The angry patient: Case and session presentation

Responding to patients who become angry at the therapist is difficult for m any clinicians. In the case and session presented, the patient is not only angry but devalues the therapist by not paying while asking for more freque nt sessions. The therapist "loses it," states she is angry, and remains ins istent on the patient keeping his bills paid or reducing the frequency of s essions.. The therapist is conflicted over confronting the patient with wha t she believes has to change in order for his symptoms to diminish-the irra tional beliefs, life style, and sense of entitlement related to the persona lity disorder of this patient, but likely to drive him away from treatment. The therapist engages in a risky confrontation and remains unclear about t he Eventual benefit of this response.