Have your progress notes written for you automatically
Therapy is a versatile tool suitable for various life challenges, from managing stress and grief to enhancing personal growth and understanding. (Brenner, 2023). One of the most important components of the therapeutic process is the relationship the client forms with the therapist. This happens in the starting stage of therapy- wherein the therapist gets to know the client; the client begins to get acquainted with the therapist, the therapeutic process and begins to trust the therapist. This is also called rapport establishment.
Some clients, especially shy or quiet ones, may find it difficult to open up in therapy. Discomfort may arise from social anxiety, unfamiliarity with the process, or fear of being judged. Understanding the unique needs of these clients can help therapists create an environment that fosters communication and comfort.
Shy Clients in Therapy
Shy clients may find it hard to deal with social anxiety which might be arising from feeling that they are not fitting in or by being in a new or foreign setting. It may take some time for them to relax, and they have concerns about being judged or saying the wrong thing. This makes it essential for the therapist to put them in a situation where they feel safe enough to open up. Allowing the client to choose between talking or switching off the camera in online therapy can give them a sense of control and relieve discomfort.
Quiet Clients in Therapy
Quiet clients may not provide as much information initially as a client who is more verbally expressive would. The therapist can try to normalize silence for quiet clients so that they feel comfortable with pauses, with no pressure to respond quickly, and therefore feel less anxious about responding back.
In general, quiet clients tend to be quiet because they are uncomfortable, unsure of what may be open for discussion, or perhaps do not feel confident enough to share their concerns. Starting a conversation on something they are familiar with or interested in or simply asking how their day has been may facilitate the opening up of a quiet client. Genuine interest in their answers may provide an opening for them to be more verbal with the therapist.
Reluctant Client in Therapy
Reluctant clients may have been encouraged or coerced into therapy by external pressures, such as family or work. They may be skeptical of the process or unwilling to engage fully. It is essential to acknowledge their reservations, validate their feelings, and help them see therapy as a collaborative process rather than something imposed upon them.
Reluctant clients may have been coerced or pushed into therapy by some type of external pressure, such as family or work. It is paramount to validate their concerns, and facilitate seeing therapy as a collaborative process and not something thrust upon them. The therapist can invite a mutual dialogue about "What brings you to therapy?" or "What is your idea of therapy?" allows will allow the client to voice their concerns. The therapist and the client can agree to have 4-5 sessions before making a decision about continuation. This might help the client feel empowered to make their own decisions. Therapists can also introduce different modalities like art or begin with conversations about topics of interest to make them feel more engaged.
Strategies for Building Trust and Comfort
Build a Strong Foundation
Rapport establishment is dependent on “effective communication skills, practitioner behaviour, collaboration, time and trust.” (J.Leach, 2005). It is especially necessary to establish a good rapport with people who are shy or quiet in nature. The rapport that is being formed sets the precedent for the rest of the therapeutic process. Shy clients may experience discomfort due to social anxiety or because they feel out of place in unfamiliar or new situations, and therefore may take time to open up. They may also worry about being judged wrongly or saying the wrong thing. This makes it crucial on the part of the therapist to make them feel secure enough to express themselves.
They may not provide as much information initially as a client who is more verbally expressive would, thus the usually used methods of rapport establishment- active listening, paraphrasing etc. might not be as effective. It may be helpful for the therapist to normalize silence for shy and quiet clients so that they feel a comfort in pause with no pressure to respond very quickly, and therefore feel less anxious about answering.
- Shy Clients: Gradually introduce the client to the therapeutic process and reassure them that there are no right or wrong responses.
- Quiet Clients: Give them their space and normalize silence, so they do not feel pressured to respond in a certain way.
- Reluctant Clients: Ask open-ended questions about their expectations and concerns about therapy.
Impact of Physical Space
Rapport need not be verbal. A sense of trust begins with the way the therapist and their space is perceived as well.Results of a research on impact of the physical environment of therapeutic space on rapport establishment (Sinclair, 2020) has shown how seating, accessibility of room, the lack of interruptions during the therapeutic process amongst other factors has resulted in greater involvement with the therapeutic process. This can also be followed for online sessions- ensuring no interruptions, a clutter free space, and a visibly clean environment. The rooms to be used for therapy with shy or quiet clients must really be quiet and well organised; this will help them be free from distractions, as anything over stimulating or unpredictable may make them close up completely or lead to an anxious response.
