[posted by dinah]
Maybe this should be titled The Angry Psychiatrist.
The patient has had a rough time of it, he's a widower who tragically lost his wife, his only child is a disappointment to him, his boss is demanding and unpleasable.
I would listen sympathetically, but the patient won't talk. He stares at the ceiling and says he doesn't know what he should talk about. I make suggestions; they are all wrong. He's already talked about those things, and why don't I remember? Or he doesn't want to talk about them, it won't help. I ask about something I hope will be benign-- weekend activities, how things are with a family member, even a TV show I know he likes, but anything that isn't charged, he's deemed a waste of therapy time. "What's important to talk about?" I ask, trying every angle I can think of. "You're the doctor," He replies. But it's not a matter-of-fact, or even a slightly annoyed, reply--it's a hostile, you're failing me, dig and he knows right where to aim.
When he does talk, it is to rail at me. I'm not helping him, the medications aren't helping him, the side effects suck. He logs my failures: the time I didn't call his meds in fast enough, the time he was certain he'd left a message I didn't return-- it doesn't matter that I tried and couldn't get through. If I make any reference to the future, one he insists won't come, he uses it as an opportunity to angrily tell me how I haven't been where he's been. He stares at my wedding ring and asks how I'd feel if my husband died, if my kid had the problem his kid has? He makes many assumptions that I've never suffered, and certainly, he announces, not the way he has.
The Angry Patient never misses an appointment, in fact, he arrives early, and he sometimes calls between sessions. He comes, he says, because he is hanging on to his last remnant of hope. He's never had a kind word for me, never even an ounce of tenderness to his tone. I've tried to suggest he see someone else (pleeeease...), for at least a consult. Empathy, I've said, is a necessary part of the psychotherapeutic process, and he feels I have none; perhaps he might find it with someone else? Even I'm giving up on him, he's quick to point out, and I'm not surprised-- I knew he'd see my referral as a rejection. He's not telling his story again, not starting over, and I'm as good as the rest of the quacks (he's test driven quite a few). Gee, thanks, I think.
The Angry Patient stares at the ceiling and I glance at the clock. I keep my tone gentle and even. I listen and I try not to say the wrong thing. I remind myself that he's still grieving, and I try to garner some sympathy for his disabling narcissism, his Cluster-B-ness which he wears like a coat of armor.
If the Angry Patient were just angry, that would be fine. Why does he have to be angry at me? Don't answer that; for the moment, I'm just striving for survival.