What is rapport?
What is required to build
rapprt?
Gambits and Curtain raisers
Minimal cues
What is said and not said?
Representational systems
Eye movements.
Three cardinal mental/thought processes
It is:
· required if effective communication is to take place
· a process, not a state and something you do actively
· showing that you understand what the other person is communicating
· being on the same wavelength
· seeing the patients problems " through their own eyes"
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Building rapport with another person requires awareness of:
· what the patient says, particularly early on in the consultation
· what the patient is not saying
· non verbal communication
Some definitions
Opening gambit
· is what the patient plans to say to the doctor as his first move in
the consultation.
(The term being derived from opening moves in a chess game)
Curtain raisers
· is what the patient actually says as he/she starts to speak
· unrehearsed & often betrays alot about their state of mind
· may indicate what they think of the doctor
· can be modified by the way the doctor looks or what he says
Examples:
" I can't remember when you last saw me up here"
" Aren't you bust today"
" I'm sorry to be a nuisance"
"you're looking tired today"
What could each of these mean??
E.g. " Aren't you busy today" Could this mean?
· "he's far to busy to deal with the real reason I came"
· "my problem isn't important enough"
· "why have you kept me waiting"
· " he's busy, I hope he has got time to listen"
Watch out for these, but don't feedback your interpretation to the patient straight away as this can be threatening and alot of time can be wasted. Use them as an indicator of how the patient is feeling.
Try not to suppress a curtain raiser.
Compare
"Hello, Mrs Jones come in", which allows the patient to use their curtain
raiser
with
"Hello, Mrs Jones what can I do for you?", which forces the patient to use
their opening gambit
with
"Ah, Mrs Jones we got the results of your blood tests and it's good news.......",
which suppresses the gambit and curtain raiser!!
Minimal cues = the physical signs of mental states
| Verbal | Speech content | Þ what is said and not said | |
| Speech quality | Auditory | Þ Pace Þ Pitch Þ Volume Þ Rhythm Þ Modulation |
|
| Idiom | Þ Vocabulary Þ figures of speech Þ metaphors |
||
| Non verbal | Representational Systems | Auditory | Þ Pace Þ Pitch Þ Volume Þ Rhythm Þ Modulation |
| Visual | Þ facial expression Þ gaze Þ eye contact Þ eye movement accessing cues |
||
| Kinaesthetic | Þ posture Þ distance Þ touch Þ gesture Þ muscle tone Þ breathing |
· We have censors that stop saying what is on our mind
· This is particularly relevant when you consider the Dr/patient
interaction
· Hesitations , omissions, vagueness and non sequential thoughts are
the signs that censoring is taking place
· Look out for these & if necessary help the patient express what
they actually mean
· By facilitating this you demonstrate to the patient that you are on
the same wavelength
· The brain encodes all experience in terms of visual, auditory and
kinaesthetic information (i.e. feelings).
· We tend to couch our perceptions, memories and descriptions in terms
of one preferred representational system.
· Many verbs, adverbs and adjectives have visual, auditory and kinaesthetic
associations, which indicate a representational system.
Examples
"I see what you mean"
"I hear what you are saying"
"I feel what you are going through"
If you latch on to the preferred system the patient uses you are literally speaking in the same language.
Can give you a clue to what the patient is thinking
Eyes up: suggest imagining or remembering a visual image
Eyes horizontal: imagining or remembering at an auditory level
Eyes down: experiencing or remembering a feeling
This again allows you to tune into the preferred representational of the patient.
Neighbour suggests that there are three cardinal mental/thought processes that the patient will exhibit and recognising these will assist establishing rapport with the patient. Each has it's own set of minimal cues.
1. Speech censoring
2. Internal Speech
3. Acceptance state
Speech censoring has been dealt with.
Internal speech
When patient's mind is thinking over what to say or do there will be almost a "shut down of external activity" but it may only last for a short amount of time and be seen externally as a pause.
Watch what happens when you ask someone a difficult question,
· they stop moving,
· their eyes often become central and appear unfocussed, but this is
combined with the eyes moving all over the place
It is important to identify that this is going on and not to disturb it. It is particularly well demonstrated in depressed patients.
Acceptance set.
· How do we know that a patient agrees with what we suggest?
· Simply asking them may give a false answer as they may say yes to
agree with us!
· However we give away how we feel by the outward expression of how
we look.
In order to find out how the patient looks when they are in agreement with what we have said, we can sate something that they will have to agree with and watch how they respond.
E.g. "Isn't the weather awful these days"
Then watch for
· posture
· facial expression
· voice changes
· eye changes
Once you have seen this set of minimal clues you should be able to watch out for them later to decide if the patient is really in agreement or not!