Issue 356 // Institute Inbrief
Dear <<First Name>>,
Welcome to Edition 356 of Institute Inbrief. In this edition's featured article we continue our two-part series on anger management. Today's focus is on strategies to de-escalate anger (including what therapists can do if that fails in-session).
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Anger Management: De-escalating Anger
Before reading this article, we recommend re-visiting our previous edition’s featured article, which defined anger and covered common myths about it. Access it here.
Presentations to therapists for help with destructive anger seem to be increasingly common these days (Fauteux, 2010), with many clients coerced by workplace or family or mandated to come by the courts. Much of the time the problem anger occurs outside the therapy room and clients are at least minimally cooperative with their therapist in working to change how they deal with it. There is, however, another scenario in which therapists may be called upon to help clients deal with their anger. That is the situation in which the client gets angry in session and makes the therapist the target. While as mental health professionals we are trained to listen to clients who are expressing frustration, probably far fewer of us have been called on to de-escalate a situation in which a client is threatening violence to us. Would you know what to say or do in order to de-escalate from a client – or anyone – threatening to harm you if they don’t get what they want? Would you know – if all else fails – how to keep yourself safe in a violent situation? In this article, we share with you a set of responses for dealing with an angry person – safely – at each of seven levels of anger.
Fauteux’s scale of anger progression
Kevin Fauteux, Ph.D., social worker, and Clinical Director of the Derek Silva Community in San Francisco, has observed that encounters with angry clients seem to be more frequent and sometimes violent in recent times. He has developed a framework for managing such situations which identifies a progression of escalating anger and suggests responses which are appropriate at each level (Fauteux, 2010). We share his framework with you in the context of suggesting that, hopefully, you won’t have to call on it often (and certainly not on its higher levels of escalation), but that if you do, it is a way of responding which may best salvage an angry situation, returning to as calm and normalised an atmosphere as possible. Note that this framework is not for the purpose of long-term education and healing of clients with destructive anger who have agreed to work with you on their anger. Here we are only sharing responses that will help to calm a situation in which someone is spiralling out of control and keep you safe from physical violence.
The seven levels of escalating anger
Fauteux identifies seven levels, which we illustrate with the example of Felix, a 20-something client mandated to come do 10 sessions of anger management work with you instead of doing jail time for the assault of a fellow patron at a local bar. Felix is clearly given to understand that he must attend all ten scheduled sessions and cooperate with any homework or other tasks (plus adhere to several other conditions imposed by the court), or else his jail term (now suspended) will be reimposed. When Felix comes, he expresses gratefulness that he has been allowed to stay out of jail, and states that he does wish to handle his anger better, so he will try to work with you to learn what he needs to. You are delighted that he seems to be on board with what will happen, and you explain that the sessions are confidential, but not absolutely so. You add that, in this case, you are mandated to tell authorities – should they ask – the truth about Felix’s cooperation with the counselling; Felix states that he understands and accepts this condition.
All seems to be going well for three sessions, but then Felix unexpectedly misses both the fourth and fifth sessions, and does not respond to texts, emails, or calls. Shortly after his non-appearance at the two sessions, the corrections officer in charge of his case rings you asking if Felix has been attending all of the sessions. You are forced to admit that the last two have been missed. For the sixth scheduled session, Felix turns up. He has had a call from the corrections officer, who has informed him that, should he breach even one more aspect of his stay-out-of-jail conditions – no matter how small – he will be put immediately into jail, to serve the full term. Felix could present himself to you at any of the seven levels. Let’s see what his behaviour might look like – and what you should do in response – for each of them.
If Felix comes in at the frustrated first level of anger escalation, he is angry and possibly yelling as a way of standing up for himself and ensuring that you see and hear his frustration. He is likely to feel that you slighted him or brought a potential jail term a step closer by telling the authorities that he skipped some counselling sessions. At this level of anger progression, Felix is not trying to control you; rather he is just “venting” frustration, so it is important for you to “get” why he is so frustrated. This means focusing not on the how of his expression of anger, but on the what. You need to validate him. This is not an admission that you think his shouting is appropriate or that you agree with it, only that you understand it; it is empathy: e.g., “I appreciate how upsetting this is for you, Felix, and I want to work with you to see how we can best deal with this situation”.
