On Anger Work

And the use of punching bags

I have been working with children, teenagers and adults for over ten years. In that time I have facilitated many anger management groups and face to face anger management/therapy sessions.

The nature of my work with clients develops in line with each individual case. The process of Anger Therapy proceeds in the best way any client might be able to do that work. There are several counselling modalities which I may use during sessions to achieve the best results. Some of these techniques include; Cognitive, Behavioural, Relational, Play Therapy (competitive transference's), Re Decisional (Gestalt) and Cathartic (Affective) modalities. The underlying modality in which my understanding of the client and the therapeutic relationship is via my Transactional Analysis background. Of course, the synthesis of my techniques are very much drawn from my experiential practice of these techniques. My own personal evolvement, empathy and genuiness with clients is paramount in the healing process.(Ongoing supervision and personal therapy helps).       

The first counselling session involves an interview designed to assess both parent and or child/person to a desired treatment plan. For example; a client may present with suppression like issues, periodic rage and other behavioural issues. Although working case by case this kind of anger issue requires building safety and trust so that the client may express their feelings comfortably.

Cathartic Artwork

Alternatively a client may present with overt anger (always angry) of which may be a “covering” emotion used as a defence to other feelings. In some cases the "covering" or expressed feeling and behaviour is not the desired feeling to work with in counselling. The client’s anger is still valid and causing dysfunction in their life however the anger is not the underlying or authentic issue. I will assess clients for the best therapeutic treatment plan in each case. In some cases there is more anger underneath surface feelings and the underlying feelings of perhaps sad and hurt. The latter client will usually need longer term therapy styles.   

Assessing the client’s resistance to working with certain feelings is usually the guide to which counselling style is best and which issue to begin with in therapy.   See article about Parent and Child assessment interview here, http://kabrahams.blogspot.com/2008/06/parent-and-child-interview.html

Some clients present with what I describe as an “unfathomable motivation” to resist all manner of techniques that might help them (defiant), however they still appear to enjoy going to counselling. Whether this particular type of client has mental health or personality issues it doesn’t really matter however the therapy in my view, must take a different path.   

With the more difficult type of psychological impasses the all important process is to connect with the part of personality (of the client) that is causing the behavioural issues. You may recognise this aspect in personality via incongruous behaviours and body language when compared to their current predicament. These behaviours are often the source of a clients “misunderstood life” and which seem to reinforce angry belief systems such as the incarcerated person or prisoner. Establishing a therapeutic relationship may take some time with this type of client or it may not be possible.

Such clients may express “gallows” laughter when the counsellor is direct and genuine in their questioning. All clients show a measure of resistance. Difficult clients usually show other ingenious and creative ploys to maintain defence mechanisms when invited to deal with authentic feelings.  

These kinds of resistant behaviours are best acknowledged in some way so that the client knows they are being understood by the counsellor. I often reflect a quality of the “genius” in this creative process even if the client has destructive or manipulative qualities. The client benefits when they can begin to differentiate aggressive and creative elements of personality. It is reasonable to say that this "sense of genius” may also render the therapeutic alliance unworkable! In some cases “no therapy” is the best therapeutic intervention to initially take.

Obviously there are creative ways in which to make client assessments without them disengaging from counselling. Clients prefer to engage after a well established rapport is developed. Some clients will resist anything that looks like a technique designed to effect change in counselling. Some techniques and cognitive activities are like chores to these clients and they sense, that in the end, it will only point out “more that is wrong with them”. Following this precarious track in counselling runs the risk of pathologising the client further. When working with anger issues and teenagers the Client Centred approach is a better idea than than reinforcing a client's potential negative attitudes towards authority.

I am familiar with a cathartic technique that I use in my sessions with clients. Its a  technique that can be very helpful with some clients. I will only use this technique with clients who I know, who have a reasonable cognitive process and who are ready to participate in cathartic work.

In some cases the cathartic technique can help children experience how anger can be okay. To experience anger in controlled situations where no one gets hurt, no one gets into trouble and nothing is damaged. If the client understands there is another way to deal with their angry feelings (safely) they usually show great relief. If the client can achieve such a revelation, they can be more open to other therapeutic styles in counselling  and cbe willing to attend further appointments.

