Anger is one of the few emotions western society does not stigmatize displays of, particularly in men. It is also one of the emotions most likely to cause social problems. However, not all anger is bad. Anger can tell us someone has crossed one of our boundaries, or show us what we’re passionate about, what we think needs to change about the world, and so on. Anger can be triggered by external events, such as in response to systemic marginalization, bullying, or institutionalized racism. Anger can also be triggered internally depending on how a person is thinking about a situation. For example, employing CBT’s unhelpful thinking styles can be an effective way in increase anger.

Rollo May said that “the mature person becomes able to differentiate feelings into as many nuances...as in the different passages of music in a symphony,” but many people’s emotional awareness is, “limited like notes in a bugle call.” ‘Anger’ is a vague term, a mere bugle call, and clarifying what clients mean when they say “I struggle with anger” is helpful. Anger can indicate aggravation, irritation, resentment, bitterness, rage, an agitated anxiety (which people can mistake as anger), and so on. 

Some clients coming in for therapy for ‘anger issues’ will be legally mandated by the justice system or socially mandated by a family member. In this case, clients are more likely than normal to be pre-contemplative, and your focus should be on building alliance and using stage-matched interventions. Strong rapport is critical in these cases. A lot of unspoken emotion and needs can lurk behind anger, so providing a safe place for these clients to feel understood can increase rapport more than normal. 

On the administrative side of things, be sure to clarify with any clients asking for ‘anger management’ if they need to meet an official or legal condition. If they do, ensure therapy with you will meet their particular requirement before proceeding. The legal system and the therapy world can be dense and complex to those not working in those fields. Clients sometimes assume that any therapy will meet their court mandated requirements. I’ve seen numerous clients who made this assumption and were vague about why they sought counselling with me. Then, after one or two sessions we find out they require a service I don’t offer. 

Many therapists feel uncomfortable being around angry clients at first—that’s normal. Countertransference is more likely to occur when working with anger, given that many therapists are wounded healers and that many people are conflict avoidant. Seek extra supervision when you first start working with anger, abuse, or mandated clients in therapy. 

Empathy when You can’t Find Any

Authenticity is even more important than normal when working with angry clients, especially mandated ones. If a therapist becomes uncomfortable and then reverts to formal or stereotypical therapist behaviour, ‘angry’ clients are more likely to become distant, and disengage from the work. 

It can be a challenge to find empathy for clients who are angry, particularly if your clients are legally mandated for things such as using abusive behaviours toward vulnerable people. Monitor your internal experience for judgement or disgust—seek supervision and reflect on countertransference when needed. It happens to many of us, and I’m not saying it’s “wrong” to feel, but when you’re newer to the field, you need to investigate this inner experience and get any support you require.

What helps me maintain empathy for clients with anger or abuse issues is the idea that “every behaviour is an attempt to meet a need.” Angry outbursts are an (unhealthy) attempt at self-protection in those moments, or their communication skills failed and they were combative instead of talking through what they need.

In my work with ‘angry’ clients, I noticed a pattern that these clients were usually hiding emotional pain and either didn’t know how to express it or felt they were unable to. Once I recognized this I was (usually) able to be patient and empathetic with them. I’ve sat with hundreds of men in therapy who were crying and shaking as they:

• spoke about shame they felt for their actions and perceived failures to live up to social pressure

• as they let down defences and admitted more fully how much they’ve hurt people they cared about, perhaps even traumatized people

• as they realize how their unskilled and passive approach to communication is both their responsibility and the cause of many of their relational difficulties
  

When I meet a new client who comes in to discuss anger, even if they’re angry with the situation and don’t want to see me, I hold on to this idea of empathy. Because I know, within a few therapy hours, they will probably be thawing out and sharing their humanity. A final point, providing empathy and support does not mean that, as a therapist, you have to put up with clients being disrespectful or rude to you. In my experience this is rare, but stand up for yourself when needed, and consult on how to proceed because each situation is so different.

Interventions for Anger

Responsibility taking is central to many therapeutic interventions for anger. Clients need to acknowledge that they are responsible for how they feel, what they say, and how they act. However, no one gets arrested for how they feel; what matters are the choices clients make when they are angry. At minimum, we want to help clients make behavioural changes so they can act in a respectful and safe way toward others and stay out of related legal trouble. Beyond that, helping these clients to reduce their level of distress and increase their emotional health are both reasonable pursuits—in addition to any specific goals each client suggests.