The major shift in intensity of anger to this second level could be signalled by Felix – upon hearing your supportive acknowledgement (as noted above) – saying something like, “Screw your appreciation for how upset I am. Just sort it out for me!” Felix could be not only upset that he has corrections authorities threatening him with jail, but also that he may feel hurt or betrayed that you “put them onto him” by telling them that he skipped the sessions. So his yelling at this stage is not only because he is now in jeopardy of losing his freedom, but also because he feels somehow abandoned, disrespected, or betrayed. He thus uses anger to stand up to you in order to feel “bigger”. The person here has moved from shouting about frustration to yelling at you. Your job here is to listen to the “what” and the “how” of the yelling, and then to let the client know that you understand how they feel, but that shouting and/or swearing is unacceptable: e.g., “Felix, I know you’re really angry and that’s ok, but it’s not ok to yell at me.”
Difficult angry people
One group of angry people we sometimes deal with is constituted by those who are generally difficult: the ones that are always abrasive, argumentative, or obstinate. They tend to make unrealistic demands so as to always have something to complain about. Here the anger is about verbally “standing up to the other” in order to keep the other (meaning you) at an emotional distance; the consequent near-impossibility of relationship is preferable to you being able to hurt or disappoint them, which they see as inevitable. The main dynamic at this level is the person’s attempt to draw you into the anger, into a win-lose type of power struggle: a contest of wills and manipulation in which the client will feel in control.
If Felix begins to argue with you, saying – for example – that you screwed up his life with your “incompetence” and that you must “fix” it (say, by going back to the corrections officer and lying or something similar), your job is to recognise that defusing this level of anger happens first by you not getting dragged into it. Warning Felix that he won’t get what he wants if he keeps arguing with you inadvertently sets up a win/lose mentality in which you may believe you are refuting his difficult ways, but in actual fact, he has drawn you into his power struggle. If this occurs, you are likely to find yourself being compelled to win the argument rather than resolve the problem.
Instead, your goal will be to set up a win-win approach which does not make him feel like you’re trying to make him lose a contest of wills. You might here make statements like, “I’m sure we can sort this out, Felix, so let’s not argue about it.” You are able to take the wind out of the compulsion to compete with you when – despite what the person believed going into it – they find they are not in a contest with you.
At this fourth level of anger, people are no longer merely using the angry energies to stand up for themselves; rather, they are now aggressively standing up against you. They may express less anger about what happened and become angry at you, cursing you not for what you do, but who you are. The maladaptive expression of anger as hostility is a verbal attack which is not trying to get you to listen; rather, it morphs from arguing (at the previous level) to bullying: from “you can’t push me around” to now “I will push you around”. It’s about control and about attempting to cruelly belittle or humiliate the other person (you), as opposed to earlier merely trying to compensate for the person’s felt humiliation. Here as anger defuser, you must walk a razor’s edge: not threatening the hostile person’s critical sense of control (making them think you are trying to take control from them), but also not allowing yourself to be intimidated by it. This is accomplished in two steps:
- You let the other person know that you understand the intensity of their anger and that you are not going to get them to stop bullying you simply by demanding it. Thus, if Felix follows up calling you an incompetent, uncaring “[enter insult here]” with statements that he won’t leave until you fix his issue by ringing the corrections case manager, your response is not, “I will not allow you to talk to me this way”. The first step, the recognising of intensity, goes more like, “Felix, I can see you really mean what you say!”
- You let the other person know that, while you “get” the intensity of their feeling, you won’t be intimidated by it, nor can you be easily manipulated. You need Felix to understand both “I understand you mean business” and also that the hostility is unacceptable: “I get your message, but getting in my face won’t work with me”. You assert your control without making the client feel that you are trying to curtail their control.
