Incomplete... But Worth Every Penny Mar 22, 2009
I was not surprised to discover that When Anger Hurts is used as a course textbook for those who will conduct court-mandated, spousal-abuse-deferment, anger management programs in some states and/or counties. I had encountered two of the authors before in online course material I was required to work through for that purpose some years ago.
By current standards, the book is a pretty thorough review of the Gestalt school, affect management and cognitive-behavioral approaches to anger management that were... even though sections here and there are substantially out of date or at least empirically suspect, given more current information... and significant advances in "emotion medicine" are left out entirely. Most of the citations are at least 25 years old, reflecting the best known data of the time, but not what is known today about brain function or therapeutic efficacy.
It is my understanding that some anger management counselors or therapists require their court-appointed "students" to read the book and even do the exercises therein. That doesn't seem like an entirely "bad" idea, but the book is written for readers at the college freshman level, and my experience is that most A/M attendees do not read at that level. Moreover, even when the mandated course is 48, 50 or 52 weekly sessions, there are probably too many concepts here for the sort of "clientel" with whom I am experienced.
I saw why I'd been told years ago that Lev Vygotsky's notion of "scaffolding" was crucial in such groups: The personality profile there tends to be at least passive-aggressive, if not narcissistic, antisocial, sociopathic and even sadistic. Such people rarely take well to didactic instruction. Thus, use of WHA as a course book is not suggested in that particular milieu (at least, not by me).
But as a training manual for counselors, a refresher or familiarization course for therapists, or a useful source of material for course design by Ph.D's, it looks like a good bet. The book digs into the issues from a cognitive perspective, pointing out (from the authors' perspective) the four principle mistaken (and, sadly, culturally pandemic) beliefs that underlie the lack of orientation towards personal responsibility: 1) Anger is solely - and wholly - a matter of brain chemistry; 2) Anger is instinctive; 3) Frustration must necessarily lead to aggression; and 4) It's useful to ventilate.
None of these common (and unconsidered) beliefs are true, and - in the best tradition of Albert Ellis, Aaron Beck, Martin Seligman, Jeffrey Young, Richard Wessler and others of the CBT / REBT way of seeing things - the authors do an effective job of punching all four thoroughly full of holes.
From the Freudian perspective of defense mechanisms, WHA also points out that anger is typically employed to 1) manage stress, 2) block painful sensations and emotions, 3) discharge over-stimulation, and 4) react quickly to perceived environmental threat. The book goes on to identify the specific mechanisms for manifesting these imperatives, including our culture's many distorted and inaccurate core beliefs, ideas, values and automatic assumptions, as well as the illogical appraisal, evaluation, interpretation and attribution schemas that result from such core beliefs.
The authors take an adroit left turn up the 101 to San Francisco for a dose of Fritz and Laura Perls' principle of personal responsibility from the `50s and `60s. They note that 1) blame is useless and counter-productive, 2) adaptation is useful and productive, 3) one is only a victim if he believes he is, 4) expecting others to change is useless, and 5) it almost always works best to either "adapt to let it go."
(If I'd been the fourth author of WAH, I would have inserted a section on Stephen Karpman's Drama Triangle, and the functional interactional concepts of support, detachment and adaptation vs. the dysfunctional interactional concepts of rescue (covert control), persecution (or punishment), and being the victim. I have found the KDT to be the single most effective graphic teaching aid for anger management - and a lot of other interpersonal and "intrapersonal" problems - I have ever used.)
Though it is certainly worth reading for its content, I found myself in disagreement with the utility of the suggested activities in Chapter 8 on "24-hour anger management." It is clear to me after more than 30 years in this line of work that such complex behaviors as those described are not only difficult to acquire and maintain at a high state of accessibility, they are almost always rejected out-of-hand by those with bipolar conditions and/or narcissistic- or passive-aggressive-spectrum character disorders.
My experience is that I do better to teach the topics covered in Chapter 9 and 10 on the logical fallacies and self-soothing. The authors do a fine job of this, covering some of my personal favorites, including 1) entitlement, 2) fairness (vs. "unfairness"), 3) dominance and submission maneuvers, 4) conditional ("if-then") assumptions, 5) retaliation, 6) black-and-white thinking (especially with regard to "all-good" and "all-bad" labeling), 7) projection (here, specifically assumption of intent), 8) magnification and 9) globalization.
They also describe and discuss 1) disciplined breathing, 2) mindfulness meditation (more or less what I teach as the "drop drill," 3) self-hypnosis (or "guided meditation," and 4) substance abuse for control of "intolerable" emotions and other sensory experience. Item 4 is, of course, probably the leading cause of treatment resistance to anger management interventions. But for the life of me, I do not understand why the authors did not tackle the matter of functional chemical interventions here.
The allied profession of psychopharmacology has made tremendous strides since WAH was first published in 1989. A brief explanation of the "soothing" benefits of such medications as Depakote valproix, Tegretol carbemazepine, Trileptal oxcarbazepine, Lamictal lamotragine, Topamax topamirate, Seroquel quetiapine, Zyprexa olanzepine, Abilify aripiprasole, Geodon ziprasidone, and Clozaril clozapine (for many, not all) would have been hugely informative.
I have seen these medications "fail," of course, and they are not "good substitutes" for therapy. But I have also seen them produce extremely useful results for manic and hypo-manic patients with anger and rage problems in conjunction with cognitive therapy.
The remainder of WAH provides useful material on problem solving, impulse re-direction, and effective interpersonal communication (or "assertion training"), though I have some difficulties with the utility of the chapters on "coping through health self-talk," "anger inoculation," and "response choice rehearsal." These `70s and `80s vintage strategies have not stood the test of empirical verification all that well, and, as noted earlier, I think that they don't because of the typically narcissistic and passive-aggressive character defense of the "terminally angry."
I was very pleased to see the new sections on "anger and children" and "spousal abuse" in this edition. David Lykken's stunning 1995 article "The Case for Parental Licensure" - which asserted in memorable fashion that the society we take for granted "manufactures criminals" - was enough to convince me that we will never be able to say too much about what parental anger does to the approval-seeking, pre-identity-formed mind.
Even with its faults and flaws, WHA is worth your time and money.