“Anger is a signal, and one worth listening to,” wrote Harriet Lerner in The Dance of Anger, her seminal book about anger and intimate relationships first published in 1985. Lerner told millions of readers — in the counseling field and beyond — that our anger is a tool alerting us that something is not working in our lives. But anger can also inspire fear in others, whether at home, in our workplaces or in our communities. This leads many people who are angry to isolate themselves from loved ones or others who are afraid of such powerful emotions. In some instances, it prompts them to seek help from licensed professionals.
Though anger may be what brings these individuals through the office or agency door initially, it is unlikely to remain the singular focus of the client’s counseling path. Eventually, with the benefits of psychoeducation and personal insight, clients often realize that their anger is simply a more acceptable, “go-to” surface emotion that covers up deeper fears and sadness. Counselors with anger management training and expertise often face the delicate challenge of helping these clients view anger as a helpful symptom and tool rather than something to be avoided whenever possible.
Anger management programs typically invoke the same cognitive-behavioral and insight-oriented therapeutic techniques that most counselors practice on a daily basis. Clients often are asked to pay attention to what happens in their bodies when they start to feel anger, to practice mindfulness and self-calming techniques, and to explore more adaptive ways of expressing their feelings. Although referring clients to anger management classes or groups is effective in many cases, counselors wishing to explore these issues in their own offices might find themselves invigorated by helping clients finally succeed at something many never thought possible.
Francesca G. Giordano, director of the Master of Arts in counseling program at Northwestern University’s Family Institute in Evanston, Ill., traces her interest in working with clients who are angry to the energy they bring into their treatment. “It was when I began to work with couples with relational conflicts that I started to be really interested in the transformational characteristics of anger,” reflects the longtime American Counseling Association member. “In 2004, I began to conduct qualitative research interviewing individuals who have been able to use their anger to transform their lives. During this time, I also did a lot of reading about social justice leaders who were able to use their angry feelings in a positive, world-changing way. This had a powerful effect on increasing my awareness that, sometimes, encouraging clients to become more angry was as important — sometimes more important — than helping them manage their anger.”
Giordano emphasizes the importance of separating the emotion of anger from its potential behavioral outcomes such as aggression or conflict. “What I think many clinicians miss are the positive characteristics of anger,” she says. “Often we are so concerned with managing the negative behaviors associated with angry outbursts, we forget that feelings [of anger] do have a positive potential to bring people together and to motivate self-care.”
Giordano further points out that a deeper understanding of a client’s anger can reveal it to be a reasonable reaction to unfair and unjust treatment. Here, she recommends that counselors help clients use the energy of their angry feelings to create action plans to move toward a more empowered existence.
Working out the anger
Jim Messina, an ACA member and counselor educator in Tampa, Fla., has written extensively about anger management and has launched a 12-step-style program to help people struggling with anger and self-esteem issues. He also asserts that counselors must be careful not to focus solely on the symptom of anger when clients present for anger management assistance.
“Too often, we are in a hurry due to agency policies and procedures or our own lack of patience to dig deep into the causation of the issues for which clients come in to see us,” he says. “We must slow ourselves down and be good FBI agents to sort out … the real causation for the behaviors which we are witnessing in the client.”
To this end, Messina helps his clients recognize the many ways that anger presents itself, ranging from holding resentments against loved ones to acting out aggressively toward others. After a journey to better understand his own anger and self-esteem issues many years ago, Messina developed a program to help others cope with intense anger and resentments. The program includes activities that he has named “Tools for Anger Work-out.” These exercises help clients notice and respond to their feelings, which they often release through a nonthreatening physical action such as beating on pillows or yelling in a parked car with the windows closed. Clients in the program learn to relax when their anger is ignited, apply rational thought to determine the source of their anger and then clarify their feelings and connect them to unresolved issues from the past.
