“A man asks for anger management. He can’t control his rage toward his children when they do not obey him. He is in law enforcement and says he is successful being powerful. He asks for therapy because his wife and his children can’t endure his anger. He agrees. Rage rises within seconds when he does not succeed. He grew up with a father, a military man who was very controlling. My client never contradicted this father he looked up to. How can I work with his problem in the best way?” Great question!
Of course, the feeling is obvious: anger. The problem is that this man channels his anger into acting out toward those he loves: his children. So what do we treat?
First of all, how is this a problem for him? He agreed to go to therapy, but notice that he says he came because he wife and children could not endure his rage: the source of the motivation, as he describes it, is them. Ask about how and why his anger is a problem for him. Unless the therapy is driven by his will, you run the risk of have a half or quarter-hearted patient. Ask him, “How is this a problem for you?” “How is this impacting the relationship with your kids?” How are your kids feeling about you?” “How is that affecting you?” “When you don’t succeed with your kids, like all fathers, this mobilizes a big reaction in you. When you don’t succeed, what do you make that mean?” Questions like these encourage reflection, make his defense less syntonic, and mobilize his will to the task.
Second, as you explore, find out where his anxiety is discharged. Is his anxiety in cognitive/perceptual disruption leading to projection onto his children, so he beats his projections? If so, anxiety regulation will be paramount.
Third, notice his affect tolerance. Clearly, rather than channel his rage into effective assertion and parenting he loses control of his rage. At what level in the therapy office do you notice early signs of problems in affect tolerance: racing speech, impulsive bodily movements, raising his voice, yelling, talking over you, impulsive speech, or a wish to leave. Now you know the level of feeling he can barely tolerate, the level you will work at and not exceed in order to build his capacity. As soon as you see any of these reactions, stop exploring feeling, and do a recap of the process to encourage intellectualization and self-observation. “I notice that you started to talk over me. Did you notice that too? Sometimes, when people do that, it’s a sign of anxiety rising. Where do you notice feeling anxiety in your body right now?” This encourages self-observation and self-regulation as a substitute for losing control of himself.
Fourth, notice his verbal defenses as you explore his problems. Does he intellectualize (offer thoughts instead of feeling) or does he hyper-mentalize (offer elaborate speculations about other peoples’ motivations without having the evidence for their motivations)? If he intellectualizes, you can explore feelings in a graded fashion. If he hyper-mentalizes, you are dealing with projection and may need to begin with anxiety regulation.
If he views his children or wife in all-good or all-bad terms, you will know he is engaging in splitting. Here you may use pressure to consciousness of both sides of the split, monitoring any rise in anxiety and feeling when you block his splitting. “So the boy who makes you angry is the same boy who likes to sit in your lap when you fish.” Reminding him of these split-apart reactions, builds his capacity to tolerate mixed feelings.
How do you help him? First, conduct a careful assessment of the triangle of conflict. Find out where his anxiety is discharged, what system of resistance he uses, what capacity for self-observation he has, and what capacity for thinking about the minds of others. Once you know his strengths and weaknesses, you will be able to tailor the treatment to his needs.