Tag Archives: anger

Voice of Experience: Three pieces of anger

By Gregory K. Moffatt September 23, 2021

He was court mandated, and to stay out of jail, he was required to engage in several months of anger management counseling, among other things. I was his choice as a counselor.

An incident of road rage had resulted in this outcome. The other driver had recklessly cut my client off on the interstate. His temper flared, and he pursued the other driver, eventually bumping her car and nearly causing an accident. The other driver was a young mother on her way to work with two children in car seats in the rear of the van. She called the police, who pulled my client over and arrested him.

My client didn’t have a single mark on his police record prior to this incident and said he had never done anything else like it in his 38 years of life. In our early sessions together, he was as befuddled by his behavior as the frightened young mother must have been on the highway.


Anger is a fascinating emotion. It is completely visceral. You can’t “decide” to be angry any more than you can decide to fall in love with someone. Instead, in a way, anger attacks us out of the blue, as it had done to my client.

People express anger differently depending on a variety of factors, including personality, coping skills, history and context. Regardless, we are all its victims at one time or another, and sometimes this emotion deceives us. In fact, anger can be much “safer” for us to express than other emotions. A counselor once told me that depression is really hidden anger, and while that may often be true, I believe the opposite is also true. It is sometimes easier to be self-righteous and angry than it is to admit that your heart is hurting.

I’ve had clients who have threatened others with weapons, engaged in violent road rage, and even some who have killed their workmates. Very few of these people planned their behaviors ahead of time. They acted spontaneously in the heat of passion (pardon the cliché).

I have witnessed anger many times in my clients, and I’ve recognized some things that help me manage it. Early in my career, “anger management” involved a set of techniques such as deep breathing and the development of varied coping skills. While those are certainly important areas on which to focus, I was missing a piece of the puzzle at the time that is also critical in managing anger.

Anger has three common components or pieces, and if we help our clients address these three issues, they will have new tools for coping in a variety of situations.

The first component is loss of control. When all of our tools for coping are expended, we are reduced to primitive behaviors. Think about how illogical (yet common) it is to push an elevator button repeatedly. In the midst of our frustration, we push the button again and again, even though we know it won’t help. This is where the use of deep breathing (or another relaxation technique) is very helpful.

My client had been feeling a loss of control at work and a loss of control at home. When the other driver’s behavior caused him to feel a similar loss of control that day in heavy traffic, he tried to retake control by “punishing” her for her reckless driving.

A second component of anger is that the precipitating event is perceived as personal. My client perceived that the other driver was doing something deliberately to him (as if she had planned specifically to make him angry) when, in fact, she was simply in a hurry and wasn’t thinking. The irony in road rage is that we depersonalize the other driver and at the same time perceive their behavior to be a personal and intentional attack on us.

Finally, the third component is a belief that one has been wronged — that life isn’t fair. My client believed that “other drivers shouldn’t be so careless.” In a way, he was trying to make the world fair by righting a wrong. That thinking is quite illogical but very common in road rage incidents.

The rage my client experienced had occurred partially because his defenses were down. He had just wrapped up a very bad day at work, his home life was at a low point, and in the safety of his car — his own domain — he let his normal coping skills fly out the window.

After weeks of counseling work, my client went on about his life a much healthier person. By looking at these three pieces of anger, he was able to learn to recognize cues and apply anger management techniques. I hope he’ll never see the back seat of a police car again.



Gregory K. Moffatt is a veteran counselor of more than 30 years and the dean of the College of Social and Behavioral Sciences at Point University. His monthly Voice of Experience column for CT Online seeks to share theory, ethics and practice lessons learned from his diverse career, as well as inspiration for today’s counseling professionals, whether they are just starting out or have been practicing for many years. His experience includes three decades of work with children, trauma and abuse, as well as a variety of other experiences, including work with schools, businesses and law enforcement. Contact him at Greg.Moffatt@point.edu.


Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Keeping victims safe: Crisis response planning with perpetrators of IPV

By Thomas DiBlasi and Kelly Smith July 20, 2020

One way that counselors can help victims of intimate partner violence (IPV) is to create behavioral crisis response plans with clients who are perpetrating the abuse. We (the authors of this article) have both worked in various roles with IPV programs, from direct service and administrative roles to research and advocacy. We believe that working with perpetrators of IPV is an essential component of reducing domestic violence.