The combination of individual counseling and workout exercises has proved effective at helping clients find healthy ways to express their anger, Messina says. For example, when he was in private practice, he maintained an “anger workout room” for clients that featured a 40-pound karate kick bag. Clients could punch and kick the bag to release the angry energy that was causing them distress. “My clients could go in and beat on it until they felt like they had released some of the pent-up energy” that had been keeping them emotionally immobilized, he says.
One of Messina’s clients during this time had a successful business career and a connected relationship at home. Despite those factors, he was experiencing horrible outbursts of anger that he felt unable to control. Using an inner child assessment that Messina had developed, the man identified childhood wounds of feeling ignored by his family, leaving home at age 18 and never having contact with them again.
“This severe emotional and physical neglect left him scarred and unable to regulate his emotional response to events, people or conditions in his life,” Messina says. “All of his friends and co-workers were getting the brunt of his displaced anger.” The treatment plan involved group therapy, daily anger workout exercises and journaling that revealed his deep sense of abandonment, resentment and guilt.
“He was able to do this work so well that he has become known in the workplace as the ‘go-to guy’ whenever you have a personal hurt or concern. He is an effective communicator now who no longer strives to be invisible,” Messina says. The counseling process helped the client understand his family members without requiring him to re-engage with them, which could have been emotionally detrimental and was clinically unnecessary, according to Messina.
Power in numbers
Hollywood has offered many cliché images of so-called anger management classes. Messina urges counselors to know what is being offered in such classes in their communities before making referrals. “Without a healthy, well-managed and well-monitored model of release of the pent-up emotions which erupt in domestic violence, child abuse, physical assault and aggression on others, it is hard to believe the folks who are so eruptive are that much better after attending five to 10 [anger management] classes,” he says.
Appreciating the difference between self-selecting and court-mandated group therapy is key. L. Kay Howard is an ACA member and licensed professional counselor (LPC) in private practice in Houston, where she conducts both individual anger management work and court-mandated anger management groups. She says her court-mandated clients often are more reluctant than her self-selecting individual therapy clients to look at their anger issues. She traces this denial to feelings of legal injustice, noting that many mandated clients initially work hard in the group setting to try to justify and explain their legal troubles. In turn, she says, they often feel even more victimized when they learn about the fees and amount of time involved in attending mandated anger management groups. Conversely, Howard has found that clients who voluntarily come to treatment for anger issues often do so at the behest of a spouse or employer and are generally more willing to admit they are struggling with anger.
Howard, like Messina, has created her own curriculum for working with clients and has become certified in the anger resolution therapy approach developed by Newton Hightower. “I prefer doing anger management in groups, even though I do both [group and individual work],” Howard says. “I personally feel they learn more about their anger [in groups]. … When listening to others in the group, they sometimes see themselves in others’ stories.”
Jennifer McClendon is an ACA member and senior counselor/co-occurring specialist at the John Brooks Recovery Center in Atlantic City, N.J., where she provides group counseling to clients dealing with mental health and substance abuse disorders. She makes the case for encouraging those with anger issues to partake in both individual sessions and group work. “The group experience provides clients the experience needed to communicate they are not alone in dealing with their issues and offers a healing atmosphere, if the group can achieve this level of intimacy. The individual counseling experience allows clients to verbalize thoughts, feelings and experiences they may not be ready or need to prepare to address in a group process,” she says.
Illustrating this complementary approach, McClendon tells the story of Tommy (not his real name), a client mandated to a residential treatment center for substance abuse. Having already served 15 years in prison for another offense, and reporting a history of verbal abuse and no knowledge of his biological father, Tommy was included in a therapy group led by McClendon that met three days per week. She recalls that Tommy was guarded and directed much of his anger toward other group members, sabotaging their work by calling them insincere and refusing to open up about his own feelings. His anger about the process prevented him from experiencing the power of the group. All McClendon could do was be patient and work to build a therapeutic alliance with him through their companion individual counseling sessions.
During his time in treatment, Tommy’s sister, whom he referred to as his “real mother,” passed away. He didn’t discuss his grief in group, but a few weeks later, one of the other group members shared about his own use of drugs to numb himself against experiencing painful anger and sadness. The group member then directly invited Tommy to share the story of his sister’s death.
