When patients get angry in session

Judith S. Beck writes in:

Some therapists are quite concerned about their patients becoming angry at them. Yet when therapists respond sensitively, they can help patients learn important lessons.

The first thing I do when a patient becomes angry is to elicit their automatic thoughts and positively reinforce them, in a genuine way. “I’m so glad you told me that.” And I am glad. If there’s a problem, I want to know about it, so I can fix it.

Next, I conceptualize the problem in order to decide what to do. If I think the patient is correct, I’ll apologize – and in so doing, become a good role model. For example, a patient might be annoyed because he felt I was interrupting him too much. If he had that reaction, he’s right. I overestimated his tolerance for interruptions, so I can – again genuinely – say, “You know, I think you’re right. I did interrupt you too much. I’m sorry.”

If I don’t think I made a mistake, I can still genuinely say, “I’m sorry you’re feeling distressed,” because I truly am sorry if something I’ve said or done (or not said or done) made the patient feel worse. Then I try to figure out how to solve the problem, which might involve helping the patient evaluate his negative ideas about me or suggesting we change what we’re doing in the session.

Demonstrating to patients that interpersonal problems can be solved is sometimes one of the greatest benefits of therapy.

8 replies
  1. Lisa Schultz
    Lisa Schultz says:

    What about the therapist exhibiting annoyance and/or anger at me? A situation arose last week where he seemed upset when he thought I blamed him for a relapse that landed me in the hospital 6 months ago. He only now showed his “true colors”. I feel bad about this, what to do without confrontation? Thanks, Lisa S.

  2. CT Today
    CT Today says:

    We’re sorry, we unfortunately are not able to give therapeutic advice but truly hope it works out okay.

  3. Barbara
    Barbara says:

    Thank you for supporting that the counselor model this. Many of my peers will not take personal responsibility or self reflect like we are asking our clients to do. I am just beginning to spend a little time at your website and enjoyed your blog today.

  4. Max
    Max says:

    a general comment might be for the client to again look at their own Automatic Thoughts surrounding any issue like that.

    For example, sometimes one friend thought I was feeling “impatient” with them, and asked me why?
    I said I was not impatient.
    She then asked me why I was breathing so deeply, like I was huffing and puffing.

    I said it was probably just me taking a deep breath out of habit, not being exasperated.

    So I think its always most useful to look at our own automatic thoughts and beliefs, to see if we are Mind Reading, or engaging in thing of that nature.

  5. Barbara2
    Barbara2 says:

    I think that there are two different situations when people get angry at me. One is when they get angry because of something I have done. For this I can try to find out what is the problem and then solve it.

    But there is a different situation and that is that people seem to be angry at me for no apparent reason and most or all the time. For example one of the secretaries at work: whatever I do, it seems not enough, not adaquate. So it looks like she is constantly angry with me, no matter what I do or don`t do.

    For this I think it helps to try to see things from the other persons perspective. For example to imagine what the situation might be like for that secretary. Maybe she feels inadaquate at her workplace, compared to all the “academics” around her who usually talk about things she can`t understand. And because she doesn`t want to admit that to herself, she treats everyone else around her as inadaquate, including me.

    Of course this is just my imagination, and it might be wrong, but it helps me not to feel offended and get defensive, but e.g. show her that I appreciate what she does so that she might feel better about her work.

    P.S. Guess there are two “Barbara`s” posting here …

  6. CT Today
    CT Today says:

    That’s it exactly. Recognizing that there’s hurt or fear behind patients’ anger helps one empathize more. Therapists do need to be aware of the activation of their own core beliefs–and often need to do some CT work on themselves beforehand when they predict that a session may be challenging.

  7. Maribeth
    Maribeth says:

    I had a client who arrived 25 minutes late for a session I agreed to work with her for the hour undertanding traffic problems occurred which caused the delay.

    The client insisted on having her boyfriend join her and he talked about my client’s issues regarding her daughter who is living with her and causes many problems.

    As I made suggestions for change at the client’s request, she became angry and left abruptly.

    I know she will not take my calls but I am wondering if a note to her is appropriate. I feel I handled the situation very well, but still feel the loss of the relationship.


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