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CreativeStrategiesforthe

TreatmentofAnger

DianeEFrey,Ph.D,RPTS

Probablythemostcommonunderlyingemotionmanyclientsexperienceisoneofanger.
Clientsmaybeoppositionalordefiant,inwhichcaseangerisexternalized,orclientsmight
bedepressed,inwhichcaseangerisinternalized.Nevertheless,angerrelatedproblems
areacommonreasonforreferraltomentalhealthprofessionals.Mostpeople,iftheyhada
choice,wouldprefernottoexperienceanger.Angeristhemoodmostpeopleareworseat
controlling(Tice,1993).Angerisoneofthesixbasichumanemotionsalongwithsadness,
happiness,fear,surprise,anddisgust.Itisanemotionthatallhumansfeel,regardlessof
culture.

Ofallhumanemotions,angerhascreatedthemostharmandcausedthegreatest
destructionwithinindividuals,couples,families,andbetweensocialgroupsandnations
(Borcherdt,1989).Angercanbeaverypowerfulanddangerousemotion.InhisbookAnger
Kills,RedfordWilliams(1993)citestheimpactangerhasontheimmunesystemandits
relationshiptohypertension,coronaryarterydisease,andcancer.Barris(1999)statesthat
angeristhemostimportantpsychologicalproblemconfrontingtheworldtoday,despite
theuniversalproblemofanger,itremainsoneoftheleaststudiedemotionsandiseven
lessunderstoodintermsofitstreatment.

AngerDefined

Angerisanemotion,anaffectivestateoffeelingexperiencedwhenneedsarefrustratedor
whenwellbeingisthreatened.Angerisemotionalenergythatcanmotivateapersonto
attempttoremedythesituationthatbroughtontheanger(Marion,1994,p.156).Tarvis
(1989)indicatedthatangerisanemotionthatistemporaryanditcombinesphysiological
arousalandemotionalarousal.Itcanrangeinseverityallthewayfromintenseragetocool
angerthatdoesntreallyinvolvearousalatall.

Healthyangeroccurswhentheintensityofthefeelingmatchestheeventandtheangeris
managedappropriately.Feelingsofangercangeneratepositivebehaviorornegative
behavior,dependinguponeachindividualsmannerofdealingwiththisemotion.

CausesofAnger

BenjaminFranklinoncesaid,Angerisneverwithoutareasonbutseldomagoodone.
Therearemanycausesofangerbiological,genetic,andenvironmental.

Stressors
Stressorssuchasinterpersonalandintrapersonalconflictscanleadto
situationalanger.Suchstressorsinschoolagedchildrencouldbeparental
pressure,conflictswithteachers,peerteasing,oracademicfailures.

Overlystrictorharshparenting
Whenparentsareoverlystrictandcoerciveandusefrequentphysical
punishment,childrenoftendeveloplowselfesteemandangerdifficulties.

PoorRoleModeling
Childrenlearnangermanagementfromtheirfirstrolemodelstheir
parents.Iftheirparentsmanageangerinappropriately,childrenwilloften
imitatethesamebehavior.

ProblematicNeighborhoods
Childrenlivingintoughneighborhoodsoftenhavetodevelopatough
attitudetosurvive.Hamer(1998)statedthatofallthethingsthatdetermine
whetherapersonwillbeviolent,aggressive,andantisocial,themost
importantfactoris...geography.Analyzedbylocation,urbanchildrenhad
higherlevelsofangerthansuburbanchildren.

UnresolvedGrief
Grievingchildrenwhodonotworkthoughtheirgriefissuescanbecome
stuckintheangerstageofgrief.

SocialSkillsDeficits
Whenchildrenlacksocialskills,theyfinditdifficulttogetalongwithothers
andtheythenbecomefrustratedandangry.

LearningDisabilities
Thefrustrationofnotbeingabletolearninthesamewayastheirpeersoften
resultsinangerdifficulties.

