Monthly Archives: May 2018

In Touch with Anger

Recently a patient of mine brought a situation to understand his being in touch with his anger and yet his feeling low thereafter. He was watching a live cricket match with his brother, and his brother’s wife walked in and changed the channel without saying anything to either one of them. When the channel was changed the patient was upset and walked away from the room as he thought saying anything would worsen the situation. Of course he was angry he said, and he wanted to shout at her. He was easily able to identify his feelings. But then he says he went to his room and started to read his book and that he was feeling very low (could this be because he did not allow to feel his anger physically in his body? And how could one help him in doing so?) He did not like it (naturally). His question to me was should I have told my sister in law that her behavior made him angry?  And in spite of the fact he was in touch with his feelings why was he still feeling low?  And what could he do in similar situations next time?

Here, the patient felt anger and used the following defenses: walking away from his anger, detaching, getting depressed (feeling low), rejecting his feeling (I don’t like it.) These offer different opportunities to intervene: “When you felt angry you wanted to walk away from it. If we take a look at this anger instead, how do you experience this anger toward her?” “Rather than feel your anger, you tried to detach by reading a book. Can we take a look instead at how you experience this anger toward her?” “So after you got angry with her, you started feeling low and depressed. If we look under the depression, how do you experience this anger toward her?”
You mention he was “in touch” with his anger when he was low. I doubt it. I suspect that he could cognitively label the feeling anger, but that when he was low, he was feeling depressed instead of experiencing the feeling of anger in his body. Rather than feel angry with his sister in law, he turns the anger onto himself and gets depressed.
Saying he feels anger (verbal label) is different from experiencing his anger physically in his body.
“Should I have told her I am angry?” he asks his female therapist, inviting her to become another woman who takes control of his life Therapist response: “Only you can know how you would like to deal with your anger.” This blocks his projection and keeps you from stepping into the shoes of another “dominating” woman.
Then you can continue, “Perhaps the issue right now is not what to say to her, but to take a look at the anger you feel toward her because we notice that rather than feel your anger, you become depressed instead. Would you like us to take a look at how you experience this anger physically in your body right now?”
As you explore, he will either become a little depressed or he will detach. If he becomes depressed, note his depression and then ask for the feelings under the depression: the feelings toward you. If he detaches, note how he detaches from you and ask what feelings he has toward you that make him detach from you. Then you will be addressing his problems as they manifest right here, right now, in the relationship with you.
2) the patient has a hard time to enact his murderous rage. Each time he does it he would say how the other person would try to restrain him from carrying out his rage.  could this be a sign of a very harsh superego where he cannot allow himself even in fantasy to enact his rage towards a loved one, and how does one deal with it in therapy? This patient also had a hard time to express any anger towards me. When i ask for feelings towards me he would only show his gratitude for the work I am doing with him. What could I do in such situations? 
You are right. Even in his fantasy he can bring in a defense, another person who holds him back. Fantastic! Another opportunity to show him how he holds himself back in fantasy just like he holds himself back in life. “Notice how you hold yourself back even right now in fantasy? Is this how you also hold yourself back in life? Would you like to break out of this prison of holding yourself back all the time? So if you don’t hold your feelings back in this room right here, how do you experience this anger toward….?”
When you ask for feelings toward you, he says he feels gratitude. Of course, he does. You are probably the best and most accepting listener he has known in his life! So ask him how he experiences his gratitude and positive feelings toward you. As you keep asking him to describe his positive feelings toward you, he will become anxious (sign of unconscious mixed feelings rising).
When his anxiety rises, then say: “Notice how you are becoming anxious? So I wonder, in addition to the gratitude and positive feelings, what OTHER feelings are coming up that are making you anxious? What other feelings are coming up here toward me?”
You see, when you ask about the positive feelings, they are connected to all the other feelings. It’s like when the fisherman pulls up the net, he brings in not only one fish, but all the other fish in the net as well. Why? Because we struggle with mixed feelings: anger and rage toward those whom they also feel love and gratitude.

Am I missing signs of anxiety?

“I have a patient, who voices his anger towards loved ones, but I rarely see any signs of anxiety and have never seen him sigh. At times he shifts in his chair, and sometimes he has dry mouth. But most of the time there is no sighing. What should what I do if the patient voices his anger without any signs of anxiety. Am I missing some signs of anxiety?” Great question!
If a patient voices his anger but is not sighing, either the anger is a defensive affect or the patient is using one of the systems of resistance. For instance, he might say he is angry, split off his positive feelings, and feel only rage toward someone, so no anxiety would rise. Remember that anger by itself does not trigger anxiety. Anger plus love mobilizes guilt which triggers anxiety.
Or he might feel angry and then turn it on himself. Then his anxiety would go into the smooth muscles, not the striated muscles. He feels only love toward you because he turns the rage back onto himself.
Or he might detach and intellectualize and detach from you. His detachment his feelings and from you would prevent feelings and anxiety from rising. Thus, we would not see a rise in unconscious anxiety in the form of sighing
So the question becomes this: when the patient does not sigh, which system of resistance does he use? 1) isolation of affect (detaching from you); 2) repression (turning anger upon himself); or 3) projection and splitting (splitting off loving feelings, feeling only rage, thus no anxiety rises).
When he does not sigh, notice what his next verbal response is. That defense will tell you the system of resistance you need to treat. If he looks away and detaches, that is isolation of affect. If he becomes depressed and weepy, engages in self-attack, or somatizes, that is the system of repression. If he projects onto you or others or views others as all good or all bad, then he is using the resistance system of projection and splitting.
Take home point: if you see no sighing, ask for feelings, notice the defenses, and then determine the system of resistance that is preventing a rise of complex mixed feelings. Now you will know why unconscious anxiety is not rising in the body.