“After what seemed like an hour of silence, Tommy tried to speak but instead cried,” McClendon says. “He also talked about his feelings of abandonment and anger toward his mother and apologized to his group members. … This loss seemed to help Tommy, probably for the first time, experience his true feelings without any substances. The story from his peer appeared to have been beneficial in helping him release what seemed like a time bomb of emotions in a healthy way.” Tommy later went on to complete a separate eight-week class in anger management.
Anger education in action
Lauren Ostrowski is an ACA member and LPC at a community counseling agency in Pottstown, Pa. She developed a strong interest in anger management during her neophyte days as a counselor because she noticed how deeply some of her clients experienced anger and how strongly connected the emotion was to the other issues they were facing. She says she always aims to teach her clients that everyone is entitled to be angry if they truly feel that way. “What matters is what we do when we are angry or intensely emotional and whether certain reactions are safe and healthy for all involved,” she says.
In her experience, Ostrowski has found that listening is the most important step in understanding the roots of a client’s presentation of anger. “While clients will often state that they have no idea what makes them angry, a few sentences later, they are unknowingly talking about their triggers,” she says.
Treatment plans usually start with safety and symptom reduction, which includes teaching clients coping skills to help them experience their anger in a safe manner, Ostrowski says. She helps clients learn to communicate with “I statements” and recognize when it might be necessary to step aside and calm down before pursuing a topic with another person. She also has had success advising clients to set time limits on discussions involving hot-button topics. “Sometimes, dreaded conversations can feel more surmountable if there are time limits,” she explains.
Ostrowski reminds counselors of the need to create a safe environment for themselves and for their clients when facing anger issues. “Remember, anyone has the potential to get angry, whether or not anger is a main focus of treatment,” she says. “A client who reports that they typically throw glass or other breakable objects may be willing to squeeze a soft stress ball or hold an ice cube when angry.
“It’s also important for counselors to remember that we are often discussing issues that lead to anger outbursts, so we may see them in session. I empower clients to tell me what they are going to do if they get angry in session — before it happens. Sometimes a subject change is in order, even if this is temporary. If a subject is important enough to make a client angry in session, they are usually willing to go back to the topic after they have calmed down.”
Giordano says most counselors are well equipped with cognitive-behavioral techniques that can easily be applied to anger management intervention, but she hopes they will also employ their developmental skills and strength-based clinical tools to assist clients struggling with anger issues. “I would encourage counselors not to limit themselves to training that focuses on CBT [cognitive behavior therapy] treatment techniques alone,” she says. “Anger is very connected to experiences with injustice, so training in multicultural counseling techniques is very helpful. Anger has a powerful gender component to it, so training in feminist treatment techniques is also helpful. … I think angry feelings need to be associated much more clearly with the need for positive healthy change and emotional connection.”
McClendon says her work in substance abuse counseling lends itself to anger management because her clients who have been mandated to treatment often exhibit behaviors that appear threatening to others. She teaches these clients that anger often is a conditioned response, not their primary emotion. Her aim is to provide a corrective experience through the therapeutic alliance that helps to normalize their experiences, educate them about the function of emotions and develop healthier ways to identify and express their feelings.
When facing resistance from clients dealing with anger at the substance abuse treatment facility, McClendon has found that motivational interviewing techniques help to establish the therapeutic alliance. “Like most clients, the clients I work with seem to want to know that it’s OK for them to be angry, afraid, reluctant, etc., without being judged. I have found that most clients will lower their defenses and talk about their beliefs, problems, etc., if I, or a group, can genuinely communicate empathy,” she says.
McClendon’s advice to counselors is never to tell a client that he or she doesn’t have the right to be angry. “Allow the client to have these experiences, but [also] help them understand themselves better, encourage them to identify how they want to change and facilitate this change process through ongoing support and education.”
Contributing writer Stacy Notaras Murphy is a licensed professional counselor and certified Imago relationship therapist practicing in Washington, D.C. To contact her, visit stacymurphyLPC.com.