An INCRAmental Approach to Building Rapport with Youth

I dreaded my weekly staring contest with the man who was supposed to be treating my depression. He’d start each session by asking me a probing question, then silently wait for my response. Since I felt too intimidated to talk about my recent suicide attempt, we just sat there awkwardly looking at each other until the end of the hour.

It wasn’t entirely his fault. My mother had unintentionally set him up for failure by being too honest about her own feelings, both toward therapy in general and toward this counselor in particular.

“I don’t really believe in this kind of thing, but your doctor recommended a counselor who’s supposed to be good at working with teens. I called and he’s not available, so I’m taking you to see someone else. It probably won’t work, so just try it once and if you don’t like it you don’t have to go back.”

No wonder I was reluctant to talk to him! Especially since after every appointment I told my mom I didn’t like it and didn’t want to go back, and each time she said, “Just give it one more week.”

But the therapist didn’t help matters by spending the whole time sitting stiffly behind his desk waiting for me to talk about things I wasn’t ready to talk about. I didn’t have any reason to trust him or believe he could help me. It felt more like I’d been sent to the principal’s office for misbehavior, even though I hadn’t hurt anyone but myself.

Many years later, I was fascinated by a scene in the TV show Mad Men where Sally Draper chats with a child psychologist while playing the card game Go Fish. When I took a course here at the Center for Adolescent Studies, I learned that this is what Dr. Sam Himelstein calls an INCRA, or Inherently Non-Clinical Relational Activity.

Dr. Himelstein explains that an INCRA is “an activity to help take pressure off the youth so the relationship can develop organically.” Playing cards is just one example. It could be taking a walk, listening to music, or baking cookies. An INCRA is essentially any activity that helps build rapport with youth, takes the pressure off a tense situation, or helps them calm down if they’re triggered or traumatized.

How INCRAs Can Help Build Rapport with Classes and Groups

One of my colleagues was having a terrible time with a group of students who were resentful about being placed at the remedial level. Then she took them on a picnic. After they got to know her, and each other, they were much more cheerful about coming to class.

And a bereavement counselor told me about a memorable experience with a grief group for adolescent boys.

They were doing an activity that involved different colors of crepe paper representing different emotions. When it was his turn to catch the first roll of crepe paper, one of the boys lifted it to his mouth and touched it with his tongue.

“Yuck!” he said. “This tastes terrible! ”

Of course all the other boys wanted to try it, too. After a moment’s hesitation, the bereavement counselor decided to join in the fun.

When they’d finished trying all the colors, the boys started opening up and talking about their feelings in a way that likely wouldn’t have happened if the counselor had scolded them for goofing off and insisted on doing the activity the way he’d planned.

How INCRAs Can Help Individual Youth

When I recently visited a trauma-informed school, the dean was playing basketball with a couple of kids who’d been acting up in class. That might seem like a strange form of punishment, or like they were being rewarded for bad behavior. But the point was to help them release pent-up energy so they could focus on the lesson.

And by spending time with an empathetic adult in a low-pressure environment, they could let their guard down and talk about issues that were bothering them, rather than continuing to act out in ways that were disruptive to their teacher and classmates.

In an earlier post on ‘A Critical Intervention For Working With Traumatized Youth’ Dr. Himelstein explains that when youth are triggered or stressed, the prefrontal cortex can get disconnected from the rest of their brains. This can make it difficult for them to communicate or take in new information.

He gives the example of a young man with a history of trauma who “found out a close relative died and was so triggered he could barely talk… and simply had an aggressive stare on his face.”

Dr. Himelstein let the boy listen to some music that he liked, and “he started bobbing his head following along with the rhythm and beat of the song… The rhythmic movements he was naturally doing started helping his nervous system self-regulate itself.” After he’d calmed down, he was able to talk about his feelings of anger and sadness.

It’s About the Relationship, Not the Technique

I have to at least give my mom credit for trying. Unfortunately, she never understood why her attempts to help me kept backfiring.

A few weeks after we’d finally given up on the therapist, she said, “I told my friends we don’t have a good relationship, so they suggested we do each other’s nails.” I stared at my hands in stunned silence as she chopped off my long rounded fingernails and made them into the pointy little tips she preferred.

Looking back on the situation as an adult, I can understand what she was trying to do. But I can also see that she completely missed the point.

The title of this post isn’t just a gimmick. INCRAs tend to work incrementally as kids get to know us and learn to trust us. There’s not a specific set of activities to guarantee instant results. For example, I wouldn’t have been any more likely to confide in the therapist if he’d suddenly pulled out a pack of cards and insisted we play poker. And the bereavement counselor never initiated a crepe paper taste test with another group of boys.

Using INCRAs in an authentic, natural way gives the youth a chance to calm down and feel more comfortable. This makes them more likely to be receptive to other types of activities or interventions. The goal isn’t to force them to confide in us, but to forge a genuine connection.

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