Tag Archives: anger

Disarming anger

By Bethany Bray September 23, 2022

Anger is personified in the animated Disney-Pixar film Inside Out as a stocky, red-faced character who is prone to mistrust and often takes things personally. He is easily upset and when he perceives a situation as unfair, he begins to yell and emit flames from the top of his head like a blowtorch.

Although the 2015 film was made with a younger audience in mind, many adults can easily relate to this character. The “flames” that erupt when Anger escalates may be figurative rather than literal, but it can feel just as real as depicted on screen.

Anger is one of a multitude of emotions that is a normal part of the human experience. Clients, however, sometimes avoid talking about their anger in counseling because it can be uncomfortable and hide emotions that may feel more vulnerable for them to reveal, says Kelly Smith, a licensed professional counselor (LPC) who has extensive experience working in the field of domestic violence, including helping perpetrators with anger issues.

Counselors can play a key role in removing the barriers and stigma that keep clients from addressing their anger, Smith stresses. This includes making it clear that anger is a normal occurrence and something to address when dysregulated. If a counselor is qualified and open to helping clients who feel angry all the time, they should emphasize that on their professional website and bio information, she adds.

“People can struggle with feeling out of control. And sometimes that is expressed as anger,” says Smith, an assistant professor in the Department of Counseling at Springfield College in Massachusetts. “It’s important to normalize that this is something to get help for.”

Interrelated emotions

Anger can be such a complicated emotion that clients struggle to describe it or identify its nuances and connections. An essential first step toward helping clients understand their anger is guiding them to explore the full range of what they’re feeling, says Smith, a member of the American Counseling Association.

Several of the counselors interviewed for this article say they use an emotions wheel to guide clients toward understanding their anger more fully, including emotions that are interrelated. Smith says she uses it in every session as a discussion starter.

In addition to shame and embarrassment, anger can be connected to feeling threatened, overwhelmed, vulnerable, resentful, overlooked or unrecognized and a range of other experiences that clients may struggle to express or connect the dots, says Reginald W. Holt, an LPC in Connecticut and Missouri and a licensed clinical professional counselor (LCPC) in Illinois.

Holt created and led an eight-week mindfulness-based relapse mitigation program that focused on emotion regulation, including anger management, with clients at an outpatient addictions treatment facility. Holt, along with Mark Pope, published the findings from this program in a 2022 article in the Journal of Human Services.

Holt says he noticed a common pattern of emotions among the program participants, all of whom were men on probation and parole. Many of the men would become angry — at their situation, at others or at the universe — when they experienced triggers, lapses or cravings for substances, he recalls. These feelings would often be intensified if the client was feeling unsupported because their family or loved ones had established firm boundaries or ostracized the client, which often happens within support networks when addiction and related behaviors cause problems, notes Holt, an ACA member.

When clients had relapses, their anger was often accompanied by feelings of remorse, powerlessness, frustration, defeat or fear that the rest of their life would be an unsuccessful, frustrating struggle to gain control over substance use, says Holt, a master addiction counselor, advanced alcohol and drug counselor and internationally certified advanced addiction counselor. This pattern would reoccur time after time until clients learned to recognize these interrelated concerns and respond, rather than react, to feelings of anger.

“Anger is the surface level, but if you dig down below that, it’s usually a sense of not having control and below that, a sense of fear,” he says. “It boils down, in some respect, to feeling overwhelmed, feeling helpless [and] feeling like it’s all too much.”

Exploring the origins

When a client appears to be struggling with anger, Smith recommends counselors conduct a thorough assessment for mental health issues that sometimes go hand in hand with anger such as substance use, domestic violence or abuse, posttraumatic stress disorder, borderline personality disorder, depression as well as medical issues such as brain injury or chronic pain. Clients who present with anger may need counseling work to address these other related issues first, either within the counseling sessions or in additional work with a specialist or in a group setting, she notes.