As such, we are familiar with the research for treating perpetrators of IPV and find the results are often weak. Most clients report an increased desire to change on self-report measures but frequently lack follow-through (for more, see the 2008 article “Motivational interviewing as a pregroup intervention for partner-violent men” by Peter Musser and colleagues in the journal Violence and Victims). We can do more as counselors by providing these clients with behavioral support as they work to change. We must give the clients real, behavioral techniques that they can use in the moment. In this article, we share behavioral techniques that counselors can pass on to their clients to bring about real behavior change.

Crisis response planning (also known as safety planning) refers to creating an actionable plan when faced with a maladaptive response to a situation. Crisis response planning is often used with clients experiencing suicidal urges (as Barbara Stanley and Gregory Brown shared in their 2012 article, “Safety planning intervention: A brief intervention to mitigate suicide risk,” published in Cognitive and Behavioral Practice). In the context of IPV, safety planning has historically been associated with helping victims prepare for and engage in behaviors that will keep them most safe when faced with threats from a partner (for example, see Christine Murray and colleagues’ 2015 article, “Domestic violence service providers’ perceptions of safety planning: A focus group study,” in the Journal of Family Violence). We are advocating for the use of a crisis response plan, similar to that of Stanley and Brown’s, with clients who perpetrate IPV.

Crisis response planning is effective for mitigating acting on harmful urges; in this case, it is to manage urges to engage in abusive acts. To be clear, the objective of the crisis response plan is crisis management. It is not a tool that will reduce the occurrence of the urges to engage in abusive acts, but instead one that targets managing urges.

When the client perpetrating the abuse has an urge to engage in aggression, they will use the skills from the crisis response plan (which they co-create with their counselor) to refrain from acting on the abuse. Utilizing the crisis response plan allows clients to decrease their emotional arousal and to train themselves to engage in an alternative behavior when they have an urge to aggress.

This is no small feat given that these clients may have an ingrained history of acting on their urge. For every second that they are engaging in a coping skill from their crisis response plan, they are not aggressing. If a client goes from immediately acting on the urge to delaying the urge for 10 minutes, then therapy would shift from a focus on riding the urge to problem-solving and cognitive restructuring.

A crisis response plan for perpetrators of IPV

The adapted crisis response plan by Stanley and Brown asks questions to help clients identify warning signs, coping strategies, people they can call, emergency contacts, how to make the environment safe, and the most important reason to not engage in abusive acts. It is recommended that clients repeatedly review the crisis response plan and carry it with them at all times. The following is a review of each section of the crisis response plan.

Identify warning signs. When asking clients who perpetrate abusive acts to identify warning signs that lead to abusive behavior, it is best to focus on cross-contextual experiences. For example, helping clients identify that they are more likely to engage in abusive behaviors when the dishes are not done is good, but what is more helpful is identifying their anger (which is likely an underlying emotion). Anger has been consistently identified as a proximal factor in IPV but is not consistently addressed in treatment for IPV. Identifying the anger as a warning sign will transcend more contexts and ultimately make the crisis response plan more helpful. Warning signs could include physiological arousal, emotions, and thoughts such as demandingness or personalization.

Activate internal coping strategies. Internal coping strategies keep the clients from engaging in abusive behavior against their partners. These strategies may not reduce their anger or the experience of their urges, but the goal of the strategies is to not act on the urge. As long as they are not choosing abusive behavior toward their partner, they are being skillful. Using distraction (e.g., watching TV, going for a walk, listening to music), practicing progressive muscle relaxation, or listening to a funny show, skit or video (humor is a useful intervention in reducing anger) can all be helpful.

A skill that many clients like is changing one’s temperature. It involves holding one’s breath underwater for 30 seconds to activate the mammalian dive reflex, at which point the temperature causes the client’s heart rate to decrease, also lowering their anger levels. If they are not able to hold their breath underwater for 30 seconds (e.g., by using a sink), they can splash cold water on their face or use ice cubes. Clients may be more likely to use this coping strategy if they practice it in session. If they are wearing a Fitbit or something similar, they can instantly see the effects. This skill is commonly used as a crisis management skill in dialectical behavior therapy.

