The relationship you have with a child is the number one factor for client change. Really! Research shows the relationship is even more powerful than any technique or theory! (Don’t cringe too much - all the schooling, degree, and extra training you have is really important too!)
The therapeutic relationship is also described as the “most important ingredient in successful therapy” by Athena Drews and Charles Schafer when talking about the therapeutic powers of play. It is the relationship that opens the door to make the other powers of play possible.
In short - if a client doesn’t trust you or think you are someone safe they can talk to, it doesn’t matter how skilled you are, how many trainings you have attended, or protocols you know. None of that will matter because the child won’t feel safe enough to engage.
Okay, so now that we know that rapport and the relationship are not only important but essential - what next? Here are four of my biggest tips to build and foster relationships with young people!
Get cued in to the child’s window of tolerance
Having a good read on the child’s nervous system and looking for cues of hyperarousal (fight/flight) or hypoarousal (dorsal vagal collapse / shutdown) is essential, especially in the early stages of therapy. If the child is going outside their window of tolerance it is your job as therapist to regulate your own nervous system and give the child safe and social cues to help them regulate. Paying attention the small cues of dysregulation can help you pull back from activities or topics before the client floods.
When the relationship is stronger a child’s window of tolerance may be wider for certain techniques, types of therapy, or activities. Pushing too far earlier on can be a significant detriment to the relationship and can damage rapport. Want more information on neuroscience and Play Therapy? Check out my training HERE!
Have a collaborative relationship
The child and family are experts in their reality and what it means to be living in their unique family system. They are also coming to you as a therapist because they are struggling.
Working together with the client and parent in collaboration as opposed to making goals or recommendations from the position of an expert can significantly increase buy in from both the child and the parent. Ask the child what their strengths are, what areas are a struggle, how they see their symptoms, and what they want to be different in their lives. AND hold their answers with care both in the way you set treatment plan goals and how you work towards those goals in therapy.
Be open to feedback
In my first session with families I let them know that the relationship is the number one factor for therapeutic change (see above). I welcome them to give me feedback on my approach and style and have openness that there might be something about my approach that doesn’t fit well with them.
As therapists we need to be sensitive and curious about whether approaches, techniques, theories, or models are not a good fit for the client, or if they are struggling for some other reason. And sometimes….well, we find out that what we have to offer and our specific style of therapy is not a good match for the client. I mean we are human beings after all and one therapist is not the perfect fit for everyone!
In this case we put on our referral hat and figure out what therapist might be a better fit. All in all when we can be open with families about this from the beginning they feel more confident to speak up, which increases retention and engagement!
Repair Any Ruptures
Working with children is complex and multilayered. You are not only working with the child as an individual but also with parents and caregivers. In a climate where parents and children can often disagree about the symptoms that are the presenting concerns and factors impacting symptoms, your role as therapist to maintain rapport within the family system is difficult.
Sometimes you are put in a place to make parenting recommendations that are in the best interest of the child, but don’t often feel good to the child. Hopefully you can relate if you have ever made the recommendation that unrestricted media time and activities could have adverse effects on mental health!
And sometimes, well...you just mess up. You are human after all. I think we all have those moments where we wish we could re-play the tape and say or do something differently in our sessions. The best thing you can do for a therapeutic rupture in rapport is to repair it. Take ownership, apologize, explore the impact on the client, and work to fix it. And this process? Well some research has shown that it actually makes the therapeutic relationship stronger! Wheew - we can all feel a little bit better now!
These are my favorite strategies for building and keeping rapport with clients along with Carl Roger’s core conditions of genuineness, empathy and unconditional positive regard. Children have excellent detectors for grown ups who are not congruent!
Let me know your favorite ways to build rapport and relationship with the young people you see in the comments below!
Looking for more support on intake sessions and rapport buildign? Check out this training HERE!
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I'm Ann Meehan, an LPCC, RPT-S, and EMDR Consultant. I help other therapists grow in their passions as play therapists, trauma therapists,and child and adolescent therapists.