The Heat of the Moment : Addressing Anger in the Therapy Room

As I sat across from the client, her words sliced through me — “What makes you think you can sit here and help me? You probably cannot even help yourself!”.

Okay, that was a lot. Welcome to Anger Management. If it's a tough journey for clients, I’d be lying if I said it was any easier for therapists. Wide eyes, the yelling, the occasional pounding of the table - these are just some of the reactions you can expect to encounter. The client earlier? That was a moment that caught me off guard, my first encounter with a client’s sudden rage directed squarely at me. The room (or I?) filled with a mix of confusion and shock as I grappled with the intensity of the situation. However, from that unexpected confrontation emerged, a journey filled with twists and turns, an intriguing path that I’ve been navigating ever since.

In the realm of human emotions, anger has got a bad rep. However, it stands as a natural expression, a language unto itself that we all experience. Nestled within this spectrum lies its behavioral counterpart - aggression, a force of destruction or volatility. Within the therapy room, I’ve observed the client’s anger showing up as hostility and aggression or sometimes cloaked in the guise of passive aggressiveness and defensiveness. It may surge outward like a raging storm or implode inward. You don’t always expect to encounter it. During a session with another client, as we delved into his innate need for control and his desire to meet the expectations of the “good boy” set by his parents, tensions began to rise. The deeper we went, the more his retaliatory instincts seemed to awaken. “I’m feeling disgusted right now. I came here to feel better, not to have a headache”, his anger was palpable. Whenever the currents of anger and aggression surge in therapy, I find myself wondering about the catalyst behind such reactions. Did they dislike what I said? Or how I said it? Did they feel challenged and not like that? Did this touch an old wound perhaps? Are they replaying a pattern from outside of therapy in therapy??

My perception of clients expressing anger during our sessions has undergone a gradual transformation over time. Reflecting on my own emotional journey during and after these encounters has been an integral part of this evolution. Initially, such displays would stir up a whirlwind of emotions within me - from confusion and annoyance to defensiveness and even the unsettling emergence of reactive anger. In the wake of the first incident, there was an undeniable temptation to respond similarly. Use some of my own power to right myself after feeling thrown off by her rage. This was swiftly followed by immense guilt for entertaining such impulses. There have also been moments where my concern for the client intertwined with a profound sense of responsibility, leading me to question my own role in provoking their anger. To claim that I have never taken it personally or that maintaining a calm demeanor hasn’t been a struggle would be a blatant lie. There have also been occasions where I have opted to sidestep addressing the anger directly, or even altogether, thinking that it could trigger their anger more. Yet, through this ongoing journey, I’ve come to realize the importance of addressing this with patience and a more nuanced understanding.

Over time, I’ve made a conscious effort to approach a client’s anger with the same openness and receptivity as any other emotion they bring to the table (I know, it’s easier said than done). A helpful trick for me has been to look at anger as something that needs to be worked with, and not against. Moreover, I’ve dedicated considerable attention to exploring the dynamics of our therapeutic relationship, as it often becomes a key protective factor in the face of possible ruptures. When the foundation of the connection feels strong, any breaches that occur feel more repairable. Importantly, recovering from anger and related episodes seems possible.?

Another aspect I’ve found particularly challenging yet essential is establishing boundaries with clients. It’s crucial to convey that while the expression of anger is valid and accepted, disrespect and boundary violation are not conducive to the therapeutic space. By setting these clear limits in a firm, yet compassionate manner, one models a healthy engagement with anger while respecting interpersonal boundaries.??

Directing the client’s attention to their experience in the present moment and gently guiding their focus to the emotions bubbling beneath the surface has been effective. I have, at times, empathetically reflected the rage back to the clients and used it as an opportunity to delve deeper into the roots of their reactions (while occasionally whispering to myself- “It's not about you! It's not about you!). The process of examining and addressing the anger has been transformative, serving as a catalyst for profound emotional insight and motivation for change. However, the true challenge lies in guiding the client towards the ownership of their anger, encouraging them to unearth the layers of sadness, frustration, or helplessness that often lie dormant beneath its surface. To put it simply, getting past the ‘ugliness’ of the emotion and being able to embrace its core functions is the crux of this process.?

How does it feel, you ask? Is it exhausting? Undoubtedly. Sometimes? I wonder, is this what I signed up for? Absolutely! Along the way, I have cultivated various mechanisms to navigate and process my own emotions, often seeking guidance and solace in supervision and indulging in self-care practices. (Hi, Netflix!). Over time, my fear of anger has reduced. I’m more comfortable with how wonderfully complex and infuriating it can be. A thought I hope to hold on to when my next client slams the table. ? ?