Clients who “Can’t Control” their Anger

Periodically I see clients who claim to be unable to control their anger, that they simply go from calm to enraged without noticing and they can’t stop it no matter what. Often these are mandated clients. I often take a ‘clever’ and somewhat confrontational approach to this.

I ask the client if they’ve been to court and spoken to a judge—usually they have. I ask what that was like, that I assume they would prefer to have not been there, to not feel embarrassed by other people hearing about what happened and so on. I mention that the judge obviously gave the client conditions and perhaps even some time in jail. We continue to discuss details in this manner, then I ask what it was like to be in court and be forced to meet all their conditions. Obviously it is a difficult and unpleasant experience for most people. I’ll say:

Therapist: it seems like a situation that would be frustrating, that might even make a person angry 

Client: yea it sucked being there

T: So…did you yell at this judge? 

C: Obviously not

T: Did you swear at them? Hit your fist on the table? Throw things around the court room?(Substitute behaviours relevant to your client’s story here)

C: “…No” 

T: “So you can control your anger, when you need to?” 

Sometimes the client is more easy going and we laugh during this conversation. Other times they can seem frustrated with me that I held them accountable for their actions and got them to acknowledge that they CAN control their behaviour. This point connects to them taking responsibility for their actions, and it’s an indication to my clients of how direct I’m going to continue to be in our time together. I’m kind with my clients, but also firm and direct, especially when they are mandated and being dismissive or evading responsibility. It’s a balance to do this while maintaining rapport. If the client hasn’t been to court, I might ask a similar thing about how they act at work, or with their boss, parents, or similar. 

Short and Long term Effects of Angry Behaviour

The early part of therapy will often be focused on interventions that are stage-matched with pre-contemplative and contemplative stages of change, which I discuss elsewhere. One of these exercises that I use specifically for anger and abusive behaviour is to have clients reflect on the short and long term consequences of their angry behaviours. 

I have clients write down what triggered their anger and what action they took based on it. Then, we consider what the short-term consequences were of those actions, and what the long-term consequences would be if they acted this way 3 or 4 days a week from now on. I ask them to reflect on that, and likely the client has real examples of using these behaviours long term, so I process it with them. Asking about this is a balance, because you need enough rapport to gently explore this difficult subject, but I do use this fairly early in the course of therapy to increase responsibility taking.

Awareness of Triggers and Signs of Escalation 

A hot coal can be a useful metaphor for anger. The anger the client feels is like a red hot coal in their hand. Regardless of the origins of that anger, if the client holds onto it, they are the person who gets burned. Other people or circumstances may toss hot coals at us (i.e., triggers for anger), but it’s up to us to decide if we catch it, and if we do catch it, how long we hold on to it for (i.e., anger). 

An effective way to help regulate anger is to 1. Improve a person’s awareness of the particular things that make them angry, often called triggers, and 2. Improve a person’s awareness of signs in their body that they are becoming angry.

Awareness of Triggers

This is highly individualized and may relate to the client’s patterns of interactions from earlier in life. You and your client should explore this together: ask them if they’ve noticed patterns in when they get angry, who’s there, what the subject is and so on. Similarly, you can point out when you notice they seem angry while talking about certain subjects.

Awareness of Signs of Escalation for Anger

This is also unique for each client, but often it includes common stress response indicators: 

• clenching their fists

• clenching their jaw

• sweating

• feeling their face or neck flush

• increased heart rate or breathing

• increased volume of speaking, and so on
  

The more nuanced a client’s awareness of these signs becomes, the better. Some clients find their anger signs escalate in a predictable pattern, and like any issue, it’s easier to stop or reverse it the earlier in the process you become aware of it. Work collaboratively with your clients to build their awareness of these signs, perhaps initially pointing them out, and later when you notice they seem to be becoming angry in session, ask them what signs they notice, and so on.