The most important thing is finding and listing the skills that work for your client.

Activate external coping strategies. It is important to help clients build self-efficacy by using their internal coping skills first. However, if they are not able to manage the urge or think they may still engage in aggression, then it is best for them to call someone. Calling a friend or a family member can serve as a distraction. The client does not necessarily need to tell the person about their urge to engage in abusive behavior. If your client can identify a friend who loves to talk about themselves, now is the time for them to call that friend. Talking to someone on the phone decreases the likelihood that the client will act on their urge. If that is not effective, they can call someone they trust (e.g., a close friend or family member, a spiritual guide) to speak to about the situation. If they are still fighting the urge to aggress, they can contact a crisis resource (see the resources provided at the end of this article).

Plan ahead. In addition to intervening, the crisis response plan also works as a preventive measure by focusing on what the client can do to make the environment safe. This could mean removing threatening objects (e.g., knives) or speaking through a locked door. For instance, if the client or their partner know they are about to have a difficult conversation concerning finances, they could agree to have the conversation standing on opposite sides of a physically locked door in the home so they are separated from each other, or they could agree to have another person present. Many clients who perpetrate IPV will not engage in abuse behaviors toward their partner in front of another person.

Lastly, the crisis response plan asks the client to name the most important reason for them to change. It is best to frame the reason in a positive direction (“I want a strong, healthy relationship with my wife and kids”) rather than the absence of something (“I don’t want to get divorced”). This reason reminds the client what they are working toward, so it is best to bring up this reason frequently in treatment.

Practice. The crisis response plan works best when it is rehearsed outside of the triggering context. Similar to basketball players rehearsing their form in practice so that they can shoot the ball in the game (and under pressure), a client needs to rehearse these behaviors prior to using them in the moment.

Behavior change is hard, particularly for clients who engage in abusive behaviors toward their partners. Trying to come up with alternative behaviors while angry is unlikely, particularly given that anger is associated with tunnel vision. Practicing these skills ahead of time allows the client to expand their behavioral repertoire in the heat of the moment.

Additionally, behavior change is challenging given that clients’ abusive behaviors have been positively reinforced in the short term. Clients who engage in IPV often get what they want after committing the abusive act (e.g., punishing their partner). Counselors working with clients who perpetrate abuse know that abusive behaviors are learned behaviors. The crisis response plan assists in clients learning new, more positive behaviors between sessions.

Working with perpetrators is an essential part of reducing instances of IPV and increasing victim safety. Crisis response plans provide an effective tool for counselors to use in their work with these clients.


Additional resources



Thomas DiBlasi is an assistant professor at St. Joseph’s College where he teaches undergraduate students and researches domestic violence, anger, aggression and revenge. He has given presentations locally, nationally and internationally and has published predominantly on anger and aggression. He is a member of the leadership committee for the special interest group of Forensic and Externalizing Behaviors. Contact him at tdiblasi@sjcny.edu.

Kelly Smith is a licensed professional counselor and approved clinical supervisor who began her work with sexual assault and domestic violence (SA/DV) agencies in 2006. She is also a certified partner abuse intervention professional. Beginning in 2015, she facilitated partner abuse intervention program groups and, most recently, served as director of abuse intervention services for a comprehensive SA/DV organization in Illinois. She is an assistant professor in the Department of Counseling at Springfield College with a research agenda that includes addressing issues related to perpetrators of IPV. Contact her at ksmith27@springfieldcollege.edu.


Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Volcanic adolescence

By Chris Warren-Dickins January 14, 2019

In the early days, Caroline, a 14-year-old girl, started each session with a chin thrust indignantly at her counselor. She wanted to be seen as a warrior, and she offered answers that were blunt as a sledgehammer.

And why should she drop her defenses? She had seen too many adults — teachers, social workers, friends of the family — try to engage with her at first, and then seemingly lose interest. In the end, she felt that she was just an inconvenience to everyone around her. Why should Caroline believe that this counselor would offer a different type of relationship?

With any new client comes the challenge of forming a therapeutic relationship, but when that new client is an adolescent, there are additional factors to consider. Aside from the legal issues of capacity and consent, I discuss 10 of those therapeutic factors below.


