Imagine walking into the waiting room where you will meet with a new health specialist for the first time.
You feel a little apprehensive about the appointment. Will you leave feeling judged and guilty? Will you feel comfortable divulging personal information? Or will you leave feeling a sense of relief and empowerment?
As you wait, you start to think about two different scenarios once you walk into the health specialist’s office. In the first scenario, the health specialist barely makes eye contact with you, seems rushed, and shoots off what seems like one hundred back-to-back questions without giving you much chance to explain. They make judgmental faces when you respond or shoot off some “hmmms…” and eye rolls. Once the interview is over, they go on to tell you how your choices and behaviors are problematic and then give you an interminable list of instructions and prescriptions.
You leave feeling worse than when you went in, vulnerable, judged, guilty, and overwhelmed by a long list of to-dos.
Now imagine a second scenario. You walk into the health specialist’s office, and you are greeted with a smile and a genuine “How are you doing?” They then go on to ask what brings you to the appointment. They ask if you feel comfortable answering some questions about your current and past health and well-being. They also let you know that if there is something you prefer not to talk about, you don’t need to respond. They acknowledge your responses and how you might be feeling.
Refreshingly, it feels like they are really making an effort to get to know you. Once the question and answer portion is complete, the health specialist asks permission to share what they think is going on and how to proceed. They pause regularly to see if you have any questions or need clarification. They also ask if you need any additional support between appointments.
After this second scenario takes place, you leave feeling relieved, empowered, and more in control of your health.
There are numerous differences between the health specialists’ approaches in each of these scenarios. One way to summarize the differences is by taking a look at the health specialist’s interest in building a genuine rapport with you.
What exactly is rapport? While there is no one definition of rapport, in the health field, rapport building is a process by which a health provider, such as a health coach or physician, nurtures an environment in which a relationship of trust, open communication, and empathy is ensured.
This article discusses the benefits of building rapport, shares some of the characteristics of effective rapport building, and discusses different ways in which you can build rapport with your clients.
The Benefits of Building Rapport with Your Coaching Clients
Building rapport with your coaching clients benefits you and your professional abilities, your client’s outcome, and even your business.
Benefits to the Client
When the health coach is interested in building rapport, the client can:
- Feel empowered
- Trust their health coach
- Feel like their opinions and desires matter
- Feel like they have an active role in their health (known as self-efficacy)
- Have improved follow-through with commitments
- Be more likely to feel motivated
- Have a safe space where individual experiences, including past childhood adversity and trauma, are acknowledged and considered throughout the support process
Ultimately, clients with whom health coaches and other health professionals have built a rapport have improved health outcomes.
Benefits to the Health Coach
Rapport is as beneficial for the health coach as it is for the client. Building rapport helps health coaches do their job better.
Some of the benefits of rapport building to the health coach include:
- Receiving detailed information about a person’s health and wellness history, including elements that are often overlooked in intake forms and questionnaires
- Gaining insight into how a client truly feels about the advice and suggestions a health coach provides
- Getting genuine feedback about the coaching process
- Gaining experience with complex client realities
- Opportunities to improve people skills, including building empathy
- Improved client retention rates, which is good for the coach, the client’s outcome, and the coach’s business.
How to Build Rapport with Your Coaching Clients
There are several proposed models for building rapport in the healthcare environment.
In general, most models propose that to build rapport, the health professional must take the first steps to create an environment where the client feels valued, heard, cared for, and understood. One of the primary unifying elements of the different models is the importance of demonstrating and maintaining true empathy throughout the consultations.
When the client or patient perceives that the health professional respects them as an individual and has a true interest in their well-being, then rapport will continue to develop through a dialogue between both the health professional and the client.
Below is a four-step framework in which health coaches can build rapport with clients. It is based on the empathy framework for establishing rapport in health consultations developed by Norfolk, Birdi, and Walsh in 2007 but adapted to the coaching environment.
Note that these aren’t concrete steps so much as stages that are vital to building empathy and rapport. The stages may overlap, and it may be necessary to revert to a previous stage if something changes in the coaching-client relationship.
