One of the hallmark features of clients with OCD is that they usually know that their anxiety is irrational and unhealthy. This is rarely the case with the typical anger management client. If anything, a hallmark feature of clients with anger problems is that they believe their anger is justified and appropriate. Clients with anger difficulties have trouble letting go of their resistance and working on their anger because they believe, “She is the problem, not me!”
One can imagine the difficulty a therapist might encounter with resistant clients because they generally do not like to be told that anything they are doing is unhealthy. To evade resistance, I use a specific series of structured disputes. Although the structure was created out of personal preference, I have a rationale for using it – it brings the client to my side by having the client come up with his or her own ideas.
First, the clients present their problem.
1. Reflect/validate their feelings. Feeling angry is normal and understandable, just unhealthy.
“That sounds like that was really frustrating for you. I can understand why you feel so annoyed with Suzie.”
2. Use socratic, functional disputes. I let them answer every question before I go on to the next one.
“Let’s assume that you were right. How do you like feeling angry? Do you still enjoy feeling it? Does it help you to hold dogmatic demands?”
3. Put the option of working on their anger in their hands.
“Since you are here and not Suzie, what do you think about trying to change the feeling of anger to annoyance for example, so that you can at least enjoy yourself a little more while still disapproving of her actions?”
4. Once they agree, I use a socratic, functional dispute on the core should.
“Great. So first of all, would you say that you can control everything Suzie does?”
They almost always say no. If they say yes, explain that even if people had a gun to their head they could still choose to die. “So given that you ultimately can’t control Suzie, will it help you in controlling her if you are angry right now?”
5. Continue to dispute socratically and functionally while introducing rational alternatives. “Let’s say there are two people. Remember, Suzie is ultimately uncontrollable. Let’s say Jake thinks: ‘Suzie should have listened to me!’ and Marty thinks, ‘I wish Suzie listened to me, but ultimately she doesn’t have to.’ Who will feel less angry, Jake or Marty?”
I’ve never received the incorrect answer. 6. Socratic functional dispute, letting them answer each question. “And does it feel good to feel angry? So since Marty feels less angry, who will feel better overall?”
7. Socratic logical dispute “And since Suzie is uncontrollable, who is actually speaking more logically and realistically? Is it Jake, who thinks that Suzie should do what he wants her to do, or Marty, who thinks that he would like Suzie to do what he wants, but ultimately she doesn’t have to?”
8. Summarize once removed “Exactly! So Marty is thinking more realistically AND feeling better than Jake!”
9. Socratic empirical dispute (only if there is a history of the client should-ing on Suzie). “So back to you. Has history shown you that Suzie has to do what you want her to do, or has it shown you that she will do what she wants to do?”
10. Summarize using client’s example “So it doesn’t only hurt you to demand that Suzie behave in a certain way, but there is no evidence nor is it logical to think that Suzie has to do what you want.
11. Practice rational alternatives. “So, since we know that Suzie will behave badly again, what would be the most helpful way for you to think about Suzie in the future when it happens?”
12. Reinforce with questions that encourage thinking rationally. “Great! How has it helped you thinking more rationally right now?”
Every question includes a statement. If we ask questions such as, “Why did you become angry?” we are telling the client that they were wrong for feeling angry. Additionally, the client is forced to answer in a way that defends his becoming angry. In my experience, I have found that using many socratic and functional disputes helps decrease resistance with an angry population. Not always 100%, but typically enough that the client is willing to work on his/her anger more than they were originally. Next Up: Candice Siu, M.A. on Don’t let the media fool you – overcoming global ratings of worth