1) A holistic assessment: It is important to adopt a strengths-based approach to assessment of adolescents. In addition, it is worth reviewing that assessment more regularly than with an adult client because more things are likely to change with a growing adolescent. As Urie Bronfenbrenner pointed out, a young person’s development is the result of a complex system of relationships that constitute the child’s environment. Therefore, assessments of young clients will include their developmental needs, the extent to which caregivers are meeting their needs, and their family and environmental contexts, including the influence that their school and peers have on them. The assessment should also gauge the influence of technology in the young person’s life.

2) Emotional “distance” from problems: As an adolescent, Caroline needs her counselor to appreciate that she does not have the same “distance” as adults experience from their problems. Adolescents have little control over their lives. They have to stay in the same home or school, even if these things might be the source of their depression, anxiety or other presenting issue.

3) Grasp of emotional language: As a 14-year-old, Caroline still has not developed her emotional language, so volcanic eruptions of anger or shoulder shrugs of apparent indifference are her only means of expressing how she feels. We have to see past the shoulder shrugging, which can easily be interpreted as nonchalance, and open ourselves to the possibility that young clients want to express themselves but just don’t know how to yet.

Images are a useful starting point, even if it is just looking at a series of facial expressions to try and help these clients identify the emotions they are experiencing.

4) The dominance of transition: Transition features heavily in adolescents’ lives. Each year, they are at a different stage of educational development and, each year, they experience bodily changes. On top of all of this, their ideas about who they are and how they fit in with their peers and wider society are in a constant state of flux.

At this level of fluidity, a counselor can offer Caroline some sort of stability. One source of this stability can be the therapist’s professional boundaries. The counselor can also offer Caroline the benefit of his or her life experiences, providing a deeper context than Caroline’s young perspective. But the counselor’s older years and life experience do not provide complete insight, no matter what the client’s presenting issues is, so a person-centered approach is crucial. We, as counselors, do not know Caroline’s worldview until we explore it with her, and we have to be careful not to make too many assumptions.

5) Disruption tenfold: It is hard for adolescents to experience so much transition, but it is even harder to manage at the same time as dealing with mental or physical health challenges, a chaotic home life or a sudden major change experienced by the adolescent’s parents (e.g., job loss, divorce, bereavement).

Because of the volcanic eruptions of adolescence, there is a danger that adolescents will become scapegoats in these situations. Just because adolescents may shout the loudest does not mean they are the source of the problems. Often, parents bring their adolescents for therapy, and these adults are completely unwilling to consider that the need for change might also rest on their own shoulders, rather than expecting just the adolescent to change and the whole family dynamic to become settled.

6) Discrimination experienced by minority adolescents: If an adolescent client is a member of the LGBTQ community or is an ethnic minority, it is likely that they have endured some sort of discrimination. If adolescents have to make sense of this — in addition to the transitions they are experiencing in their bodies, at school and at home — it can be challenging to deal with.

Is it any wonder that we sometimes see volcanic behavior in adolescents in the form of outbursts and defiance, screamed at us in a burning rage? If we are to help these youngsters, we have to see past the behavior that spews out like lava. We must dare to imagine what unmet needs might be fueling this volcano.

To help us, we can consider Abraham Maslow’s hierarchy of needs, and we can assess to what extent our adolescent clients may be getting their basic physiological needs met. Perhaps they are hungry, or there is the constant threat of homelessness hanging over them. Or perhaps their basic safety needs aren’t being met because domestic violence is present in the home. We can continue working our way up Maslow’s hierarchy (love/belonging, esteem and, ultimately, self-actualization) to understand what unmet needs may be fueling what appears on the surface to be irrational and unacceptable behavior.

7) Trauma-informed care: If the adolescent has a history of trauma, it is especially important to see past his or her volcanic eruptions of anger. In a 2017 article in Counseling Today about young clients in foster care (“Fostering a brighter future”), Stephanie Eberts states that therapists need to “help these children heal” by acting as a “translator” of the child’s behavior: “This includes explaining what a child’s behavior means and what motivates it, and then equipping both the child and the parents … with tools to redirect the behavior and better cope with tough emotions.”

8) Testing (to discover and take reassurance from) the boundaries: Adolescents may test boundaries more than adult clients do. Modeling behavior is important, and this is where congruence comes into play. If young clients are constantly pushing the boundaries by turning up late to sessions or missing them entirely, you can communicate the resulting emotion you are experiencing as a result of their behavior.

