anger … blame or need?

January 5, 2012

in Hospice & Palliative Medicine,Journal Club,KU Med School,Spirituality

“The ability to interact effectively with  angry  patients is a  skill  that is often  learned with  experience and  is extremely useful in both transforming the patients’ reaction into a more creative emotion and  in developing a therapeutic relationship … Almost always, anger will resolve if the patient is given time, respect, clear information and consistency from the health team.” (Philip et. al.)


 four options for receiving negative messages …

blame ourselves (guilt)

blame others (blame)

sense our own feelings and needs

sense others’ feelings and needs


What is the cause of anger? … “Anger is generated when we choose the second option [blaming others]: whenever we are angry, we are finding fault – we are choosing to play God by judging or blaming the other person for being wrong or deserving punishment. I would like to suggest this is the cause of anger. Even if we are not initially conscious of it, the cause of anger is located in our own thinking … [the correct response] is to shine the light of consciousness on our own feelings and needs. Rather than going up to our head to make a mental analysis of wrongness regarding somebody, we choose to connect to the life that is within us. This life energy is most palpable and accessible when we focus on what we need in each moment.” (Rosenberg)



Clinical Approach – Strategy  (Skill)  [Process Task]

1. Allow patients to recount their grievances … (ask open questions) … [do not act defensive; avoid interruptions]

2. Work toward a shared understanding of the patient’s emotion/experience … (ask open questions, clarify, restate) … [avoid leading questions, avoid premature reassurance, negotiate the emotion’s name]

3. Empathically respond to the emotion/experience … (acknowledge, validate, normalize, praise) … [apologize]

4. Explore attitudes and expectations leading to anger … (ask open questions, restate, clarify, acknowledge) … [direct anger constructively]

5. Facilitate coping and connect to social support … (make partnership stmt, express willingness to help) … [make referrals, explore problem solving options, explore patient’s networks, avoid anger-causing isolation] (Bialer et. al)


Rosenberg’s example of the Prisoner … an illustration of the process in action

Anger in Palliative Care: a clinical approach. Philip J et. al.

Responding to patient anger: Development and evaluation of an oncology communication skills training module. Bialer PA et. al.

Nonviolent Communication: A Language of LifeNonviolent Communication: A Language of LifeNonviolent Communication: A Language of Life. Rosenberg.

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