The word report comes from the French rapporteur and literally means receiving something in return; if we focus on communication between two people, it alludes to what one person sends to the other and the other sends him back. More simply, the report refers to the connection between two or more human beings, the psychological and emotional harmonization that is necessary for changes on each side.
The report is one of the most important problems in therapy and is often overlooked. It is believed that most of the success of psychological treatments is due to a good therapeutic alliance or a good relationship between the therapist and the patient.
- The school.
- Psychological evaluation or techniques used during treatment are of paramount importance for the treatment of the patient.
- However.
- It is no less important to establish a good relationship with the patient.
- So that the patient fully trusts the therapist and is motivated to face treatment.
The rest is useless if we do not have feelings with our patient, because it will have a negative impact on other variables: the person will stop undergoing therapy, will not be involved in inter-session tasks, will not be motivated to achieve change and will not. we believe what we propose or indicate as a strategy.
Therefore, when we talk about therapeutic rapport, we mean the mutual understanding, collaborative attitude and empathy required for two people to address a common problem and achieve the desired goals. It is such a relevant therapeutic element today that it is taught to future therapists in universities and there are even specialized courses designed to train the most diverse professionals, especially health professionals, who will come into contact. with people with problems who need it, solved in society.
The therapeutic or relational alliance developed throughout the twentieth century. The well-known psychoanalyst Freud, in his 1912 book The Dynamics of Transfer, proposed that the psychoanalyst have an interest and a global attitude towards his patient: the objective of this?Strategy? It was that the healthiest part would establish a positive relationship with the analyst.
Freud, in his early writings, defined the patient’s affection for the therapist as a form of positive and beneficial transfer. We must remember that for psychoanalysis, transfer is the psychic function by which the client transfers his unconscious thoughts and emotions to the other person. in this case to the therapist.
This transferal aspect would promote trust, acceptance and credibility in the therapist’s interpretations, as we explained above, however, it was subsequently verified that it was not the transfer that was interpreted as generating trust and climate of mutual collaboration between the professional and the professional. customer, as sometimes there may be misunderstandings in the relationship and this was by no means positive.
It was Zetzel who later differentiated the transfer of the therapeutic alliance, suggesting that the alliance was the non-neurotic part of the relationship, which allowed therapeutic exchanges to be understood or assimilated.
Subsequently, the concept of relationship or alliance was incorporated by most therapeutic schools, moving away from the transferred reading presented by the psychoanalytic context. According to Rogers, father of the humanist school with Abraham Maslow, special attention should be paid to the quality of the Therapist-Patient Relationship. Rogers then proposed three fundamental characteristics that the therapist should have: authenticity, unconditional patient acceptance, and empathetic understanding.
According to this author, the possibilities of therapeutic advancement would depend less on the personality and attitudes of the therapist than on how these characteristics are felt by the patient in the therapeutic relationship, so that this interpretation is positive it is essential that the patient feels understood (that there is empathy) and accepted unconditionally.
Subsequently, Bordin, in the 1970s, described the common characteristics that should exist in the therapeutic relationship in all schools. This author has identified three elements that make up the report: task agreement, positive connection and objective agreement.
The two fundamental pillars on which the report currently rests are trust and fluid communication, when we talk about fluid communication we do not mean that it must be symmetrical, but the most important thing is that the therapist and the client understand each other to the fullest. all levels: verbal and nonverbal.
Communication, in fact, should be asymmetrical, in which the patient intervenes much more than the therapist, some techniques that have proven their effectiveness in establishing good relationships are:
It is a simple technique at first glance, but in many situations it is difficult to achieve, it is about listening to what the patient means without interrupting, predisposed not to make value judgments, but showing through gestures and expressions that are at his side, listening attentively, understanding what he wants to convey to us and establishing empathy with his emotions.
For a good relationship to exist it is extremely important that the therapist is receptive to his client, a professional can know many techniques and accumulate a lot of knowledge, in addition to having a lot of experience, however, if you are not receptive to your patient, everything else will have little value.
As explained above, the person will not be able to trust your therapist, will not open up to it, and therefore a lot of information will be omitted. In addition, lack of confidence will have a direct impact on the degree of patient involvement in therapy: low confidence will increase the patient’s chances of not performing the tasks the therapist offers outside the appointment.
You have to think that you are dealing with someone who is suffering a vital or emotional problem, so coldness does not help at all. To promote the empathy and acceptance Rogers spoke of, you must be receptive.
It’s obvious that putting yourself in the shoes of the person you’re dealing with is critical if you want to help them, no matter if our patient is a person who suffers from an emotional disorder or is a criminal. When dealing with him, we must see the world through his eyes, even if we do not share his feelings or think his actions are correct. Only by having empathy will we build trust so we can help that person.
As mentioned above, for the future of therapy, it is very positive that the patient feels confident and comfortable when he goes to the sessions, to build confidence, in addition to everything we have just mentioned, we must be persuasive and, above all, seem convincing.
The person must realize that we are professionals, properly trained and updated, and that, if not in some respects, we will do our best to give an answer as soon as possible, either by referring to another professional or by better informing us of it. Specific aspect, in this way the patient will believe that we can help you.
This point refers to the need to focus attention on the search for common interests, in this case orient ourselves towards the therapeutic objective initially proposed by the client, it is important not to deviate from the subject and end up talking about common points, but that has nothing to do with our objective, if we do we waste time in the session and in the end the relationship would no longer be asymmetrical , specialist-client, aspect that is not recommended in therapy.
However, it is never too difficult to be flexible and create a relaxed atmosphere in the session, an environment in which you can comment on things that are out of the goals, but always careful not to make the mistake we just mentioned.
We should try to be careful when communicating with our patient, as we can often say something that may seem inconsistent with our expression or actions. Consistency between verbal and nonverbal language is fundamental in the therapeutic relationship, because without it there will be no possibility of creating the climate of trust and collaboration that we are talking about.
When there is a contradiction between what we say and our position or expression, the second, which is in fact the truer, prevails, since nonverbal language operates at a level more unconscious than verbal.
Therefore, it is necessary, as Rogers said, to be authentic and truthful with our patient, to always pay attention to forms and to maintain receptivity, acceptance and empathy, but without producing inconsistencies between our verbal and nonverbal language when we talk to our patient. .
While all these techniques may seem a bit common sense, the truth is that they are not easy to implement in front of a patient at appointments: the therapist is also a human being, with his own values, emotions, etc. , and it is often necessary to leave certain things out of therapy to advance it.
Even with all this, we may not create a good relationship with the client and this should not disappoint us, as in informal relationships, we may not have a good feeling with someone, it can also happen in the therapeutic relationship, even if we do our best to make sure that doesn’t happen.
In this case the most honest and sensible thing is to refer the patient to another professional with which he can develop a better therapeutic alliance and continue his personal growth, in this way neither party will waste time and we will advance in what really matters: patient recovery.
Rogers, C. (1951). Customer-centered psychotherapy. Buenos Aires: Editorial Paidós.
Corbellá, S. , Botella, L. (2003). The therapeutic alliance: history, research and evaluation. Publications service of the University of Murcia. ISSN: 0212-9728
Freud, A. (1936). The Self and the Vienna Defense Mechanisms: Int. Psychoanal. Verlag.