In the last section, we discussed challenges in helping clients recall their emotions during their trauma: resistant clients, risks, and unresolved grief and anger.
In this section, we will more closely examine aspects of clients who are suffering from unresolved anger: how they articulate anger, the targets at which they direct their anger, and forgiving their targets. Also in this section, we will relate PTSD resulting from combat and natural disasters.
♦ #1 Repression and Expression
First, we will examine how several clients articulate their anger. Have you found like I that there are two different ways that clients deal with anger: repression and expression? Everyone represses anger at one point or another whether it is to save face or to prevent harmful words from being spoken.
However, with PTSD clients, repressed anger can hurt the more it is repressed. They spend most of their energy suppressing the urge to "fly off the handle" so that they can appear that they are acting like "normal people."
On the other side of the spectrum, those clients who choose to express their anger at the drop of a hat do so in a harmful way as well. Many times, this over-expressed anger manifests itself through sarcasm, melancholy, frustration, depression, and outright rage. This type of anger most directly affects the client’s relationships with others.
Michael had suffered from near-fatal injuries during combat training for the Corps. Because his wounds occurred during training and not actual combat, many of his friends and family tended to undermine his condition, thus resulting in secondary wounding which we reviewed in section 7. This resulted in Michael acting out his anger through sarcasm. He felt as though his sufferings meant nothing to his loved ones and as a result, began to make harmful and sarcastic comments almost hourly.
Michael related to me one incident that occurred during dinner, "My mom had spent hours on this chicken. I’m talking the whole day. When she finally laid it on the table, I took a bite and said, "Jesus, mom, dry enough for ya?" My dad was livid. He told me I should be grateful for this "feast" my mom had taken all day to cook. Thankful, yeah right. I’ll be about as thankful as they were to get their son back medalless and combatless."
As you can observe, Michael expressed his anger through sarcasm in an attempt to harm those he felt did not give him due credit for his trauma.
Think of your PTSD client. Has he or she been expressing their anger? Has he or she been repressing their anger?
♦ #2 Targets of Anger
Second, we will discuss the targets at which many clients direct their anger. Often, these targets take the form of people involved in the trauma or secondary wounding, in Michael’s case. However, if no one individual is responsible, clients will direct their anger at broader groups such as insurance companies who refused to compensate their clients; governments which failed to protect its citizens; or even the client’s concept of God who seemed to have deemed it just to afflict them.
Rachelle was living in New Orleans when Hurricane Katrina hit.
Rachelle’s anger, obviously, had many targets which included:
1. The federal government for cutting the budget of the levees and for apparent bias in their rescue time;
2. The local government for not fighting for more funds to improve the levees;
3. FEMA for their delayed response time;
4. The national guard for shooting innocent civilians; and
5. The citizens of New Orleans for letting themselves succumb to chaos and anarchy.
Rachelle stated, "We were left high and wet by those sons of bitches in Washington. They’ll give parades for their white boys over in Iraq suffering, but they don’t give a shit about black and poor drowning. I lost my mother, my home, my neighbors, my job, and all FEMA can do is sit around and scratch their ass." As you can see, Rachelle verbally expressed her anger at a variety of targets.
Now, think of your client who is expressing their anger. At what or at whom are they directing their rage?
♦ Technique: Gestalt Chairs
To help Michael and Rachelle reduce their anger with their targets, I asked them to try the "Gestalt Chairs" technique. We have already listed Rachelle’s targets, but Michael’s targets were slightly more complex. Although Michael experienced some anger for what happened to him, most of his sarcasm was directed at his family as a direct result of their secondary wounding.
To help resolve your client’s anger with their targets, I recommend having them complete the following exercise either during a session or even in the privacy of their own home.
During this exercise, the client will imagine themselves confronting the target of their anger:
- Arrange two chairs... facing each other at an angle and have the client sit in one.
- Ask the client... to take two, easy, deep breaths. Tell them to relax and calm themselves as they prepare to touch honestly with their feelings.
- Tell the client to imagine... the target of their anger sitting in the other chair. Ask them to notice what it is like being with this person. Michael imagined his mother in the chair opposite him.
- Ask them to begin... a dialogue starting with a positive statement. Michael stated, "Years from now, I want to have the relationship I once had with you, but right now we don’t. I want to resolve this."
- Then ask them to move... on to explain what they want. Michael stated, "I want you to hear and understand my pain. Don’t cut me off with ‘I’m sorry’ or ‘I didn’t mean it’ before hearing me out."
- Next, ask the client... to tell their target what they are thinking or feeling by describing what happened and the impact of the offence. Michael stated, "When I came back from the hospital, everything went on as normal. Dad even cracked jokes about it. I was nearly killed, and he made jokes like, "Well, at least you knew who was shooting at you." That hurt me, but it hurt me more that you, mom, didn’t stop him, and didn’t tell him that I need some time to heal. You were always there for me before, but not then, when I needed you most."
- Now, ask the client... to change seats and ask them to voice the feelings of the target. Michael stated, "I’m sorry, Michael. I’m your mother and I let you down. I feel guilty, sad, and ashamed of myself as a mother."
I have found this exercise helpful in getting clients to express their feelings in a constructive way and not through anger.
♦ #3 Forgiveness
In addition to how clients articulate their anger and the targets of the client’s anger, the third aspect of unresolved anger is forgiving. Through forgiveness, the client may more fully release their burden of anger and blame. To help Michael forgive the many people he felt anger towards, I found the "Letter Writing" exercise helpful.
I gave Michael specific writing formats for each person he felt anger for. For his first letter, I asked him to describe his feelings and what that person did. For his mother, he wrote, "Dear Mom, I felt angry when you failed to defend me from dad’s jokes because I wasn’t expecting my pain to be so undermined. I still feel angry and hurt." In a second letter, I asked him to write about his forgiveness.
Michael wrote, "Dear Mom, to the best of my ability, I now choose to forgive you for all these hurts. I release my burden of ill will toward you now, and free you and me to live." I then asked him to sign it. I found this exercise helpful in aiding Michael to release his past and present feelings of anger.
In this section, we more closely examined aspects of clients who are suffering from unresolved anger: how they articulate their anger, the targets at which they directed their anger, and forgiving their targets.
In the next section, we will discuss the three levels of grieving losses which include: grieving specific losses, grieving the realization of powerlessness, and grieving mortality.
Peer-Reviewed Journal Article References:
Christ, N. M., Contractor, A. A., Wang, X., & Elhai, J. D. (2020). The mediating effect of rumination between posttraumatic stress disorder symptoms and anger reactions. Psychological Trauma: Theory, Research, Practice, and Policy. Advance online publication.
Diamond, G. M., Shahar, B., Sabo, D., & Tsvieli, N. (2016). Attachment-based family therapy and emotion-focused therapy for unresolved anger: The role of productive emotional processing. Psychotherapy, 53(1), 34–44.
Khayyat-Abuaita, U., Paivio, S., Pascual-Leone, A., & Harrington, S. (2019). Emotional processing of trauma narratives is a predictor of outcome in emotion-focused therapy for complex trauma. Psychotherapy, 56(4), 526–536.
Tsvieli, N., & Diamond, G. M. (2018). Therapist interventions and emotional processing in attachment-based family therapy for unresolved anger. Psychotherapy, 55(3), 289–297.
What are three aspects in addressing clients who are suffering from unresolved
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