Settling into and moving in a climate of care: styles and patterns of interaction between nurse psychotherapists and clients.

PURPOSE. To study nonverbal manifestations of rapport between nurse psychotherapists and clients. METHODS. A phenomenological investigation of eight pairs of nurse psychotherapists and clients was completed using video-cued narrative recall. FINDINGS. Emotional congruence, physical mirroring of gestures, postures, expressions, and shared cadences were significant to the participants. Matching behaviors were responsive, not technique-driven, and occurred only at meaningful junctures. Matching behaviors showed up simultaneously and as turn-taking responses, and felt genuine because they incorporated imperfection and were expressed in varied ways. Settling into the climate of the client's world and matching her response helped the nurse therapist shape intervention possibilities, create a comfortable sense of timing, and establish rapport. CONCLUSIONS. Video-cued narrative recall was an effective research strategy. Search terms: Mimicry, nonverbal mirroring, postural congruence, relational synchrony Styles and patterns of interaction during therapy sessions were examined to determine how these factors contribute to a sense of connection and rapport between nurse psychotherapists and clients. The expertise of nurse psychotherapists was evident in the patterns of interaction that were established as the session progressed. Background The purpose of the study was to examine nonverbal markers of rapport during therapy sessions and to explore episodes of relational synchrony from the perspective of involved participants. For the sake of consistency, the term relational synchrony or the phrase settling into and moving with the climate of care is used when referring to synchronous responses occurring between a therapist and client. An example of synchrony is when the therapist matches a movement, gesture, or emotional response of the client, creating a mirroring that facilitates the client feeling seen and understood. Clients report that these types of relational occurrences help them hear and accept the therapist's feedback more easily. There has been considerable agreement in the social psychology literature that relational synchrony is associated with a sense of rapport between the participants (Bernieri, Davis, Rosenthal, & Knee, 1994; Kendon, 1974). Different authors have used a wide spectrum of terms to describe varied aspects of the complex phenomenon of synchronously occurring responses, including postural congruence (Scheflen, 1964); posture sharing (Fraenkel, 1983); postural mirroring (La France, 1985; Urdang, 1999); unconscious mimicry (Hull, 1933); nonverbal mirroring (Charney, 1966); motor mimicry (Bavelas, Black, Lemery, & Mullett, 1986); felt, reciprocal responses (Mehrabian, 1972); confluence (O'Leary, 1997); interactional synchrony (Condon & Ogston, 1966); shared rhythmicity (Kendon, 1970, 1973); and mood/tempo similarity (Bernieri, 1988). Clearly, the abundance of terms highlights the complex and multifaceted nature of the scholarly debate about synchronously occurring responses within dyads. Debate within the literature has centered on how best to research relational synchrony, whether it is preferable to examine postural congruence, body orientation (Fretz, 1966), head movements (Hadar, Steiner, & Rose, 1985), smiling (Bayes, 1972), facial expressions (Tronick, Als, & Brazelton, 1977), mutual gazes and expressive gestures (La France & Ickes, 1981), or the simultaneous timing of coordinated movements (Cappella, 1981). Most of this research has explored the effect of one specific nonverbal behavior when examining relational synchrony. There has been controversy over what is a unit of analysis; whether it is better to track a small number of behavioral components in a quantified, time-sampled, precise way; or whether it is preferable to adopt a holistic approach in which the interaction itself is taken to be the unit of analysis (Bernieri et al. …