Letting Go of “Righteous” Anger with

Willingness: Strategies for Working with

Anger Rooted in the Past, Present, and
Future
Andrew P. Santanello, Psy.D.
Veterans Affairs Maryland Health Care System

Hank Robb, Ph.D., ABPP

Private Practice
 What is an “Anger Problem?”
• No diagnostic criteria for “anger disorders”
• High frequency/intensity of anger episodes?
• Lack of skill in expressing anger “correctly?”
• History of interpersonal aggression?
• Defined by a referral for anger management?
• “Righteous” anger: anger sensations + fusion with cognitive
rules about justice, etc. ?
 Anger Problem or Behavior
Problem?
• Anger is a confusing term that most
people use to refer to private events
associated with the term “anger” as well
as aggressive behavior
• It may be possible that anger problems
are not problems related to anger at all
Functional Definition of Anger
Problem
• Narrow, inflexible repetoires of behavior
emitted in the presence of anger with
potentially “positive” short term
consequences and negative long term
consequences
• Refers to repetoires for responding both
privately (e.g., fusion with thoughts) and
publically (e.g., aggression)
 Some Problems with Traditional
Anger Management (AMT)
• General goal is to teach clients to “regulate” physiological
responding, reduce believability of “trigger thoughts” by
proving them false and inhibiting aggressive behavior
• Good AMT outcomes are defined by decreases in
frequency/intensity of anger and inhibition of aggression
from pre- to post-treatment
• Treatment goal involves further narrowing of behavioral
repetoire in presence of anger and encouragement of
anger suppression
• Although some evidence that control-based CBT can
reduce anger (DiGiuseppe and Tafrate, 2003; DelVecchio
and O’Leary, 2006) these interventions miss the point
(based on our definition)
 Oh, and by the way…..
• How do clients tend to feel about AMT?
• Is it generally well accepted?
• How do you feel about doing AMT?
• Experiential Exercise
• Imagine situation when someone really
pissed you off
 Pick a rationale that you can
get behind
A) “Treatment is about helping the client
to learn more effective ways of
reducing both his/her anger and
his/her aggressive behavior.”
B) “Treatment is about helping the client
experience his/her anger and act in a
way that honors his/her values.”
 Life Management Vs. Anger
Management
• Maybe a better goal of treatment is to
help clients learn more workable ways
to respond when anger shows up
• Use action consistent with values rather
than frequency/intensity of anger
episodes as an outcome measure
• ACT is an ideal intervention for these
goals
 Goals of Life Management
• Increase willingness to experience anger sensations as
sensations and anger stories as stories
• Suggest forgiveness as an alternative to holding onto
resentment.
• Teach defusion as an alternative to buying anger thoughts
• Increase contact with present moment as an opportunity to
instantiate your values rather than impulsive, anger “autopilot”
(“I’ll fix their fucking wagon”)
• Increase contact with self as context as an antidote to defending
the self-as-content against past hurts
• Promote behavioral commitments in the service of values as an
alternative to behavior in the service of revenge or short term
pain reduction
 Life Management is about
VALUES
• If this work could be about something,
what would you choose?
• If anger didn’t have to decide what you
do, what would you like to do?
• Where does following your anger take
you? Would you like to go in a different
direction?
 First Order of Business
• Can quickly ally self with client, present ACT
model, and do inform consent in 4 steps
• Assess the function of the anger and responses to
anger
• Be vigilant for anything that looks like a value. Uncover
leading principles worth fighting for.
• Validate the heck out of the value
• Reframe the work of therapy as life management
rather than anger management
• Ask if client would be willing to experience anger,
confusion, and other discomfort in the service of
building a life worth living
 Role Play
• Separate into groups of 3 (1 person is the
client, one is the therapist)
• Client: Take a few moments to contact the
situation that you thought of at the beginning of the
workshop. Talk to therapist about the experience
as you normally would. Be authentic!
• Therapist: Practice using steps on previous slide.
• Observer: Watch the interaction and notice
opportunities to elicit values. Notice the client’s
reactions to interventions. Possibly offering
coaching to the therapist.
Resentment

QuickTime™ and a
TIFF (Uncompressed) decompressor
are needed to see this picture.
 Anger Rooted in the Past:
Resentment
• Hook Metaphor
• Rumination Metaphor
• Essential questions:
• Who is being hurt by this resentment?
• What is the goal? What is this in the service of?
• What do you hope will happen as a result of
holding onto this resentment?
• What would happen if you made the choice to
forego vengeance?
 Forgiveness
• Does not mean forgetting, condoning, denying,
excusing, etc.
• Forgiveness means no longer holding the facts
AGAINST the person, place, thing, etc. that hurt
you as justified by the “story” your mind has
created ABOUT the facts
• Letting go of the “story” in order to move on with
life
• It is a move done in the service of one’s values
• Intrapersonal rather than interpersonal process
 Graduated Forgiveness
• Focus on concrete in the moment
events (e.g., “the pharmacist was rude
to me”) and generalize to abstract,
across time events (e.g., “the way the
government treated me”)
• Forgiving in the momentary
resentments is the exact same move as
forgiving longer term resentments
 Forgiveness Exercise
• Get in pairs
• Push finger as hard as you can against part
of neighbor’s body that’s solid
• Review story that justifies pushing
• With the story experienced as a story,
willingly stop pushing
• Discuss what that was like to stop pushing
• Discuss all the things you couldn’t do while
you were pushing on other person
The Angry Mind
 Anger Rooted in the Present
• Patience: Ride the Tiger, Ice Metaphor
• Question: Are you interested in a positive
connection? If so, what are you willing to
experience in the service of that?
• Asserting self in a “positive” way that honors
values
• Defusing from anger trigger thoughts
• Exercise: Stoking the Fire
• Anger bully/Drill Sergeant
• Anger Programming: Jack and Jill
 Exercise: Defuse to these
Statements
• “I’m not angry.”
• “I need to let my anger out”
• “I need to get my anger under control.”
• “If I see him/her again, I’m going to beat the crap out of
them.”
• “I can’t stand being disrespected.”
• “Don’t get me angry or else.”
• “Why should I do what you tell me?”
• “I don’t have an anger problem. I’m just surrounded by
idiots.”
• “He/She deserves what I did to them.”
 Anger Rooted in the Future
• Reconciliation: willing vulnerability
• Defusion from rumination about future
situations
• Plan for vitality or ruminate about it.
• Plan for vengeance or ruminate about that.
• Act on your plan?
Now get the
fuck out!