Good communication skills and building a strong therapeutic relationship are the cornerstone of nursing work (Collins 2015).
Part of being a good communicator is the ability to develop rapport, and neuro-linguistic programming (NLP) gives practitioners an easy and reliable way of enhancing their communication skills.
What is Neuro-Linguistic Programming?
Neuro-linguistic programming (NLP) encompasses the three most influential components involved in producing human experience: neurology, language and programming (Pensieri 2013).
In its simplest form, it’s using the power of words to re-program the brain and change behaviour.
NLP is composed of three parts. ‘Neuro’, how we use our neurology to think and feel. ‘Linguistic’, how we use our language to influence others and ourselves and ‘programming’, how we act to achieve the goals that we set (Walker 2015).
Everything you know about the world relates to one or more of your five senses: sight, sound, touch, smell and taste. In NLP terms these are called ‘sensory modalities‘.
In order for us to code, store and give meaning to the input we get from these modalities, we use language. That’s the ‘linguistic’ part of NLP.
The phrase ‘representational system’ is used to identify this process of translating experience into words.
The ‘programming’ aspect of NLP refers to how our behaviours are wired to our experiences and language.
Most people use the three primary modalities of visual, auditory and kinaesthetic, V-A-K, as their primary representational systems. This means that they understand the world mainly through what they see, hear, or feel.
Using NLP to Enhance Rapport
When you are in rapport with someone the similarities between you are emphasised and the differences are minimised. It is that sense of harmony, recognition and mutual acceptance that occurs when people are at ease with one another and communication is flowing easily.
Being in rapport with someone naturally happens over time. It occurs because people naturally like people who are like themselves.
However, it can also be generated deliberately and very quickly as a means of enhancing the therapeutic relationship.
Matching and Mirroring
A quick and easy way to begin to generate rapport is by matching and mirroring.
This is not overt mimicking or copying, which would most likely have the opposite effect of breaking rapport. It’s a subtle process of reflecting the patient’s body language back to them in a way that feels natural and comfortable.
In general, the aim is to do as little as possible to achieve rapport, maintaining a subtle approach that doesn’t intrude into the other person’s conscious awareness.
- Body language, e.g. head tilt, arms or legs crossed
- Posture, e.g. slumped or upright, facing or leaning to the side
- Gestures, e.g. hand gestures whilst speaking
- Breathing rate (if easily observable)
- Voice, e.g. tone, pitch, pace and volume
For example, in response to a patient who crosses their left leg over their right, the practitioner might reflect the patient’s movement back to them by crossing their right leg over their left, as if the patient were looking in a mirror.
In all cases however, it’s important to be subtle as obvious copying may decrease rapport.
Verbal mirroring occurs when the practitioner uses a similar voice tone, pace and pitch as the patient. It can also help to repeat the patient’s last few words and occasionally use a slight questioning inflexion.
Matching the Primary Representational State
The words that have the greatest impact and convey the most meaning to us are always the ones that are most closely aligned with our own preferred representational system.
Visually oriented people respond best to how things look. People with auditory preference are most influenced by how things sound and kinaesthetic types relate best to how things feel.
Sturt (2012) confirms this by suggesting that our internal representations of the world will always show a bias for a particular sensory modality (visual, auditory, kinaesthetic, olfactory or gustatory), and that a person’s dominant modality, or preferred representational system (PRS), is reflected in the words they use to express themselves.
For example, a patient with an auditory preference might use sound-based language such as “I’m not sure I like the sound of that”. If the practitioner also responds using the same sensory modality, such as “I hear what you say”, then rapport can occur much faster and more easily than if they were to use a different sensory modality from the patient.
For example, “I see”, or “what do you feel is the best way forward”.
The key to this is to be aware of your own sensory preferences and to set those aside to match the patient’s primary sensory modality. As Lang (2012) states, awareness of each patient’s communicative preferences allows healthcare professionals to adapt to the patient’s state of mind greatly facilitating the communicative process.
Likewise, Yapko (2011), suggests that identifying and matching the patients’ primary representational language preferences appears to enhance rapport.
Words that reflect a visual preference include: look, see, envision, show, picture, appear, and outlook.
- “I see what you mean…”
- “I get the picture…”
- “What is the outlook…?”
