Magazine article Psychotherapy Networker

IN CONSULTATION: Cease-Fire

Magazine article Psychotherapy Networker

IN CONSULTATION: Cease-Fire

Article excerpt

Q: I find myself getting extremely reactive when clients lose their temper in my office. What can I do to better control my anger and anxiety in the presence of an angry client?

A: Most therapists are trained to process emotional reactivity by examining content: "Why do I feel this way about this client?" They may be able to take the edge off their anger by realizing, for example, that this not their father or some other authority figure disregarding their feelings; rather, this is a client, a troubled person who has come to them for help. The only problem with this strategy is that anger arises faster than thoughts do. "Working it through" keeps you several steps behind an angry client, like poor Dr. Melfi struggling with Tony Soprano.

Like soldiers, therapists need self-regulation skills that kick in automatically under fire, and developing them is akin to undergoing basic training. These skills must become automatic--conditioned responses to fight-or-flight cues--so that the experience of anger and fear triggers them. In fact, the skills that will help you in sessions are the same ones your clients need to reduce the level of anger and resentment in their own lives.

One method of developing a conditioned response to regulate emotions is a technique called HEALS, which has proven as successful with clients as it has with me. The technique is aimed at producing an immediate and unconscious response that transforms anger, resentment, or anxiety into interest and compassion. Practicing the technique lowers baseline anger levels, reducing the frequency and intensity of waves of anger. I've found that it takes 4 to 6 weeks of 12 repetitions per day to develop a conditioned re­sponse. HEALS was initially developed for use with violent prison inmates, but I use it with clients who have even mild resentment problems that distort their thinking and make it next to impossible to see other perspectives.

Before they learn HEALS, clients need to understand that most anger and resentment (and a lot of anxiety) come from what I call "core hurts," the feeling that one is disregarded, blamed, devalued, rejected, powerless, inadequate, or un­lovable. Though we learn core hurts early in life, we're born with what I call "core value," our intrinsic worth and lovability. When we're aware of our core value, we feel the most humane and the most compassionate.

The first task of HEALS is to disrupt the usual desire to attack or avoid in response to anger and resentment. To learn HEALS, I ask clients to recall an incident that made them angry and to talk about it until they can feel the physical sensations of the anger. I then tell clients to visualize "HEALS, HEALS, HEALS," flashing over the face of the person who made them angry. This is the trigger of the entire conditioned response.

I then teach clients to identify and experience the core hurt that stimulated their anger, a hurt that led to guilt, powerlessness, inadequacy, or rejection. They might say, "I feel unlovable," and feel that core hurt for just a moment. Each time they do this, their sensitivity to the core hurts decreases.

The next step in this process is for clients to access their core value. We become aware of our core value by identifying and remembering what's deeply important to us, what we most value in life, such as our desire to heal, to serve, to improve, to build, to love, to renew.

There are many exercises that can help clients discover their deep values. My favorite is the creation of a "core value box. …

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