Anger can also be a “learned behavior,” says Toni Moran, an LPC and co-owner of a consulting and counseling practice in Denver. This was the case for Moran, who grew up in a household where there was a lot of yelling — and never an apology or repair. As an adult, it has taken a conscious effort to unlearn these patterns she saw as a child, she says.

Clients who, at an early age, witnessed caretakers, adults or even siblings default to anger and lose control of their emotions learn that it’s a way to connect, communicate, be heard and get one’s needs met. “It takes a lot of self-awareness and insight to say, ‘I probably could have handled that in a better way,’” Moran says, “And a lot of the people who are coming to me with anger problems weren’t modeled that in childhood.”

Moran and the other counselors interviewed for this article agree that delving into a client’s childhood and historical narrative can be a key way — for both client and counselor — to understand the context for their angry feelings and behavior.

However, Moran stresses that practitioners should use their “counselor intuition” to gauge how soon a client might be ready to talk about their childhood and the origins of their anger. Building rapport and trust with clients who struggle with anger should take priority, she says.

Alice Edwards, an LPC who specializes in helping clients with anger at her Houston private practice, agrees that questions about a client’s childhood can help shed light on the roots of their anger, as well as make it clear to the client that long-held patterns of anger and/or aggression will continue to plague them until they are processed.

Edwards begins these discussions by asking a client to remember the first time they experienced the type of anger that they struggle with now as an adult. She prompts them to recall how old they were, what was going on in their life at the time, how they felt and if the situation was ever resolved.

The counselor’s role, she says, is to guide the client with gentle questioning that can help uncover connections between past situations and patterns that occur in their adult life.

This was the case for a male client of Edwards’ who was struggling with problematic, angry feelings toward his work supervisor. Conversations about the client’s upbringing revealed that his father, who was in the military, had been absent a lot during his childhood because of work travel. And whenever the father returned home, he was extremely strict and often angry with the client. Exploring this history in counseling helped the client draw connections between his anger at his father and his anger at his boss and helped him move toward healing, Edwards recalls.

Diffusing anger

Humans express and present anger in different ways, which means each client will have unique needs and they may need to work on a variety of issues in tandem with their anger in counseling. These issues can include processing trauma, improving self-compassion, learning communication skills or conflict management, and working on better expressing their needs. And for some clients, it may be all of the above.

The counselors interviewed for this article, however, agree that clients won’t be able to delve into a treatment plan until they learn coping mechanisms to diffuse their anger in real time. They shared the following techniques to help clients learn to calm themselves, reflect and find ways to reroute their emotions to keep anger from escalating into problematic and negative patterns and behavior.

Breathing and mindfulness. Breathing techniques can serve as a useful and easily accessible way for clients to pause whenever they feel themselves becoming angry. Breathwork was the first layer of the mindfulness method that Holt used with clients in the relapse prevention program. Focusing on breathing often calmed the participants to the point where they could be mindful of their other physical sensations, range of emotions and five senses, which further helped them to slow down. The clarity of mind clients gained through this progressive mindfulness technique allowed them to reflect on the “rational and reasonable choices” they could make to replace anger as a response mechanism, notes Holt, an associate professor in the Department of Counselor Education and Family Therapy at Central Connecticut State University.

Breathing techniques work well as a primary and go-to tool for clients because they can bring the person out of fight-or-flight mode and reactivate their logical, problem-solving ability, Holt explains.

He encourages clients — and students, when teaching mindfulness as a counselor educator — to practice and hone these skills during mundane, everyday activities such as brushing their teeth, washing the dishes or taking a shower. Individuals can learn to focus on the temperature of the water or the taste of the toothpaste instead of letting their mind wander, he explains. And when it inevitably does, they can learn to gently lead themselves back to a mindful focus without self-judgment.

He challenges clients (or students) to gradually increase the amount of time they practice mindfulness, and then they discuss what did and didn’t work and what they learned when they debrief with him in session (or class).

Safety planning. Creating a safety plan is a common and important practice in domestic violence work, but it can also be helpful for clients who struggle with anger, Smith says. The key is to create safety plans with clients before they need them and to have the client come up with the content.