My aim in the initial therapeutic setting is to establish a “contract” for change if that is at all possible. It doesn't matter that a contract is about "support" through the juvenile justice system or if the client is an unwilling participant. If the client is going to entertain the idea of "change" its a good idea if they have an understanding of their current emotional patterns and learn to visualise new models.    

“Where do you keep your anger and when does it come out”

Youths and adults who wish to devise their own plans for anger management must have some basic skills of the cathartic process and be armed with an idea about "practising different behaviours". The rules of engagement with regards to using punching bags are the boundaries and discipline involved in clients helping themselves. I advise against some mothers who suggest buying punching bags for use at home until the client has learned how the process works. I would prefer if the client practices the method in therapy at least a few times before disengaging from counselling (if that is their intentions).

If parents must buy a punching bag then I advise them to buy a tackle bag which is comprised of foam and plastic covering. The old boxing bag filled with socks and sawdust is too hard and could potentially injure the client. The foam filled tackle bags do not require the person to tie on boxing gloves to protect their fists when hitting the bag, the person can also avoid any delays in expressing anger.    

After the initial interview and if the client is ready to experience “Big Red” I will help the client pick a minor issue in their life where they experience anger. That is, instead of a complex parental rejection or abuse issue the client chooses a recent but identifiable issue that reflects their current concerns. The client may report that a particular person could “treat them better” or a particular situation is “unfair”.

 

The idea is to express anger whilst acknowledging (validating) the underlying feelings, such as “unfairness” (read as sad and hurt feelings). Slowly and methodically I will help the client approach the punching bag and to hold the batarcka stick with two hands.

I invite them to say a few words before expressing their anger on the punching bag. I may go back over the scenario they presented and pick the best cathartic statement for them to use when hitting the bag. I might invite them to say “its unfair” before hitting the bag. “BANG”. It may take a few hits to get in the swing of things however after some encouragement the client reaches a level of catharsis. Depending on what is going on for the client at this stage, I ask them to stop and invite them to reflect on what they are feeling in their body. All the while I am observing the client's body language for  signs of other feelings emerging. 

“What is going on” “what is happening inside” “is it a good feeling or unpleasant feeling”??

Usually it’s a feeling of joy and relief and the client is smiling. They report, “it’s a good thing”. I invite them to hit the bag a few more times and then reflect how they just proved to themselves that getting angry feelings out feels good. I ask them “did anyone get hurt”? “Did anyone get into trouble”? “Is anything broken”? They reply No! On many occasions clients swing their hips or bend over saying that they feel tired now.

I let them know again “That’s one way to express anger where it feels good and where no one gets into trouble”.

During group anger management sessions a client may develop confidence over time to express re decisions about themselves through cathartic techniques. If the client believes that they are unimportant (not good enough in the eyes of someone) they use the words “I am important” “I am good enough” before hitting the bag. The technique is useful in self esteem and assertiveness training where the client alleviates stressful internal or dynamic dialogues.  

I don’t often enjoy setting up therapeutic techniques to fail however if a particular client will not hit the bag and begins to cry or offer greater resistance to the idea, I will carefully back out by nurturing and acknowledging their bravery in attempting such a thing. In some cases the client may acknowledge feeling their "resistance" to the activity and that “it” stopped them from expressing what they thought they felt like expressing. The psychotherapeutic concepts in Potency, Protection and Permissions for effective therapy underpin my style of work with clients. In many cases children require therapeutic "permissions" to have feelings in counselling. Sometimes mothers are in the room during the session and I will ask her "is it ok if I show your child how to get some anger out".
 

In summary the cathartic technique is only a part of a larger therapeutic plan and is not to be considered the panacea for angry feelings or behaviours. In some cases, clients show behavioural improvements in the short term and gain a great deal from a few counselling sessions. Others may require further work, building trust and safety before expressing their feelings. Perhaps the way I work with catharsis allows the therapeutic relationship to develop further, while dismissing preconceived ideas about anger counselling? The person experiences feelings by putting their feelings into motion in safe and controlled settings. They learn to move stressful feelings outside of their body and gain a sense of empowerment by “doing something”. To begin taking responsibility for feelings and having a way that helps is empowering. Having a device that works in counselling in contrast to the fear of being out of control (rage) or helpless is a step towards expressing feelings appropriately.

Ken Abrahams

Information about my services can be found by clicking here. 

