Building Therapeutic Rapport: Motivation, Engagement, and Authenticity

I’ve recently taken on a new professional role, getting involved in teaching at the graduate level.  This is something I’ve been wanting to do, probably since as far back as the days when I was a graduate student myself, and it is a real privilege to be at a point in my career where that feels like an opportunity I am both ready for and have earned the right to step into with some degree of confidence.

The course I will be teaching is one on Brief Therapy, which has been interesting in as much as it has pushed me to reflect on roles and institutions I worked in prior to my private practice, as well as stretch beyond the kind of principles that inform the more long-term interpersonal work that is part of my current clinical sensibility.  Thinking about working briefly does change some of the contours of the usual expectations I bring into the work, though it does not change the essence of how it is I think I ought to show up.  I first cut my teeth as a clinician well before I was technically qualified to do any kind of therapy as a mental health tech on the floor of an inpatient psychiatric unit.  It was there that I first identified an underlying facility with relationship building and developing a quick rapport that has been a central tenet in my work ever since.

I haven’t had many clients leave my practice “prematurely” and I sense that I have a pretty good rate of transitioning potential clients from the consultation phase into an active role in my practice.  I want to think aloud about the specific qualities that go into that kind of rapport building and how I understand what it is I am doing in a more conceptual sense, boiling it down to a kind of methodology that can be codified and taught.

To my mind, the basis of rapport building comes down to three things: identifying motivations, fostering engagement, and cultivating your own authentic presence.  Before we get into defining these terms, I want to notice a kind of flow in the location for each of these in the therapeutic relationship.  Motivations, to my mind, sit mostly within the purview of the client, potentially waiting to be evoked.  It can be our responsibility as the therapist to help the client identify and enhance what those motivations are, but fundamental motivation is about a client’s relationship with their own desire for and willingness to change.

Engagement is the relational dimension of this triad.  It is the kind of shared mutual presence that gets cultivated—and in short-term or brief work that must get cultivated quickly.  The literature identifies engagement as being fostered by developing a client-centered approach organized around shared goals and outcomes.  I think, basically, that this is right.  I would also add that those components I think help the client engender a sense of trust in the therapist, which spurs me to think about therapy through an Eriksonian lens.  Before we can begin to think about what we can do or what we will do, we have to be willing to say yes to the process.  Believing we are in good hands is central to that experience.

Authentic presence is about what the therapist brings to the interaction.  I believe the language I am using here is different from what you might encounter in other schools of thought, where there might be a predisposition to using words like “genuine” presence or “empathic” presence.  I think a sense of genuineness and being empathic can be a part of being authentic but are not necessarily the same thing.  I also do not think that either of those alone is sufficient.

Empathy is a powerful therapeutic tool, and it can endear us to someone to know they are empathizing with our situation.  That said, I have had plenty of folks offer words of empathy and support to me throughout my life.  That did not always entail that I would then be willing to turn my life over to them to help me sort out whatever the problem was.  Perhaps more so, my wanting to split up genuineness and authenticity might be tripping readers up, as I think colloquially they are often meant to communicate the same thing.  Looking at their etymology can help us to sort out the difference.

Genuineness comes from Latin meaning “to beget” and means something like “innate, not acquired”.  Authenticity, on the other hand, coming from Greek words for “self” and “action” means “acting on behalf of one’s own authority”.  It is not just about possessing a quality of genuineness, but about exercising some authority and ownership over one’s own being.  As such, I would say authenticity can carry a sense of genuineness, but genuineness is not always authentic.  The best example I can think of is the kind of relationship to authority I often had to maintain while working in inpatient settings or prisons.  There were times in those settings where I was called on to be somewhat disingenuous, as I am not someone who innately feels some affiliation with institutions of power and wants to reinforce systemic imbalances.  However, given the context and the respective needs of the clientele, there were many occasions where the authentic thing to do was to assume the authority of the institution I was representing; not as an unreflective exercise in domination or control, but because assuming that authority provided something to the interaction that was therapeutically valuable to the client.  Said more simply, genuineness seems to be about doing what feels reflexively kind or therapeutic, while authenticity is more contextual and may involve holding a frame that needs to be held for the sake of the demands of a specific clinical encounter.

Phenomenologically, I think we can see how these three components—motivation, engagement, and authenticity—intertwine and inform one another.  Each brings something to the interaction which is essential for the others to thrive.  As with anything we do in therapy, knowing how to hold all of them in consideration, determining when to amplify one or the other, and developing techniques for knowing how to elicit one or more of them at any given time are about training clinical sensibilities related to language, the body, presence, and affect.  We feel our way into the encounter and what shows up is rooted in reciprocity and mutual enactment.

I also want to take a moment to examine the difference between therapeutic rapport and the therapeutic alliance.  Rapport building, as we have been discussing it, is (at its basis) about developing a kind of kindredness in the therapeutic relationship.  It is the cultivation of the relationship itself and the sense the client has of what it feels like to be in the presence of the clinician: how it feels to be contained, comforted, pushed.  The alliance is about the shared sense of how a clinician and client work with what is being worked on in the therapy.  Alliance has a connotation of the strategic to me.  Taken more broadly, then, the alliance and rapport are about efficacy and intimacy, respectively.  You can even feel it in the way that the word alliance feels more natural with the article “the” whereas rapport has more permission linguistically to stand on its own merits.  The alliance is something to be pointed to and understood, the rapport is felt and embodied.

I hope that this has been helpful/interesting to those who come across it.  It is good to be able to write in this space again.  I have had to take some time away from the blog to really set time aside to begin the development of this course.  Additionally, I was working on a much longer piece to be a part of the upcoming conference series for the New England Center for Existential Therapy, that I hope to post some version of here after I have a chance to give that talk.  I expect to be able to keep this site alive by continuing to share interesting intersections that arise between the course content and my own theoretical dispositions that I bring to my teaching.  I will have to trust I’ve done enough to keep you all motivated and engaged enough to keep reading.