for building rapport include community involvement, relating to their personal lives, and building friendships.

Benefits of Rapport Creation within the Clinical Setting

Rapport creation in the clinical setting facilitates the satisfaction of psychological needs, involvement of family in the delivery of healthcare services, and the improvement of healthcare outcomes. Understanding the concept of rapport is a key determinant in successfully applying effective interpersonal skills, which are predicated upon building rapport with patients and families. When receiving bad news from a physician, breaking rapport may result in psychological discord and resistance to treatment (Akamoglu et al., 2018). Service delivery may be adversely affected without establishing rapport between healthcare providers and patients or between family members. Rapport creation also helps satisfy some psychological needs, such as the need for relationships among vulnerable populations such as those suffering from aphasia. This is because one of the characteristics of rapport that people show is acceptance and support (Dang et al., 2017). People with aphasia may have difficulty initiating or maintaining conversations, understanding conversations, and communicating with others; therefore, they need others to help them satisfy their social needs—meeting the psychological needs of patients and families while creating rapport can improve health outcomes in a variety of ways. Ultimately, rapport creation in the healthcare setting helps to improve outcomes for populations such as people living with HIV/AIDS, new patients, and patients who continuously seek healthcare services (English et al., 2022). First, family members would be more likely to take an active role in healthcare by taking responsibility for their loved ones’ health by playing an active role in treatments. The therapeutic relationships resulting from rapport creation, which are based on trust among patients and healthcare providers, consequently create a safe space for patients to disclose inner thoughts and feelings and share ideas about treatment. Second, it makes patients feel more comfortable and relieves stress which improves their immune system.

Methods of Improving Rapport within the Clinical Setting

Rapport in the clinical setting might be improved through community involvement, especially of marginalized populations such as low-income families, incorporating personal experiences of healthcare providers, and building friendships through home visits and telepractice. Rapport, defined as "a connection characterized by harmony or accord (usually between people)", is an important component of medicine in that a rapport between the practitioner and patient can help alleviate pain and create a better understanding of treatment plans (Dang et al., 2017). However, it is often difficult for medical professionals to relate to their patients because they may come from different cultural backgrounds or socioeconomics (Akamoglu et al., 2018). This disconnection in the medical field between providers and patients has been seen as a major deterrent in treating some populations, such as those with low literacy levels, low-income levels, limited access to healthcare, or ethnic minorities. Based on these factors, the healthcare providers’ understanding of the patients’ lived experiences contributes to high levels of rapport (Akamoglu et al., 2018). On top of this, medical professionals can create better relationships with their patients if they utilize community resources such as home visits or telehealth.

Empathic skills can be learned through observation and role-play. The ability to identify with a patient’s experience and imagine what it would be like for them to feel how they feel helps providers develop a rapport over time. Providers should be able to identify when a patient is in pain and use the skills of empathy to help them through the tough times. Providers need to learn how to move from the past, present, and future so that their patients will feel better about their care. One way to improve empathy would be for providers to find ways to be comfortable in the clinical setting with their patients (Akamoglu et al., 2018). Although providers are more likely to have more rapport with patients they have worked with longer, having an empathic bond is useful in short-term arrangements and long-term ones.

Conclusion

Various theories can justify the need for rapport creation within the healthcare settings, including the theories of social exchange governed by concepts of reciprocity. By implementing rapport within the clinical setting through various means such as community involvement and telepractice, various benefits can be observed. For example, healthcare outcomes can be improved, and families become motivated to be included in the care of patients as much as patients are motivated to be involved in the decision making of matters related to their health and the satisfaction of psychological needs. Therefore, rapport creation within the healthcare setting can help improve the system’s efficiency. Healthcare providers should therefore be sensitized to the need for rapport creation. At the same time, system-wide changes are implemented to equip healthcare providers with the requisite skills to implement rapport with patients.

References

Akamoglu, Y., Meadan, H., Pearson, J. N., & Cummings, K. (2018). Getting connected: Speech and language pathologists’ perceptions of building rapport via telepractice. Journal of Developmental and Physical Disabilities, 30(4), 569–585. https://doi.org/10.1007/s10882-018-9603-3

Baker, Z. G., Watlington, E. M., & Knee, C. R. (2020). The role of rapport in satisfying one’s basic psychological needs. Motivation and Emotion, 44(2), 329–343. https://doi.org/10.1007/s11031-020-09819-5

Dang, B. N., Westbrook, R. A., Njue, S. M., & Giordano, T. P. (2017). Building trust and rapport early in the new doctor-patient relationship: A longitudinal qualitative study. BMC Medical Education, 17(1). https://doi.org/10.1186/s12909-017-0868-5

English, W., Gott, M., & Robinson, J. (2022). The meaning of rapport for patients, families, and healthcare professionals: A scoping review. Patient Education and Counseling, 105(1), 2–14. https://doi.org/10.1016/j.pec.2021.06.003

Sauerland, M., Brackmann, N., & Otgaar, H. (2018). Rapport: Little effect on children’s, adolescents’, and adults’ statement quantity, accuracy, and suggestibility. Journal of Child Custody, 15(4), 268–285. https://doi.org/10.1080/15379418.2018.1509759

Therrien, M. C. S., Madden, E. B., Bislick, L., & Wallace, S. E. (2021). Aphasia and friendship: The role and perspectives of speech-language pathologists. American Journal of Speech-Language Pathology, 30(5), 2228–2240. https://doi.org/10.1044/2021_ajslp-20-00370