Anger Iceberg

One way to conceptualize anger is that it’s a “secondary emotion”, that it builds up as a result of other unmet needs or emotions a person has. When those underlying feelings and needs are too large, or unmet for too long, a person becomes increasingly angry until the pressure is released somehow. This is not a perfect approach and some folks disagree with it. I find it intuitive and useful for many clients, providing a clear path forward.

The imagery I use for this is the ‘anger iceberg’, with the general metaphor being that we only see the ‘tip of the iceberg’ above the water while most of it is hidden below the water. We don’t usually see the shame, fear, and neglect that’s underneath the water of someone else’s emotions, instead we just see the ice that’s above the water when they get angry. A volcano is probably a more accurate metaphor overall, and I’ll use it if clients suggest that during our discussion.

After discussing the idea with clients, I draw a quick iceberg. I’ll write anger in the small section above the water and ask them what their anger looks like. If I was in the room while they were angry, what would I see? How would I know they’re becoming escalated? And I note these in that upper section as well. I’ll reference a few parts of their story that we may have previously established as fueling their anger and write them in the section below the water. Then I ask the client what else might be down there, what else they’re carrying around. This often takes some prompting and reminding of previous discussions to get a few more ideas. Once they run out of ideas I’ll hand them a feelings wheel and ask them if anything else on the wheel might be on the iceberg.

Here’s an example of how to draw the anger iceberg from therapist aid:

The point of the anger iceberg is to open up useful process discussion with clients about the concerns underneath their anger, both so it can be worked on in therapy and so clients can be more aware of it themselves. 

Communication Styles, Skills, and Anger:

Anger often has its origins in communication problems. In relationships, the more unskilled or non-assertive a person’s communication is, the more time they will spend feeling angry, used, resentful, misunderstood, and so on. Explore what communication looks like in your clients’ relationships: ask for examples, ask them to slow down, reconsider important moments, and get specifics; or say that you don’t understand: “I’m confused Jeff, how did you two get from talking about the dishes to her shouting that you’re an asshole all the time? Were both of you swearing? Both shouting?” And so on. Claiming you’re confused is a useful way to seek clarification on seemingly conflicting information from a client without directly telling them you think they’re being deceptive or something similar.

Psychoeducation on healthy communication styles is impactful for anger in relationships. In my experience, as we discuss it most people notice that instead of being assertive, their communication pattern is to be quite passive most of the time. For example:

1. After months or years of passive communication, clients don’t get what they want, so feelings of resentment, frustration, feeling used, or disappointed build up

2. This pressure needs to go somewhere, and most commonly I see people channeling it into passive-aggressive behaviour, which makes both people more tense

3. At some point there will be a ‘blow up’ of aggressive communication

4. Followed by guilt and withdrawal, and an attempt to ‘do better’ by being really nice

5. This is actually just a re-doubling of passive communication, and the cycle continues 

I hate to stereotype, but a pattern I’ve noticed with many of the men I work with is to claim they are extremely assertive. They usually tell me this with needless bravado. In reality, they are conflict avoidant and use passive communication the majority of the time. When they do express their feelings, it’s because they’ve let their anger build up so much that their style of communication becomes aggressive, and the explanation of their grievance ranges from slightly garbled to nonsensical.

Assertive communication is letting people know what you’re thinking and feeling as it arises. Being assertive also means being kind, firm, and direct with people. It’s a balance between waiting for appropriate moments to share your concern, but also not waiting so long that the pressure builds—a few hours to a few days is reasonable.

There are many approaches to improving healthy communication; two key resources I use are Nonviolent Communication by Rosenberg and various free articles from the Gottmans. Perhaps you noticed that the above pattern sounds reminiscent of the cycle of abuse. These are related and potential precursor activities. You should keep risk assessing in mind throughout this entire discussion. 

Time Outs

Knowing when and how to diplomatically take a break from a difficult conversation can make all the difference in whether the outcome is success or simply another argument. The Gottman’s write about this, and I use this with couples or individual clients when arguments are a concern. In either case, the two people need to discuss this time out strategy during a calm time, and agree upon what it will look like for them.

