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Trust between a counselor and client

Counselors must overcome barriers to trust in order to begin effective patient treatment

counselor client trust

After a diagnosis has been established but before any therapy begins, the rehabilitation counselor must establish trust with his or her patient. One of the critical skills learned in a degree program in psychology is interpersonal communications.

The ability to relate to and gain the trust of the person suffering from a disability is one of the first hurdles of the rehabilitation process. In some cases, the rehabilitation counselor is embarking on a several month or year-long relationship, one that involves every aspect of the patient’s life. According to BioMed Central Health Services Research, patients that trust their healthcare provider are more likely to follow through with their prescribed treatment plan.

The rehabilitation counselor establishes trust through empathy, consistency, and reliability. While trust must be earned over time, rehabilitation counselors begin by establishing a rapport with a patient, including getting to know the individual on a personal level. Empathy is the ability to relate to someone who is suffering without feeling sorry for them. It means conveying a sense of compassion without pity or judgment.

Counselors must be consistent in their moods, communications and behaviors. Keeping things simple and predictable for a patient suffering from a disability is the best way to accomplish this. They learn to ask patients questions about themselves, maintain eye contact, and actively listen to their answers. Showing up on time, following through on promises, and being dependable even under adverse circumstances are all part of being reliable and trustworthy.

Counselors also learn not to immediately assume that they have a patient’s trust. When patients don’t respond well, rehabilitation counselors remain kind, and refrain from anger or returning unpleasantness. No one – including counselors - fully comprehends how others are feeling, how much pain they are in, or what other emotional issues are causing them to be unhappy at that moment.


Barriers to trust are both physical and emotional. Someone dealing with the loss of their legs, for example, is going to have emotional barriers, depression, anger, and other frustrations. Someone with a mental disability might exhibit paranoia, dementia, distrust of the counselor and strangers, and other psychological barriers. Brain injuries often cause disassociation, hostility, and aggressive behavior. And paralyzed patients will have feelings of helplessness, which creates fear, and therefore distrust.

Gaining the trust of children is yet another skill for rehabilitation counselors to master. A child who was battered will have emotional issues around trusting adults. Disabled children may not fully understand what a disability really means, and may be subjected to intense pressures to “fit in” as they return to school. Children with learning disabilities or developmental disabilities do not process emotions as others, often requiring additional mental health counseling. Above all, consistency is especially important when dealing with children. (see also Childhood Developmental Psychology).

As the process of establishing trust evolves, the rehabilitation counselor will employ different strategies to maintain relationships and motivate patients. It requires the ability to be flexible, patient, and honest throughout the duration of the treatment plan. It means working hard to understand the patient, identifying each individual’s physical and psychological barriers to trust, and finding ways to overcome them.

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