Rapport and Relationships in Clinical Interactions


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Rapport has been described as “the relative harmony and smoothness of relations between people” (Spencer-Oatey, 2005, p. 96). It is a highly valued part of clinical practice, but it is often talked about as secondary in importance when compared to the “real work” of therapy. Indeed, rapport is often viewed as an exchange of pleasantries. It is seen as something to be fostered early in a therapy session, so that the more important therapy goals can be more easily accomplished.One reason for rapport's peripheral role in communication has to do with our way of conceptualizing communication. For example, there is little room for considering rapport within a framework that treats communication as a linear series of messages being passed along a conduit between senders and receivers. In this “conduit metaphor” (Reddy, 1979), messages are seen as being made up of encapsulated thoughts sent along a pipeline from the lips of a speaker to the ears of a hearer.The conduit metaphor has had a powerful influence on how clinicians see their role (Duchan, 2011). If communication is depicted as message passing, then it follows that the therapist's task is to determine where in the message the communication problem arises. For example, diagnoses often involve determining which parts of the message are problematic (phonology, morphology, syntax, semantics, pragmatics), and therapies often are designed to remediate the problematic domains. That is to say, the clinical enterprise involves finding and fixing the discrete aspects of psycholinguistic information that disrupt the client's ability to create messages and pass them to conversational partners (Kovarsky & Walsh, 2011). Rapport only becomes significant in this framework when it is problematic, or negative (see Kovarsky, Schiemer, & Murray, 2011 for a discussion of negative rapport). Put another way, clinicians have typically focused on rapport when problems with it threaten to undermine therapists' efforts to do the work of identifying and repairing the client's ability to transmit messages.In this issue of Topics in Language Disorders (Volume 31, Number 4), the authors call for another view of communication: one that is interactive, coconstructed, and emotionally grounded, and one in which rapport plays an integral role. In so doing, they challenge the message-passing metaphor and other prevailing conceptions of communication that have marginalized the role of rapport.Furthermore, rapport is regarded here as a key to the meaning-making that goes on between interactive partners. This collaborative depiction simultaneously expands upon and challenges a traditional semantic view in which meaning is seen as being primarily linguistically determined. Instead, meaning-making in interaction involves the constant negotiation of interpersonal and emotional relationships that take place in discourse. This places rapport in a central role in communication rather than as a mere lubricant for the therapy process. It follows also from this wider collaborative view of meaning that miscommunications can occur as part of rapport building and can take place even when the linguistic content of verbal messages are successfully conveyed (Grimshaw, 1980; Varonis & Gass, 1985).Because ongoing meaning-making is a key to success of therapy as well as communicative success in other kinds of interactions, it follows that rapport needs to be studied as it is happening in clinical discourse. Discourse analysis offers our authors a way to examine and evaluate how rapport is being managed and achieved by participants in the course of therapy interactions. Simmons-Mackie and Damico (2011), for example, identify occasions of missed opportunities in which one partner fails to pick up on the emotionally laden overtures of another.Kovarsky et al.

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