Guest Columns

How to deal with overwhelmed and overwhelming patients

Mark Goulston
Mark Goulston

When patients and their families feel overwrought and overwhelmed, a group of cells called the amygdala, located in their emotional brain, hijacks them away from being able to listen to you or follow what you say.

If you're a long-term care nurse it's up to you to calm them down and enable them to listen to reason so they can become less anxious and then cooperate with you.

I want to help you with how to talk to your agitated patients and family members, and walk them from their agitated hijacked brain up into their rational brain so they can have productive conversation with you.

In my book "Talking to Crazy: How to Deal with the Irrational and Impossible People in Your Life" (Amacom Books), I explain how the best strategy to use if a dog has bitten into your arm is to not try to pull your arm from the dog's grasp. That will only cause it to dig its teeth in deeper. What you need to do is push your arm deeper into his mouth, which will cause him to release it as he starts to choke.

That is exactly the strategy to use when you find that patients or their family members are becoming demanding, pushy and agitated. Rather than avoid then or become defensive, you want to “lean into” their agitation.

There is a well-known adage (author unknown) that says, “If you can name it, you can tame it.”  UCLA psychologist Matthew Lieberman, Ph.D., explains when you name an emotion accurately – what he refers to as affect labeling – it lessens amygdala activation. By doing that, you decrease the possibility that a person's amygdala – the mind's emotional sentinel – will hijack commandeer the brain, preventing it from being rational, and forcing it into a pre-wired “fight or flight” reaction.

The correct moniker(s) to use when dealing with frightened patients or their families are: “frustration” or “worry.” Choose the one that you think most accurately describes the predominant feeling a patient or their family member is having along with their fear.

“Frustration” is preferable to “anger,” because calling someone “angry,” could seem accusatory, as if you are scolding or shaming that person. As you can imagine, that is likely to add insult to injury and cause the situation to escalate. Similarly, “worried” is a better adjective to communicate to patients and their families than “scared,” or “afraid;” words that also run the risk of escalating the patient's emotions.

In either situation, let these individuals express or vent or complain. Then pause for 2-4 seconds. After that, say to the patient or family member, “You sound frustrated/worried, what is that about?” In either case, be sure to lean into the word “that” in a way that invites the individual(s) to talk more.

While they talk, look into their eyes in a non-confrontational way and intent on having the patient or family member express what is really going on that is so frustrating or worrisome to them. Pay attention to potential uses of hyperbole, heightened intensity, and strong adverbs and adjectives. These are all indicators that these individuals have emotion attached to their current situation.

Do not interrupt your patient or their family member while they are speaking. Let them finish, pause again for 2-4 seconds, and say some iteration of, “Tell me more about [whatever the emotional words were].”

Continue to maintain eye contact, but, if they are venting, imagine that their complaints are going over your shoulders, instead of hitting you between the eyes. After they finish, pause again and ask, “Really?” in a tone of voice that will invite them to talk even more.

Feel that you are in charge of the conversation without being controlling.  Rather, you are guiding whoever you're speaking to in a direction that will allow them to get their overlying anger and underlying fears off their chests, so that they can calm down and listen to reason.

Then say to them, “We've covered a lot and I want to know what is most upsetting for you and most urgent that we deal with now. So what would you say that is?”

When you're dealing with people who drive you crazy: Letting them get their feelings off their chests first is far more important than what you say to them. Allowing them to vent will help them come back to their senses, so that they can have a constructive and less stressful conversation with you.

Mark Goulston is a psychiatrist, crisis counselor, and author of Just Listen (AMACOM, 2010). His new book, TALKING TO CRAZY: How to Deal with the Irrational and Impossible People in Your Life (AMACOM) was released in October.

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