53easy and good relationship with the participants. She established rapport through
positive verbal and nonverbal encouragement. Good eye contact, smiling and open
body language ensured that the participant felt comfortable with the process and
sufficiently relaxed to ‘talk back’” (p. 729). These behaviors are consistent with
recommendations in the literature on physical attending behaviors.
3.1.3 Why and How Psychological and Physical Attending
Skills Matter
Tickle-Degnen and Gavett ( 2003 ) postulate a three-phase model of relationship
development: (1) rapport building, (2) development of working alliance, and (3)
ongoing working relationship. Three nonverbal components promote relationship
processes and outcomes corresponding to these phases, namely, attentiveness,
positivity- negativity, and coordination (p. 76): Attentiveness is the degree to which
two individuals (e.g., a genetic counselor and patient) focus their attention on each
other (through eye contact, body position, etc.). Positivity-negativity is the degree to
which they respond in ways that convey cooperation and a “readiness to do no harm”
(e.g., smiling, moving closer), versus in ways suggesting dislike or hostility and a
“readiness to hurt the other person, at least emotionally” (e.g., frowning, looking
angry). Coordination is the extent to which their behaviors mimic each other (e.g.,
similar arm and leg positions, voice tone). Later in this chapter, we use the terms
“synchrony” and “synchronicity” to refer to the coordination nonverbal component.
Applied to genetic counseling, this three-phase model emphasizes the impor-
tance of nonverbal behavior throughout the relationship in order to make a connec-
tion, establish agreed-upon genetic counseling goals, exchange relevant information,
and work toward goal accomplishment. When counseling patients, you should strive
to use good physical attending skills, psychologically attend to patients’ behaviors
and their possible meanings (attentiveness and positivity), and try to be aware of the
extent to which your behaviors match those of the patient. Matching of behaviors
(coordination) should occur only when appropriate, however (e.g., you would want
to speak softly with a crying patient but avoid raising your voice when a patient
speaks loudly in frustration).
Attentiveness, eye contact, and open posture are important practitioner behaviors
for improving trust, communication, and rapport (Leach 2005 ), and they are posi-
tively related to other clinician skills and qualities. Studies of psychotherapy dem-
onstrate that increased therapist eye contact is related to better rapport, respect,
empathy, and genuineness (Darrow and Johnson 2009 ); increased therapist facial
expressions of a positive nature (happiness, interest, concern) have been associated
with greater rapport (Sharpley et al. 2005 ); nodding and gesturing resulted in more
favorable ratings of therapists (Darrow and Johnson 2009 ); and good eye contact in
combination with forward leaning by the therapist enhanced ratings of empathy, the
working alliance, and treatment credibility (Dowell and Berman 2013 ). Henry et al.
( 2012 ) found that greater clinician warmth and listening were related to higher