If you’ve worked as an occupational therapy practitioner long enough, you know one thing for sure: you will encounter a challenging situation when working with a client. Maybe emotions are running high, communication is breaking down, or someone is overwhelmed by their current circumstances. Whatever the cause, these moments can leave you mentally and emotionally drained if you’re not prepared.
Labels matter.
As I was preparing this, it was almost impossible to find any articles on dealing with the “challenging situation in healthcare”. But when I changed the search to “difficult”, that is when I found out this topic has been discussed at length for over 40 years! A seminal paper published in the New England Journal of Medicine in 1978 by Dr. James Groves is titled “Taking care of the hateful patient”. It was revised and updated in 2006 in the European Journal of Internal Medicine by Strouss et al and titled “The hateful patient revisited: relevance for the 21st century medicine”. I believe we can all do a positive service to ourselves and those we serve by reframing from the “hateful” and “difficult” patient, to navigating this inevitable situation to one that is “challenging”.
Gain Understanding
A key to navigating challenging situations is understanding why they happen. Most of the time, the behavior you’re seeing is a response to stress, fear, pain, or loss of control. Add trying to deal with the complications of health insurance, and now the situation is ripe for conflict. When you remember that, it becomes a little easier to meet people where they are—without taking it personally. Yes, you are put in the middle of this sticky and negative situation, but it is not about you. Easier said than done of course, but understanding the bigger picture can help keep a much needed perspective.
Stay Grounded
Staying grounded is essential. When things escalate, your calm presence can make all the difference. Slowing your speech, softening your tone, and using open body language sends the message that you’re steady, supportive, and not a threat. At the same time, it’s important to set clear boundaries. You can be compassionate and still maintain limits that protect your well-being. Something simple like, “I want to work together, and here’s what I need from us to make that possible,” can help reset the interaction.
Communicate Effectively
Communication is your best tool. Acknowledging emotions—even briefly—can instantly lower tension. Offering small choices helps restore a sense of control, which is often what people crave most in healthcare settings. And when in doubt, keep it simple, patient, and kind. And repeat the mantra, “this isn’t about me” can only help reduce your own emotions and focus on behavior and where you can make a difference.
You Matter Too
But here’s the part we often forget- you matter in this equation, too. Challenging situations take energy. Taking a breath before responding, stepping out for a quick reset, debriefing with a teammate, or reflecting afterward can help you process the moment rather than carry it with you. Self-care isn’t selfish—it’s professional maintenance.
Challenging situations will always be part of healthcare. But with empathy, boundaries, and a little self-compassion, you can navigate them with confidence—and keep showing up as the caregiver your clients need.
