Consult-Liaison Education Informal-curriculum Lessons Medicine Observations

Personality Disorders to Difficult Interactions (I).

I successfully delivered my talk on personality disorders recently. The second half of the talk strayed from personality disorders to a discussion about how to manage difficult interactions with people. The two topics are peripherally related, as you will recall that individuals with personality disorders often have difficulties with interpersonal relationships.

To be clear, though, just because you have a difficult interaction with someone doesn’t mean that that person has a personality disorder. There are plenty of people without personality disorders who behave in unbecoming ways.

Think about the last time you had a rough day. It is within the realm of possibility that, during that slice of time, you behaved in ways that suggest you have a personality disorder. It may not happen often, but it happens to all of us at some point.

Most of us rely on “gut feelings” to identify when we’re having difficult interactions with people. There are behavioral cues, though, that can serve as “red flags” to alert you that an interaction isn’t going well:

1. There are frequent interruptions. The other person keeps interrupting you… and you keep interrupting the other person.

2. There is a lot of repeating. You keep saying the same thing over and over again… and the other person keeps saying the same thing over and over again.

3. Many words are spoken, but nothing is really said. The literature describes this as “disengagement”. You’re just saying things to end the conversation. (e.g., “There’s nothing else I can do. Sorry. There’s nothing else I can do. Sorry.”)

Though emotional cues are valuable, sometimes it is easier to recognize these behavioral cues. We may not realize how we’re feeling until it reaches an uncomfortable intensity.

Once you recognize that you are in the midst of a difficult interaction, what can you do?

A useful first step is to stop talking.

The reason why it is important to stop talking is because when you stop talking, you can then self-reflect. I know that sounds “woo woo”. Hang in there with me.

Acknowledge the emotions you are experiencing. If you do not recognize and acknowledge what you are feeling, those emotions will likely manifest themselves in behaviors that you may not like.

If I refuse to acknowledge that I feel angry with someone, I might speak in a tone of voice that sounds sarcastic and condescending, give an icy glare, or say something biting and rude. Acknowledging what I am feeling gives me the opportunity to adjust my behavior accordingly. It gives me choices as to how I want to proceed.

To be clear, people aren’t stupid, so the other person probably knows that I feel angry. Acknowledging my anger, though, can cue me to take a deep breath, relax my face, or do something else to prevent the situation from getting worse. If I’m not paying attention to how I feel, I won’t do any of those things.

The other important aspect about acknowledging your emotions is that it grants you permission to feel what you feel. People sometimes have this idea that you must like all of your patients (or clients or customers or…). However, you won’t like all of your patients. That’s okay. That’s not the expectation. The expectation is that you show respect and provide the best care you can to them. That doesn’t mean that you have to like them.

You feel how you feel. There may be days when you feel anger towards people you like. And that’s okay. You will be much more effective if you acknowledge how you feel to yourself because you will be giving yourself choices. Those choices can give you significant influence over the rest of the interaction.

This is one important reason why you stop talking. More reasons to follow.