By Ran D. Anbar, MD, and Mac E. Lancaster, BS
The foundation of a good therapeutic relationship begins with the establishment of rapport, which can be defined as a harmonious relationship in which people communicate well, collaborate equally, and feel understood by each other (Butt, 2021). Therapeutic rapport embodies a part of the therapeutic alliance, and focuses on the positive emotional bond between the therapist and patient (Murphy et al., 2021).
Rapport can be developed through sharing common interests and responding to verbal and non-verbal communication in an affirming way. Rapport encourages patients to share important information and enhances clinical treatment decisions, resulting in improved patient commitment and therapeutic outcomes (Ross, 2013).
During clinical encounters, we have observed that when rapport is especially strong, it can take on mystical qualities. Some of these qualities include feelings of unity, sacredness, positive mood, transcendence of time and space, a sense of deep intuitive knowledge, and ineffability (Barret et al., 2015).
For instance, during some sessions, both the therapist and patient can feel as if they are experiencing a timeless, and loving connection, defined by an intense feeling of presence. During such interactions, it seems as if both people are sharing concordant thoughts, and that their connection at that moment represents a peak life experience.
The revised Mystical Evaluation Questionnaire (MEQ-30) was developed to assess the mystical qualities of experiences with psilocybin, which is currently being tested as a therapy for depression and anxiety (Barret et al., 2015). It is thought that the mystical aspects of experiences with psilocybin account for some of the rapid improvements in emotional health that have been observed in some patients (McCulloch et al., 2022).
Notably, when rapport and the therapeutic alliance are strengthened before administering psilocybin-assisted therapy, patients experience a higher degree of emotional breakthroughs and mystical-type experiences (Murphy et al., 2021).
The predominant focus of empirical inquiry regarding health applications of mystical experiences primarily centers on hallucinogenic substances, such as psilocybin. However, a recent study conducted on cancer patients utilized the MEQ-30 to illustrate that suggestions administered during hypnosis can also result in mystical experiences and improved quality of life (Grégoire et al., 2022).
When we applied the MEQ-30 immediately before and after clinical encounters involving a therapist and some long-established patients, without the use of hypnosis or drugs, the level of reported mystical feelings increased to a very high level in both the therapist and patients.
Perhaps similar to the study results observed with psilocybin, clinical improvement sometimes may be related to new perspectives garnered through mystical experiences that occur as part of therapy involving strong rapport. The shared mystical experiences between the therapist and patients may further intensify their rapport and the resultant efficacy of the therapy.
It remains to be established whether a strong rapport between therapist and patient activates the same neural pathways that lead to mystical experiences with psilocybin or hypnosis.
In hypnosis and mystical experiences alike, patient’s beliefs tend to shape their experiences. For example, "spiritual but not religious" individuals compared to the general population are more likely to have mystical experiences (Maclean et al., 2012). The placebo effect demonstrates that beliefs can shape expectations and reality, influencing physiological, behavioral, and cognitive changes (Sternberg, 2011). Likewise, we believe that practitioners who expect mystical experiences are more likely to feel mystical.
We wonder whether discussing secular spiritual matters like compassion, love, and sacred connection among human beings as part of therapy may set the patient's expectations for mysticism throughout their therapeutic journey.
Just as beliefs shape reality, so do previous experiences. Many long-term patients have reported feeling safe, comfortable, and familiar, just before or as soon as they enter a consultation office, which are key factors of therapeutic rapport. This is consistent with a conditioned response, anticipating strong rapport, and may serve as a self-fulfilling prophecy, resulting in increased rapport (Sternberg, 2011). Similarly, patients or therapists who have had previous mystical encounters may be more predisposed to recognizing and experiencing mysticism.
Finally, we suspect that rapport between close friends or lovers sometimes also involves mystical elements. Perhaps this accounts for some of the great level of influence people in close relationships have on each other.
As therapeutic rapport deepens, patients and therapists may experience moments characterized by mysticism, potentially enhancing therapeutic outcomes and offering new perspectives on the nature of human connection and the process of healing.
Mac Lancaster obtained his undergraduate degree in Cognitive and Behavioral Neuroscience at UC San Diego.
References
Barrett, F. S., Johnson, M. W., & Griffiths, R. R. (2015). Validation of the revised Mystical Experience Questionnaire in experimental sessions with psilocybin. Journal of Psychopharmacology (Oxford, England), 29(11), 1182–1190. https://doi.org/10.1177/0269881115609019
Butt, M. F. (2021). Approaches to building rapport with patients. Clinical Medicine (London, England), 21(6), e662–e663. https://doi.org/10.7861/clinmed.2021-0264
Grégoire, C., Marie, N., Sombrun, C., Faymonville, M. E., Kotsou, I., van Nitsen, V., de Ribaucourt, S., Jerusalem, G., Laureys, S., Vanhaudenhuyse, A., & Gosseries, O. (2022). Hypnosis, meditation, and self-induced cognitive trance to improve post-treatment oncological patients' quality of life: Study protocol. Frontiers in Psychology, 13, 807741. https://doi.org/10.3389/fpsyg.2022.807741
Maclean, K. A., Leoutsakos, J. M., Johnson, M. W., & Griffiths, R. R. (2012). Factor Analysis of the Mystical Experience Questionnaire: A Study of Experiences Occasioned by the Hallucinogen Psilocybin. Journal for the scientific study of religion, 51(4), 721–737. https://doi.org/10.1111/j.1468-5906.2012.01685.x
McCulloch, D. E., Grzywacz, M. Z., Madsen, M. K., Jensen, P. S., Ozenne, B., Armand, S., Knudsen, G. M., Fisher, P. M., & Stenbæk, D. S. (2022). Psilocybin-induced mystical-type experiences are related to persisting positive effects: A quantitative and qualitative Report. Frontiers in Pharmacology, 13, 841648. https://doi.org/10.3389/fphar.2022.841648
Murphy, R., Kettner, H., Zeifman, R., Giribaldi, B., Kartner, L., Martell, J., Read, T., Murphy-Beiner, A., Baker-Jones, M., Nutt, D., Erritzoe, D., Watts, R., & Carhart-Harris, R. (2022). Therapeutic Alliance and Rapport Modulate Responses to Psilocybin Assisted Therapy for Depression. Frontiers in pharmacology, 12, 788155. https://doi.org/10.3389/fphar.2021.788155
Ross, L. (2013) Facilitating rapport through real patient encounters in health care professional education. Australasian Journal of Paramedicine, 10, 1-11. https://doi.org/10.33151/ajp.10.4.50
Sternberg E. (2011). A self-fulfilling prophecy: linking belief to behavior. Annals of the New York Academy of Sciences, 1234, 98–99. https://doi.org/10.1111/j.1749-6632.2011.06190.x
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