Don’t mirror anger.

We discussed the technique of mirroring in Moments Matter #18 and how it can pull you further into your patient’s narrative, which is usually a very good thing. The one situation in which I intentionally don’t mirror is with an angry patient. If your patient is angry and posturing, or pacing the room, then you certainly don’t want to posture and pace beside them.

So what do you do in a situation like this? How do you respond to a volatile emotion like anger? I’ve found several techniques helpful. First, check your own emotional temperature and remind yourself to wonder more (stay curious, rather than closed off). Second (or perhaps first), make sure you’re safe. I’ve had to literally break up a fist fight in a family meeting, and it’s not something I dream of ever doing again. Along with staying safe is making sure there is an “out” in the room for your patient. You don’t want to set up a tight ring of chairs and create a sense of feeling trapped, which may escalate tension further. Leave a nice opening in case your patient needs to escape for a moment.

Third, figure out the direction of the anger. Is the anger directed at you because of something you said or did? Or is your patient angry at God, or the hospital, or cancer, or having had nothing to eat for 12 hours? Identifying the direction of anger can help identify your patient’s need in the moment, and help inform your response.

Finally, adopt a strategy of active listening and emotional alignment through empathetic response. Say as little as possible, and just listen. Often someone fuming with anger just needs time and space to vent, and a nonjudgmental ear. Sit down to physically lower the tension in the room, listen, and respond with empathy. Don’t feel like you need to apologize or justify the actions of others. Just listen.

In my experience, this strategy works 9 times out of 10 and often your patient de-escalates automatically. Many times my patients have thanked me for listening, and apologized for the angry outburst.

We’ll discuss what to do that 1 time out of 10 when it doesn’t work later…