Healthy Expression of Anger - Counseling and Mental Health Center

62 Pages·2002·0.09 MB·English

by  Martha Hartzog

Healthy Expression of Anger
TI 084
A group treatment for individuals interested in developing more
effective ways of expressing anger and handling conflict
Victoria Beckner, M.A. & Kalina Brabeck, B. A.
May 2002
The Clearinghouse
for Structured/Thematic Groups & Innovative Programs
Counseling & Mental Health Center
The University of Texas at Austin
100 A West Dean Keeton Street
1 University Station A3500
Austin, Texas 78712-0152
512/471-3515
www.utexas.edu/student/cmhc/clearinghouse
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Table of Contents
Introduction to the Topic_________________________________________________ 1
Model for Treatment ____________________________________________________ 4
Phase I: Understanding the Anger Cycle & Points of Intervention___________________6
Phase II: Applying the Anger Cycle to Relationships______________________________7
Phase III: Termination & Continuation_________________________________________8
Group Format _________________________________________________________ 9
Population ___________________________________________________________ 10
Group Screening Interviews _____________________________________________ 11
Group Session Overview ________________________________________________ 12
Session 1: Sharing Experiences __________________________________________ 13
Session 2: Understanding Anger__________________________________________ 15
Session 3: Identifying Needs and Misinterpretations Underlying Anger __________ 17
Session 4: From Anger to Action _________________________________________ 20
Session 5: Putting it All Together; Improving Communication _________________ 23
Session 6: Anger Patterns in Relationships & their Origins ____________________ 25
Session 7: Under-Expressing Anger_______________________________________ 27
Session 8: Over-Expressing Anger ________________________________________ 30
Session 9: Clarifying Responsibility _______________________________________ 33
Session 10: Anticipating Resistance & Solidifying New Behaviors_______________ 35
Appendices ___________________________________________________________ 38
Appendix A: Pre-Group Interview Questions___________________________________39
Appendix B: Group Rules ___________________________________________________40
Appendix C: Clarifying Feelings Exercise______________________________________41
Appendix D: Daily Anger Log A______________________________________________42
Appendix E: Errors in Thinking Handout______________________________________44
Appendix F: Daily Anger Log B ______________________________________________45
Appendix G: Anger Cycle Reference Sheet_____________________________________47
Appendix H: Needs Underlying Anger Handout_________________________________48
Appendix I: Daily Anger Log C (final)_________________________________________49
Appendix J: Charlie Vignette ________________________________________________52
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Appendix K: Communication Contrasts Role-play_______________________________53
Appendix L: Anger Styles Handout ___________________________________________55
Appendix M: Will & Tanya Vignette__________________________________________56
Appendix N: Bea Vignette___________________________________________________57
References ___________________________________________________________ 58
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Healthy Expression of Anger
Introduction to the Topic
Anger is a frequent experience for most people, and often plays a significant role
in their relationships with others and with themselves. Averill (1983) claimed that most
people become moderately angry anywhere from several times a day, to several times a
week. Anger is a signal, a message that we are being hurt, that our needs or wants are not
being met, that our rights are being violated, or that something simply is not right. Our
anger may tell us that we are avoiding an important emotional issue or that too much of
our self is being compromised in a relationship. Anger can be a sign that we are doing or
giving too much in a relationship, or else that others are doing so. In fact, anger can be
quite helpful as a tool for change, when it challenges us to become more of an expert on
the self, rather than focusing on others. It can be a means of getting in touch with our
individual needs, thoughts, and feelings, (Lerner, 1985).
Some people have difficulty expressing their anger in a way that meets their needs
and maintains healthy relationships with others. For some individuals, anger is difficult to
control, and they tend to let their anger explode. Overt anger can have a myriad of
undesirable consequences, including negative evaluation by others, poor self-concept,
low self-esteem, interpersonal and family conflict, verbal and physical assault, property
destruction, and difficulty in work or school (Deffenbacher, 1992). Other people may
bottle up their emotions and swallow their anger. Their needs and grievances never get
adequately expressed. Suppressed anger is also associated with certain medical
conditions, including essential hypertension, coronary heart disease, and cancer
(Harbrurg, Gleiberman, Russell, and Cooper, 1991; Spielberger, Crane, Kearns,
Pellegrin, and Rickman, 1991).
