Responding to difficult emotions

Patient distress can be acute or enduring, and contribute to the experience of a challenging consultation. Difficult emotions could include anger, resentment, morbid fear, intense grief, despair, or demoralization. A narrative approach is recommended involving active listening to the story, empathic acknowledgement of the emotions expressed, involvement of experienced clinicians, and reframing of the experience constructively to enable symptom relief and containment of the distress. When suffering persists, its further acknowledgement is warranted with efforts to promote adaptation and coping by exploration of the person and their life, sources of meaning, value and worth, and affirmation of these in the ill person. Role play in communication skills training involves the practice of a variety of empathic responses. Clinical scenarios for these difficult situations are provided in this chapter.