Parent and Child Interview

Working with children often requires gathering as much information from the parent and child relationship as possible. Often the nature of the relationship between Mother and child 'contains' the information required for the child's treatment plan in counselling. How can a counsellor gather Parent and Child information while effecting therapeutic gain at the same time?





Usually when I see a new client under 17 years of age I will invite both child and parent to the first counselling session. While taking the contact details and asking routine client information details, the child and parent being to settle comfortably in the room. I often find that the parent is needing to launch into the problematic scenarios of their child and sometimes they might be holding a report from school. Taking the initial interview slowly is helpful and is a containing method in counselling. I will always ask the parent whether the child is receiving treatments for anything. I ask the child his or her age inviting them to engaging with me. Often the reply to treatments is in relation to ADHD medications or asthma etc. This is a good opportunity to ask the child whether they think the medications work for them. Some children say yes and others say no. I stroke the child's ability to respond by saying "I like the way you know that".



The next thing to do is inquire about the contract for counselling. I invite the parent to describe the things she hopes her son or daughter might achieve in counselling if he/she is ok about doing some work with me. Leaving the option whether the child continues counselling is helping to peel off Driver functions and the pressures for child adapting in counselling. It is also building my relationship with the child and allowing time to observe any adverse reactions in the child.


It is also important (in some cases) to "hear" the Parent Contract from the parent directly. What I mean by this is to observe how the parent expresses their "hopes" for the child in terms of their own values. Often the Mother will begin to describe negative behaviours, however I will stop her and invite her to think about the positive things she hopes her child will gain from counselling. This is not an easy question for some parents. The most common and easy option for a parent is to say "I want my son to be happy" or "I want him to control his anger". I will spend some time helping the parent to re frame her "hopes" and investigate the benefits for the child if he does achieve such things from counselling. The positive outcomes for the child might mean having more friends, better relations at home etc. The child is listening intently to the parent voice and aligning mothers hopes with the possibilities in their mind. The child at seems to acclimatize to the counselling process as I work with the parent.




I will engage with the child next by asking about siblings and their ages while I am drawing the genogram of the family unit. In many cases parents have split up, so by asking empathicly, "when did you see Dad last" is imperative. Checking how often the child engages with a separated parent is also very important information. If there are any signs of affective responses in the child's body language I will note that.



Observing the body language between child and parent in the early stages of the interview is the best means of information gathering.




It may be that the child is sitting in the chair in some manner, or the child diverts their attention to some play toys near by. Perhaps the child is siting quietly or being vocal, answering questions which are directed at the mother? All of these initial observations are very important signs to the child's attachment style and adaptations to the parent.

Perhaps I will ask the child in a straight way "do you think you have an anger issue" (like what mum is saying). I will always stroke their answer if they offer one.


The next part of the interview is to gain the permission from the child for me to ask the parent about behaviours. I describe that feelings are like snow flakes, everyone has unique ways to express feelings. "If I know about your special kind of feelings then I will know more about you". I invite the child to have a say if he or she disagrees with what the parent says. Usually the child says "yes ok". But it is not enough to leave this invitation just there, its best to formalise the contract to speak up by asking "How will you let me know that you disagree with her"? It is a simple question however most children stumble around before saying "I will just say something". "Ok, good idea", I say. I need the child to be "in the room" (psychologically) and in this way to invite them into thinking about what is being said.


If the issue of anger has been raised initially I ask the parent to describe their observations of what the child "does" when he or she gets angry. I develop safety with the child by containing the parent from describing all manner of problems the child may have. "I am writing a small list" I say. The list will usually show the kind of anger that the child exhibits. The child may throw objects when angry but not breaking anything, the child may be throwing things which are smashing. The anger might be verbal, or with clenched teeth or fists. The child might be using a threatening style of behaviour which may indicate concerns around control.

The child's behaviours may reflect backing away or standing his ground. The child may run out the front or back door when angry. These are the important pieces of information to understand how the child's process of resentment, repression, displacement, withdrawal are working. In many cases this information may help to locate particular developmental stages the child may be recycling in their attempts to handle their life. Perhaps self esteem work is required in combination to anger work? Along the way I support the child's concerns by offering nurturing responses such as "that doesn't sound fair" or "that is a pretty common behaviour that I hear of".


The best outcome for ongoing counselling with children requires the enlisting of both parent and child into committing to the process. Developing safety and building relationship with the child is paramountl. The initial counselling interview with parent and child is not only about information gathering however developing all manner of contracts and establishing the counsellor-client relationship. I have so far described about one half of the initial assessment interview. I guess we are about half way through the hour session at this point.


