Coping with the Angry Patient

This patient is enacting two chronic maladaptive patterns. In one he alternates between the role of victim and abuser while inducing the therapist to play the counterrole. He tries to master the abuse he suffered passively as a child by becoming abusive with the therapist and having her experience what it feels like to be mistreated. My effort would be to interpret this pattern even while acknowledging and absorbing some degree of his anger. In a second pattern he acts like an angry, demanding child in an effort to extract nurturance and special treatment from the therapist. I would help him explore this posture in terms of his deprived background and its maladaptiveness in his current life. Finally, I present vignettes from my own practice to demonstrate how I work with patients' anger when it is expressed indirectly rather than in Mr. P's very direct manner.