- Shy and quiet Clients: A cozy, warm lighting, welcoming setting can help reduce anxiety for the shy and the quiet clients.
- Reluctant Clients: Giving them control over where they want to sit or giving them options with respect to using different modalities while engaging in therapy may help them feel more empowered.
Be Mindful of your Body
Body language is also vital while establishing rapport. Taking inspiration from rapport processes in everyday life, research has indicated that non-verbal interpersonal communication reduces embarrassment (d’Abreu et AL;2021). Clients would feel more comfortable when the therapist mirrors their body language, appears calm and collected in face of their distress, maintains a steady demeanor and appears friendly. Shy clients might be unable to make eye contact and this should be normalised for them in therapy. For example, the therapist might look away at an object while speaking or use soft gestures to reinforce their engagement.
Appearing friendly would mean something like having a smile on the face, uncrossing arms and legs, increasing eye contact and nodding head to indicate listening. Appearing friendly is a conscious effort, and is based on the non-verbal cues that clients send. These non-verbal cues can look like a change in facial expressions (flash of annoyance or panic for example), change in tone of voice, and lack of maintenance of eye contact. Observing this not only gives the therapist input about how the client perceives them, but also provides clues that can help them understand the state of mind of the client.
Observing the body language and changes in eye contact, tone form components of what is known as microskills for therapists. This also clues therapists into paying attention to the words that clients use, thus they can choose to pursue a particular conversation (verbal tracking) or let the client speak.
- Shy Clients: Do not force direct eye contact. A therapist can use side-by-side seating if needed or the therapist can let the client look down or at a wall while speaking.
- Quiet Clients: Nonverbal cues, such as nodding and open posture will show curiosity and interest which can encourage expression.
- Reluctant Clients: Mirror the client’s level of engagement to build trust naturally.
Patience is the key
Apart from the microskills, a counsellor needs to be patient- the process of therapy can be daunting, especially for people who are shy. There is no particular amount of time in which rapport can be formed, it is a gradual process. Employing icebreaker questions as done in groups can be helpful. Discussing happier memories, less sensitive topics, topics that interest the client can eventually lead to deeper conversations, thus making the process one of gradual comfort.
Shy and/or quiet clients may need longer silences, and their participation in therapy might start off slow. Therapists should reassure them that there is no rush and that their comfort matters more than how much they share in the beginning.
- Shy Clients and Quiet Clients: Allow them to open up at their own pace. Let them know there is no rush to respond.
- Reluctant Clients: Respect their skepticism and give them space to voice their concerns.
Open up with your client
Self disclosure (sharing personal information about self with some purpose and under limitations of professionality) is seen to have resulted in positive therapeutic experiences (Steuber et al;2018). Therapy isn’t impersonal: the little warm touches added in therapy- be it manner of speaking, actions by the therapists that went beyond textbook process of treatment- are the moments that have stayed with the clients (Gottlieb, 2019). This makes the client feel less intimidated by the therapeutic process, and helps them feel more involved. Self-disclosure from the therapist can be effective in downscaling the perceived power difference in interactions and making them intimidating for shy clients. Even the slightest of disclosures, such as mentioning a shared interest or a private anecdote closely related to the client's experiences, can help break down barriers. Having similarities with the therapist also provides a sense of validation, that the therapist understands how they feel and makes them appear more empathetic. It provides a source of connection with the therapist and humanizes them.
- Shy Clients: Share minor relatable experiences to ease anxiety, reassure that the therapy space is non judgemental.
- Quiet Clients: Offer prompts for discussion so that the client feels easy to open up.
- Reluctant Clients: Use self-disclosure to show authenticity and highlight shared experience.
Be Curious
Connection is also forged through words. The words that the therapist uses and the way they greet (with warmth) helps the client relax. Words can look like open-ended questions- questions that require more than one word answer. These questions usually do not have a right or wrong answer, thus taking any perceived pressure off the client. These questions also lead to deeper conversations leading to the therapist using skills such as verbal tracking, facilitating exploration and rapport establishment. However, shy clients may still feel reluctant to fully and freely express their views. The therapist at this point, could invite the client to make use of different mediums of expression including asking whether they would prefer to write or draw their thoughts instead of speaking them. Information also helps in rapport establishment- when the therapist gives information regarding how the therapy process occurs, the structure as well as what the client can expect, it reassures them and reduces the novelty, thus fear regarding the situation.