Temperament
Someindividualshaveatemperamentthatcanmakethemirritable,short
fused,andeasilyfrustrated.Hammer(1998)notedthatangrypeoplearenot
solelytheproductofabadchildhoodorneighborhood.Geneticfactors
constitute50percentofanindividualsbehavior.

SensoryIntegrationDysfunction
Childrenwithsensoryintegrationproblemsmayoverreacttoloudnoises,
brightlights,orthefeelofcertainclothing.Thesereactionsoftenleadto
anger.

LanguageProcessingProblem
Whenchildrendonotknowhowtoexpresstheirfeelings,theymaybecome
angryand,iftheydonotknowthewordstoexpresstheiranger,they
explode.

MoodDisorder
Childrenwhoare,forexample,bipolar,depressed,oranxiousmaydevelop
angeroutbursts.

AttentionDeficitDisorder(ADHD)
ADHDchildrenoftenhavedifficultymaintainingattention,screeningout
distractions,andregulatingmotoractivity.Theycanbecomefrustratedor
angry.

Sexual,Physical,EmotionalAbuse
Childrenwhohavebeenmaltreatedaremorelikelytodevelopapatternof
aggressionandinappropriatebehavior.


AssessmentofAnger

Thefollowingisasummaryofproblematicanger:

Itistoofrequent.
Itistoointense.
Itlaststoolong.
Itmasksotherfeelings.
Itdisturbsfamilyand/orworkrelationships.
Itbeginsadestructivecyclethatoftencannotbecontrolled.
Ithurtspeople.

Acomprehensiveassessmentofangerexplorestheaboveareas.Anotherwaytoassess
angeriswiththeChildrensInventoryofAngerGame(WesternPsychologicalServices).
Thisinventoryisappropriateforages6to16.Thisselfreportinventorycanbehand
scoredinfourminutes,providingtheevaluatorwithaprofileofthechildsanger.

Childrensdrawingsaswellasnondirectiveplaycanrevealpatternsofintrapunitive
and/orextrapunitiveanger.

Selfratingscalesthataskclientstoratethemselvesfrom1to10onhowtheyexperience
angerinvarioussituationsintheirlivesoratvarioustimesduringthetherapysessioncan
behelpful.Thisprocessnotonlyhelpsthementalhealthprofessionalassesslevelsofanger
intheclientbutalsohelpstheclientbecomemoreawareofangertriggers.

RationaleforUsingPlayTherapyinAngerManagement

Manyclientswithangermanagementconcernsareresistanttotreatment.
Manyaresentbycourtreferralsorcomeeventhoughtheydonotbelieve
theyneedtherapy.Manyclientswithangerconcernshaveanattributional
biasinthattheybelievetheirangerissuesarecausedbyothers.Therefore
theybelievetheothersneedtreatment.Consequently,traditionaltalk
therapyisineffective.

Manyclientswithangerissuesareindenial.Theydonotbelievetheyhavean
angermanagementproblem.Ifthisbeliefsystempersists,itisdifficulttouse
traditionaltalktherapywiththem.

Forclientswhoareverballydeficient,talktherapyisinsufficient.Suchclients
mighthaveintellectualdisabilities,selectivemutism,orautismspectrum
disorders.Thesymbolismofplaytherapycanbeveryhelpfultothem.

Clientsmightbeproficientattalkingaboutsomeconcernsbut,whenit
comestodiscussinganger,theyfinditverydifficulttotalk.Playtherapy
helpsthemtoexpressthefeelingofangersymbolically.

PlayTherapyStrategiesfortheTreatmentofAnger

Kagan(1998)notedthatthebrainsof9millionpeoplearelikeamilliondifferentcansof
tomatosoup,eachhavingaslightlydifferentcombinationofrosemary,pepper,salt,and
thyme.

Assuch,eachtreatmentplanneedstobeindividualizedtoeachclient,takinginto
considerationtheparticularangerdynamicpresented,evidencebasedapproaches,
environmentoftheclient,skillsofthetherapist,andlearningmodalitiesoftheclient.

