The Patient Who Stormed Out — And What It Taught Me

A patient once stormed out of my consultation room. I was trying to help him.

Have you ever known someone whose behaviour just doesn’t add up — warm and cooperative one moment, then suddenly demanding or accusing the next, for no reason you can point to?

It’s Not Random

If you’re watching someone you care about go through this right now — a partner during a separation, a colleague, even yourself on a bad week — you’ve probably already tried the obvious things. Stay calm. Be reasonable. Give them the benefit of the doubt. Try to help.

Those instincts aren’t wrong. But they’re built on an assumption that doesn’t hold here: that the confusing behaviour is random, or just “how that person is.” It isn’t. There’s usually a structure underneath it.

My Own Blind Spot

I asked my trainer at the time why it had happened. He shrugged. “It just happens sometimes. You don’t always get on with a patient.” I didn’t believe him then, and I don’t now.

Looking back, I think this was one of my real missteps as a young GP. Instead of stepping back, I leaned harder into being the empathetic listener — tuning in even more closely to every nuance, every flicker of “I need help,” trying to catch it before they had to ask. It felt like good medicine. It felt like care.

What I didn’t know yet was that I’d tuned into the Drama Triangle — and that the more I rescued, the more the pattern had to escalate to keep itself going.

Three Roles, One Script

This pattern was named in 1968 by psychiatrist Stephen Karpman, in a paper called “Fairy Tales and Script Drama Analysis.” He called it the Drama Triangle, and it has three positions:

The Victim — “Poor me.” The core belief is that nothing can be done. Karpman was deliberate that this describes a stance, not necessarily someone who is actually being victimised.
The Rescuer — “Let me help you.” Feels generous. Actually manages the rescuer’s own discomfort, and quietly confirms the Victim can’t manage alone.
The Persecutor — “This is all your fault.” Controlling, critical, blaming — and often experiences themselves as the one under attack.

Nobody stays in one seat. People rotate. The former partner who is cooperative one day and controlling the next isn’t necessarily being inconsistent — they may be moving around the triangle. Each position offers a psychological payoff: relief from anxiety, a sense of being justified, a hit of control, or permission to avoid responsibility.

A quick word on the evidence: this isn’t a rigorously proven theory, it’s a clinical/coaching model. But a 2022 validation study (Lac & Donaldson, Journal of Interpersonal Violence) tested it properly across nearly 1,000 adults and found the three-role structure held up, with the Victim stance correlating strongly with insecure attachment, anxiety, and depression. Useful lens — not a diagnosis.

You Don’t Need Them to Change First

The triangle needs at least two people to keep turning, and it self-perpetuates because every role gets a payoff without the underlying problem ever being addressed.

That means you don’t need the other person to change for the pattern to change. If you can recognise which seat you’re being invited into — and decline to sit in it — the system loses its energy source.

For the men I work with, this shows up in three places most often: a marriage or separation under strain, a difficult boss or colleague, and inside their own head — where you can persecute yourself, rescue yourself from feeling bad about it, and end up feeling like a victim of your own standards, all before lunch.

Change One Thing

Next time a conversation leaves you feeling unexpectedly guilty, unexpectedly furious, or unexpectedly responsible for fixing something that isn’t yours to fix — pause and ask: “Which seat have I just been offered?” Naming it, even silently, is the first move that isn’t part of the script.

If This Is Happening to You Right Now

Next week I’ll cover why we keep switching seats. If this is live for you or someone close to you right now, you can book a consultation here.

References

Karpman, S.B. (1968). Fairy Tales and Script Drama Analysis. Transactional Analysis Bulletin, 7(26), 39–43.
Lac, A. & Donaldson, C.D. (2022). Development and Validation of the Drama Triangle Scale: Are You a Victim, Rescuer, or Persecutor? Journal of Interpersonal Violence.
Gerlach, J. (2024). Caught in the Drama Triangle? Psychology Today.