Why rapport matters

• Improves disclosure, adherence, engagement and clinical outcomes.
• Reduces dropouts, therapeutic ruptures and misunderstandings.
• Enables collaborative goal setting, honest feedback and shared decision‑making.

Core principles

• Safety: create a predictable, private and non‑judgmental space.
• Respect: honour identity, preferences and expertise of the client.
• Curiosity: ask open questions and be genuinely interested in the person’s experience.
• Transparency: explain roles, limits of confidentiality and next steps.

Micro‑skills: what to do in the first 5–10 minutes

1. Warm greeting, introduce yourself with name and role; offer choice about seating or camera position for telehealth.
2. Check immediate needs: pain, privacy, comfort, urgent safety concerns.
3. Use the client’s preferred name and pronouns; confirm how they like to be addressed.
4. Set a brief agenda together: “I have 30 minutes — what would you most like to focus on today?”

Active listening & reflective responses

• Techniques: paraphrase, reflect feeling, summarise, and use short verbal encouragers (“I see”, “mm” ).
• Reflective example: Client: “I feel overwhelmed at work.” Clinician: “It sounds like work is taking a lot from you right now and that’s exhausting.”
• Avoid over‑interpretation early; prioritise simple reflections and check for accuracy.

Powerful opening questions (choose and adapt)

• “What brought you here today, in your own words?”
• “What would make this session useful for you?»”
• “Tell me about a time recently when things felt a little better — what was different?”
• Scaling: “On a scale 0–10, how concerned are you about this? What would a 1‑point improvement look like?”

Nonverbal rapport builders

• Maintain open posture, appropriate eye contact, nodding and mirroring tone/pace subtly to match client comfort.
• Respect personal space; adapt proxemics by cultural norms and client cues.
• For telehealth: camera at eye level, minimise distractions, use active nods and verbal checks frequently.

Building trust quickly — brief interventions

• Express empathy early: “That sounds really hard — I’m glad you told me.”
• Offer small, concrete help immediately (e.g., safety planning, referral info) to demonstrate usefulness.
• Use normalising statements: “Many people feel like this when…” but avoid minimising the person’s suffering.

Cultural humility & identity‑affirming practice

• Ask respectfully about identity, beliefs and cultural practices—don’t assume; use open prompts (“Tell me about what’s important for you culturally/religiously”).
• Be aware of power differentials and historical mistrust—validate concerns and negotiate care collaboratively.

Handling ruptures & difficult moments

• When misattunement occurs, acknowledge it: “I may have missed that — tell me more about what you meant.”
• Apologise briefly when appropriate and repair: “I’m sorry — I want to understand better.”
• Use curiosity rather than defensiveness to explore differences and restore connection.

Boundaries, ethics & safety

• Clarify confidentiality limits, session length and expectations early.
• Maintain professional boundaries—avoid dual relationships when possible; document any necessary boundary decisions.
• Screen for safety (suicidality, abuse) and act promptly with safety planning or referral when needed.

Common pitfalls to avoid

• Rushing to solutions without understanding the client’s perspective.
• Overused platitudes (“It’ll be fine”) or minimising language.
• Unconscious bias: avoid assumptions about socioeconomic status, education or culture based on appearance.

Case vignette

Client: P., 28, anxious about first psychiatric appointment. Clinician used warm greeting, asked preference for seating and privacy, reflected feelings, normalised anxiety and offered a short breathing exercise. Within the first session P. disclosed sleep disruption and agreed to a safety plan and follow‑up—engagement continued.

Key takeaways

• Rapport is built through safety, respect, curiosity and transparency—micro‑skills in the first minutes matter.
• Active listening, culturally humble questions and clear boundaries together create durable therapeutic alliances.
• Repair ruptures quickly with curiosity and apology; prioritise safety and follow‑up to sustain engagement.