Establishing rapport (an anecdote)


“What?” Ms. Oakes replied.

The rest of our first session went downhill from there. I stopped at the nursing station on the way off the unit. “She never wears her hearing aid,” the nurse reported. “I’ve got it right here but she refuses.”

The following Thursday I approached Ms. Oakes with the hearing aid box in my hand. “I’M GOING TO PUT THIS IN, OKAY?” I pointed to the box, to my ear and then hers.

“All right.” She allowed me to fumble with the device and stick it in her ear.

“Can You Hear Me?”

“You want to know if I can hear you? Yes.” She looked worried. “I can’t find my glasses.”

“When Was The Last Time You Had Them?” I asked.

“When the girl took me for a shower this morning.” A pair of unmarked glasses in the shower room could disappear forever.

“I’m Going To Look For Them. I’ll Be Right Back.”

I returned a couple of minutes later with the glasses in my hand.

Ms. Oakes looked at me with amazement. “Lord a mercy, I didn’t ever think I’d see them again!”

I cleaned them off and slid them into place. She beamed.


2 thoughts on “Establishing rapport (an anecdote)”

  1. I have been practicing as a Mental Health Counselor in NYS for about a Year- all with residents in long-term care facilities for senior citizens. Establishing rapport is often not difficult at all, but sometimes –much more often than I’m satisfied with — just getting my foot in the door seems difficult or impossible.

    The most frequent hurdle I find is what appears to be an underlying distrust of psychotherapy. Immediately after introducing myself to clients, I often am met with numerous questions, the most frequent being: “Who thinks I’m crazy?” “What are you here for?” “Why did they tell you to see ME?”

    I typically respond respond by saying that their referral has nothing to do with anyone thinking they are crazy, that many residents here experience loneliness, or sadness, or difficulty adjusting to losing their independence, and that many people find that just talking to someone like me can be very helpful- something along those lines.

    I get a sense that many clients aren’t satisfied with my answers, though, and either effectively shut the session down, or proceed with what feels like a barrage of questions which, put together, are rather overwhelming. I often find it very difficult to respond effectively to their concerns, which leaves me feeling frustrated and the client feeling distrustful. All of this sets a tone that is hardly conducive to positive engagement.

    Just to add some background, I work at two facilities: one in an urban area and one in a rural area; I find that residents at the urban facility are much more likely to be receptive to engaging in therapy, and generally more willing to share their experiences and feelings, while residents at the facility in the rural area are much more likely to be distrustful and/or defensive initially, and less open/talkative. (These observations, by the way, have been confirmed by the three other therapists on my team, all of whom have worked at these facilities for years.)

    I’m wondering if anyone with similar experiences has any suggestions?

    • Thanks for writing, Eric. Great question. The approach I take with residents is to say that I talk with a lot of people here because sometimes it can be stressful not to be feeling well, to be away from home, and to deal with all the personalities in a place like this. That’s usually enough because most people can agree that the situation is stressful. Sometimes I add that it can help to talk to someone who knows how these places work, or that a particular staff member asked me to see them because they were worried that the resident might be feeling down or worried about things. If people seem distrustful of therapy, I explain to them the limits of confidentiality and that I need to write notes to let the other staff members know what’s going on, but that I keep things general so that no one would know the specifics unless the resident and I decided we needed to talk to them about it. Sometimes residents, who have so many things happening out of their control, need to feel in control of at least this, so in those cases I might tell them that it’s fine if they want to think about it and that I’ll check back later in the week. If they agree to the initial interview and seem like they’d benefit from treatment but are hesitant, I let them know that they don’t have to decide right away and that I’ll check in with them the following week to see if they want to give it a try and that they can stop at any time. All this is based on my belief that coming into a facility would be stressful for even the hardiest of individuals, that it’s basically a medical facility and that the residents deserve as much privacy as possible regarding their mental health concerns (within the bounds of proper safety, teamwork and documentation), and that as a psychologist part of my role is to help them regain as much control as possible in a challenging situation.


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