Child Therapist Tips: Building Rapport

Mental HealthBehavior ManagementSchool CounselorsCounselingTherapeutic ActivitiesChild TherapyTherapistsParents

Oct 22

What is **rapport**?

In a clinical setting, rapport is the therapeutic relationship, “the collaborative and trusting bond between the therapist and the client” (Opland & Torrico, 2024). Rapport is the foundation of effective therapy because it represents trust, respect, and positive regard. When a therapist thoughtfully establishes this connection, a child is more likely to open up, express emotions, and securely engage in the therapeutic process to facilitate healing and growth.

Considerations:

When working with kids, rapport must also be established with the significant others in the child’s life: parents, caregivers, teachers, siblings, etc. Strong rapport fosters collaboration among the therapist, child, and their support system to ensure that the child feels cared for both inside and outside of a therapy session. Ultimately, family rapport enhances the effectiveness of treatment and promotes lasting positive outcomes.

**Initial Session**

The initial session is often a diagnostic interview that is attended by the guardian(s) and the child. Take this opportunity to set expectations about rapport—**rapport-building is a personalized process that takes time**. The time line is different for each kid, but the process is clinically essential for positive treatment outcomes. Rapport-building might not look like clinical work (pretend play, art, games), but it is the most important foundational piece of the therapeutic alliance.

Initial Session Tips:

When other adults are present, make sure to include the child in the conversation and be mindful not to talk about them as if they are not in the room. This establishes the foundation of an alliance between the therapist and the child.
Sometimes it’s helpful to offer a separate private phone call with the parent or guardian to discuss sensitive subjects out of earshot of the child.
Not all children will want to fully participate in the diagnostic interview, but they can still be a part of the process through engaging, age appropriate, independent-use activities. Set the activities out and encourage the child to explore and feel at ease in the environment—the goal is to make the therapeutic space somewhere they want to go. If a kid has to be dragged to therapy sessions, they are less likely to engage.
At the end of the session, ask the kid what kind of things they like and have those things available at the next session. Many kids will shrug at this question, so have some examples ready for them (water color painting? doll house? matchbox cars? marble run? UNO? hide-and-seek? books? Candy Land? Play-Doh?). Read on for our suggested resources and activities for the initial session!

**Subsequent Sessions**

Approach the first few sessions with flexibility and keep the goal of rapport in the forefront. The goal of rapport is not to resolve anxiety, tame tantrums, or explore trauma (that comes later). The primary goal of rapport is to create a positive association with the therapeutic environment.

Subsequent Session Tips:

During the first few sessions, prepare flexible plans that allow you to follow the child’s lead. For example, set up a few activities and allow the child to be drawn to one (art, games, toys, fidgets). For young children, have a few books or toys available (books are a great way to facilitate conversation with little kids: How do you think that character is feeling? Have you ever felt that way?). For older kids, have conversation starters queued-up to get the ball rolling!
Pay attention to how a kid is engaging with an intervention. Going through the motions without true participation is unproductive, so allow yourself to be flexible and pivot when an intervention is unsuccessful. You can always try it again when rapport is stronger!

**Setbacks**

Sometimes there can be setbacks in the therapeutic relationship and rapport can be damaged. When trust is breached due to safety or legal concerns by the therapist or when the client undergoes a new trauma that causes them to lose confidence in the therapeutic process, progress may cease or regress.

Setback Tips:

Setbacks can be demoralizing for the the therapist and the client, but there are ways forward. Each situation is unique, but we usually recommend being upfront with clients and involving them in the repair process:

What kind of questions can you pose to the client to understand their perspective and motivation?
Allow them to ask you questions and be prepared to answer in an honest and clinically-thoughtful way.
Consult with a supervisor or colleague to ask yourself difficult questions. Am I still the right person to treat this client? What steps can I take to rebuild the foundation? Do I need continuing education to meet emerging needs?

In these times, revisit the initial goal of establishing a positive association with the therapeutic environment: back to basics.

Rapport-Building Resources:

Initial Session:

During the initial session, the therapist gathers a wide array of relevant information for diagnosis and treatment planning. Despite the formal and informational nature of this session, make sure the child is engaged. For older kids, that may mean they have an active role in the exchange of information. For younger kids, that may mean having activities available for them while an adult relays information on their behalf. Here are some of our recommended resources and activities for the initial session:

About Me

This worksheet is a great “get-to-know-you” tool. For school-aged kids, it is often used during a therapy intake session while the parent or guardian is communicating with the therapist.
Explore our printable writing prompts for kids and teens HERE!

