{"title":"When Patients Express Anger","authors":"Danielle Chammas MD, Teddy Scheel LCSW MPH, Mike Polisso LCSW APHSW-C, Keri Brenner MD MPA","doi":"10.1016/j.jpainsymman.2025.02.069","DOIUrl":null,"url":null,"abstract":"<div><h3>Outcomes</h3><div>1. Participants will be able to reflect on their reactions (e.g. countertransference) to various clinical examples of anger and utilize that self-awareness to better inform their understanding of a case.</div><div>2. Participants will be able to practice creating a formulation or differential diagnosis of a patient's anger and using that explanatory model to guide a nuanced therapeutic approach to the anger.</div></div><div><h3>Key Message</h3><div>Anger frequently emerges among patients and families facing serious illness. Hospice and palliative care (HPM) clinicians report feeling ill-equipped and under-trained to assess and respond to intense, disruptive anger. This presentation introduces high-yield principles from psychotherapy and psychology, offering effective and nuanced strategies for HPM clinicians to manage and address anger during clinical encounters, thus enhancing skills and sustainability.</div></div><div><h3>Abstract</h3><div>HPM clinicians are routinely prepared to attend to common emotions such as sadness, fear, and disbelief. However, many report inadequate training on how to respond to anger–a prevalent and often normative emotion among patients [1]. Clinician discomfort and insufficient skills on ways to respond to anger can impact patient coping, the therapeutic relationship, and clinician sustainability.</div></div><div><h3>Objectives</h3><div>Designed by two HPM social workers and two psychiatrists, all experienced in psychotherapy and practicing general palliative medicine, this session offers high-yield psychotherapeutic insights for managing anger in palliative care settings. The content will be presented through an interdisciplinary lens, incorporating essential DEI concepts, such as the roles of identity and cultural expressions of affective states [2]. This session aims to provide actionable strategies that clinicians can integrate seamlessly into one's daily practice, thereby enhancing therapeutic effectiveness at the interface of anger.</div></div><div><h3>Engagement</h3><div>Participants will partake in interactive exercises aimed at fostering greater introspective reflection on their reactions to various forms of anger. These activities will illuminate how clinicians’ own emotions, identities, and unconscious biases may affect interactions with patients [3]. Attendees will also develop skills in formulating an expansive differential diagnosis for anger, which will inform a personalized therapeutic approach tailored to each patient's unique needs and coping mechanisms [4, 5].</div></div><div><h3>Conclusion</h3><div>Anger is a common emotion experienced and expressed by patients and families facing serious illness, yet many palliative care providers receive minimal training on effective assessments and therapeutic responses. This session will utilize high-yield psychotherapeutic principles to equip clinicians with a nuanced understanding and management of anger [6]. By moving beyond standard formulaic strategies, this presentation aims to embolden more empathic and efficacious patient-provider interactions, thereby enriching and improving overall care quality.</div></div><div><h3>References</h3><div>[1] Kubler-Ross, Elisabeth. On Death & Dying. 50th Anniversary Edition. Simon & Schuster Touchstone; 201 [2] Chammas, D, Brenner KO. “The Angry Patient.” GeriPal. Podcast audio. Published February 16, 2023. Accessed August 3, 2024. <span><span>https://geripal.org/the-angry-patient-a-podcast-with-dani-chammas-and-keri-brenner/</span><svg><path></path></svg></span> [3] Rosenberg LB, Brenner KO, Jackson VA, et al. The Meaning of Together: Exploring Transference and Countertransference in Palliative Care Settings. J Palliat Med. 2021 [4] Shalev D, Rosenberg LB, Brenner KO, et al. Foundations for Psychological Thinking in Palliative Care: Frame and Formulation. J Palliat Med. 2021 [5] Chammas D. Formulation. GeriPal. Podcast audio. Published December 12, 2016. Accessed August 3, 2024. <span><span>https://geripal.org/improving-serious-illness-communication-by-formulations/</span><svg><path></path></svg></span> [6] Chammas D, Brenner KO, Gamble A, et al. Top Ten Tips Palliative Care Clinicians Should Know About the Psychological Aspects of Palliative Care Encounters. J Palliat Med. 2023</div></div>","PeriodicalId":16634,"journal":{"name":"Journal of pain and symptom management","volume":"69 5","pages":"Pages e453-e454"},"PeriodicalIF":3.2000,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of pain and symptom management","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0885392425001290","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Outcomes
1. Participants will be able to reflect on their reactions (e.g. countertransference) to various clinical examples of anger and utilize that self-awareness to better inform their understanding of a case.