This group treatment is based on a model, proposed by the manual authors, of the
“anger cycle.” The cycle begins with an unmet need or injury to the self. Lazarus (1991)
proposed that the ego identity, or self, is made up of set of beliefs, values, and
commitments that a person deems important. This ego encompasses what people think of
themselves and how they think they should be treated by others. We react with anger
when another’s actions are perceived as insulting us, disrespecting our values and beliefs,
or belittling who we are and/or what we deem important. We would take this a step
further, and argue that underneath all of these thoughts and beliefs may lie a more
universal need to feel like others care about us. We need to feel valued and liked. When
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someone is insensitive or disrespectful, we are robbed of this fundamental need and our
self is injured.
It is, however, a person’s perception of an event, rather than the event itself,
which results in feeling angry rather than some other emotion (Schacter and Singer,
1962). This is the second step in the anger cycle. While anger, the emotion, cannot be
described in terms of “right” or “wrong,” the interpretations that precede the emotion
may or may not be accurate. Beck (1999) noted several cognitive distortions that
specifically are thought to cause emotional distress, including personalization,
catastrophization, dichotomous thinking, selective abstraction, arbitrary inference, and
overgeneralization. These errors in thinking can distort one’s perception of a situation,
and it is that perception of threat to personal sense of wellbeing, competence, or security,
that causes us to become angry.
The resulting emotion of anger (the third stage of the cycle) is an uncomfortable
affective state, and is accompanied by certain physiological reactions in the body. These
reactions result from activation of the sympathetic nervous system that prepares the body
for “fight of flight” or the “emergency reaction” (Canon, 1929). These physiological
changes may include deeper and faster respiration; dilation of pupils; increases in heart
rate, blood flow to muscles, sweat gland activity, blood pressure, and skin temperature;
and/or decreases in flow of saliva. These bodily reactions together with the strongly
negative affective state strongly influence the nature of a person’s behavioral responses,
the fourth step of the anger cycle. For example, a person may feel so overwhelmed and
intense that calm, rational conversation is impossible. Unhealthy behavioral expressions
of anger can range along continuum from explosive rage (verbal and physical), to
simmering, fuming, and silent discontent. Ineffective ways of expressing anger include
blaming, venting, misdirecting one’s anger toward a neutral third-party, silent
submissions, and ineffective fighting (Lerner, 1985; Finchman and Jaspers 1980).
Angry action always has consequences, the last step in the cycle. The treatment is
designed to examine how the behavioral response to anger affects oneself and others, in
order to determine whether a given action is a “healthy” expression of anger. If the
consequence of one’s actions perpetuate the original problem (one’s needs are still
unmet, the conflict has not been resolved), then the cycle continues. Consideration of the
consequences is thus essential to interrupting the anger cycle.
Each person has his or her own unique anger cycle, with its origin in early
relationships. People’s early attachment relationships with their primary caretakers shape
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the internal working models they bring with them to other significant relationships
(Bowlby, 1988). These early attachment encounters give rise to scripts that guide
people’s reactions to unmet needs. Such scripts can also be described as “styles” of
managing conflict in relationships. Two archetypal anger “styles” are the emotional over-
and under-expresser. The over-expresser of anger tends to react to anxiety by seeking
greater togetherness in a relationship, and to feel personally rejected when a significant
other desires more time or space in the relationship. The under-expresser of anger, by
contrast, tends to seek emotional distance or physical space when stress is high, and may
cut off a relationship entirely when things get intense, rather than persevering and
working it out (Lerner, 1985). When an emotional over-expresser and an under-expresser
are involved in a relationship, the two positions mutually provoke and reinforce each
other’s behavior. Thus, when one partner begins to alter her/his maladaptive patterns of
relating, the behavior of the other partner, and therefore the relationship itself, will
change.