Community Play Mat

A representation of a community can be a symbolic microcosm where children can navigate and make sense of their world. The town rug provides a structured yet flexible platform for play, and encourages a sense of community, problem-solving, and the development of social skills.
Learn more about play therapy and explore our recommended toys and games HERE!

Scratch Paper

This is a great independent activity for kids to work on while following along with the initial session.
Check our our recommended materials for art therapy HERE!

Fidget Toys

Fidget toys offer relief in moments of emotional tension or during arduous cognitive tasks (like a therapy session).

Yoga Ball

Initial sessions can be tedious, so provide safe opportunities for movement with a yoga ball. The yoga ball promotes sensory integration and body awareness in kids, which can enhance focus and emotional regulation!
Learn more about sensory integration and sensory processing disorders HERE!

Coloring Book

Have a coloring book and colored pencils available!
Learn more about the value of art therapy HERE!

Subsequent Sessions:

During the first few sessions, get to know the kid and make a gentle effort to understand their perspective, environment, and circumstance. These early sessions are not for challenging negative beliefs, confronting behaviors, or addressing trauma. Rather, they should focus on prioritizing positive therapeutic experiences in order to build rapport. Here are some of our recommended resources and activities for early sessions:

My Home

Ask kids to draw their home (or homes) and the people and animals that live there. Build a holistic family systems perspective by using the drawing to explore environmental and family dynamics. Bond over a shared love of cats or a favorite outdoor activity while learning about the child’s support system!
Explore our other therapeutic activities HERE!

Your House, My House

Bibliotherapy is a therapeutic approach that utilizes literature as a means to address and alleviate emotional, behavioral, psychological, and social challenges. The power of storytelling allows kids to explore those challenges from a safe space within the pages of a book.
Your House, My House explores themes of social dynamics, family, and community.
Explore our collection of recommended children’s books HERE!

Build-It Prompts

This therapeutic activity is a great way to roll the dice and find constructive inspiration. We love to use this activity with Lego or Play-Doh! (Check out our therapeutic activities with Play-Doh HERE!)
After each turn, try these talking points: What did you build? Why did you choose to build this? Would you change anything about your creation? If you could take a magic wand and make this creation real, would you do it? Why or why not?
Explore our other therapeutic activities HERE!

Kinetic Sand

The unique texture of kinetic sand provides a calming sensory experience that creates a soothing and grounding effect. As kids manipulate the sand with their hands, they engage in a practice that encourages mindfulness and focus within the therapeutic space.
Explore our recommended toys and games for play therapy HERE!

Counseling Activity Guide

Oobleck is a non-Newtonian fluid that is kind of like us—its behavior is variable depending on stress! This hands-on sensorial experiment can help kids understand that stress (anxiety, frustration, disappointment, failure, anger) can change our behavior.
Learn how to make Oobleck and how to talk to kids about transformative nature HERE!

Taco Cat Goat Cheese Pizza

This fast-paced, easy-to-learn card game disarms tension and helps a child feel at ease in a therapeutic setting.
Card games are FUN and while therapy can be hard work, it should also have elements of levity. Games can help establish trust and rapport between the therapist and the child which allows for meaningful therapeutic work to take place.
Check our our recommended counseling games HERE!

Tumble Tower with Question Prompts

A tumble tower is a great hands-on game to break the ice. This game requires competitive teamwork to get the tower as high as possible.
Write your own questions on the blocks, or print and adhere our question tabs and answer them as you play!
Learn more about counseling games HERE!

How to Talk to Teens

Effective communication during adolescence builds mutual trust, understanding, and respect. This kind of communication allows parents and therapists to better recognize cues and attend to the needs of teens. Learn more about parent-teen communication and checkout our printable conversation starters.
Explore our mental health infographics HERE!

Setbacks:

After a setback, rebuilding can be difficult. Consider the circumstances and proceed with flexibility. Here are some of our recommended resources and activities for repair after setback:

Child Therapist Tips: Building Rapport

Considerations:

Rapport-Building Resources:

Initial Session:

Subsequent Sessions:

Setbacks:

RelateD Blog Posts:

References

Child Therapist Tips: Building Rapport

Considerations:

Rapport-Building Resources:

Initial Session:

Subsequent Sessions:

Setbacks:

RelateD Blog Posts:

References

Children’s Books About Grief

Therapeutic Activities with Play-Doh