In previous session excerpts, Dr. Patricia Smelt paid close attention to the therapeutic alliance which she felt needed nurturance. That’s because her client, Fred, was court ordered to therapy for anger issues and demonstrated defensiveness. Let’s pick up a segment of session 3.

Fred arrives at this session steaming, “Alright, doctor, now I have a real problem. My boss told me yesterday that I need a new attitude. Unbelievable. I work harder than anyone there and yet ‘I’ have an attitude issue. For gosh sakes, I work mostly with computers and numbers, not people. And I’m great at my job. I don’t even know where she’s coming from.”

Dr. Smelt, not particularly surprised, says, “Help me understand this, Fred. Were you getting a performance review or what?”

“No, not even. I’d been in another department helping out another idiot get his computer running again. People are so stupid. All I did was tell him to at least try rebooting before coming to me for help. Then the guy complained to his manager that I’d been rude.”

Dr. Smelt pauses; then asks, “So, I’m guessing that his manager went to your manager and then she came to you. Right? Do you remember exactly what she said?”

“Sure. She told me that I was condescending and dismissive. Go figure.”

“You know Fred, speaking for myself, I usually find that when people criticize me, and yes, people do criticize me sometimes, there’s usually at least a sliver of truth in what they’ve told me. Is there any chance at all that your style reflects how you feel about your coworkers? In other words, I’ve heard you call them stupid, idiots, and so on, here and there. Do you think that your voice and tone could convey some of that belief?”

“So, even you agree with her? I need a new attitude? Thanks a lot.”

“Hold the phone a moment, Fred. Let’s go back to what I asked you. Is there any chance that your tone of voice could possibly contain at least a little bit of the scorn you feel inside?”

Fred responds, “Well, maybe. I hate to admit it, but my wife has told me the same thing. She says over and over that ‘it’s not always what you say, but how you say it.’ But here’s the deal. I don’t feel like I’m being angry or rude.”

Dr. Smelt notes, “That must be very frustrating when people say you’re acting rudely, yet you don’t feel angry or upset. Let’s examine the situation with your coworker just a bit more. What were you thinking just before you told him to reboot his computer before asking for help?”

“Well, I thought he was an idiot and he’d wasted my time.”

“OK, good. Let’s tie this together a little. You have the thought ‘He’s an idiot,’ then you say, ‘Next time, try rebooting your computer before you call me.’ Is it possible that your thoughts led you to feel irritated and that your voice tone reflected that annoyance, even just a bit?”

“Alright,” Fred concedes, “you may have a point. But he is an idiot. So how am I supposed to change that?”

Dr. Smelt replies, “You’re absolutely right, Fred. You can’t change someone else. The good news is that you don’t have to. Instead, I recommend a different strategy. Specifically, I think it may be worth your while to consider changing a few of your thoughts about people and situations.”

Fred asks, “How in the world am I supposed to do that?”

Dr. Smelt smiles, “I’m glad you asked that.”

NOTE: Dr. Smelt’s patience and focus on the therapeutic alliance has started to pay off. She will need to remain vigilant, however. Fred will need careful handling for therapy to stay on track.

Photo Credit: Robbie Green

In Therapy Session 2.5: Fred
In Therapy Session 4: Fred