- Shy Clients: Frame open ended questions gently to reduce anxiety.
- Quiet Clients: Ask about the client’s interests to initiate conversation in a flow.
- Reluctant Clients: Invite them to share at their comfort level, do not coerce any form of sharing.
Psycho-educate when Necessary
Psycho-education is also proven to be helpful during the process. While it is not advisable to do it immediately, it validates the client and makes them feel like the therapist “gets” them. Psycho-education is creating awareness regarding their nature of concern or coping skills for the same. A research article has determined that presence of psycho-education as well as therapeutic relationship has indicated more positive client outcomes (Hasan et al; 2015). A word of caution while using psycho-education: it is better to use this gradually, especially in case of shy clients, and having a clear purpose for educating the client.
Let the Client have the Autonomy
Consent is another method through which rapport can be established. This can be as simple as checking in with the client regarding their willingness to participate in a particular activity or topic. This gives space for an otherwise shy client to express their opinion, and creates a sense of control over the therapeutic process. Since shy clients may struggle with asserting boundaries, regular check-ins help them develop confidence in voicing their preferences and feeling heard. This also helps build trust as the client feels that their boundaries are respected by the therapist. In addition, it leads to better therapy outcomes.
Feedback from the Client
Feedback after a session also leads to better therapy outcomes. Clients reflect on how the therapist helped them, while therapists simultaneously get a space for improvement, thus leading to a more fulfilling experience. This is very helpful for shy clients as it sends an indirect message about how they can control the session, they can shape the therapeutic process and helps them trust the therapist more. If shy clients express discomfort in voicing their concerns and feedback verbally, structured feedback methods, such as rating scales or written reflections, might allow them to express themselves with relative independence and relieve direct verbal pressure. A therapist must be proactive in offering these methods for feedback so that the client feels empowered to choose. Additionally, reassuring clients that they have control over what they share and the pace of the sessions helps clients feel at ease.
While sessions with shy clients might be intimidating for therapists- in- training or others, it is not very different from other sessions. Being warm,empathetic, patient, appearing friendly and being non-judgemental is a good point to start from. Apart from this, paying attention to body language , attending to what they communicate and the manner of communication helps the process of rapport establishment occur more smoothly. The therapist can also ensure confidentiality , impact information on the nature and process of therapy to make the client more comfortable. Asking open-ended questions, checking for consent and feedback improve the therapeutic relationship. Rapport establishment cannot be forced. Giving time for the process to develop naturally reduces any existing discomfort. Rapport establishment also involves trial and error, hence with experience, the therapist would be able to facilitate the same easier.
To Summarize –
For shy and quiet clients, understanding their hesitation and letting it go at their own pace really helps the therapeutic alliance. Establishing rapport cannot be forced, the client should be allowed to take time to start feeling comfortable in the therapeutic alliance.
- Normalizing silence in the therapy room will allow the client to set the pace of the sessions.
- Create a structured and predictable environment such that anxiety of the client is reduced.
- Nonverbals of the therapist should mirror that of the client’s.
- Encourage self-expression of the client through writing or drawing.
- Slowly introduce self-disclosure to work on perceived unequal distributions of power in the therapy space.
- Indirect eye contact will reduce pressure on the client to make eye contact with the therapist.
- Regularly check in with the client to see that they feel comfortable and respected.
- Attach formal feedback mechanisms within session plans so the clients have the means of self-expression without verbal pressures.
LINKS
https://www.sciencedirect.com/science/article/abs/pii/S174438810500071X
https://onlinelibrary.wiley.com/doi/abs/10.1002/capr.12376
https://geiselmed.dartmouth.edu/news/2023/more-than-words-body-language-and-patient-communication/
https://www.internationaljournalofcaringsciences.org/docs/3-steuber_special_10_2.pdf
Book-Maybe You Should Talk to Someone (Lori Gottlieb, 2019)
https://positivepsychology.com/rapport-building/
https://pmc.ncbi.nlm.nih.gov/articles/PMC4394557/
