Anger in Therapy

anger Therapy shouldn’t always make you uncomfortable or angry but if you’re in treatment and working on changing long standing patterns of behavior and thinking – always walking out of session with a head full of rainbows, unicorns and lollipops probably means that at least some part of the work that needs to be done isn’t happening.

When a client expresses anger towards their clinician, the therapist should avoid getting defensive for a couple of reasons. Acting defensively usually makes people angrier because it typically involves invalidating some part of what the other person is saying off the bat.  Most clinicians, I suspect, would agree that “client will increase rage towards therapist” is not a goal that appears on any of their treatment plans.

Another reason has to do with opportunity – invalidating a client’s anger or defending yourself against such statements as “God, you can be such a  [explicative] [explicative] sometimes” means being inattentive to what creates the anger. Defending yourself means you’re not trying to understand; it means you’re trying to cover your ass.

When a client expresses anger towards me, the first thing I try to do is get a lot of detail as to their understanding of the trigger –

Was it an expectation I communicated?

Did I mismatch an intervention with where the client is at?

Did I communicate in a way that reminded the client of someone in their life (past or present)?

Did I demonstrate frustration or disappointment non-verbally?

Is there a piece of beef jerky stuck in my tooth that my client can’t stop focusing on and wishes would just go away?

I’ll also try to explore the beliefs surrounding the event and the client’s interpretation of the event while gently checking in with them on whether they are able to bring themselves to the possibility of different interpretations. If they are open to it,  I’ll ask them to talk about that as well.

Of course, during this process, good communication skills (mirroring, validation and empathy) are key as these interventions can be easily misinterpreted as trying to make the problem all about the client’s perception – which is usually not the case. These skills also go a long way in perhaps giving the client what they needed from you in the first place but didn’t get, which may have been the reason or a reason for the anger.

Substantial exploration of a client’s anger allows the therapist to not only understand where the client is coming from but may also help the client learn and understand adaptive methods of dealing with anger in the moment. It can also improve a client’s comfort level in disclosure – the better we handle difficult content and emotion, the safer clients will feel in divulging it.

When a client becomes angry towards their therapist, the therapist’s behavior usually played some role in it; it’s usually not just about the client’s “stuff”.  It’s important to identify it so that you can either make amends (when you’re in the wrong) and/or set the boundary/expectation (when the client’s expectation is unreasonable).

Now,  just because I may have been in the wrong on one or more fronts doesn’t mean everything the client believed about the event and their reaction should be let go.  Clients are going to come across people who are going to get them angry – that’s a fact of life.  Therapy, like anything else, is imperfect and how that imperfection is processed and dealt with is important.

As a general rule I wait until the next session to bring my thoughts up and many times a client will have come to a different understanding of what happened by then which really makes the whole thing more useful. Time and distance gives a therapist and client the ability to compare thought patterns and conclusions, in relation to the trigger between two points in time.

One obvious exception to all this involves threats (direct or indirect) which need to be dealt with directly.  Threats are really very rare, usually impulsive, not meant, and the result of the therapist having to do something unpleasant – calling child protective services for example.  Even in those cases, most clients understand why you’re doing what you’re doing. Just because we don’t think the client “means it” however does not mean we shouldn’t act like they do.   I’m not going to get into how to handle threats here (that’s a topic in and of itself) but I brought them up as one example where exploring anger may not be appropriate – sometimes therapists need to act first in setting a boundary before any discussion about triggers and the relationship can safely take place.

If you’re the client, understand that getting angry over something your therapist said or did once in a while is a reasonable thing to expect. Feeling that way after every session or having intense feelings of anger towards your therapist more than a few times may mean there’s a problem with what’s going on in the room. Even then it could be about the work being done and where you’re at with it; which is why it’s important to be honest with your therapist about your anger instead of not saying anything or changing therapists without first examining what’s causing the anger. Talking to your therapist may not resolve the issue-it usually does – but terminating the relationship (if that’s where it goes) in an adaptive (non-avoidant/non-aggressive) way could hold a real benefit.

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