Clients can often identify how, where and why their angry behavior usually occurs, Smith notes, which makes them the best experts on ways that behavior can be diffused or curtailed. So the safety plan won’t have the desired effect unless the client, not the counselor, identifies the steps in their plan, she stresses.

For example, a client who has a history of physical expressions of anger might suggest removing the doors from the kitchen cabinets so they cannot be slammed or replacing metal or wooden drink coasters in their living room with cardboard ones so they cannot be thrown as easily, Smith says.

A client can also create a plan to use when they’re with a person or in a situation that usually makes them angry. Perhaps they come up with a signal to let a trusted friend or partner know when they’re starting to feel angry and need to take a break, she says. Then the client could go outside and take a quick walk or use other coping mechanisms to calm themselves.

Safety planning in this way ensures that clients have healthier alternatives at the ready to express themselves or release their anger, Smith adds.

Journaling. Journaling can serve as an outlet to document the strong feelings that clients who struggle with anger sometimes have trouble tolerating or understanding. Moran asks each of her clients to find or purchase a notebook for journaling as they begin counseling work together. Clients can often benefit from documenting their thoughts and tracking their progress in a journal, she says, but it can be a particularly helpful medium for clients who are working on anger issues. Moran sometimes suggests these clients turn to their journal after an angry incident to record the feelings and sensations they experienced and, in turn, reflect on what they learned.

Prompting clients to keep track of the events and interactions that happened before an angry episode, Edwards adds, can help them connect the dots between triggers and patterns that influence and lie underneath their anger.

Writing assignments, however, may not be a good fit for all clients. Edwards says that she sometimes encourages clients to record themselves (using audio or video) on their cellphones, which they can replay later.

Releasing through movement. Anger is an active emotion, so it helps to move one’s body to release it, Moran says. She sometimes teaches clients who struggle with anger a technique she calls “shaking leaf,” where they stand and shake their body to release tension, anger, frustration and related feelings. She says she often stands up and does this with clients to encourage them and illustrate the technique in session. Any movement that feels therapeutic to a client can be helpful in this way, she notes. Moran also finds that tapping and bilateral stimulation techniques can be useful for clients to process anger in the moment.

Movement in the form of exercise played a key part in helping a client who once sought counseling from Moran after being written up twice at work for angry behavior, including throwing a chair. He had chronic stress that was unaddressed, and it escalated to a boiling point when co-workers were not completing tasks in a certain way, she recalls. He also felt intense shame about his behavior after the fact.

In counseling, Moran and the client found that a three-pronged combination of coping mechanisms — physical exercise (walking his dog and riding his Peloton bike), journaling, and breathing and mindfulness techniques — provided the outlets he needed to release, process and reflect on the anger he was feeling. The client found it particularly helpful to do breathwork and body scanning in his car when he arrived at work each morning and at the end of his day before driving home, she says.

Moran counseled the client for two years and he was never written up by his employer again. By the end of their sessions together, he continued to journal regularly to process his feelings and thoughts, but the client no longer found work to be a source of frustration, she says.

Interjecting humor. Alison Huang, an LCPC with a private practice in Silver Spring, Maryland, often counsels clients who struggle with anger. When a situation seems unfair, clients who are prone to anger often take it personally, Huang says, so she sometimes takes a creative, humorous approach to help clients who react in this way to reframe the situation.

Huang often suggests that clients picture people who have made them angry as a minion, the yellow creatures who first appeared in the 2010 film Despicable Me. Loyal and loving, the minion’s childlike behavior and attempts to help often result in unintended mayhem.

Picturing the person who cuts you off in traffic, a difficult co-worker or your irritating neighbor as a minion makes it hard to get angry at them because they didn’t mean it and they don’t know any better, Huang explains.

She sometimes plays video clips of the minions for clients in counseling sessions as they talk through scenarios that made them angry. She asks clients: How would you feel and react if you were a bystander in this scene with the minions? How is it different than your reactions in real life?

Introducing the minions as a coping mechanism often makes clients laugh and instantly diffuses their anger, she says.

