Chronic anger is a growing problem in America reaching epic proportions. A therapeutic treatment method that has gotten a lot of press is called anger management. This type of treatment is often conducted in the format of group psychotherapy. Through group dynamics such as effective communication modeling, assertiveness role- playing, and problem solving skills training, clients will garner new skills, will learn to find outlets to let off steam, and will have self-efficacy in their ability to navigate their world and the natural anger feelings that arise.
The interesting part of treating venomous anger is that you are sometimes treating other issues, as well, such as personality disorders (e.g., Anti-social and Borderline personality disorders), you may have clients with Bipolar disorder, clients whom have been through a horrific trauma, or clients with adjustment issues. All of these facets may be considered in anger treatment.
A big motivator for change in anger clients is the recognition of the costs of anger/aggression. Often there are severe consequences to clients’ anger issues including problematic or lost relationships, problems at work, legal issues, and others. Clients need to understand that what they have been doing to cope with anger has not worked for them. Chances are their methods have actually driven them away from the very things that are most meaningful to them. This recognition sets the stage for behavioral change. Additionally, anticipation of consequences is a powerful management tool.
We teach basic principles through psychoeducation early in the treatment process. For instance, it is important to note that anger is normal feeling. However, this normal feeling can turn problematic when anger becomes aggressive behavior.
There are two different types of aggression that I want to discuss: passive anger and aggressive anger.
Passive anger tends to be expressed with manipulation, secretive behavior, self-critical thoughts, suicidal ideation, and other modes. Passive anger is often not recognized because there are no apparent outbursts or exhibitions.
The more widely recognized form of anger problem, aggressive anger,has very different symptoms, such as demonstrated acting out, revenge seeking behavior, violence, and other forms.
In my anger treatment methodology, I target 4 main areas of aggression.
- Physical aggression toward others (e.g., physical fights and altercations).
- Verbal aggression toward others (e.g., yelling, screaming, arguments, threats)
- Aggression toward property (e.g., breaking things, throwing things, punching holes in walls)
- Aggression toward oneself, or aggression turned inward. This is the realm of self injurers such as self-injury (e.g., cutting, suicide attempts). These people often say “I’m not angry, I’m just depressed”.
Another concept in anger treatment is the recognition that aggression is a choice we make. I want to help my clients and group members begin to develop a sense of responsibility as well as an internal locus of control. Also we will practice being empathic, that is, understanding situations from others perspectives, stepping out of our own shoes.
Another portion of treatment is the recognition that anger is almost always a secondary emotion. There are numerous underlying “primary emotions” that drive anger. These include fear, shame, guilt, frustration, feeling disrespected, hurt from abuse, and many others. The work we do on the primary emotions is important for a couple of reasons:
- We begin to process some inner conflicts and painful experiences, even early in life, that have contributed to our personality development, our view of ourselves, and the way we conceptualize relationships and the world around us.
- We glean insight into our own personal sensitivities, or triggers, so that we become aware of warning signs, then let off steam by means of communication or stress reduction activities, before we explode.
Another important aspect of anger management is addressing the tendency of many clients to hold onto bitterness and hostility for an unhealthy period of time. This has many negative consequences on the person’s physical health and often keeps patients in a stuck position. We need to learn acceptance through forgiveness (for ourselves, not the other person) through mindfulness skills practice empathy training, behavioral techniques, and values clarification.