Patient-Centered Counseling & Rapport Building Strategies for Long-Term Impact 

• Set the Tone Early – Warm, conversational, mirror their pace & language.
  “I’m really glad you’re here today. 

• “We’ll take this at your pace.”

Quick Tips: 

• Use the patient’s name 

• Acknowledge what they share 

• Reflect their language

• Smile, nod, and make eye contact in the camera

• Pause to let them talk

• Avoid sounding like you are reading off a script

Lead with Empathy & Curiosity

Strong rapport is built when clients feel seen, heard, and understood—not just “coached” toward goals.

• Empathy means meeting clients where they are without judgment, acknowledging struggles, fears, and unique circumstances.

• Curiosity means asking open-ended questions to understand their world—not to “fix” them.
  

Example Reflection Questions:

• “What’s felt hard or confusing about nutrition in the past?”

• “How has your week been—not just food-wise, but life-wise?”
  
  

Language Shifts That Build Trust:

• ❌ “Why haven’t you followed the plan?”
  ✅ “Can you walk me through what your week looked like?”
  

• ❌ “You just need to prioritize meal prep.”
  ✅ “I know planning ahead can be tough. What’s getting in the way of prepping meals right now, and is there something we can adjust?”

Use and Notice Subtle Engagement Cues

Nonverbal and verbal cues give valuable insight into a client’s comfort, understanding, and engagement.

Recognizing Client Cues:

• Shorter answers, breaking eye contact, or crossing arms may signal discomfort or resistance.

  • Response: “I noticed a shift—did something I said feel off, or are we heading in the right direction?”

• RD hears frustration/anger in patient’s voice, potentially giving shorter answers, resistant to responding

  • "I can hear some frustration in what you’re saying—can you tell me more about what’s feeling most challenging right now?"

Using Your Own Cues to Encourage Engagement:

• Lean in slightly, pause to show active listening, mirror tone, maintain warm eye contact, nod to show understanding.
  

Collaborate on Plans – Make the patient a partner in their care.

• “Which of these options feels most doable for you right now?”

• “What feels like a realistic place to start—for you?”

• “Here are a couple of options—do any of those resonate?

Balance Credibility with Empathy -Build trust in your clinical expertise without overwhelming.

• “Some of my other patients have found it helpful to…”

• “I can dive deeper into the science if that’s helpful—or we can keep it more practical.”

Use Targeted Follow-up Questions -Active listening and guiding the conversation deeper

• “You mentioned stress eating—when do you notice it most?”

• “How did that feel emotionally — relief, guilt, or something else?”

Gather a Comprehensive History– Consider culture, history, identity.

• “Are there cultural or family factors that influence how you eat or view food?”

• “What was your experience like with other providers or RDs?”

• “Tell me more about what food and meals were like in your household growing up?”

Support Continuity– Reference past conversations to monitor patient progress

• “You mentioned holidays are tough—any coming up we should plan for?”

• “Since our last session, have you noticed any shifts in how you’re feeling or thinking?”
  
  

• Assess – Find their starting point, stage of change, and “why.”

  • “What’s motivating you to focus on nutrition right now?”

  • “What do you want to see change in your life when these goals are met?”
    

• Align – Co-create SMART goals tied to values.

  •  “Since energy for your kids is a priority, let’s start with a breakfast plan that supports that.” 

  • Example SMART goal: Eat a balanced breakfast with 25-30g protein daily 3x this week. (include examples meals planned in session)
    
    

• Empower – Reinforce autonomy & celebrate progress.

  • “You’ve made real shifts — let’s build on that next week.”

  • “Your self-awareness is a powerful tool — how can you use it more?”
    
    

• Prepare ahead 

  • Go into each session with a flexible plan. Be ready to pivot based on patient needs and interests. 

• Communicate with Clarity 

  • Check in on patient understanding frequently.

  • “Does that make sense so far?”

  • “Would it help to go over that again in a different way?”

• Use Visual & Digital Tools

  • Leverage visual aids like handouts, virtual white boards, and screen sharing.

• Simplify Concepts with Memorable Language

  • Use metaphors, analogies, and plain language that make the message memorable.

  • “Fiber works like a gentle broom for your digestion.”

• ​​Assess & Adapt to the Patient’s Education Level

  • Gauge patient’s baseline knowledge so you can tailor your education

  • “How familiar are you with the idea of carb counting?”

  • “Where do you get your nutrition information from?”

  • “What do you know about protein and how it supports energy?”

• Connect Education to the Patient’s Goals

  • Help patients understand why education relates to their specific goals. Keep education relevant to them.

  • “This strategy supports your goal of reducing energy crashes in the afternoon.”

  • “Using this app to log meals will help us see patterns and move you closer to lowering that A1c.”
    
    

• Example Verbiage:

  •  “How’s the pace and structure of our sessions feeling for you?”

  • “I want to make sure this process feels helpful and relevant to you - how are things feeling so far?”

  • “Everyone’s different - what kind of support or communication works best for you between sessions?”

  • “Sometimes people worry about being honest if something isn’t working - I really appreciate open feedback so I can adjust things to better support you.”

  • “Would you like more structure and planning, or more open conversation?”
    
    

• Quick Tip: Respond to feedback with curiosity, not defensiveness — it builds trust.
  
  

• Identify Barriers Early - ask about them early
  “What might make this hard for you this week?”
  
  

• Offer Practical Solutions- meet barriers with specific and actional steps

  •  “Let’s brainstorm 2–3 five-minute meal ideas for busy nights.”
    
    

• Normalize Setbacks - reframe these moments with compassion
  “One tough week doesn’t undo your progress — let’s refocus together.”
  
  

• Highlight small wins often - recognizing success builds confidence and maintains motivation

  • “I really want to acknowledge how you chose to swap soda for sparkling water this week — that’s a fantastic step toward your health goals.”
    
    

• Use Short, Personalized Messages:

  • “Noticed you tried the mindful eating strategy — how did it feel?”

  • “Curious how the mindful eating strategy felt this week?”

Quick Tip: Find dedicated times in your week for patients to reach out to keep it efficient and fit it into your workflow without it being too time consuming. Set clear expectations with patients on communication.

• Use the Nudge feature & personalize messages

  • Aim to nudge earlier rather than later.

  • Example:  Hi Sarah, I hope you're doing well and that your move into the new apartment has gone smoothly! I was just thinking about how far you’ve come since we started working together - especially the progress you made in managing your blood sugar levels. I noticed we don’t have a follow-up on the calendar, and I’d really love to continue supporting you. You can book your next appointment right from the Home tab, or feel free to message me here and I’ll be happy to help you find a time that works best. Looking forward to reconnecting!
    
    

• Regularly check retention metrics and any metrics that are in the red zone.

• Refresh and Reflect on on Motivation Interviewing Skills

• Put intention into 1-2 counseling skills or goals weekly

  • Example: I will practice assessing a patient's stage of change and validating patient emotions intentionally this week. 

• Reach out for Support - CRCs, Slack, 1:1 with CQM, help center resources - be proactive