Auditory words that appear regularly in conversation include, hear, say, tell, listen and sounds.
- “I like the sound of that…”
- “That rings a bell…”
- “Tell me about it…”
Words that reflect a preference for feeling or kinaesthetic language include, grasp, feel, impact, let go, and hold on.
- “That feels right.”
- “I need to get a better grasp of the situation?”
- “What impact will that have on me?”
Much less common but still worth being aware of are people with auditory/digital preferences, e.g. “that makes sense”.
Rarely, the practitioner may also come across people with an olfactory /gustatory preference. Most people however, have a preference for being either auditory, visual, or kinaesthetic in the way they relate to the world.
Using the Preferred Sensory Modality to Enhance the Therapeutic Relationship
Using language patterns that best suit the other person’s preferred communication style, whether their perception of the world around them is primarily visual, auditory or kinaesthetic is a great way of enhancing rapport.
It does mean however that you have to be aware of your own language preferences so that you can change ‘sensory channels’ to match the patients’ primary representational system if needed.
- Visual: “Do you see what I mean?“
- Auditory: “How does that sound to you?“
- Kinaesthetic: “Does that feel alright for you?“
The skilful use of sensory modalities is just the tip of the iceberg in applying NLP techniques to patient communication. Techniques such as re-framing, future pacing, the use of indirect suggestions and pre-suppositions are also easy to integrate into conversations and offer the practitioner useful ways to enhance the therapeutic relationship and encourage self-care.
Of course, occasionally matching and mirroring can also be used to help gently break rapport with a patient too. For example, by mismatching their preferred language patterns or body posture.
Should NLP be an Integral Part of Practitioner Training?
Sturt et.al (2012) suggests that there is little evidence that NLP interventions improve health-related outcomes. However, she goes on to say that this conclusion reflects the limited quantity and quality of NLP research, rather than robust evidence of no effect.
From a practitioner’s point of view however, Henwood (2013) comments that healthcare staff recently qualified in NLP felt that their training had a positive impact both for themselves and their patients.
More realistically perhaps, Al Ali and Elzubair (2016), calls for more training in this area suggesting that although establishing rapport is important when dealing with patients, it’s currently not given sufficient attention.
- Al Ali, AA & Elzubair, AG 2016, ‘Establishing rapport: Physicians’ practice and attendees’ satisfaction at a Primary Health Care Center, Dammam, Saudi Arabia, 2013’, Journal of Family and Community Medicine, vol. 23, no. 1, pp. 12-7, viewed 13 February 2018, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4745196/
- Collins, S 2015, ‘Good communication helps to build a therapeutic relationship’, in The Nursing Times, 15 May, viewed 13 February 2018, https://www.nursingtimes.net/roles/nurse-educators/good-communication-helps-to-build-a-therapeutic-relationship/5003004.article
- Henwood, S 2013, ‘The impact of neuro-linguistic programming (NLP) training in clinical health care practice: a case study’, Current Research in NLP, vol. 3, viewed 13 February 2018, https://www.researchgate.net/publication/259801804_The_impact_of_neuro-linguistic_programming_NLP_training_in_clinical_health_care_practice_a_case_study
- Lang, EV 2012, ‘A Better Patient Experience Through Better Communication’, Journal of Radiology Nursing, vol. 31, no. 1, pp. 11-9, viewed 13 February 2018, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3587056/
- Pensieri, C 2013, ‘Neurolinguistic programming in health: an analysis of the literature’, Medic, vol. 21, no. 2, pp. 97105, viewed 13 February 2018, http://www.medicjournalcampus.it/fileadmin/MEDICS/archivio/vol2-2013/16_Pensieri.pdf
- Sturt, J, Ali, S, Robertson, W, Metcalfe, D, Grove, A, Bourne, C & Bridle, C 2012, ‘Neurolinguistic programming: A systematic review of the effects on health outcomes’, British Journal of General Practice, viewed 13 February 2018, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3481516/pdf/bjgp62-e757.pdf
- Walker, L 2015, Consulting with Nlp: Neuro-linguistic Programming in the Medical Consultation, (First ed.), Florida: Routledge.
- Yapko, M 2011, ‘The Effect of Matching Primary Representational System Predicates on Hypnotic Relaxation’, http://www.tandfonline.com/doi/abs/10.1080/00029157.1981.10403262