Building Trust With Patients

Available with English captions and subtitles in Spanish.

A conversation with Lisa W. Coyne, PhD, McLean Hospital, and Brent P. Forester, MD, MSc, Tufts Medicine.

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The Patient-Clinician Relationship

The development of an alliance based on trust may be the most important aspect of the therapeutic relationship. Forester and Coyne discuss tried and tested methods for building trust with patients.

Watch now to learn more about:

  • Why a clinician’s sense of presence is key to gaining trust
  • The role of authenticity and how to convey it
  • How to strengthen the therapeutic alliance without self-disclosure

Whether you are just starting out in the field or are a seasoned clinician, building trust with patients is an essential, and sometimes daunting, skill. While it is important to build trust from the beginning, the process can take time.

A sense of trust from patients can also wax and wane throughout the therapeutic relationship, depending on issues that come up in treatment.

Reflecting on their own careers as providers and their experiences with patients, Coyne and Forester stress the importance of presence, careful listening, boundaries, humility, and authenticity.

Forester states it is important for clinicians to hear patients tell their story in whatever way patients feel comfortable sharing. “Not feeling the pressure to get at what your agenda is, but rather to hear their agenda, is critical,” he says. “And that takes time. It takes patience. It takes confidence that you’ll eventually get to where you need to go.”

According to Coyne, the most powerful intervention clinicians have is their presence. “How open we appear and how carefully we listen is very important,” she states. “As you make the space for the story to unfold, [patients] will begin to feel safe and will relax into the work.”

The clinicians emphasize that the space created between clinician and patient is a safe harbor.

Providers should take care to convey to patients that the relationship is not a friendship, but rather a space where patients can express anything at all, and the clinician will continue to be there for them.

Coyne and Forester outline how authenticity plays a role. They point out that therapists should not presume to know anything about patients’ interests and priorities without hearing these needs from patients.

In addition, clinicians should not be afraid to be open with patients about the challenges they’re working on together.

From such a trusting foundation, patients can learn how to relate to the world, relate to other people, and grow in their relationships.

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Audience Questions

  • If you could go back in time and talk to your younger self about the value of building trusting relationships with patients, what would you tell them?
  • Could trust-building lessons often learned through experience be taught in an academic setting?
  • How would you describe the relationship you are looking to create with a patient?
  • How do you go about trying to put yourself in the shoes of kids and teens? And is it possible to try too hard?
  • What personal boundaries have you set for yourselves when dealing with your patients? Have they changed over the years?
  • How do you feel about therapists sharing their own mental health struggles with their patients?
  • How do you re-establish boundaries when a patient seems to view the relationship as a friendship?
  • Can you provide examples of questions to prompt patients to identify their values? How do you go about doing that?
  • Any tips for having goals that you can set for yourself to show a tough-to-reach patient that you care and that you’re also invested in their wellness?
  • Do you have any tips for managing your own emotions when you feel yourself getting frustrated with a patient?
  • Do you have any tips for building trust with a patient you will only see for a short period of time?
  • Any tips for working with older patients who are more resistant to building a relationship because they aren’t concerned about the future?
  • What are your thoughts regarding including disclosures in bios, such as what brought you to the field?
  • Do you ever find that you and a patient are not a good fit? If so, how do you handle that?
  • Can you speak a bit more to the notion that you need to be authentic with patients even when it’s uncomfortable?

The information discussed is intended to be educational and should not be used as a substitute for guidance provided by your health care provider. Please consult with your treatment team before making any changes to your care plan.

Resources

You may find this additional information useful:

About Lisa W. Coyne, PhD

Dr. Coyne is an assistant professor of psychology in the Department of Psychiatry, part-time, at Harvard Medical School, and a senior clinical consultant at McLean Hospital. She is also an associate clinical professor at Suffolk University in Boston, a licensed clinical psychologist, and an internationally recognized acceptance and commitment therapy (ACT) trainer.

Dr. Coyne has published numerous peer-reviewed articles and chapters on anxiety, OCD, and parenting. She is the author of “The Joy of Parenting: An Acceptance and Commitment Therapy Guide to Effective Parenting in the Early Years,” a book for parents of young children.

About Brent P. Forester, MD, MSc

Dr. Forester is the Dr. Frances S. Arkin Professor and Chair of Psychiatry at Tufts University School of Medicine, psychiatrist in chief and chair of the Department of Psychiatry at Tufts Medical Center, and director of Behavioral Health for Tufts Medicine. He previously served as the chief of the Division of Geriatric Psychiatry at McLean Hospital and senior medical director for Value Based Care Solutions in the Population Health Management department at Mass General Brigham.

Dr. Forester is an expert in geriatric psychiatry, specializing in the treatment of older adults with depression, bipolar disorder, and behavioral complications of Alzheimer’s disease and related dementias. His research focuses on novel treatment approaches to manage the disabling behavioral complications of dementia, such as agitation and aggression.

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