Partnering with Clients: The Dance of Rapport

• Partnering with Clients: The Dance of Rapport (177.1 KB)

Imagine you are dancing with a partner with whom you feel open and safe. What does this dance look like? It’s probably smooth and flowing, and when one person makes a move, the other follows, to keep the connection.

Now imagine this dance with a different partner, someone with whom you feel uncomfortable or out of synch. What happens to the flow, especially when one of the partners tries to change direction? The result is usually resistance, stumbling, and frustration.

Helping clients feel safe and at ease in the veterinary setting is crucial to the process of creating relationship-centered care. Developing and maintaining nonverbal rapport to create this safety and ease is one of the most important skills team members can cultivate. Creating a sense of connection and flow allows the client to offer all the information and associations that may be important for the patient’s care.

Nonverbal rapport can be thought of as a dance. Basically, it is moving as the other person moves to create an interactional synchrony whose basic message is, “I am with you.” When you can mirror or match the client’s behavior, the client experiences a sense of being supported or understood, and is more likely to be receptive to the therapeutic options that are offered. For the team member in this synchrony, a natural empathy emerges.

The dance changes with different clients, so it’s important for the clinician to be able to follow and then to lead.

Matching & Leading
There are two parts to developing nonverbal rapport: matching (or mirroring) and leading. Matching is the process of moving as the client moves so as to acknowledge aspects of the client’s behavior as a reflection of the state he/she is in. You can match anything you can notice—body posture and gestures, voice volume and rate, or facial expression.

For example, a guarded client who is putting up barriers of her arms or her animal is likely to respond more favorably to a clinician who is in a more “closed” posture, rather than a clinician who has arms open and is closing in on the interpersonal distance between them (Figure 1). Likewise, an angry owner whose voice is loud will respond better to a clinician who raises his/her voice volume somewhat in response but does not match the angry tone (Figure 2).

Figure 1. The guarded client has a barrier up, protectively clutching the animal. The veterinarian is matching the barrier the client has put up with his/ own barrier of his relaxed arms, as well as giving the client extra interpersonal space.

Figure 2. Veterinarian is matching angry client’s body posture, as well as opening his arms somewhat to communicate “I am with you,” and showing the client that  he is not defensive. If the client’s voice volume is loud, the veterinarian could mirror this by subtly raising his own volume—but never matching the client’s angry tone.

Leading is the use of the interpersonal synchrony that has been set up by matching. This is analogous to changing direction with a dance partner, where the change is easier to follow when the pair of dancers is in step. People in rapport are motivated to try to stay that way, and a leading motion by one person is quite likely to produce a reciprocal response in the other.

Leading invites the client to move with your recommendations or concerns rather than feeling rushed or coerced into them. If led too fast or too dramatically, however, rapport may be interrupted. Recover it by returning to matching.
 
For instance, you may be in synchrony in your rate of speech and mirroring as the client begins to express important feelings. If in the middle of the expression of those feelings, you reach for the animal or medical record, interactional synchrony is disrupted and the client may feel a distinct disconnection. This can be readily repaired by a return to nonverbal matching and getting back into “step” once again.

Any new or unexpected verbal content introduced into the interaction can be considered leading. For example, recommending medication or procedures the client was not expecting or giving bad news are leads, and it helps to be in rapport with the client when they are introduced. Conversely, if a client suggests unnecessary treatments or procedures, it is easier to understand the perspective of the owner's world in which that behavior makes sense, and to have more empathy, by going back to nonverbal matching.

Obviously, getting into nonverbal rapport is easier with some people than with others. When the doctor or other team member is working with clients he or she enjoys, matching is effortless and usually unconscious. It’s important to prepare for visits you expect will be uncomfortable by planning to mirror some of the client’s behaviors.

Happens All the Time
Matching and leading are occurring all the time. If you are not aware of the structure of rapport, clients or staff may lead you into a less useful physical, and thus emotional, state of mind and feelings. Most clinicians experience this frequently—a depressed or anxious client can be a drain who leaves you wondering what happened to your initial energetic and optimistic state of mind.

Remember that there are two parts to interactional synchrony. You need to be willing to behaviorally match the other person, experience what he or she may be feeling, and then lead yourself (and hopefully the client) into a better form of the dance.

Noticing nonverbal behavior takes some practice; treating this more subtle form of interaction with the thoughtfulness and observation with which we approach any other clinical problem can produce a set of skills that can be applied in every encounter.

The power of this nonverbal technique is not limited to clients; relationship-centered care extends to staff and colleagues as well as into personal relationships. When rapport is combined with verbal skills such as open-ended inquiry, reflective listening, and expression of empathy, the combination deepens and extends the possibilities for creating partnership in veterinary care.

Steps for Developing Nonverbal Rapport With Clients

1. Step into their shoes by matching some aspect of their behavior.
2. Begin to experience the feelings in their world.
3. Experience the natural empathy that arises from this, and respond to it.
4. Introduce the next step—diagnosis, procedure, tests, referral.
5. If rapport is broken (ie, the next step is too big), go back to matching.

References
1. Nonverbal communication. Carson C. Vet Clin North Am Small Anim Pract. 37:49–63, 2007.
2. The expression of emotion through nonverbal behavior in medical visits: Mechanisms and outcomes. Roter D, Frankel R. Hall JA, Sluyter D. J Gen Int Med 21:S528–S534, 2006.

Dr. Carson is an internist who has taught and published on communication skills in the medical field for the past 25 years, with a primary focus on nonverbal communication. She is training faculty for the Institute for Health Care Communication and was Clinical Associate Professor of Medicine & Psychiatry at the University of Rochester Medical Center from 1986 to 2006.