Working with people who are frustrated or angry
Lisa Illich, MCSD, CCC-AuD
Rebecca Hunting Pompon, PhD
Today’s agenda
I. EXPLORE
 Brainstorming
 About frustration and anger
II. ACT
 4 steps
 Strategies for de-escalation
 Exercises, demonstrations
I. EXPLORE
Small group discussion
[HANDOUT]
 Think about an occasion when you’ve been frustrated and/or
angry.
 How would you describe your non-verbal behavior?
 How was your communication impacted?
 What was (or would have been) a useful response from
your conversation partner?

Think about an occasion when you’ve been on the receiving
end of frustration and/or anger.
 How did you feel?
 How did your body respond?
 How was your communication impacted?
Themes
Your frustration/anger
 Nonverbal:
 Communication:
 Useful responses:
On the receiving end
 Your feelings:
 Body responses:
 Communication:
Frustration and anger
 A violation of expectations
 Misunderstanding, disappointment, grief
 Frustration; reaction to injustice
 Anger may be secondary to depression,
anxiety, pain
 Cynicism/sarcasm – explosive behavior
 May be displaced
 For some, part of the impairment
Examples of sources of
frustration and anger
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[Clinical faculty examples]
Source  Loss
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Identity and self-image
Communication
Relationships
Goals and plans
Employment
Financial stability
other Activities, Participation…
Grief and anger are connected…
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Anger is one “stage” of grief (Kubler-Ross)
“Episodic grief”
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Different from “stage grief” (death)
Detachment from participation or plans
May not be identified as grief
Grief is complex
“Why me/my child?”
“Who’s at fault?”
Identifying the source 
empathy

Understanding
 Easier to empathize if we can understand
the behavior
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Value of behavior
 “passion” helpful for action/recovery
Phases of Anger
1.
2.
3.
4.
5.
Triggering
Escalation
Crisis
Recovery
Post-crisis/depression
Smith, 1981
II. ACT
ACT
1.
2.
3.
4.
Self-awareness
Empathy
Listen
Acknowledge
Strategies and demonstrations
1. Self-awareness
If you are NOT aware of your reactions and behaviors,
will you be able to help yourself?
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Know yourself
What types of behavior make you
uncomfortable, frustrated, angry?
How do you respond: verbally, non-verbally?
How can you help yourself when you’re on
the receiving end of frustration/anger?
A few common techniques…
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Body check
Pause before you speak
Breathe deeply – slow inner pace
Remind yourself -- you and client probably want
the same thing (improvement, functional recovery)
Empathy…
2. Find empathy
Research shows empathy leads to…
• improved patient satisfaction
• greater adherence to therapy
• better clinical outcomes
Batt-Rawden et al, 2012
Client:
“I don’t want you to feel BAD for me,
I want you to UNDERSTAND me.”
Empathy
• What is the source and purpose of the
behavior?
• Imagining what life might be like
• Remind yourself – you and client probably
want the same thing
Build empathy by considering your
own experiences and reactions

Remember what your reactions have been…
3. Listen
Listen to understand rather than reply.
Employ active listening skills
 Maintain culturally appropriate eye contact
 Minimize distractions (chart, devices)
 Orient body to indicate listening
 Reflective listening
○ Paraphrase
○ Summarize
Reflective listening
Replace some…
With…
“Uh-huh…”
Short paraphrase
(1-2 words often sufficient!)
“Interesting...”
Phrase of observed
feeling
“Oh good.”
One sentence summary
of what was said
Reflective listening – paraphrase
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Listen for high impact words, phrases
Restate – reword – repeat
Indicates you have heard more than
other generic affirmations (“uh-huh”)
Result –
 acknowledges the client
 builds rapport
Let’s
practice…
Reflective listening – summarize
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Recap what has been said
Include concrete and emotional content
Be brief – sentence or two
Result –
 acknowledges the client
 builds rapport
 clarifies information
Let’s
practice…
Client:
“You are the first person
who has listened to me!”
4. Acknowledge
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It’s not about helping the client/family feel
better (or helping yourself feel better)
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It’s about acknowledging whatever it is
they’re feeling
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It’s an opportunity to express
understanding and connection
Ways to acknowledge…
Innumerable
 Communicates empathy
 Genuine to you
 Examples
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Okay, I’ve done steps 1-4.
Now what?
Sometimes 1-4 is all we need, or…
 May need to revisit
goals, treatment plan
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 Mutual?
 Change?
Demonstration

What clinician responses do you see?
 Paraphrase
 Summary
 Interpretation
 Acknowledgement/statement of empathy
Now it’s your turn…
Find a partner; take turns being the
clinician and patient for 2 cases
 Focus on…
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 Paraphrase or short summary
 Acknowledgment/statement of empathy
(see next slide for practice cases…)
Practice cases
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Teenage client: “This is stupid. My mom keeps telling me
to come here but I know you can’t help me. Why do I have
to keep coming here? I can hear just fine! And you make
me do the same stupid stuff over and over again. There’s
no point to it! No one can help me!”
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Family member: “My dad has been in this ICU bed for 3
days. I’ve come in every day to speak with the
neurologist, wait for hours and miss him every time! We
are getting no clear answers to any of our questions – it’s
absolutely mindboggling! I know you are just here to help,
but I have had it! What if this was your dad?!”
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What was it like to be the clinician?

What was it like to be the patient?
Phases of Anger
1.
2.
3.
4.
5.
Triggering
Escalation
Crisis
Recovery
Post-crisis/depression
Smith, 1981
De-escalation strategy
BEFORE YOU RESPOND:
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Note your physical reaction; breathe deeply
Find empathy
Attend and listen fully; do not interrupt
De-escalation strategy
RESPOND…
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Pause before speaking
Be intentional about rate, volume
 more slowly
 lower volume
 with confidence
Employ paraphrase, summarize, genuine
acknowledgment.
Goal: get on the same team
If anger has been an outburst…
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(employ strategy prev described)
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When ready, transition to cooling off
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Allow opportunity for “do-over”
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Take responsibility as appropriate
Video
“Sara” is a 46yo female with oropharyngeal
cancer. She is a community college
biology instructor who lives with her
boyfriend, Grant.
Treatment plan: patient has chosen
radiation, then surgery.
SLP plan: oral care, pre-surgical exercises
Watch and note: what works? what doesn’t?
In conclusion…
1.
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3.
4.
Self-awareness
Empathy
Listen
Acknowledge
Then, as appropriate, find ways to help…
Thank You!
Questions?
Clinical Counseling Resources & Consulting
Rebecca’s Winter Quarter office hours
Wed and Thurs
12:30 – 1:30 pm, or by appointment
[email protected]