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← How to Break Bad News: The SPIKES Protocol

Lesson

Difficult reactions: anger and denial

Practice SPIKES in emotionally difficult situations — with an angry person and with someone in denial.

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When emotions run high

Anger, denial, and silence

Sometimes the emotion isn't tears but a wall: anger, denial, icy silence. The instinct is to defend yourself or argue. That almost always makes things worse. Anger: don't take it personally and don't get defensive. Name it and acknowledge it: “I can see this wait has worn you out, and it's truly infuriating.” Let them vent. Behind anger there is almost always fear; respond to that. Denial: don't break down their defenses by force — that only reinforces the wall. Gently but firmly hold on to reality while offering support: “I understand this is hard to believe. And I want to go through this together with you.” Return to the facts carefully, a little at a time. In both cases the same SPIKES framework and the NURSE technique work — you'll just have to stay at step E longer. We'll practice this in two tough scenarios.
Lesson notes
Anger, denial, and silence
Sometimes the emotion isn't tears but a wall: anger, denial, icy silence. The instinct is to defend yourself or argue. That almost always makes things worse. Anger: don't take it personally and don't get defensive. Name it and acknowledge it: “I can see this wait has worn you out, and it's truly infuriating.” Let them vent. Behind anger there is almost always fear; respond to that. Denial: don't break down their defenses by force — that only reinforces the wall. Gently but firmly hold on to reality while offering support: “I understand this is hard to believe. And I want to go through this together with you.” Return to the facts carefully, a little at a time. In both cases the same SPIKES framework and the NURSE technique work — you'll just have to stay at step E longer. We'll practice this in two tough scenarios.
Difficult reactions: anger and denial — How to Break Bad News: The SPIKES Protocol