I like to think of this like a sonar device: Young clients are checking to see if you are still emotionally there and whether they are also still present in the interaction. You can share this with young clients, showing that certain behavior has consequences. Then you can jointly look for a way to resolve the matter.

Psychotherapist Rozsika Parker wrote about parents’ relationships with their children, but the following statements could apply equally to counselors and their young clients. Young clients “need to learn that they have an impact, that it’s possible to hurt” an adult, but it is also possible to “make it up with them.” Parker encourages adults to “show joy, hate, love, satisfaction — the full range of emotions — that will help the child to know themselves.” Parker wrote that she “heard the same note of reproach in their wails when they teethed, as in the studied criticism of me they could launch as teenagers.”

9) The resistant adolescent: As with any resistant client, adolescents need to feel that they are choosing to be in the sessions. But what happens if they are given no choice? If a therapist is working with a young client and the client’s family, and the young client chooses to leave the session early, what should the approach be?

I have heard some therapists adopt the following approach: They tell young clients that they are free to return to the session at any time but that the session will continue with the other family members. I quite like this approach because it avoids sessions becoming hijacked and held hostage by young clients, which might be a parallel process to other times in which these young clients have held more power than they knew how to handle. For example, they might have been forced to adopt a parental role with a younger sibling, or even a neglectful parent, at an inappropriately young age.

10) Mindfulness and meditation: I have seen and heard some of the criticisms of mindfulness and meditation. I struggle with this because, when I was starting out in this profession, my mentors raved about mindfulness and meditation. I need to see where this debate goes, but in the meantime, I cannot help but believe that there might be some value in mindfulness and meditation in our work with young clients.

Everything we offer our clients involves a balancing act between thoughts, feelings and bodily sensations. Society is built to engage the thinking side of our awareness, and this casts a shadow over our feelings and bodily sensations. Yet all three are important sources of information. If we focus solely on our thoughts, we are arguably functioning at only a third of our capacity. Short and simple mindfulness or meditation exercises can help young clients tap all sources of information, while also giving them a moment of relief from the constant demands of life.




Chris Warren-Dickins is a licensed professional counselor in Ridgewood, New Jersey. Contact him through his website at exploretransform.com.




Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Angry nation: A counseling perspective

By Carol ZA McGinnis January 18, 2018

“O say does that star-spangled banner yet wave …” is a favorite line in our country’s National Anthem because it seems to simultaneously confirm our current liberties and challenge us to answer how relevant this symbol still is. In light of the events of the past year — horrific shootings, kneeling protesters, the ravages of addiction and various controversies that pitted one patriot against another — it prompts us to ask, “Does the flag wave for me?”

Some who have responded with unreasonable aggression may be answering that question in anger. I would argue that Americans as a whole do not have healthy anger modeling readily available to them. Consider audience behavior at select sporting events, the returns experience at customer service counters and vigilante films from Hollywood. Our culture does not offer a wide variety of positive angering examples.

Anger is a research topic that has not received much attention. For that reason, it is important to ask a question: What if the root of this violence and political division stems from a limited understanding of how to anger in a healthy way? It could be that our nation suffers from dysfunctional anger associated with a wide variety of diagnoses.


Dysfunctional anger

Regardless of our personal thoughts on this topic, it is important to note that President Donald Trump conceptualized the Nov. 5 shooting at the First Baptist Church in Sutherland Springs, Texas, as being the result of a mental health problem. If we are to approach this from a sociocultural counseling perspective, it makes sense to add our professional thoughts on how that may be so.

Since the Columbine tragedy in 1999, research has shown that ostracism and isolation are correlated with aggressive actions. The perceived injustice of being left out or treated unfairly often results in dysfunctional anger and violence. Could it be that we have an epidemic gap in social modeling for functional anger? If so, how can we in the counseling profession begin a national process for addressing this psychoeducational need?

This may seem like crazy talk to many people. When news breaks of another Sandy Hook, the Las Vegas shooting or the more recent Baptist church tragedy, there are those who ask, in genuine bafflement, “Who does this?” We have difficulty making sense of such senseless acts. We want to reassure ourselves that the individuals who carry out these acts are much different from the rest of us in the “normal” population. To this question of “Who does this?” I would like to present the Lucas scenario.


