Harris, Nagy and Vardaxis (2006) defined rapport as “a sense of mutuality and understanding, harmony, accord, confidence, and respect underlying a relationship between two persons” (pp.1470) Rapport building is an essential aspect of occupational therapy practice as the level of rapport can potentially affect the success of intervention and impact on the level of motivation that the client has to participate in intervention.
Clients often view the therapist to hold more power within the client-therapist relationship. Taylor (2008) stated that this is due to the client viewing the therapist as having knowledge, information, and resources that could influence the client’s functioning or quality of life in some way. I believe that the simple offering and sharing of a cup of tea can assist the client-therapist relationship by challenging the roles within the building relationship. These role changes shift the level of power between the participants in such a way to create more equality between the two. Robertson & Hale (2011) shared this belief when they stated that the “Gifting of time, to accept the offer of a cup of tea for example, marks a role change from interviewer to guest, from interviewee to hostess, ensuring an equality between the two and possibly increased trust and willingness to share.” (pp. 6) This notion of role changes during the offer of a cup of tea provides the host with the power. This moment of feeling in control and having the power also means that the guest is then left without therefore challenging the belief that the therapist holds the power. This challenge on the power imbalance in the client–therapist relationship works towards creating a more equal relationship between the therapist and client and enables the client to have control in making changes with the knowledge and guidance of the occupational therapist. Clients whom have input into their intervention are said to be more motivated during intervention. Having an equal relationship with a client and having the client actively participate in the direction of intervention also assists the occupational therapist in ensuring that the intervention they are providing is client centered.
Reflection
I was on my mental health placement in my second year of my degree. My supervisor and I were going to visit a client at his home. When we arrived at the door I could see that the client appeared nervous and had sweat beads on his forehead. He welcomed us both in and while in discussion with my supervisor showed us around the house. When we reached the kitchen he offered us both a cup of tea. My supervisor accepted so I followed her lead and also accepted. The client prepared us both a cup of tea with milk and no sugar. Once he had prepared the drinks we sat down and my supervisor and the client talked about the client’s interests. I sat at the table observing my supervisor talk with the client. I started to drink my tea and realised that I did not like the task as I like sweet tea. I chose just to drink the tea even though I did not enjoy it. When myself and my supervisor returned to the car my supervisor told me that this was the first time this client had ever allowed her into his home, prior to this day he had talked to her outside on the lawn or at the gate.
During this experience I remember feeling unsure and uncertain about whether it was appropriate to accept the offer of a cup of tea. If I had not been with my supervisor I believe that I would’ve declined the offer as at the time of this experience I didn’t not understand the importance of this cup of tea. I chose to wait and follow my supervisor’s response. She accepted the offer of the tea so I felt that I may have appeared rude if I had declined the offer, so I accepted. I had not realised that the tea had no sugar until I took my first sip. I hated the taste of it, as at this time I had only just started drinking tea and liked at least too sugars in it to make it drinkable. At this time I thought to myself whether I should ask for sugar or not. I chose not to ask as I thought he may not have offered because he has not got sugar or it may have just been because he was nervous that he forgot. I decided not to ask because I felt this could potentially embarrass the client if he did not have any. I also decided that I would drink all of my tea as my personal values include that I show that I appreciate the offering of food or drink by finishing the amount given to me. When my supervisor told me that it was the first time she had been invited into his home I felt privileged that he had welcomed me in as well. The anxiety and nervousness that I observed had now made sense as my supervisor explained that no one had been into his house for a long time. At this point I was glad that I had accepted the cup of tea and drunk it no matter how it tasted, as I believe that if I had declined the offer or not drunk the tea it could have potentially impacted on the rapport I had with the client and potentially have left the client feeling unsuccessful in his emerging role as a host.
From this experience and reflection I learnt to consider the impact declining a cup of tea could potentially have on the person offering, and also the rapport that I am trying to build with a client. I learnt not to take the welcome into someone’s home and to be offered a cup of tea for granted as this welcome may not be as easy for the host. This has changed my previous thinking as prior to this experience I didn’t think that welcoming a health professional into you r home could be difficult. In my future practice I will use this reflection to ensure that I respect my client’s cultural needs and ensure that I take the time to engage in and to respect the welcome that they provide me with. I will also ensure that I consider the impact my reply may have on the rapport that I may have with my client and also the impact it may have on the client themselves.
Opinion
Research completed by Van Kuyk-Minis & Madill (1997) showed results that enabling one or two therapists at a time to devote substantial amounts of time to a special task is much more effective than trying to split time among many people. I believe that this same notion applies when building rapport. If a therapist is to take the time and have a cup of tea with a client to ensure that the relationship between them has a solid base I feel that this will increase the effectiveness of the treatment given with this client.
In my opinion I think that if there is adequate time and the situation is appropriate then all therapists should take the time to have a cup of tea if offered as I believe that this will make the client feel more worth the therapist's time therefore increase the rapport within the client-therapist relationship and also as stated above will even out the power balance that is in most client-therapist relationships, increasing the chance for successful intervention.
Harris, P., Nagy, S., & Vardaxis, N. (2006). Mosby’s dictionary of medicine, nursing and health professionals. Marrickville: Elsevier Mosby.
Robertson, L., & Hale, B. (2011, July). Interviewing Older People; Relationships in Qualitative Research. The Internet Journal of Allied Health Sciences and Practice, 9(3), 1-8. Retrieved December 12, 2011, from http://ijahsp.nova.edu/articles/Vol9Num3/pdf/Robertson.pdf
Taylor, R. (2008). Challenges to Client-Therapist Relationships: The Inevitable Interpersonal Events of Therapy. In The Intentional Relationship: Occupational Therapy and Use of Self (pp. 117-127). Philadelphia, United States of America: F. A. Davis Company.
Van Kuyk-Minis, M. H., & Madill, H. M. (1997). Workload management in occupational therapy: the approach taken at University Hospital Nijmegen, St Radboud. Occupational Therapy International, 4(2), 151-159. Retrieved December 16, 2011, from CINAHL with Full Text (0966-7903).
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