How much anger is enough?

“In ISTDP there is a lot of focus on recognizing, labeling, and viscerally experiencing one’s feelings. But how do we get clients to deal with anger in their everyday life? Is it enough “just” to recognize, label, experience, and thus contain the feeling, or should you respond more outwardly so that others get to know your limits? How do we prepare clients to handle their anger in their everyday lives?” Thanks to Erik for this important question.

Why do we focus on feelings in the first place? We focus on feelings because the patient’s attempts to avoid his feelings (his defenses) create his presenting problems. Once he can face his warded off feelings, he does not need to use defenses, and then he won’t have his presenting problems any more.

But this raises more questions, which Erik poses for us, and correctly so! In the therapy room, we encourage the patient to experience his feelings as deeply as possible so that he can access the previously repressed unconscious feelings which have been triggering his unconscious anxiety and defenses. Once he can bear those unconscious feelings, unconscious anxiety drops, and the defenses against those feelings are no longer necessary. However, there is the additional question: what is the relationship between accessing these deep conscious feelings in therapy and the conscious adaptive channeling of feelings in everyday life?

In everyday life our task is to feel our feelings so we can receive the information they can offer. Perhaps the anger arises because of the need to set a limit. Then the patient can enlist her anger in the service of setting a limit with an abusive boyfriend. She might set that limit by not returning his calls, changing her phone number, telling him that his behavior is unacceptable and that that behavior must leave the relationship or she will. Or she might enlist that anger in the service of filing a restraining order. In other words, depending on the situation, there is a spectrum of responses that would set an appropriate limit. And anger is the emotion that would help her do so.

First we help her face her rage in session so she can experience it without anxiety and defenses. Sometimes that is enough for the patient to use her pre-existing skills to assert herself in an adaptive way. Sometimes patients may not have those skills. In those cases, we might help the patient think about how to assert herself.

Sometimes therapists give patients advice or patients take assertiveness training classes. But then the patients don’t use the advice or training. Why? Because their anxiety and defenses block them from using this knowledge.

So task number one: help the patient face her rage as deeply as possible while restructuring her anxiety and defenses. Then she can put her knowledge into action. If she does not really know what to say or do, then you can offer advice and she’ll be able to put it into action because you have restructured her anxiety and defenses.

Take home point: build the patient’s capacity to face her rage without anxiety and defenses. Then she can use her knowledge to assert herself. If she lacks the knowledge (What John Gedo calls an “apraxia”), your advice and suggestions may give the patient guidance on how to channel her anger into adaptive action in a way that fits her. Since she can now tolerate her feelings, she will be able to integrate your advice and set the limits she needs to set.







One response to “How much anger is enough?”

  1. Sepide Avatar

    Hi Jon,
    As I told before, I am translating your facebook posts into Persian to make them accessible to more therapist. In this post, in paragraph three (the last two lines) where you mention an additional question: “what is the relationship between accessing these deep conscious feelings in therapy and the conscious adaptive channeling of feelings in everyday life?” is it “conscious” or “unconscious” before the “feelings in therapy”?

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