Effective Communication

Figure 13. The Share Approach decision-making process. Graphic from AHRQ Web site.

The primary goal in effective communication is to develop quick rapport and trust.

Steps to foster a positive connection during the first five minutes of an initial encounter are to:

  • Observe how the person interacts and reacts to their personal and physical space.
  • Assess the environment and create a calm, safe space for interaction.
  • Try a smile, say “hello”, and check their response. 
  • Be relaxed and use humor.
  • Show compassion, grace and humility.
  • Give your undivided attention, and act like you have all day.
  • Be yourself, be real, and not perfect.
  • Find out their goals.
  • Ask strategic questions and share reflections.
  • Identify ambivalence.
  • Show unconditional, positive regard.
  • Nurture hope.
  • Begin to enter their world, and learn their backstory.
  • Find out their struggles, hopes and fears.
  • Leave behind your bias and judgement.
  • Establish quick rapport and start the process of earning their trust.
  • Treat each person as the expert on their life.

The following are tactics to promote trust through effective communication:


  • Focus your attention on the individual and use active listening skills.
  • Tune in to the person’s feelings.
  • Show compassion and mirror mutual respect.
  • Do not agree or disagree with delusional content; instead look for a shared reality.
  • Reflect back what is heard.
  • Ask clarifying questions, explore for meaning and keep it simple.
  • Engage patients in making informed choices about their lives.
  • Discuss lack of choices in situations where warranted.
  • Remain polite, say goodbye, and ask if you may meet again if a person does not want to talk and wants you to leave.
  • Ensure that engagement is non-threatening;
  • Avoid lecturing, judging, demanding. Consider following with, “No judgement here,” when asking about sensitive subjects such as substance use.  
  • Consider the impact of word choice on implicit and explicit bias.