“Humor and reframing are a good combination for [addressing] anger. Having some laughs shifts their energy suddenly, softens their demeanor and increases their capacity for empathy for others and themselves,” Huang continues. “It’s very easy for those who struggle with anger to take things personally. [In counseling, try and] find ways for them to detach and keep from taking it personally — get out of that loop and find new thought patterns.”

Befriending anger

Anger is often viewed with negative connotations (both by clients and within society), but counselors can guide individuals to see that it is only negative when it’s dysregulated and results in unhealthy behaviors and patterns. When used in a productive way, anger can inform us, alert us and protect us — it can actually be a good thing, Moran says.

In fact, her goal, she says, is not to help clients get rid of anger — which is a normal human emotion and will always be present — but to help them learn to process it in a more constructive way.

Depending on a client’s needs and situation, Huang uses a combination of methods, including relational therapy, mindfulness, and acceptance and commitment therapy, to help individuals process anger and the deeper issues that sometimes underlie it, such as fear of abandonment.

According to Holt, the crux of helping clients overcome dysregulated anger is helping them learn to see it as an emotion to explore and learn from, rather than something to suppress or be overcome by. He aims to help clients rewrite their “automatic pilot” use of anger as a go-to response.

Offering the client psychoeducation on the nervous system and how anger can be connected to humans’ fight-or-flight response is an important first step in this process, Holt says, as well as teaching mindfulness techniques, such as body scanning, to help clients become attuned to how anger feels in their body and the physical cues that indicate it’s beginning to escalate, such as a clenched jaw or upset stomach.

“It can be an empowering experience [for the client] to acknowledge that ‘I felt angry and I sat with it, investigated it and realized that it didn’t have to overtake me,’” Holt notes.

Drawing from psychologist Tara Brach’s RAIN method, Holt used mindfulness to teach the participants in the relapse prevention program to explore and learn from their anger. Brach’s acronym can be a helpful way to introduce clients to the idea of pausing to consider why they’re becoming angry and finding other ways to channel that energy, Holt notes. RAIN prompts users to:

Recognize what is happening

Allow and acknowledge that the experience is happening

Investigate it with curiosity

Nurture with self-compassion

Holt says the clarity that comes with this measured, calm response also helps clients to learn to take in the full context of an anger-provoking situation and assess whether it is a source of true harm or simply perceived harm.

It can be a hard thing to learn for those who have used anger to express themselves or react to uncomfortable feelings for a long time, Holt admits, and it will need to be repeated and practiced. It also requires them to be able to identify the full range of emotions that they’re feeling and deploy self-compassion.

This focus on exploring anger creates “an opportunity to slow down; become more intimate and familiar with your emotions as they rise, crest and fall; and be able to tolerate the discomfort of that in the moment,” Holt continues. And it introduces skills for “checking where the anger is residing in your body and befriending it, rather than being afraid of it and avoiding the impulse to discharge it immediately because it’s uncomfortable.”

Moran takes a similar approach with clients by using techniques to help them detach and separate themselves from their anger. For example, she says counselors can encourage clients to view situations that provoke anger with curiosity. It can be helpful for clients to consider why their anger is showing up now, she adds, and think through the events that led to these feelings by asking what activities they were doing, who they talked to and what happened earlier.

Slowing down to consider the potential reasons for and the context of their anger in this way can also help them identify needs that aren’t being met, and in turn, prompt them to communicate their needs instead of responding in anger, Moran says.

She also teaches clients who struggle with anger to rephrase their “I” statements. Instead of thinking or saying, “I am angry,” they can learn to describe it with language such as “I feel anger” or “Anger is showing up right now.”

It can be helpful to teach clients to view anger as a person who is coming to visit, Moran notes. “Have the client address it, [saying] ‘I see you and I feel you. What are you trying to tell me?’ It’s often trying to warn us that something’s not right. And when we ignore [its message], it gets to a boiling point.”

