The Angry Patient: Case and Session Presentation

Responding to patients who become angry at the therapist is difficult for many clinicians. In the case and session presented, the patient is not only angry, but devalues the therapist by not paying while asking for more frequent sessions. The therapist loses it, states she is angry, and remains insistent on the patient keeping his bills paid or reducing the frequency of sessions. The therapist is conflicted over confronting the patient with what she believes has to change in order for his symptoms to diminish—the irrational beliefs, life style, and sense of entitlement related to the personality disorder of this patient, but likely to drive him away from treatment. The therapist engages in a risky confrontation and remains unclear about the eventual benefit of this response.