I don’t really think there is a valid reason for “snapping” at a patient. That said, I’ve definitely found myself in some sessions with my blood pressure high, saying things in a way that’s rather forceful, which is not something I often do, and not something I’m comfortable doing.
I will provide this one example, that I’m not particularly proud of.
In this one session with someone I had met for the first time, we came to the end of the session, after the person at effectively given a monologue for 45-minutes.
I had already noted some red flags to myself during our phone consultation, in which I suspected there might be some issues, and I found myself having difficulty ending the phone call. My initial phone consultations are free, and I generally speak to someone 15–20 minutes, more or less. I’m not a stickler regarding the time, but this is usually enough for us to get a feel for one another, for them to summarize why they are interested in therapy, for me to explain my basic ideas about therapy, and some of the logistic such as schedule, the fee and insurance. With this individual, however, we ended up on the phone for about 45-minutes.
Well, it should have been no surprise that after I informed the individual our time was up, they asked me how I was going to help them. Now, I understand that this is an important piece of information for anyone embarking on therapy, but we had already had a 45-minute phone consultation and a 45-minute session, and they had cancelled another session prior to this without giving me any advance notice at a peak time in my schedule.
I tried to give them a brief explanation but they did not seem happy with this, in fact, no matter how I explained my process, they seemed to want something more concrete. After we had gone over about 10 minutes, I became rather exasperated, and decided to share my thoughts with them about what was going on. It was rather harsh, I thought, although they seemed finally satisfied with the answer. I correctly assessed I would not see them again.
In retrospect, I knew this patient was not a good fit for me, but scheduled an appointment anyway, because I generally have a desire to help anyone who is willing to come to see me. I think I could have handled it better and should have probably just ended the session when our time was up, leaving her without an explanation. The fact is, many people use this as a way not to come to therapy. Anyone who gives you a guarantee or makes promises regarding how they are going to fix you is either deluded themselves or a trying to dupe you. This is why many people fall for charismatic con-artists, but never end up getting the help they really need.
Therapy can be hard. It can mean tolerating now knowing. It can means challenging your beliefs about yourself, which can be scary, because it can leave you feeling lost and without direction. It might mean rebuilding yourself, while feeling like you have no foundation. It can mean questioning everything that you held to be true for the better part of your life.
So, while I snapped at someone, dumping what I thought was a harsh truth on them, it was not the therapeutic thing to do. If I had not let my buttons get pushed, I would have handled it professionally, and told them calmly that we could talk about it next week.