Changing one’s ineffective ways of expressing anger involves going to the source
of the feeling, and identifying the underlying need and the (mis)interpretation that
resulted in the feeling. Once one has defined a clearer sense of one’s self, the next step is
to communicate these needs and feelings in a non-blaming way that focuses on the self,
rather than criticizing, blaming, or telling another how he or she should feel. If the
physiological changes that accompany anger are overwhelmingly intense, stepping back
and taking a “time out” can be an effective way of cooling down, gathering one’s
thoughts, and preparing for a level-headed, calm discussion. When ready to confront, one
may use skills such as active listening, empathy, problem-solving, and communicating
with “I” statements, to effectively communicate discontent.
Fundamentally, establishing new ways of expressing anger and handling conflict
in relationships with others necessitates continuous practice. Given that one’s anger
management “style” likely finds its roots in early familial relationships, these styles are
deeply entrenched within us and may operate at an unconscious level. The rehearsal of
the old pattern has formed a linked network of thoughts or interpretations, physiological
reactions, words spoken, and actions taken when angry. This reaction may happen so fast,
it feels automatic. Thus, continually practicing new behaviors to create new ways of
reacting is essential to change. Establishing new patterns of behavior also demands that
one anticipate resistance from others and from the self and commit to maintain emotional
contact with others, while at the same time asserting an independent sense of self.
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Model for Treatment
Treatment is designed to generate change in the individual. What kind of change
is desired depends upon the goals of the treatment. As implied in our title of the group,
our goal is not the reduction of anger—as is often the case in anger management
interventions—but the development of “healthy” ways to express anger. Our assumption
is that anger is a form of communication. Anger informs both the angry individual and
others that an important need has not been met. For example, anger at a friend for
arriving late may signal that one has a need to be a priority in her/his friend’s life, and
does not feel that he or she is. Unfortunately, anger often drives behavior that undermines
the individual’s goals. Thus yelling at the friend may result in alienation rather than
connection. We define “healthy” expressions of anger as behaviors that result in positive
consequences that facilitate resolving the problem and meeting one’s needs. The goals of
the treatment are thus to increase awareness of unhealthy anger patterns, to develop a
process for evaluating whether an alternative course of action is healthy, and to
incorporate these new behaviors into one’s life and relationships.
We conceptualize the change process during treatment as involving change in
awareness, emotional responses, and behavior. Although an increase in awareness is generally
the prerequisite to behavior change, each mode positively reinforces the others (see below).
How Change Occurs During Treatment
Increased
Behavior change
Awareness
Emotion
Thus (following the top arrows, the blue arrows), awareness through education provides
the logic and motivation for the client to try new behaviors (talking about needs instead
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of blaming). New behaviors and the responses they elicit from others (listening,
understanding) generate emotion in the client (hope, relief, connection); this provides
evidence for the educational component, reinforcing it and related behaviors. Awareness
(following the bottom arrows, or red arrows), such as a change in how one interprets a
situation), also leads directly to new emotions (hurt or compassion instead of anger).
These “softer” emotions motivate new behaviors (talking instead of yelling), which also
reinforce the new way of understanding anger.
Our treatment was therefore designed to introduce new levels of awareness and
related behaviors and skills with each session, rather than placing all of the educational
material and awareness work at the beginning. The progression of the session themes
initially follows our Anger Cycle (see below). Each conceptual “box” is introduced and
explored, and provides different intervention points (new behaviors) at each point. The
second half of the treatment applies the anger cycle to relationship dynamics.
It is not expected that individual members will find all components of the Anger
Cycle useful or relevant to their situations. Some may find the cognitive restructuring of
interpretations particularly helpful, while for others, identifying needs underlying anger
will be the most effective means of intervening in the Anger Cycle. For this reason, we
encourage all intervention points (i.e. steps in the Anger Cycle) to be thoroughly explored
during the treatment.
