When Cognitive Psychology does not work
In: Psychology| anger management| cognitive psychology| therapy
30 May 2009
A couple of months ago I wrote an article which included a mention to a client with anger management issues.
Weeks ago, that client that had made notorious improvements was involved in an incident with one of his staff. After a not very significant event, he went berserk and stabbed him with an antenna. How could this happen? I think the reason is simple. His anger management therapy not only didn’t work, but it also backfired.
One of the characteristics of cognitive psychology is that it’s focused in the “here and now” and in the future. And this is what triggered the meltdown.
His treatment was so focused on controlling (and this is a key word) his anger that it lost sight of the roots of his issues.
His therapy helped him control his anger so well, that it provoked his explosion. By controlling his anger, instead of purging and processing the symptoms, he “stored” them within him. Every time he managed to get it together, that anger, instead of being vented was sent into an inner “reservoir”. That reservoir started to get filled until the point where it could no longer hold all that rage that was still circulating in his system.
Looking back now, it’s obvious that once his “storing capacity” was overloaded it blew up in an unprecedented manner.
In this case, cognitive therapy worked for some time as a patch. It patched his symptoms temporarily. But one peculiarity of every symptom is that you can patch it as many times as you want, but it will end up showing up somewhere else. The symptoms always find their way to express themselves. That’s the reason why symptoms should not be suppressed, but “digested” or transacted. The symptoms have to be dismantled part by part and analyzed. In order to do this, working with the here and now is not enough, simply because the reasons why the symptom developed are not located in the present, they go way back in the history of this person.
Since the cognitive resources of this particular client are not enough to place him under a psychoanalytical therapy, a mixed approach should be taken.
What’s important, is to complement his current cognitive therapy with something that would enable him to make insight and dive into the causes that made him who he is. It would take time, a long time. But lifelong issues cannot be resolved in weeks or months… you can patch them, but sooner or later you’ll have to face the consequences.
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12 Responses to When Cognitive Psychology does not work
Julie Christiansen
May 31st, 2009 at 12:09 pm
Excellent observations and you are abolutely right that traditional anger therapy is a patch, not a solution. Check out these two entries: http://angersolution.blogspot.com/2009/03/when-does-anger-become-problem.html – explaining the truth about anger, and
http://angersolution.blogspot.com/2008/07/band-aids-dont-stick-why-anger.html – explaining why traditional anger programs don’t work.
Enjoy, and keep up the good work!
Fernando Tarnogol
May 31st, 2009 at 12:40 pm
Hi Julie, thanks for stopping by and commenting. I have read both articles and I agree in a 100% with your views. The way anger management is usually perceived in professional environments works as a barrier to alleviate the symptoms.
People, if you are interested in the subject, check out Julie’s blog . She’s posted very insightful on topic articles.
mary-aloe
August 1st, 2009 at 11:00 am
I wanted to introduce myself – Thanks :)
Mary Aloe
Fernando Tarnogol
August 1st, 2009 at 11:22 pm
Hi Mary!
Thanks for stopping by. I’m looking forward to discussing ideas with you!
cheers
Fer
Don Laird
September 26th, 2009 at 2:26 pm
Fernando:
Spot on – I couldn’t agree more with your comments. I too have observed first hand the failings of assertive CBT, motivational inteviewing and DBT approaches.
Best regards,
Don
George Anderson
September 26th, 2009 at 3:30 pm
It is important to point out that anger is not a pathological condition and is not listed in the DSM. The American Psychiatric Association considers anger to be a “lifestyle” issue and therefore is not a focuse on psychiatric treatment.
Anger is a normal human emotion which is a problem when it occurs too frequently, lasts too long, in too intense, impacts health, leads to violence or destroys interpersonal relationships.
Anger management is neither counseling or psychotherapy but rather, a class which teaches skill enhancement in recognizing and manageing anger, recognizing and manageing stress, improviing assertive communication and increases emotional intelligence.
Prior to enrolling in an anger management class, an assessment is necessary to determine the clients level of competence in the areas mentioned above.
If the anger is a symptom of a diagnosable disorder like depression or anxiey, it should be the focus of major concern.
Don Laird
September 26th, 2009 at 6:54 pm
Fernando:
Spot on – I agree with your comments. I too have observed first hand the failings of assertive CBT, motivational interviewing, and DBT. All too often these approaches are little more than a dollar store band-aid for a client in need of a depth or integrative orientation.
Regards,
Don
Fernando Tarnogol
September 27th, 2009 at 6:34 pm
Hi Don,
Thanks for dropping a line, and yes, sometimes choosing the shortest path ends up leading to nowhere.
@George: totally appropriate clarification. Thank you for completing the post :-)
best
Fernando
Dr. Anne Perschel
October 1st, 2009 at 12:27 am
Agreement here. A Vice President I’ve been working with is having great success reducing frequency and intensity of anger episodes by identifying and dissolving leftover emotions, stuck thought patterns and physical reactions from old pattern of father-mother-child dynamics. Core pattern is feeling ignored and abandoned by father at critical positive and negative events. In addition client as child felt need to protect parental relationship by not expressing feelings otherwise would cause an argument between Mom and Dad. Realizes this core pattern is the trigger for current day episodes. We then used EMDR to revisit and distance from associated emotions, thoughts and physical reactions to this pattern via core memories. Cognition is only one piece of a multi-part puzzle. Other approaches work but all the pieces – cognition, emotion and physical need to be addressed.
Thanks for the post and the many thoughtful responses.
Dr. Anne Perschel, Psychologist to Leaders and Business Adviser to Psychologists
Fernando Tarnogol
October 1st, 2009 at 8:00 am
Hi Dr. Anne,
Thank you for stopping by and sharing your experiences.
The case to which this article refers:
is based on a client which like in your case, was abandoned in several occasions by his father.
By the way, I’d love to know more of the techniques and procedures you utilize
Thanks for thanking :) I try to reply to every comment. If someone takes the time to read one of my posts (and the effort to try to understand my sometimes confusing english) and also minds in dropping a line, I’d feel in infraction if I didn’t at least thank that person.
best
Fernando
Manasra Mahmud
October 2nd, 2009 at 6:49 am
To reduc frequency and intensity of anger episodes i use Rational Emotive Behavior Therapy (REBT).the client will learn and remember, ”although we cannot always change a particular situation or event (”A”) (e.g., loosing a close relative), we CAN manage and take control of our own thoughts. As a result, we can feel better or less distressed about situations we may have to confront.
We want to emphasize that learning this skill can be challenging, and it takes practice. The more you practice, the easier it will become to change your thoughts and feelings, and the better you will feel”.
Over time and with practice, REBT skills will become natural for the client, like riding a bike or driving a car.
Fernando Tarnogol
October 2nd, 2009 at 4:51 pm
Hi Manasra,
It’s great to hear about all the different approaches. How long does it take with REBT to achieve lasting results?