2. Participants will be able to practice creating a formulation or differential diagnosis of a patient's anger and using that explanatory model to guide a nuanced therapeutic approach to the anger.
Key Message
Anger frequently emerges among patients and families facing serious illness. Hospice and palliative care (HPM) clinicians report feeling ill-equipped and under-trained to assess and respond to intense, disruptive anger. This presentation introduces high-yield principles from psychotherapy and psychology, offering effective and nuanced strategies for HPM clinicians to manage and address anger during clinical encounters, thus enhancing skills and sustainability.
Abstract
HPM clinicians are routinely prepared to attend to common emotions such as sadness, fear, and disbelief. However, many report inadequate training on how to respond to anger–a prevalent and often normative emotion among patients [1]. Clinician discomfort and insufficient skills on ways to respond to anger can impact patient coping, the therapeutic relationship, and clinician sustainability.
Objectives
Designed by two HPM social workers and two psychiatrists, all experienced in psychotherapy and practicing general palliative medicine, this session offers high-yield psychotherapeutic insights for managing anger in palliative care settings. The content will be presented through an interdisciplinary lens, incorporating essential DEI concepts, such as the roles of identity and cultural expressions of affective states [2]. This session aims to provide actionable strategies that clinicians can integrate seamlessly into one's daily practice, thereby enhancing therapeutic effectiveness at the interface of anger.
Engagement
Participants will partake in interactive exercises aimed at fostering greater introspective reflection on their reactions to various forms of anger. These activities will illuminate how clinicians’ own emotions, identities, and unconscious biases may affect interactions with patients [3]. Attendees will also develop skills in formulating an expansive differential diagnosis for anger, which will inform a personalized therapeutic approach tailored to each patient's unique needs and coping mechanisms [4, 5].
Conclusion
Anger is a common emotion experienced and expressed by patients and families facing serious illness, yet many palliative care providers receive minimal training on effective assessments and therapeutic responses. This session will utilize high-yield psychotherapeutic principles to equip clinicians with a nuanced understanding and management of anger [6]. By moving beyond standard formulaic strategies, this presentation aims to embolden more empathic and efficacious patient-provider interactions, thereby enriching and improving overall care quality.
References
[1] Kubler-Ross, Elisabeth. On Death & Dying. 50th Anniversary Edition. Simon & Schuster Touchstone; 201 [2] Chammas, D, Brenner KO. “The Angry Patient.” GeriPal. Podcast audio. Published February 16, 2023. Accessed August 3, 2024. https://geripal.org/the-angry-patient-a-podcast-with-dani-chammas-and-keri-brenner/ [3] Rosenberg LB, Brenner KO, Jackson VA, et al. The Meaning of Together: Exploring Transference and Countertransference in Palliative Care Settings. J Palliat Med. 2021 [4] Shalev D, Rosenberg LB, Brenner KO, et al. Foundations for Psychological Thinking in Palliative Care: Frame and Formulation. J Palliat Med. 2021 [5] Chammas D. Formulation. GeriPal. Podcast audio. Published December 12, 2016. Accessed August 3, 2024. https://geripal.org/improving-serious-illness-communication-by-formulations/ [6] Chammas D, Brenner KO, Gamble A, et al. Top Ten Tips Palliative Care Clinicians Should Know About the Psychological Aspects of Palliative Care Encounters. J Palliat Med. 2023
期刊介绍:
The Journal of Pain and Symptom Management is an internationally respected, peer-reviewed journal and serves an interdisciplinary audience of professionals by providing a forum for the publication of the latest clinical research and best practices related to the relief of illness burden among patients afflicted with serious or life-threatening illness.