What does it take to help a patient come to terms with anger?
Just last week, and many times over the years, a patient asks, “Please help me get rid of my anger. I want to get rid of my anger.”
While nobody is happy to hear from me that there is no “getting rid” of anger, the people who are able to make use of my company take an interest in the answer: The task in dealing with anger is to integrate it.
Integrating means bringing everything relevant to bear on the matter at hand and putting the whole catastrophe into perspective. My wisest mentor, Dr. Elvin Semrad, used to say, “What can we do with a feeling? We must acknowledge it, then bear it, and finally, put it into perspective. I have learned, over a lifetime of living and doing therapy, that there is no rushing any aspect of this process.
Oftentimes the reservoir of anger that we hold was filled over time with experiences originating in childhood. Certainly, as children we have fewer resources, both internally and externally, with which to manage life’s challenges. It is my intention as a therapist to be a resource in helping a person to recognize and acknowledge anger where it exists. Sometimes anger is apparent. Other times anger is obscured by depression or converted into somatic concerns or other neurotic symptoms. The work to uncover anger at its source requires careful investigation of the details of a person’s life experience. Whenever I feel unsure about how to proceed, I think of Semrad’s mantra: Investigate, Investigate, Investigate.
Once acknowledged, the feeling of anger must be borne — without action. One of the challenges in bearing anger is that anger is a feeling that physiologically presses for expression and action. The body, when feeling anger, is stimulated to produce adrenalin, the “fight or flight” hormone. It can take a substantial effort to acknowledge anger and to bear it without acting on it. Speech is action, too. And actions have consequences, which often distract from the task of holding the feeling while beginning to put it into perspective.
One particular patient had no problem feeling and expressing anger, but could not tolerate the smallest effort at putting his frustration and anger into perspective — a process which would require that he take the feelings and actions of others into account when they did not correspond to his expectations and wishes. When I made a perspective-encouraging observation, he turned his anger verbally against me. This was painful, but useful in bringing the dynamics right into the office. We had over time established enough trust and respect toward one another to tolerate the anger until we evolved to a quieter place. This was a real-life experience of bringing our resources to bear on my patient’s frustrations and anger — to integrating it.
Some people are afraid to feel angry. They try to skip over experiencing the anger and race ahead to seem to put their anger into perspective. In my experience, the final step in integrating anger is its evolution into sadness and grief. Unintegrated anger can go on for a lifetime, erupting at nodal points forever. Integrated anger evolves to sadness (the gap between what we wish for and what we have), which can be grieved and eventually lessen and fade. Semrad said, “Sadness is the vitamin of growth.” Grief means letting go of what’s not available, which makes room and frees up energy to attach to what IS available.
“I want to get rid of my anger.” The process: Acknowledging the anger. Bearing it. Putting it into perspective to allow it to evolve into sadness. Grieving. Growing.
Rako, S, & Mazer, H. (2003). Semrad: The Heart of a Therapist. iUniverse.