Oneofthemosteffectivewaystohelpclientswithangerrelatedtreatmentissuesistouse
the3Csofcoaching,cheerleading,andcounseling.Coachinggivestheclientfeedbackand
encouragement.Cheerleadinggivestheclientpositivereinforcement.Counselinginvolves
treatmentapproachesthatprovideinsightdevelopmentandcopingskills.

Creativetechniquesfortreatingangerdifficultiesinchildrenarepresentedbelow.

AngerFortuneCookies:Inthistechniquethetherapistcanpreparefortunecookies
andinsertvariousquotationsaboutangerthatareappropriatefortheageofthe
clients.Someexamplesmightbe:Angerisonlyonelettershortofdanger.For
everyminuteyoureangry,youlosesixtysecondsofhappiness.Speakwhenyou
areangryandyouwillmakethebestspeechyouwilleverregret.

Clientsopenthefortunecookiesanddiscusshowthatquotemightapplytothem.
Clientscanbecoachedtoreplacenegativeselftalkwiththepositivemessagesfrom
thefortunecookies.Theclientscantheneatthefortunecookies.

FistFriends:Thisisahandpuppettechniqueinwhichtheclientisaskedtodrawa
faceonhis/herhandintheareawherethethumbandfirstfingermeet.Whenthe
thumbistuckedunderthefirstfingeramouthcanbeformedbymovingthethumb
upanddown.Theclientisaskedtodrawanangryfaceononehandandacalmface
ontheother.Askthefistfriendstotalktoeachother.Forexample,theangryfirst
friendmightsay,ItsnotmyfaultIhithim.Thecalmfistcouldhelptheangryfist
bysaying,Maybenexttimetrycalmingdownbeforeyoudoanything.

TheAngryBox:Theclientisaskedtowriteanangrywordorsymbolontheoutside
ofthebox.Thetherapistputssentencestemspertainingtoangerinthebox.The
therapistsandclienttaketurnspickingsentencestemsfromtheboxandcompleting
thesentences.Examplesofsentencestemsinclude:IgetangryeverytimeI___.
WhenItellsomeoneImangry,Ifeel___.Somewaystogetmyangeroutwithout
hurtinganyoneare____.Throughthisactivitythetherapistandclientcandiscuss
selftalkstatements.

TheUnMadSong:Musiccanbeaneffectivedistractiontechnique.Clientscanlisten
tomusic,whichcapturestheirattentionandcanhelptocalmthemdown.Theun
madsongcanbehelpfulingeneratingideasfordistractions.Itissungtothetuneof
Row,Row,RowYourBoat:

Mad,Mad,Madfeelings
Itstimetogoaway
Idontwantyouanymore
Ivehadenoughtoday

PickUpSticks:InthismodifiedversionofPickUpSticks,theclientisdistracted
fromhis/herproblematicselftalk.Forexample,ifachildisbeingbullied,the
therapisttellstheclientthathe/sheisgoingtotelltheclientthebullystatements.If
theclientissuccessfulinpickingupastickwhilebeingbulliedbythetherapist,
he/sheearnstwopoints.Iftheclientpicksupastickwhilenotbeingbullied,he/she
earnsonepoint.Theconceptbehindthisgameistohelpclientslearntothink
thoughtsthatwilldistractthemfromtheiranger.

MovieTherapy:Manyprosocialexamplesofusingangermanagementtechniques
arefoundinmovies.Clients,especiallythosewhoareresistantorindenial,can
viewasegmentofthemovieandlearnhowthatcharacterusedatechniquesuchas
distractiontomanagehis/heranger.ExamplesofthesemoviesincludeTheLion
King,Pocahontas,TheParentTrap,InspectorGadget,Cinderella,ToyStory.Theclient
canbeaskedtodrawwhatthecharacterwoulddofollowingtheviewing.Theclient
andtherapistcoulddoapuppetshoworareenactmentwithdressupclothes.

