Angry Patient

I Want a Second Opinion

Sometimes patients blame their psychiatrist for worsening symptoms. An angry patient may say things such as, “I don’t think the medication is working; my suicidal thoughts have gotten worse since starting the antidepressant; I want a second opinion!” Patients will split with their psychiatrist for various reasons:

• Age and immaturity
• Lack of patience
• Frustration and wanting to take out their anger on their psychiatrist
• Unconscious inner conflicts
• Boredom with therapy
• Drug use

As a psychiatrist, you have to understand that it’s better to allow the patient to seek another provider’s care rather than trying to convince them to stick around. Patients, you have to understand that we are not perfect and cannot always effectively help you with your problems. As a patient, you should also understand that seeking a “second opinion” does not mean that you will be satisfied. You might actually set yourself a few steps back, because that means you’ll have to start all over with a psychiatrist who does not know you.

How to Treat the Angry Patient

The best recommendation for psychiatrists is to stick by their professional expertise and utilize empathy as much as possible. It’s very easy to get annoyed with your angry patient and dismiss their complaints. Don’t make the mistake of losing your patient to follow-up because of your countertransference. Countertransference is when a patient says something that reminds you of a family member in your past who said something similar. This happens on an unconscious level and influences you in the present. For instance, if an angry patient starts blaming you all of a sudden, what they say can remind you of when your uncle blamed you for something when you were 12 years old. This might cause you to react in a negative way towards your patient.

When experiencing countertransference, do your best to hold anything back that may be offensive to the patient. Therapy is not the place for you to express your negative emotions. Leave this space for the patient to vent and express their frustrations. The patient will appreciate you more if you remain within your professional boundaries, rather than becoming confrontational. It’s not easy to treat angry patients, especially when they are venting and you did nothing wrong. Try to understand where they’re coming from and adopt an empathic stance. You’re here to help the patient with their symptoms and this includes their random angry outbursts.

Recommendation for Patients

The best recommendation for patients is to trust their psychiatrist and avoid making impulsive decisions based on frustration encountered during therapy. Your psychiatrist is not a punching bag. They are human too and do their best to help you. Keep in mind that psychiatrists have many patients. It’s not easy for them to treat so many patients and also encounter agitation, psychosis and anger. Do your best to maintain your anger within appropriate boundaries. Don’t allow your anger to jeopardize the therapeutic alliance you have built with your psychiatrist. Help the psychiatrist better understand you because you’re the one who needs help at the end of the day.

Are you Ready? (This is Defeating Stigma Mindfully)