Rapport: A key to treatment success

Complementary Therapies in Clinical Practice (2005) 11, 262–265
Rapport: A key to treatment success
Matthew J. Leach

School of Health Sciences, University of South Australia, North Terrace Adelaide SA 5000, South Australia
Summary The therapeutic relationship is a concept often ignored in current
literature. As such, the importance of good patient rapport may be overlooked. To
address these concerns, the following paper highlights the effects that strong
therapeutic relationships may have on patient satisfaction, treatment compliance
and client outcomes. Strategies that practitioners can employ to facilitate the
development of good patient rapport are also discussed.
& 2005 Elsevier Ltd. All rights reserved.
Introduction
The first and most important objective of any
client–practitioner interaction is the establishment
of client rapport. Aside from facilitating commu-
nication between the practitioner and patient,
good patient rapport may also improve client
assessment and the achievement of expected
treatment outcomes. 1 Nonetheless, development
of the therapeutic relationship requires time and
skill. 2 As the therapist’s contribution to this
alliance is often overlooked in the literature, 3 the
purpose of this paper is to enlighten readers of the
importance of establishing a strong therapeutic
relationship with their clients, and to provide
practitioners with useful strategies to improve
client rapport in clinical practice. These skills
may also facilitate a practitioner’s ability to
develop effective working relationships with other
health care providers. 4 Firstly however, an explora-
tion of the terms used to describe the therapeutic
relationship will allow readers to understand the
context in which this paper is situated.
Definitions
Many terms exist which describe the bond between
a client and practitioner. The terms most fre-
quently identified in the literature are therapeutic
alliance, therapeutic relationship and patient rap-
port. By definition, a therapeutic alliance is a
‘yconscious and active collaboration between the
patient and therapist’. 3 Similarly, a therapeutic
relationship is ‘a trusting connection and rapport
established between therapist and client through
collaboration, communication, therapist empathy
and mutual understanding and respect’. 4 Likewise,
patient rapport is defined as a ‘harmonious rela-
tionship’. 5 As each of these terms incorporate
similar underlying themes, including collaboration,
reciprocality, parity and growth, these terms are
considered interchangeable.
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KEYWORDS
Rapport;
Therapeutic
alliance;
Therapeutic
relationship;
Clinical outcomes
1744-3881/$ - see front matter & 2005 Elsevier Ltd. All rights reserved.
doi:10.1016/j.ctcp.2005.05.005

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Importance
There are many reasons why practitioners should
be encouraged to develop strong therapeutic
relationships with their clients. On the whole,
building and maintaining patient rapport leads to
positive client outcomes. 6-8 A recent survey ex-
ploring the views of 129 Connecticut Occupational
Therapists on therapeutic relationships supports
this claim. 4 Whilst descriptive surveys are not the
most appropriate design for evaluating causal
relationships, clinical evidence is beginning to
mount that validates the association between good
rapport and positive client outcomes.
To illustrate this, a cohort study involving 354
patients in a community-based non-profit drug
treatment programme and 223 patients from a
private for-profit programme, found lower levels of
client rapport during counselling treatment re-
sulted in poorer treatment outcomes, including
greater cocaine use and criminality. 9 Likewise,
studies of patients with non-chronic schizophre-
nia, 10 depression, 11 post-traumatic stress disor-
der 12 and alcoholism 13 demonstrate that good
patient rapport can improve treatment outcomes.
Although these studies suggest that the develop-
ment of a strong therapeutic relationship may
benefit patients receiving psychotherapy, the ef-
fect of good client rapport on the outcomes of
interventions in other health care fields is lacking.
Further research is therefore needed to ascertain if
changes in practitioner behaviour can ameliorate
treatment success and reduce unnecessary demand
on existing health and welfare services.
A reason why well-established therapeutic rela-
tionships may contribute to improved client out-
comes may be explained by increased treatment
compliance.14 To support this claim, mothers attend-
ing a Los Angeles children’s hospital reported greater
treatment compliance when highly satisfied with a
physician’s attitude.15 Similarly, peri-operative pa-
tients reporting a higher level of satisfaction with
their care were more likely to take responsibility for
their decisions.16 Thus, client satisfaction appears to
be a strong motivator of treatment compliance and
as such, maybe fundamental to treatment success. In
other words, good client rapport may be responsible
for improving patient satisfaction and treatment
compliance,7 and ameliorating patient outcomes.
Even though the needs of patients are a priority in
any consultation, there are also professional implica-
tions associated with building a therapeutic alliance.
Firstly, strong therapeutic relationships between
patients and clinicians may improve the public’s
perception of a practitioner group.4 Secondly, by
increasing client rapport and treatment compliance,
the risk of litigation may be reduced.6,15,17 Although
this claim is speculative, Eastaugh 18 and Panting 19
both agree that improving client trust and commu-
nication, such as that developed through good
rapport, results in fewer malpractice claims. Alter-
natively, because good patient rapport is critical to
formulating adequate diagnoses,15,20 practitioners
may misdiagnose less frequently if therapeutic
alliances are well established.
Because the practitioner is predominantly re-
sponsible for developing and maintaining client
rapport, 21 the following section will highlight
several useful strategies that clinicians can employ
to strengthen therapeutic relations and improve
client outcomes.
Application
The clinician’s behaviour and communication style
can have significant impact on the practitioner–-
client relationship. For instance, therapists who are
warm, friendly (P ¼ 0:01), affirming and under-
standing (P ¼ 0:05), demonstrate a higher thera-
peutic alliance with their patients than those who
do not manifest these abovementioned qualities. 22
These attributes may also increase client compli-
ance 15 and improve treatment outcomes. 23 Another
essential ingredient in the development of the
therapeutic relationship is time.
Developing patient rapport within the first few
minutes of a consultation builds client trust 24 and
minimises defensive client attitudes by blurring the
transition from ‘small talk’ to formal assess-
ment.15,25 Increasing constraints on practitioner
time, such as escalating workloads, costs, organisa-
tional and political pressure, lessen the opportunity
for practitioners to build a strong rapport with their
clients. 4,26
In support of the relationship between time and
rapport, a study examining 623 tape-recorded
sessions between medical practitioners and their
patients found consultations that were booked for
10 minutes resulted in improved client education
and more detailed patient assessment than ap-
pointments booked for 7.5 minutes. 27 Because time
constraints can also have a negative impact on
client outcomes, 4 adequate consultation time is
therefore as important as effective communication
skills. Thus, professions that can afford the luxury
of providing consultations of unlimited duration
may establish greater therapeutic relationships
with their clients as opposed to practitioners
constrained by time. For clinicians where time is
scarce, strategies such as providing a quiet envir-
onment; actively listening; avoiding interruptions;
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Rapport: A key to treatment success 263