In a nutshell

Doctor

So, what did you think of that patient?

PTR

Well his relationship with his wife seemed very strange.  She's very passive and seems to out-source her aggression to him.  And she's very dependent on him but he just shuts her down when she vocalises her guilt.  He seems like someone with a lot of frustration in his life but the only way he is able to express that frustration is through anger.

Doctor

There's a simpler way of putting it - he's an arsehole.