My next installment will describe how to gain information about the child's own ability to deal with angry feelings, their ability to desensitise. I will describe how the child can identify patterns in their thinking feeling and behaviours. I will describe how I Invite the child into a contract for change and then participate in a simple activity where they can prove themselves that anger can be expressed without getting into trouble. I will also describe how feelings arise for the parent during the interview and the benefit for the Parent and Child relationship.




Kenoath

Can't Come Won't Come

I am starting to wonder how many ways a client find to not come to counselling. It seems that the surf must be good today and the waves might be a better option to counselling sessions.

Is it the weather or is there something going on in the stars? I was even cancelled by my dentist this week which resulted in my own supervision session being cancelled. I have dealt with many intermittent cancellations over the last ten years however when there are several cancellations all in a matter of hours, I begin to wonder about the "collective". Teenagers can easily not be around for their parents to bring them in for counselling rather than taking responsibility in saying they don't want to come today. For some clients I have an idea that some part of the "not coming" to a session relates to recent situations in their lives they wish to avoid. "Won't Come"! I wonder what they are hiding from?

Perhaps it is the Moon or the stars, like Seasonal Affective Disorder. On my other blog (Kingsley) I talk about the current state of Astrological effects and it seems to be spot on for this week happenings. I feel ok about clients taking a different approach because it means that something is changing for them. Not many clients like getting a cancellation fees however their decision in not coming must say something for them.

I know I don't like going to the dentist because my teeth are pretty average. I know the dentist won't be critical of me but somewhere in the back of my mind there is some resistance to put myself in the chair. Perhaps I will feel bad? I will have to confront myself with the reality of my fillings etc. I know that I am not bad, even one or two of my teeth are bad. Well, this week I made an appointment only to be cancelled. Phew! Hang on, I need to get something fixed and it has taken me some effort to be assertive to make the appointment.

I can understand that clients need to cancel occasionally. There is a perceived degree of pain perhaps that some clients can't or wont face. In my mind that is the best time to go to counselling because there are some issues close to the surface. I know the spate of cancellations recently have nothing to do with my abilities and my cancellation fees will hopefully be paid.

Sometimes its just a matter of making a decision not to go. In my mind that is not a bad thing. At least the client is in some way making a decision from their child part

kenoath

Mind Snap

There seems to be a great deal of controversy in the ranks of Australian Rules Football these days. As the football nation gets over the all encompassing Ben Cousins drug affair, new players are emerging into the bad behaviour spotlight. Recently we have seen how some football stars have been caught for pissing on police station walls. At the moment the spotlight is on big bad Barry Hall.

Apparently Barry Hall is seeing a Psychiatrist for what he has called his "Mind-snap" and his unprovoked king punch to footballer Brent Staker. Well, the Sydney Swans and Barry Hall are in damage control and using whatever PR to shift focus away from an incident which in my view has brought the game into disrepute.

I have heard of situations where people suddenly "snap". Often kids and teenagers become overwhelmed with feelings and "do something" all of a sudden without thinking. I have two aspergers clients who exhibit this type of behaviour, weekly. Perhaps Barry Hall fits the aspergers profile and his psychiatrist will diagnose him with adult ADHD? Will the Australian football world accept that his actions were a part of his mental illness? But what about other footballers who have to play on Barry Hall after his suspension for the "one punch" on Brent Staker? Will these players be prepped in "psycho" techniques to avoid the wrath of Barry Halls mind snaps?

It is interesting that Ben Cousins received a 12 month ban for bringing the game into disrepute by his drug use and Barry Hall received only seven weeks for his "mind-snap". Then again, Australian football fans tend to enjoy a bit of rough play on the field. Even football commentators in the recent weeks have joked about physically aggressive incidents on the field like it was entertainment.

So it seems Australians, according to social sentiment, prefer knocking other blokes out with king punches rather than blokes "punching themselves" with drug abuse. 

So the scoring of this sentiment stands so far as:
One Punch Mind snaps (aggravated assault causing grievous bodily harm) brings a 7 Week suspension.
Using drugs and having a co dependant substance abuse issue brings 12 month suspension and de listing from the AFL.

We Australians are a very funny and interesting lot.

Kenoath