SoothingBottles:Thetherapistprovidestheclientwithanemptyclearplasticwater
bottle.Itemssuchassmallpicturesoffamily/friends,specialstones,smalltoy
objects,glitter,foodcoloring,andwaterarealsoneeded.Theactivityinvolves
puttingwaterinthebottlethenaskingtheclienttochoosevariousitemsthathelp
theclientfeelcalm.Theseitemsareaddedtothebottlealongwithwhateverglitter
andfoodcoloringtheclientmightlike.Thelidorcaptothebottleisgluedand
sealed.Theclientisthentoldthatthebottlecanbeheldontoandlookedatwhen
he/sheneedstocalmdown.Itwillremindtheclientoffavoritethingsinhis/herlife.

SquareBreathing:Thetherapistmakesasmallcharttogiveclientsavisual
representationonhowtorelax.Squarebreathinginvolves:

1.Breatheinforfourseconds 2.Holditinforfourseconds
3.Breatheoutoverfourseconds 4.Pauseforfoursecondsbefore
sayingordoinganything

EmptyChair:Theclientisaskedtopretendthatthepersonhe/shehasangertoward
issittinginanemptychair.Theclientisencouragedtoexpressangerverballytothe
pretendperson.Byexpressingthisangerinasafe,controlledsetting,theclientis
abletobecomecalm.

Conclusion

Angertreatmentprogramsneedtofocusonboththemanagementofalreadyexistinganger
andthepreventionofanger.Theprimaryfocusofthisarticlehasbeenonthemanagement
ofexistinganger.

ItwasAristotlewhosaid,Anyonecanbecomeangrythatiseasy.Buttobeangrywiththe
rightperson,totherightdegree,attherighttime,fortherightpurposeandintherightway
thisisnoteasy.Thisquotationtrulyrepresentsthegoalofusingplaytherapytomanage
anger.

ManyotherstrategiesforthemanagementofangercanbefoundinthereferencesbyFrey
attheendofthisarticle.

References

Borcherdt,B.(1989).Thinkstraight,feelgreat!Sarasota,FL.:ProfessionalResource
Exchange.

Frey,D.(2002).Playtherapysolutionsforbulliesandvictims.Dayton:MandalaPublishing.

Frey,D.(2003).Playtherapystrategiesforthetreatmentofanger.Dayton:Mandala
Publishing.

Frey,D.andFitzharris,T.(1999).Chartyourcourse.Dayton:MandalaPublishing.

Hammer,D.(1998).Livingwithourgenes.NewYork:Doubleday.

Kagan,J,(1998).Howwebecamewhoweare.FamilyTherapyNetworker,98,5263.

Marion,M.(1994).Encouragingthedevelopmentofresponsibleangermanagementin
youngchildren.EarlyChildDevelopmentandCare,97,155163.

Tarvis,C.(1989).Anger:Themisunderstoodemotion,2
nd
Edition.NewYork:Touchstone.

Tice,D.(2000).131creativestrategiesforreachingchildrenwithangerproblems.Chapin,
S.C.:Youthlight,inc.

Williams,R.(1993).Angerkills.NewYork:RandomHouse.

AboutTheAuthor
Dr.Frey,PhD.,RPTS,iscurrentlyaProfessorofCounselingatWrightStateUniversityin
Dayton,Ohio.Inadditiontoteaching,writing,andmaintainingaprivatepracticeasa
licensedclinicalpsychologist,shehasappearedontalkshowsandhasbeenakeynote
speakerattheWorldConferenceontheGiftedandTalented,MENSAandnumerousstate
andregionalconferences.ShehasbeenaninvitedguestspeakeronABCNews,20/20and
NationalPublicRadio.Sheistheauthorofnumerousbooksandjournalarticlesonself
esteem,playtherapyandthesocialemotionalneedsofthegifted.Shecanbecontactedby
emailat:diane.Frey@wright.edu