Thank you to everyone for your input.

I have discussed trigger with him to some degree but perhaps I could explore this further. As for aggressive behaviour running its course, you are exactly right.

The only reason this patient is still seeing me is because I let them have a chance at the beginning of every appointment to "vent" in the privacy of my treatment room. Sometimes this takes 10 min, sometimes 30 min. For this reason I always have them booked before my lunch so that I never have to rush the appointment. This also happens to be a typically quiet time in the clinic and a time of the day when the patient is usually doing better physically. I've found that the only way to have any PT happen is to let this aggression run its course and then we get to treatment. So many days I end up running into my lunch hour to treat.

This individual has walked out on at least 4 other PTs in the area. I'm the only one that he has stuck with for any length of time. So in a sense I feel like I'm doing a good job handling him. He's getting treatment consistently. I must be doing something right to have him still coming in. But there are days when I wonder why I'm trying so hard to accomodate him when he does things like he did today. And really, today wasn't that bad, he wasn't truly aggressive, not to the extent where anyone was concerned for their safety. But he was very mean to my receptionist and said several hurtful things to her.

He is receiving psych treatment and he is on medication. But he is very ill and there are days when I feel like I'm in over my head.

NbyNW, I would love to see some research on those types of issues. That's part of what I was hoping for, some references to articles that would apply to my profession directly.

Alright. Now that I'm done venting... maybe we can get on with talking about bikes.