The Lucas scenario

Imagine an ordinary classroom of preschool children. The room features a large space in which to play with building blocks. Every child in this room has access to the same number of blocks and the same space to work, either independently or together, as desired. Imagine that all of the children are happily at work, building towers, bridges, cities or whatever else comes to mind.

In the corner, Lucas is busily stacking block after block in his effort to build a tower when someone walks by to open the door for a parent. This action shifts the rug just enough to interfere with the balancing act of Lucas’ creation. As a result, the stack of blocks falls. Lucas collects the blocks and begins anew, taking care to brace the bottom of the tower with heavier reinforcements. He gets his tower back to the previous height in a short amount of time.

Minutes later, one of the other children throws a wadded paper ball that Lucas tries to catch. Inadvertently, he knocks the top of his own tower over. He must rebuild half of his tower yet again. Undaunted, Lucas is excited to be moving into the second phase of his design when the teacher stops to give him encouragement and suggest that he consider replacing the bottom blocks with thicker options because of the height his tower is reaching. When he tries to swap those blocks out, the tower crumbles yet again. When Lucas expresses dissatisfaction with this event, the teacher scolds him gently and tells him, “Just start again.”

Having already endured multiple mishaps that required him to start over, Lucas twice more attempts to build “the highest tower ever.” When a friend falls close by and knocks over his highest version yet, Lucas reaches the end of his rope. He has lost all hope. He is frustrated and angry that everyone else has been able to build without interruption. He feels this injustice at the very core of his being. Nothing that he has attempted has worked. Even the teacher was complicit in his failure to have what everyone else has had.

What do you think Lucas’ next move might be? What models for anger has he witnessed at this young stage of development? What choices are available?

More than likely, Lucas will want to exact justice by leveling the playing field. To destroy everyone else’s towers would help them all to know firsthand what Lucas had had to endure, and doesn’t he deserve a little payback? Why should he be the only one to suffer? Why shouldn’t the other children feel as miserable and alone as he does?

It is not difficult to see how this response might also play out in the adult world, where the prospective offender is provided with guns, bombs, cars and other means for leveling the field. The fact is that many people never learn how to anger in a healthy way; it is our job as counselors to fill that gap.


Theoretical explanations

This scenario is just one possibility for Lucas, but the point is clearly made when we consider the decision for otherwise “normal” people to decide on a whim to obtain a gun, or a vast array of guns, and go shoot innocent men, women and children. What if this breaking point is not only understandable but preventable if we can introduce another way to anger?

Gun laws and mental health funding may be important to consider as we begin to address violence in our society, but it is also easy to see how new theoretical explanations will be needed. Some counselors may ask whether these violent outbursts are tied to a resilience issue, whereas others will want to learn if these responses are related to cognitive processes, behavioral reinforcement or social modeling.

No matter what orientation is taken, however, it seems obvious that anger must be included in research on this topic. According to most theoretical approaches, our work does not stop at the individual level but must also attend to the larger community. The ACA Code of Ethics also calls for our aspirational response to the needs of the larger community.

One way to do that is to consider how we can help people find alternative ways to express their anger without using a gun to shoot innocent people. Might cultural role models such as Mahatma Gandhi, Martin Luther King Jr. and Jesus Christ provide a starting point? What options can we introduce for clients who may not have skills in this area? How might we begin the process of helping others to express anger in positive ways?

Let’s hold President Trump to his opinion on this topic with requests for research funding that will help to create change in angering. Together, we can help our Angry Nation become a community of change and resolution without the need for violence.





Related reading, from the Counseling Today archives: “Angry words

Counselors often face the delicate challenge of helping clients to view anger as a helpful symptom and tool rather than something to be avoided: wp.me/p2BxKN-3ho




Carol ZA McGinnis, a licensed clinical professional counselor and national certified counselor, is a pastoral counselor and counselor educator who specializes in anger processing. Her passion involves teaching with attention paid to religion and spirituality as positive factors in both counseling and counselor development. Contact her at cmcginnis@messiah.edu.

Letters to the editor: CT@counseling.org




Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Angry words

By Stacy Notaras Murphy December 20, 2013

Angry-words“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.