Anger’s aftermath

A final — and important — step for clients to overcome problematic anger is learning the skills to acknowledge when they have responded in anger or hurt others and apologize, when appropriate, Moran says.

She uses the repair techniques outlined in the Gottman method of couples therapy with clients — both individuals and couples — who struggle with anger. Depending on a client’s needs and situation, a person can work on repair individually by writing in a journal or recording their thoughts or collaboratively by speaking with others who were affected by their angry behavior.

Repair is helpful because it prompts the client to acknowledge what happened as well as its context, Moran says. “They can come back to the person or people who were involved and say, ‘I was feeling angry and this is why, and it wasn’t OK for me to do or say XYZ,’” she explains.

For clients, the process of making amends by verbalizing or writing how they felt and behaved during an angry episode can also help strengthen their skills of distancing themselves from their anger, separating facts from feelings and communicating their needs, Moran adds.

“When I see shame [in clients who struggle with anger], it’s often because their angry behavior resulted in hurting someone else or made them look bad,” she says. “I try and help clients separate themselves so they don’t see themselves as the emotion.”

Benjavisa Ruangvaree Art/Shutterstock.com

Clients who don’t see anger as a problem

Practitioners may encounter clients who describe angry feelings and behaviors in counseling sessions but don’t see them as inappropriate or problematic.

In some cases, anger has become such a go-to or automatic response for a client and a way to get their needs met that they don’t even recognize it as anger, says Kelly Smith, a licensed professional counselor (LPC). It can also be a learned and internalized behavior, especially when a person has not had examples in their life of people who deal with anger in a healthy way.

Smith, who has extensive experience working in the field of domestic violence, says this is not uncommon among clients who are perpetrators of abuse. She once worked with a perpetrator of domestic violence who mentioned in session that every time they were upset with their partner, they went into the kitchen and tightened all the lids on the jars so their partner would have trouble opening them.

This client described this behavior as playing “a joke” on their partner, recalls Smith, an assistant professor in the Department of Counseling at Springfield College in Massachusetts. They didn’t see it as an act of aggression or anger; they thought it was funny.

“When working with perpetrators, they might not see themselves as angry, but it’s a part of their situation,” Smith explains. “They often minimize [anger], deny it or justify it to make it something other than what it is. They might say ‘I only did X …’ to make [behaviors associated with anger] sound smaller than what it was or deny that it was aggression or abuse in the first place.”

For example, one of Smith’s clients shared that in an attempt to leave an argument with their partner, they simply “picked their partner up to move them out of the way.” But the police report shared another perspective: This act of “moving” their partner resulted in a broken door.

It may go without saying that clients who struggle with anger can benefit from learning coping skills to be able to calm themselves and respond in a less aggressive way. But, as Smith notes, individuals who minimize or ignore their anger may not be ready to learn these skills — let alone address the heavy issues that can dovetail with anger, such as substance use or trauma.

She recommends counselors find and focus on motivation to connect and prompt growth with these clients. For clients who minimize anger, this often takes the form of finding a reason to change besides wanting to avoid getting in trouble for their angry behavior (e.g., wanting to change because they love their spouse), Smith says. And, most importantly, these reasons for motivation to change must be concepts (or people) that the client, not the counselor, identifies, she emphasizes.

Clients may need to revisit these conversations and remind themselves of their motivation throughout counseling work for anger or aggression. Smith suggests that counselors prompt the client to talk about where they want to see themselves in 10 years: How will they behave? What will be different in their life? How will they handle things that have made them angry in the past? Then, have the client identify things they need to do one week, one month and one year from now to reach that 10-year goal, Smith says.

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Bethany Bray is a senior writer and social media coordinator for Counseling Today. Contact her at bbray@counseling.org.

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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.

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.

Leremy/Shutterstock.com

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.

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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.

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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

The National Domestic Violence Hotline (800-799-7233) is available 24/7 for speakers of more than 200 languages
Crisis response plan template
Counseling Today’s July 2019 cover story, “Addressing intimate partner violence with clients”

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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.

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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.

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

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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.

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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

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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

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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.