The Importance of Rapport

I have had the privilege of working in a large hospital in Raleigh for several weeks. My days are of full of a-ha moments as I see so much of what I have learned come alive, and come together. One of the subjects that keeps coming up in our studies is the issue of rapport with our clients. I have found that this is something that is easier said than done. Some clients are very friendly and talkative and it is so easy to connect with them and establish a rapport, for others who are not in good spirits or cannot even speak, it seems much more difficult, maybe even impossible.

I had a strange experience my very first day when I was with an OT doing an eval on a very sick patient. The nurse was interacting with her so gentling and patiently. Then the OT began her magic and I was so impressed to watch her connect with her patient within seconds, chatting in such a warm friendly way in what I know was a very thorough evaluation, but appeared on the surface as nothing but conversation. I remember thinking "this is what rapport looks like". Right in the middle of this interaction the patient's doctor walked in and loudly interrupted with a "how ya doin'?" I noticed that the patient appeared very startled and almost afraid. She never said a word as the Dr. conversed with the PA about her meds, and then left the room without even a reply from her about how she was doing. I felt really sad for her and wondered what she must be thinking...it didn't seem to me that he was genuinely concerned with how she felt she was doing.

On another occasion I was working with an OTA who was queen of rapport. Every single patient got her full attention and she went out of her way to talk eye-level with them, finding out how they were, discussing any and everything they wanted to, from toileting to eating, going home to even their meds and other therapies they were receiving. I noticed how carefully she tailored herself to each person, adjusting her tone and temperament to benefit the client. I was so impressed with her rapport. What I took away from my experiences is that these patients are first and foremost human beings. They are not machines that we just do stuff to. They have feelings and questions and concerns that need to be heard and responded to. There is simply no substitution for the conversations we have with them in their healing process.

I recently read an article about how the insurance companies are doing away with coverage for talk therapy. What once was a 50-60 min. talk therapy visit with a psychiatrist with a possible prescription for meds, has now become a 15 min. visit for "prescription adjustment". How sad that is that we don't even consider the possibility that words can heal. Some psychiatrists resist the insurance mandates and still offer up to 90 min. visits - good for them. One therapist is quoted as saying "medication is important, but it's the relationship that gets people better." Amen to that.

Below is the link to the complete article I quoted. It has a lot of detail about the changes in talk therapy. Very interesting and worth the read.
http://www.nytimes.com/2011/03/06/health/policy/06doctors.html