🪷 When Your Patient Becomes Cross with You

A reflection on therapeutic rupture, repair, and professional growth

Introduction

It wasn’t long ago that I experienced this for the first time as a therapist — a client sent me a message after a session expressing their utmost contempt for what I had said and the way I had approached things.

It may surprise you to read that rather than feeling triggered, I felt excited — almost triumphant.
“This is it!” I thought. My rite of passage.

We read over and over in therapy textbooks about the normalcy of being confronted by a patient’s emotions — the healthiness of having them expressed at us. This was mine. An important moment. Would I step up to the plate with integrity? Could I hold space in an honest, human, and professional way? Would I repair successfully?

When Confrontation Triggers the Therapist

For therapists, confrontation can trigger our own schemas.

For those unfamiliar with the term, a schema is a pattern of automatic thoughts, emotions, and reactions that we develop in childhood as adaptive strategies — ones that often become less helpful in adulthood.

It’s crucial for a therapist to notice if or when we become activated, to identify which of our schemas is being triggered and why. We need to move into metacognition — to understand what’s happening — rather than slipping into who’s right or wrong, what was said, or what was misunderstood.

The first thing to do is settle into this truth:

The patient is right.
Something you’ve said or done has made them angry.

As the therapist, it’s your job to repair.

(Of course, I’m not talking about situations of abuse from the client — but rather normal relational conflict that does not qualify as abuse.)

How to Repair

Step 1: Apologize.
You did something that angered your patient. It doesn’t matter if your intention was good, or if you used the most evidence-based, life-changing technique — it still landed wrong. That doesn’t mean it’s your fault, but it does mean you’re responsible for repair. Start by apologizing for how you made your patient feel.

Step 2: Validate the anger.
Their anger is absolutely valid and welcome here. Don’t be afraid of it or shy away from it — embrace it with open arms.
Congratulations! Your patient is expressing themselves clearly. Isn’t that exactly what you’ve been working toward?

Step 3: Explore their perspective.
Ask how they would have liked things to go, or what they’d prefer in the future. What would have felt better?
If their answer is reasonable and facilitates growth, adapt accordingly.
If their idea would block growth, discuss this openly and explain why.
These moments are gold — I’ve actually adapted parts of my practice based on feedback from this step.

Step 4: Give them space.
Don’t chase after them or worry that they’ll leave therapy. Sometimes they will. They’re adults, after all, and have every right to make that choice. If you’ve done your best to repair and it doesn’t work, it becomes either a lesson in how to repair better next time, or a lesson in letting go when you’ve done all you can.

Leave your patient their autonomy — what they decide belongs to them, and no amount of insisting will help.

When Repair Becomes Healing

While I haven’t had a client leave my practice in anger (thankfully), I know it happens — those same textbooks that got me excited about patient confrontation also remind us that it’s part of the work.

So if your patient is angry with you, don’t dismay.
This is a stepping stone in your practice.

Emotional confrontation offers a powerful opportunity to explore anger, schemas, and automatic thoughts — safely, within the therapeutic relationship.

When a patient can express anger towards a therapist (a healthy adult) and see it received with deep listening, care, accountability, and an authentic apology, something profound happens.

They learn that confrontation doesn’t have to lead to rejection.
They learn that relationships can survive honesty.
And they learn, often for the first time, what a healthy repair looks like.