At this fifth level, anger is not the problem; the problem is that it is uncontrollable. At earlier stages, a person might manage their anger by aggressively trying to control you. Now they explode in rage, losing all control. Where anger is not merely an extreme expression of a person’s angry feelings but an anger that the person can’t manage, it is rage. The DSM-5 refers to some people who are prone to rage as having “intermittent explosive disorder” (APA Dictionary of Psychology, 2020).
Weirdly, at this level the raging person needs your help to prevent their anger from spinning out of control. Thus, your task is to rein in their rage and restore the order that they cannot manage themselves, and you do it by staying in control yourself. Remaining calm demonstrates to the out-of-control person that you are not overwhelmed by the chaos of his anger and subtly sends the message that you will not let them be overwhelmed either. So if Felix should come to this level of raging anger, making statements such as that he “can’t take it anymore” or “This is making me crazy”, your approach is to: 1. Ensure him that it’s going to be ok AND SO, 2. The rage has to stop.
This is not demanding that the person stop ranting. It’s more about letting him know that his out-of-control anger expressions can be and must be controlled. Thus, a statement to Felix might run something like, “Felix, this is manageable. We will work it out, but I need you to get hold of yourself.” Or alternatively, you could say, “I understand why you are angry, but I need you to control it a little.” Felix would need to understand that, without at least a bit of control, you would be unable to help him, and he might therefore lose all control.
If Felix’s anger, say at Level 5 (Rage) did not succeed in controlling you, he could re-double his aggressive efforts, possibly with statements such as, “I need those conditions rescinded or else I might just have to hurt someone” (presumably you). If pushing you around psychologically (as in earlier stages) didn’t work, he now could escalate to Level 6, where he threatens to physically push you around: mostly because he sees himself as being out of options to make you comply, apart from threatening. What should you do? Your list for de-escalation here consists of strong “do NOT do” actions as well:
You do not challenge Felix. A person in this situation would feel pushed into a corner upon meeting your aggressive response, and they would then have to follow through on their threats rather than “lose face” or look weak.
You do not want to look weak either, so your job is not to accept threatening behaviour. Rather, you acknowledge that you understand him: “Felix, I know you mean what you say . . .” – AND at the same time you let him know that you will not tolerate the threats – “. . . I also know you want this problem solved, so you need to stop the threats and let’s work on it.” Your job here becomes to help Felix see that he has choices, so you work with the side of him that can help engage in finding a solution before it’s too late.
You want to reinforce the idea that he has not reached a “point of no return”. You might say, “It’s not too late to settle this problem. You haven’t done anything wrong, so let’s put the gun away and figure it out.” You can also get him to think about consequences, such as by saying, “I know what you said, but think what would happen if you did it.”
You begin to look around. If you cannot de-escalate his threat, what objects in the immediate vicinity might you be able to use to defend yourself? Where are the doors and the windows in the room? You should try to position yourself so that you have access to exits and he is not between you and the best escape route.
Know that you do not have to wait until he attacks in order to call for help. Many organisations have a “code” phrase they can use so as not to alarm the threatening person into doing a rash action (such as firing the gun). Here you might say, for example, “Felix, I want to help you, but this situation is beyond my level of expertise/authority to deal with”. You then offer to summon a supervisor. Hopefully, your workplace/practice has a coded system, where you can use a non-alarming coded phrase, such as, “I’ll be late for my next appointment”: code for, “I need help here now!” One annual conference used to instruct attendees volunteering at the conference to call on the loudspeaker or in-room telephone, “Is NORA in the room?” NORA was an acronym for “Need Officer Right Away”, whereupon the hotel security would materialise immediately at the dialled-from location in the hotel.
