Why do patients become hostile towards therapists in session?

What is it about?

Client hostility in session is a rare but powerful event in therapy. Contrary to the assumption that hostile behavior is simply a product of a hostile patient, this study paints a much more complex and nuanced picture. In addition to factors related to the patient, this study highlights factors related to the therapist (e.g., empathy, lack of flexibility), therapy (e.g., degree of structure), and therapeutic relationship that also play a central role in explaining the emergence of patient hostility.

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Photo by Priscilla Du Preez on Unsplash

Photo by Priscilla Du Preez on Unsplash

Why is it important?

Cognitive-behavioral therapy (CBT) is a first-line treatment for panic disorder, which is a debilitating psychiatric condition associated with impaired functioning and quality of life. Hostile behavior in the therapy room is related to worse outcomes in CBT for panic disorder (i.e., worse symptom improvement, higher rates of drop out). Therefore, it is important to understand the origins of hostility in session if this behavior--and its negative consequences--are to be prevented and addressed effectively. Findings particularly underscore the need for greater attention to fundamental therapy skills (or common factors, such as empathy) and more flexible applications of treatment protocols.