Committing to understanding the client through engaging with their individual experience
To build rapport, the health coach must begin with the desire to understand a client's individual perspectives and experiences. This is sometimes referred to as empathetic motivation.
Empathetic motivation requires a sense of humility in knowing that, while you are knowledgable, you do not know what your client is experiencing or how they are experiencing it. It also requires a sense of curiosity, demonstrated by your questions and listening skills.
Some of the communication qualities that help to reinforce this first stage are warmth, openness, and caring for your client, expressed through your tone of voice, body language, eye contact, and how you ask questions.
Note that this first element is primarily the responsibility of the health coach. If your client resists, it is your responsibility to roll with the resistance rather than challenge it.
Employing the skills necessary to demonstrate a willingness and ability to empathize
Norfolk and his research team make a clear distinction between a health professional’s desire and their ability to understand their client. As a coach, you may feel motivated to understand your client and build empathy, but when they share their experience and logic, you find it difficult to fully understand why they would feel, act, or think in a certain way.
This requires specific communication skills that encourage client disclosure of information and feelings. It involves verbal skills such as the appropriate use of open questions, such as those that might be employed in motivational interviewing, and nonverbal skills, such as tone and warmth of voice, posture, staying silent when appropriate, smiling and nodding. While these skills often develop in the teen years in an appropriate developmental environment, these skills can also be developed intentionally later in life.
The transition from a desire to understand to an ability to understand requires the development of several empathic skills. These include:
- Picking up clues about what your client is thinking through what they say and their body language. For example, if your client hesitates after you ask them if they feel it is realistic for them to eat breakfast soon after waking up, you may deduce that they are thinking it is not possible but are unsure if they should express it.
- Picking up cues about how your client is feeling. This includes listening to what they say and their body language. For example, if your client is crossing their legs and arms and looking down, they may be feeling uncomfortable speaking about a topic you brought up.
- Building nonjudgmental perceptions about their thoughts and feelings. Processing what your client is thinking and feeling and understanding them and how they might think, feel, or act in a certain way reflects the extent to which the coach has empathy for the client.
Throughout this process, the client determines whether or not they can trust and feel a positive connection with the coach, making way for a constructive rapport-building process.
Creating a space for an equal-ground dialogue with your client
In the healthcare space, the health professional is generally expected to be the “teacher,” and the client or patient is expected to act like the “student.” This traditional model doesn’t allow space to build empathy and much less rapport. Instead, it assumes the health professional knows everything and that the client just needs to do exactly as they are told to feel better.
From what you have read so far, the traditional model of healthcare described is not an effective way to build rapport, and, as a result, the benefits of rapport building to both the client and the coach are totally missed.
Asking questions, allowing and encouraging the client to tell their story, and listening actively and nonjudgmentally allows for a space to construct an empathic understanding of the client’s perspective.
Empathetic understanding refers to the degree to which the coach is able to accurately identify the client’s perspective. This could involve rephrasing the client’s statements and asking if you captured their feelings, logic, or experiences appropriately. Throughout the coaching process, empathetic understanding can be expressed in multiple ways, including:
- Rephrasing the client’s statements to ensure understanding
- Mirroring the client’s language as you describe their experience or offer advice or an explanation
- Verbalizing connections by observing and asking whether your interpretation was accurate
- Modifying or personalizing the coaching process to meet individual needs and uplift strengths
Building rapport is generally considered the first step in an effective coaching process. It ensures a strong foundation on which the coaching process can be built.
While rapport building occurs mostly in the initial stages of the coaching process, keep in mind, however, that your rapport is reinforced or broken down with each interaction. Empathic motivation, or your openness, warmth, and professional dedication, during all sessions helps to reinforce the sense of empathic motivation, and empathic skills, such as listening actively and your ability to understand their perspective, can be employed throughout your interaction with your client.
Rapport building provides benefits to the coaching client as well as to the health coach. Whether you feel you currently have the skills necessary to build rapport or not, you can learn about them and develop empathic skills at any stage in your life or career.
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