You must keep calm, especially if you do not have the means to accede to the person’s demands. Thus you can say: “I want to help you, Felix, but guns make me very uncomfortable. Can you please put the gun away so that we can work at this calmly?” If you can’t de-escalate and you have to comply with his demands, so be it. Rewarding bad behaviour is preferable to ending up as a statistic. When all else fails, your primary concern needs to be safety.
Most angry people do not become violent. Hopefully, the strategies here will help de-escalate any angry client you might encounter before the encounter would escalate into physical violence. But sometimes anger does escalate into assault. The angry energies that, at earlier stages, energised Felix to stand up for himself now become energies which make him “stand up to knock you down”. In the first instance, the violence often has a goal: to get what he wants when nothing else will obtain it; he has reached a “boiling point” and when even threats do not work, he decides to hit or otherwise hurt you (which sometimes occurs with a warning and sometimes does not). At this level, you are about to be hurt; it is about to happen, and the situation is irreversible. De-escalation is no longer about defusing the anger; now it is about protecting yourself.
The first important thing is to remain calm (!@#!). If you can safely exit, do so. If you can call for help, do so. If you can do neither, what objects can you put between yourself and Felix? What barriers might protect you somewhat from the attack? If you are going to be hit, there are techniques – tactics from self-defence and other disciplines – that are helpful to know. Look into them now so that, should such a situation arise in the future, you are prepared to face it. Ultimately, you may decide to hit in return, as part of your self-defence. “Reasonable force” to protect yourself will likely be legal, but know that you will be hit back: probably much harder.
We don’t typically deal with such a grim, scary possibility as threats or violence to you from a client. We reiterate that most angry feelings don’t escalate into assault, and our sense is that many therapists will never need such information, as the vast majority of the time you and the anger client are probably dealing with tendencies toward anger which have manifested “out there”: outside of session. Beyond that, you may not agree with every detail of Fauteux’s progression. The general notion of escalation from frustration to violence is worth familiarising yourself with, however, in case you do find yourself, whether with a client or someone else, in a tense situation with the potential to explode.
Editor's note: The material in this article is informational and does not show clients with destructive anger how to change their relationship with that emotion. For that, see the upcoming Mental Health Academy course series “Helping Clients Deal with Problem Anger”, from which this article is excerpted. Anger is a basic human emotion and a complex phenomenon; understanding how to re-calibrate the ways of dealing with it is essential understanding for both clinician and client.
- APA Dictionary of Psychology. (2020). Anger. American Psychological Association. Retrieved on 7 April, 2021, from: Website.
- Fauteux, K. (2010). De-escalating angry and violent clients. American Journal of Psychotherapy, Vol. 64(2), 2010, 195-213.
Understanding Diverse Genders and Sexualities
Diverse genders and sexualities are becoming more common and visible in the mainstream, affecting how people identify and understand themselves and each other. To work effectively with a range of clients, it is important for therapists to understand the concept of diverse genders and sexualities and to reflect upon what these concepts mean in the context of their own practice and the client-therapist relationship. This article offers some definitions, explores brief case studies, and provides general tips for therapists to work effectively – and compassionately – with LGBTIQ+ clients.
A Case of Lost Direction
Jenny has come to counselling due to strong feelings of dissatisfaction with her life. She is 48 years old, unemployed and does not hold much hope of employment in the future. She has worked in the past at restaurants, in pubs and as a cleaner at a Motel. She said that she could not see any positive changes in her future and was concerned that she would live out her days caring for her son, having little income and no sense of direction. She felt that she lacked any control over her life and was just “marking time”. Jenny came to counselling because she wanted to find out about herself and to find her direction.
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Counselling Immigrants in Australia
If you are a counsellor, you will always be faced with the challenge of counselling someone who comes from a different culture. So, what do you do if you feel you are unequipped to take these clients on? Will it be too difficult to work with someone who speaks a different language, or who comes from a vastly different culture? How can you be sure that you are giving them the assistance they require? Should we avoid these clients, or refer them elsewhere?
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