We often get frustrated when our patients repeatedly don't do their exercises (e.g., non-compliant or non-adherent behavior). 

We review, reinstruct, and do the exercises with them, but they still return visit after visit, explaining why they didn't do them. But in the end, no matter what we do, they return with reason after reason why they didn't do them. For some therapists, this can result in frustration while grasping at straws and figuring out how to overcome this problem. 

So, how do I keep my cool when encountering these frustrating patients? 

I do it in three steps.

Step 1: seek to understand the problem - For example, when I encounter a patient who repeatedly doesn't do their exercises, I ask, "What do you think would help you do the exercises as prescribed?" They may respond with any of the following common statements:

"The exercises aren't working."

"The exercises are too hard."

"I don't even know if I'm doing the exercises right."

"The exercises are painful."

"I think the exercises might be making my pain worse."

"I don't know if they're helping."

Step 2: problem-solve - Notice that each of these statements would require problem-solving on the therapist's part. For example, if the exercises aren't working, find out how to make them work. If the exercises are too hard, make them easy enough to do but not so easy that they're no longer therapeutic. You get the idea here. But, it can still be frustrating to problem-solve one thing after another. That's why the third step resolves the frustration. 

Step 3: notice the patient's perspective -  For example, would you want to do something you felt wasn't working? Or, what about the patient who says that the exercises are too hard - Could you understand why a patient might put off doing the exercises and not do them at all? When you take on the patient's perspective, you'll notice that you have a better understanding, and this critical step is where the frustration melts away. 

Notice that the first two steps have more to do with the "physical therapy" problem-solving elements, while the third step has much to do with the ability to empathize. We all have this ability, but it may seem far out of reach or even out of sight when we're on the verge of losing our cool. 

So, how do I find my ability to empathize while wrestling with frustration and anger? 

We've all been there. Arguing, fighting, quarreling, "you should do this, you should do that, etc." We "should" all over each other, and nothing good usually comes of it. Where was our ability to empathize when we needed it? Sometimes, all we need is a little reminder. A study I just read reminded me of this important idea. 

 In 2014, Hepper et al. published a study showing how narcissists can empathize, despite the common notion that they are not usually interested in other peoples' suffering or feelings. In other words, it's commonly thought that narcissists can't empathize. They showed that perspective-taking enabled "high-leveled narcissists" to empathize when the researchers cued them to take on another person's perspective.

Hepper thinks this simple technique of reminding narcissists to take another person's point of view can do the trick:

"If we encourage narcissists to consider the situation from their teammate or friend's point of view, they are likely to respond in a much more considerate or sympathetic way."

Hepper reminds us that sometimes, we may need a reminder when the lack of empathy is an automatic state of mind: 

"…the current findings […] imply that narcissists' low empathy is automatic (instead of consciously suppressed or under-reported), and also that perspective-taking induces a genuine change in the way that narcissists process a distressed person's experience." (Hepper et al., 2014).

While we aren't narcissists, we may find ourselves in similar situations where we forget that we can empathize, especially when we're on the verge of losing our cool. But more importantly, we want to avoid the consequences of losing it altogether. 

Unfortunately for me, it was too late.

I lost my cool with Zaven, throwing his toy train onto the floor and breaking it into pieces. I thought I was teaching him a lesson by showing him what could happen. When I told my wife what happened, she reminded me that Zaven was only 3 years old. She said, "You realize he's only 3 years old, right? That's what 3-year-olds do! What were you thinking?" The feelings of pain, shame, and regret that flooded my mind left me gasping for air.  

That reminder is all I would have needed to keep me from losing my cool. If I had only reminded myself to take on his perspective at the time, Zaven would still have that toy train. 

Next time, while you are on the verge of losing your cool, avoid regretting how you might respond to your patients by setting up some reminders. I now use a mirror, but when I can't find one, I'll never forget the day I broke my son's toy train.