Mrs Unwell has come to our clinic feeling annoyed today. Her appointment with the hospital has not gone well. Mrs Unwell is not happy at all with the consult. She says the consultant did not listen to her. When you ask what the management plan was, she says he said nothing whatsoever. She feels dismissed.

You are puzzled by this. You know your colleague is normally very good.

You try to explain the management plan from the notes. Mrs Unwell is not having any of it. She wants you to rearrange another appointment with the consultant – by next week – and complain on her behalf.

You try to explain you cannot do that. Now she is really upset. She goes on to say that all the doctors in this clinic are useless anyway.

Now you are the one feeling upset and aggrieved. You have spent a lot of time previously with this patient. Now she is basically telling you that you are useless. You are totally cheesed off.

This is a common and typical example of a drama triangle at play in healthcare. Mrs Unwell is fictitious, of course, but interactions of this flavour are everywhere. 

What are Drama Triangles?

Drama triangles were originally described by US psychiatrist Stephen Karpman.

They are a common interpersonal dynamic – or ‘game’ – usually between three people, where each one takes the role of victim, rescuer and perpetrator. 

At some point one person will ‘flip the switch’ on the triangle and move into a different role. This forces others to also move roles – unless they spot the game at play and decline the invitation to play.

Understanding the scenario

Mrs Unwell enters in victim mode, claiming the other doctor is the perpetrator. You attempt to step in as rescuer, which Mrs Unwell rejects, (‘flipping the switch’) turning into the perpetrator herself. You are then moved into the role of victim.

Most of us have a natural entry point on the triangle – often rescuers as doctors although I’m sure most of us know colleagues with a tendency to the other roles. 

The good news is they are easy to spot and often easy to step out of – saving your sanity in the process.

Stepping out of the triangle

Recognise the game is being played.  If you are working harder than you think you should be in a consultation, you may be in rescuer role

Think of the responsibility as being in the middle for certain consultations or conversations – not entirely with you.

Ask open questions that invite the other party to be more empowered and start thinking for themselves. Examples of these are: ‘what can we do to get this conversation back on track’ or ‘what can we do together to resolve this?’ The emphasis here is on WE – which puts the responsibility back in the middle.

Bonus tip

Use ‘what’ or ‘how’ rather than ‘why’ questions.  ‘Why’ tends to lead people to start justifying themselves!

Not everyone can respond to this – some people are very entrenched in their roles – but some will – and it makes a big difference to everyone. 

Spotting drama triangles is often the first step in avoiding and managing conflict at work both with patients and colleagues or situations that are ‘energy drains.’ 

They also ultimately help all parties as they are more empowering than ‘rescuing’ people which removes rather than adds power to a person.

Drama triangles are common everywhere, including within friends and families – can you spot one at home this evening?

For more information about working together for a drama-free life, I offer a free 30 minute call – just click below to book.

Share this post

Leave a Reply

Your email address will not be published. Required fields are marked *