We all could benefit from some time to cool off during a heated discussion, so agreeing that either person can initiate a short ‘time out’ or a break can help. Several things need to be clear: 

• The timeout is brief and specifically to let one or both people calm themselves down

• Minimum time is 20 minutes apart, but probably not too much longer at maximum. 45 minutes or an hour is getting pretty long, though everyone is different

• The break is being taken out of care for the relationship. The 2 people want to be able to have respectful and constructive discussions, but when they get too irritated or angry, that becomes impossible, so a break is required
  

A critical distinction to make is that the person initiating the time out is not abandoning their partner or “running away.” A classic criticism is “if you actually cared about our relationship you’d want to stay and keep talking until we figure this out”, often with much more colourful language. Clients can also suggest a time out when they can tell the other person needs one; regardless of who suggests the break, both people get the time away.

As a person gets increasingly overwhelmed and angry in a situation, their ability to be rational decreases proportionally. Time outs are a life saver for many couples and an important tool for safety. Sometimes anger is just anger, but this is also what 99% of domestic violence situations look like before the actual abuse happens, so both clients and therapists need to take this seriously and risk assess for safety.

Labeling Shame

Many interventions for anger can bring up feelings of shame for clients. Examples could be the short and long term consequences activity described above, or challenging a client’s claim of not being able to control their anger, or the communication styles discussion. I’m asking the client to look at these ugly behaviours of theirs, to examine them and acknowledge that the behaviours were unhealthy and no one’s responsibility but their own. 

Accepting responsibility for anger and its subsequent behaviours is uncomfortable and difficult for many clients. To sit with me and take responsibility for a single instance of ‘bad’ behaviour becomes complicated. In that moment many clients are thinking “but, if that was so wrong to do… I do shit like that all the time, in fact I do worse things than this—things that I haven’t admitted to him yet, and I’ve been doing it for years, to my wife, my kids, coworkers.” It can feel overwhelming to contemplate all of it. 

There’s a horrible, poignant moment of shame that you come to recognize after doing this work for a while. It’s similar to any moment observing a client silently process their inner experience, but you can tell they’re looking at this mountain of shame the two of you have stirred up. The moment often hangs there with awful gravity; it can be truly uncomfortable to witness.  

Some clients talk during this moment, but often I’m the one who begins. “This moment, this feeling right now…this is shame. It’s something we’ve been talking around but neither of us has said it yet. I know how awful it can feel to look at yourself and see what you’re seeing right now. It’s so much easier to blame someone else and just continue being angry. Anyone who lives long enough will have regrets. Anyone who tells you different is either lying to you, lying to themselves, or hasn’t done much living. But you told me you want to act differently because of [some meaningful reason we’ve previously discussed].” I say this slowly, and I take breaks when relevant, as this can lead to a lot of processing.

I speak candidly in these moments, sharing a lot of what I mention in this article. It’s hard to demonstrate exactly, but the above is an example of how I mix caring therapy with what some might call ‘confrontation’. This relates to my thoughts on content vs process, because once therapy has dipped into a few conversations like this one, the work becomes very focused and direct. Clients trust that you can collaborate with them on difficult subjects without judgment. 

Forgiveness

Self-forgiveness can be a key step after a client does work on anger and shame. It’s good to have reduced or stopped the problematic expressions of anger, but most people will feel a need to ‘make peace’ with all the time they spent acting out previously. Sentiments such as “now that I know better, I do better” are enough for some clients, though I often use self-compassion exercises when clients want to take self-forgiveness further. 

Forgiveness of others will be a central theme in some counselling for anger. For example, if a client is angry at a bully from a previous workplace or a parent for childhood neglect or abuse, then finding ways to let go of that anger can help.

Conclusion

Once clients know what’s ‘below’ their anger and how to recognize their signs of escalating, they need to know how to release some of that energy before it builds up. There are many workbooks for anger available that cover this, as well as all the typical methods of dealing with any emotion (e.g., breathing exercises, meditation, exercise, and so on). See my articles on emotional regulation and emotional processing for a deeper look.

My angry clients are the ones most likely to be rude to my administrative staff (they apologize later), but they are also some of the most redeeming and hopeful client stories that I get to be a part of. I find these cases can be draining, particularly the early sessions. Be sure to monitor that in yourself and seek support or supervision when needed. Watch for a history of trauma in clients with excessive anger, and keep risk assessing in mind with these clients. 

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