Establishing greater rapport

Take a moment to consider what would be different if you could achieve a deep sense of trust and connection with your patients within moments of them entering the surgery. It goes almost without saying that if you could achieve this, your relationship with your patients would deepen, you would find out your patient’s motivation for treatment, and then when you address this you would have a higher uptake of treatment and a reduced risk of litigation. By learning how to build rapport effectively you will rapidly develop trust and connection with your patients.

What is rapport?
The dictionary definition tells us rapport is:
‘1. A feeling of relationship, especially when characterised by emotional affinity
2. A conscious feeling of harmonious accord, trust, empathy, and mutual responsiveness between two or more persons (i.e. physician and patient) that fosters the therapeutic process.’
Why is rapport important?

Rapport is essential when establishing lasting and respectful relationships with people, whether they are with your family, friends, colleagues or patients. Rapport is fundamental to effective communication and understanding.

Establishing rapport is a natural and spontaneous phenomenon, however you can learn to enhance your skills, and you can enhance your communication, developing deeper, more influential relationships more quickly. People generally like other people like them, and people buy from people they like. It pays to be like your patients, so I am going to show you simple yet effective ways to let you become more like your patients in their eyes.

Rapport is valuable because when you are in rapport with someone:
• You promote trust and comfort
• You are able to have greater understanding by meeting others in their ‘model’ of the world
• You are able to match your communication style to the way the other person prefers to receive information
• You increase the clarity of your communication
• Misunderstanding and conflict is minimised.

The importance of respect

Many of you will also have heard the cries of those around us: ‘so and so did not understand me’ or you may have even commented, ‘I did not have a clue about what they were talking about’.

Whether it is at work, home or at the dental practice, most people want to be understood, listened to and feel that someone else is interested in them.

This two-part series of articles is designed to give you skills that, when implemented, will increase your level of trust, understanding and communication. Characteristics of communication we will be reviewing include posture, energy levels, language and speech patterns, tonality and rhythm, gestures and breathing.

Refining your rapport skills will require you to enhance your sensory acuity, that is to increase your powers of observation, so that you consciously begin to notice what you are seeing, hearing and feeling, in yourself and others, as you interact. As you practise these skills you will begin to notice far more about yourself and your patients, you will be able to develop even more personalised treatment plans and find your work more rewarding.

A word of warning – when you move towards establishing deep rapport with someone, it is essential that you start with a genuine wish to understand them better, help them or serve them in someway, basically putting them and their needs first. If you attempt to use the rapport-building technique with the intention of manipulating another you will fail. All human beings, and our patients in particular, are extremely talented at sniffing out a fake – if your patient senses that you are trying to manipulate them for your own ends, they will know. If you approach rapport-building with a desire to manipulate, you will totally destroy any rapport or trust you have. Conversely, using the rapport-building skills that I am going to teach you, with genuine interest in helping your patients, friends and colleagues, will build deep and lasting trust and pay dividends.

The power of gestures

You are probably familiar with the research published in the Journal of Counselling Psychology in 1967, which suggested that communication is much more than the words we use and that the impact of our communication is:
• 55% body language
• 38% tonality
• 7% words.

As you look around your waiting room or staff room, notice that the people who get along with one another and who are in rapport adopt similar body postures, unconsciously. In his book, Manwatching, Desmond Morris called this a ‘postural body echo’, the way friends unconsciously act in unison. This natural phenomenon of matching and mirroring can be effortlessly incorporated into your practice, by all team members, to increase the connection you have with your patients.

To establish a postural body echo, match or mirror the other person’s gestures, choosing one of the following:
• Whole body posture
• Half body, that is just the arms or legs
• Part body, just the position of the head, foot, hand, etc
• Gestures
• Facial expressions.

To establish good rapport, follow a person’s moves respectfully – more like a dance than pure copying. Watch someone you wish to build rapport with for a short while and notice their gestures, and begin to follow them. Do this gently and respectfully, remembering the purpose of establishing rapport is to build a relationship with other people by understanding their ‘model’ of the world. It is possible to match and mirror bold gestures, obvious ticks and mannerisms without raising the awareness in another, although I would not recommend this. Manipulative mimicking without respect will quickly break any rapport that you may have developed.

On occasions it is not appropriate to match another person’s behaviour directly, and cross-over matching can be useful. To cross-over match you match one aspect of a person’s behaviour with a different part of yours. For example, when the other person sitting with their legs crossed repeatedly flicks their toes, you could tap your finger on your knee, thus unconsciously linking the toe flick to the tap of your finger.

There is a presupposition that as the dental professional you will want to establish rapport to have a degree of influence over your patients and this can be true in some situations, such as relaxing an anxious patient so they are willing to accept treatment. It is essential, therefore, that you know at what point you can start to influence effectively.

Pacing and leading achieve this. You spend time matching, mirroring or cross-matching your patients’ gestures (pacing) until you want to know if you have established sufficient rapport to influenc; you then change one of your gestures (lead). If you and your patient are in rapport, they will follow, copying your new gesture. At this point, you know that you are in deep enough rapport to communicate influentially.

A good maxim to follow is pace, pace, pace, lead. This is an excellent process when dealing with very anxious, new patients to determine when they are ready to accept the clinical examination. Start in a non-clinical chair to take your history, matching, mirroring and cross-matching. When you would like to move to the dental chair, test if the patient is ready to take your lead; if not, continue to pace until they are.

Miss-matching (failing to match or mirror another person) is also a useful skill and can be a very graceful way of ending a conversation.

Matching, mirroring, cross-over matching and miss-matching should be practised at home with friends and family, so that you can do it effortlessly before you bring it into your practice. Then notice the amazing change it has on your communication and understanding.

Practising exercises with others during staff meetings and team trainings will be hugely beneficial, as well as fun. This really works, but don’t just take my word for it – try it for yourself.

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