Anger Cycle
Interpretation
Need (not met) Emotion
Consequences:
Response from others? Behavior
Impact on others?
Feelings toward self?
Needs Met?
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Phase I: Understanding the Anger Cycle & Points of Intervention
The first phase of change involves understanding the Anger Cycle, and developing new
behaviors to interrupt the cycle. The first goal is thus to deepen members’ awareness of how
unmet needs and certain types in interpretations lead to anger, how anger leads to certain
types of automatic behaviors, the consequences of those behaviors, and how those
consequences often perpetuate the problem (and thus anger). The second goal is to have
members develop a set of “criteria” for evaluating these consequences to determine whether a
given expression of anger is “healthy.” The final goal of the first phase is to introduce several
new behaviors that can “interrupt” the anger cycle, including a focus on oneself (to clarify
one’s feelings and needs), cognitive restructuring skills, and effective communication skills.
Step 1: Identifying Feelings & Interpretations
The first step for initiating change in the treatment is to raise awareness about the
nature of anger. This includes introducing the idea that interpretations generate emotion,
and teaching members to identify the situations and interpretations that generate anger. It
is emphasized that anger is adaptive as a “cue” that something is wrong and in energizing
one for action. Members are instructed in self-focus in order to explore and clarify their
feelings when angry (or in situations in which they should be angry).
Step 2: Identifying Needs Underlying Anger
The next step involves introducing the first three “boxes” of the Anger Cycle, and
how they are related. Attention is turned to the concept that preceding one’s angry
feelings and related interpretations are unmet needs. Group members are encouraged to
explore the needs that may underlie recent anger episodes. This provides members the
first point of intervention in the cycle: identifying one’s needs (and other feelings)
enables one to get to the “heart” of the matter, and to approach communication in a more
empathetic way. Members are then instructed in the common errors people make in
interpreting situations and responsibility. Cognitive restructuring—the evaluation and
revision of interpretation—is introduced and practiced. This provides members a second
point of intervention in the anger cycle.
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Step 3: Determining “Healthy” Expressions of Anger
Having looked at the antecedents of anger, the next two “boxes” in the Anger Cycle is
considered: behavior and consequences. The group, in exploring different ways of acting in
response to their anger, are made aware of their choices and habitual ways of reacting. Focus
then turns to examining the consequences different behaviors: 1) the response from others, 2)
impact on others, 3) resulting feelings toward oneself, and 4) whether one’s needs have been
achieved by the action. The group will use these consequences as the starting point for
establishing evaluation criteria for determining whether a given action is a “healthy
expression of anger.” Awareness of the complete anger cycle, particularly the consequences,
provide members the logic and motivation for changing behavior. Communication skills are
introduced, evaluated, and practiced.
Phase II: Applying the Anger Cycle to Relationships
The second phase of change takes new awareness of the anger cycle and skills for
intervening at different points in the cycle, and applies these to relationship patterns.
Members are introduced to the concept of “anger styles,” their origin, and how they are
maintained in relationships. New behaviors aimed at changing anger patterns in
relationships are introduced.
Step 4: Identifying Anger Patterns in Relationships and their Origin
Members learn that their behavioral response to anger is often a habitual way of
coping with conflict and unmet needs. One’s anger “style” generally develops through
family interactions and is maintained in adulthood. Members are encouraged to explore
the origins of their style in expressing anger, and to recognize that unmet needs in
childhood can often exert a powerful response to similar situations in adulthood. The
anger cycle is used to determine whether current needs are being met, interpretations are
correct, and whether the consequences suggest the behavior is “healthy.”
Step 5: Developing Alternatives to Over-expressing and Under-expressing
Anger
Two fundamental anger “styles,” the “over-expresser” and the “under-expresser,”
are introduced to explore in greater detail how anger patterns function in relationships.
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