BALTIMORE -- Cognitive-interpersonal therapy is an effective treatment for angry people who are mired in interpersonal conflicts for which they hold others responsible.
The "price they must pay to get better" is to let go of their need to blame someone else and accept personal responsibility, Dr. David D. Burns said at an anger management meeting sponsored by the Institute for the Advancement of Human Behavior.
According to Dr. Burns, who developed cognitive-interpersonal therapy (CIT), angry people convince themselves that they are the victims of those whom they blame, and they deny their role in the interpersonal conflict.
Since CIT requires people to face some unpleasant truths about themselves, therapists who use it should be prepared for nearly constant resistance from their patients.
CIT requires three things of motivated patients: Patients must list the pros and cons of remaining angry. The list enables them see all of the ways in which they have benefited emotionally from remaining angry with another person, as well as all the ways that they themselves have been hurt by their anger. (See sidebar on the emotional cost-benefit analysis.)
* Patients must believe that the disadvantages of their anger outweigh the advantages. Not all patients want to improve their relationship; some of them are just interested in talking about it.
"The most common error therapists make is to believe that they can talk someone out of a blame problem. When the advantages of blame are greater than its disadvantages, I know as a therapist that I have no tools to help that person," said Dr. Burns of Stanford (Calif.) University.
* Patients must revamp their communication style. In essence, the patient may learn to say, "I am wrong and you are right," which takes a lot of practice. The first step is for the patient to provide the therapist with a specific example that includes details on person, place, and time of an instance of interpersonal conflict. The patient should write down exactly what each person said and then assess the quality of his or her communication in the dialogue.
Patients are going to resist any communication style that requires them to accept blame, express their feelings, and listen respectfully to the very person who has made them so angry. But if they can sincerely agree with criticism from the person with whom they are in conflict, they can show how wrong that criticism is.
The process always is very painful for patients because they resist facing what Dr. Burns called "the dark side of the human heart." Patients who undertake CIT need to be able to tolerate self-examination. Some may require cognitive-behavioral therapy (CBT) on the side to boost their self-esteem.
For their part, therapists must exude sincere empathy, be willing to reset the agenda every 15 minutes of therapy, and accept that therapy will move forward in fits and starts.
The therapist's empathy for the patient is so crucial to the effectiveness of CIT that Dr. Burns urges therapists to have patients measure their empathy at the end of each session. (See sidebar on the empathy scale.)
"The person who comes to you with a relationship problem deserves their day in court. That's what you give them with your empathy," Dr. Burns explained.
He stressed that CIT is not a variant of CBT.
CBT is an effective treatment for depression, anxiety, and low self-esteem; patients with these problems tend to blame themselves, while patients with anger problems blame others.
CBT challenges patients to abandon their distorted thoughts; CIT actually requires patients to accept the unreasonable thoughts of the person with whom they are in conflict.
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