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Rapport-Building in Adult Speech-Language Therapy

Posted September 21, 2016

Ridge Zeller Therapy's, Sarah Jordan Strong, M.S., CCC-SLP, shares her experience about the importance of building rapport with her adult patients in this two part blog series. Click here to view Rapport-Building in Adult Speech-Language Therapy, Part 2!


Rapport-Building in Adult Speech-Language Therapy, Part 1

A little over three years ago, I started my clinical fellowship year providing speech therapy to adults in an outpatient rehab setting; I was armed with a pile of textbooks and class notes. 

I had memorized the different types of aphasia, I could name all of the structures involved in swallowing from a line drawing, and I had the different levels of cueing down pat. 

I had completed an internship, providing therapy under the supervision of a licensed, and had taken copious notes regarding the therapy tasks she liked and those she preferred to avoid. 

This is all very important, but none of it really prepares you for being fully responsible for your own caseload. 

One of the things that school and a part-time internship had not prepared me for was rapport-building.

It was mentioned briefly in a couple of my classes, but mostly as something you have to think about with children.  In fact, one of my professors told me “Working with adults is easy. You tell them what to do and they do it.”

I learned quickly that this isn’t true. Or, more accurately, that it is true in some cases, with some people, but it’s rarely the full story. 

I realized as the first few months of my CF flew by that people immediately latched onto anything that provided them with the sense of having a relationship with me beyond just having therapy “done” to them. 

This all came together in my head as I observed patients’ reactions to one of the tasks on my standard language evaluation. 

To measure delayed recall, I tell a patient four facts about myself, ask them to repeat these back, then ask about them again following a five minute delay. 

It amazed me how many people recalled these facts and referred to them days or weeks later. 

I evaluated one woman who didn’t require speech treatment.

I was walking through the rehab gym where she was attending physical therapy a month or so after her speech evaluation, and heard a shout of “Sarah!  SARAH!  You live in Queen Creek, you graduated from ASU, you have a dog named Nikita, and you like to cook. How’s Nikita doing, anyway?”

And it wasn’t just that patients remembered personal information. People seemed to want to feel a personal connection, and they worked harder and better when they had one.

When the rapport wasn’t there, it was harder to figure out how to cue appropriately. Patients were more self-conscious and less likely to take risks in therapy, and it was more difficult to figure out what the focus of treatment should be. 

Creating rapport also increases the functionality of therapy. Communication is highly personalized.  

We interact with different people in different ways. Think about how you talk to your doctor versus how you talk to your sister or your spouse. It’s not the same at all, right? 

Now think about which one of these is more important in your day-to-day life. I bet it’s not the doctor.

Without putting forth the time and effort to build a relationship with my patients, I was stuck in the “health care professional” role.

It’s important to be able to interact with providers, but that’s not really what most people want to be able to do.

They want to tell their grandkids that they love them, describe the secret to their meatloaf recipe to a son or daughter, and tell their next door neighbor they’re sorry her husband died. 

And please don’t think I’ve got the rose-colored glasses glued to my face -- they also want to guilt-trip their kids for not calling enough, complain about the neighbors’ tacky holiday decorations, and tell that guy from bingo that his politics are what’s sending this country to Hades in a handbasket. 

You can’t practice any of these things in speech therapy if you’re on your best behavior, but you can if you’re comfortable having a conversation with your therapist.

Click here to view Rapport-Building in Adult Speech-Language Therapy, Part 2!

What have your experiences with rapport-building in adult speech-language been like? 

Please leave a comment below!

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