O.K, the patient has just told you to "Go F@#K Yourself!" Now what do you do?

Let's begin with what not to do. First off, do not 'react' back. I have seen and heard inexperienced counselors do this and there is no telling where this will lead to; usually not to a very healthy place indeed. Phrases such as, "How dare you say that to me, should be avoided like the plaque."

I will get in the 'respect' factor in a little while.

Secondly, when an eruption like this starts I usually drop my head slightly (keeping my eyes on them) and hold my arms at my sides (in a non-threating manner) turning slightly sideways (defensive position) making sure I am at least an arm’s length away (another defensive position). I lower my voice almost to the point of it being inaudible and 'child-like.' Lowering the voice causes them to concentrate more on what I am saying in order to hear what I am saying.

I want the person to feel they are in control and I am non-threatening. This can greatly enhance the de-escalation process.

If the eruption began in and around the patient community I will ask them if we can talk in my office or another room. Usually they will.

When the person begins to 'come down' I will say something to the effect, "Wow, I am really concerned about you. You seem really angry and upset, is there anything I can do to help you out, do you want to talk?"

I like to use the following analogy, if you see a dog get hit by a car and you race to assist the animal, the first thing you should do is take off your belt and muzzle the injured creature. The reason being that in the process of trying to help him, he may feel pain and snap at you; much like the example above.

Alcoholics and Addicts can be hypersensitive; especially in early recovery. Therefore, as a professional in order to effectively help them, I must never personalize what they say to me (easier said than done sometimes). If you cannot do this then maybe you are in the wrong field.

Now as far as the 'respect' factor, when they are at a point of being able to truly hear me, I might say something such as, "you know, when you told me to go F-myself, I really wanted to know what was going on that you would disrespect yourself by making that kind of comment to me, thereby disrespecting me.

Psychic and emotional pain can definitely cause people to 'strike out' at others. Some of the’ reasons' patients may do this are many-fold; from the patient that is experiencing trauma flashbacks, to the person about to move on to another program and they just cannot say goodbye so they 'blow out' of the program instead.

It is important to not allow ones-self to get caught up in their drama, and maintaining a clear rational mind in order to focus on what is in that person’s best interest.