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Section 22
Family Therapy for Anger

Question 22 | Test | Table of Contents


 Conjoint treatment as described in my model draws on family systems therapy techniques combined with violence-eliminating strategies. Family therapy techniques form the framework for this method. A knowledge of family therapy, however, is not in itself sufficient for treating couples where violence is present. In addition, one must be equipped with a cadre of violence-eliminating strategies used in concert with family therapy techniques.

Identify the Patient
In family therapy, the emphasis shifts from an individual to a family focus. That is, the family, not the individual, is identified as the patient or problem. According to the family therapy systems theory work of Jay Haley, the reasons for this shift in focus have to do with the fact that families have a history and a future together.

Families follow organized ways of behaving together, and each person has a place in a family’s hierarchy; some above and some below the others. Everyone helps to maintain this hierarchy, and the family members step in to restore the hierarchy when someone steps out of order, a process often referred to as maintaining the homeostasis. Roles have been established, and every member has a relationship to every other member. One person’s stepping out of order affects everyone else. In unhealthy families, the hierarchy needs to be shifted, but there is a resistance to change because of comfort with the familiar, even if it is dysfunctional. The resistance to change is not conscious or deliberate, however.

Family Hierarchy
In families with problems, the hierarchy is, in Haley’s parlance, “confused.” Roles are unclear, and one member at one level of the hierarchy may form a coalition against a peer with a member at another level of the hierarchy. In couples therapy when violence is present, it is common for each partner to try to form a secret coalition with the worker. The task for the worker is not to side consistently with any one member against another, which forms another coalition. The worker must join in different coalitions at different times while ultimately not siding with anyone against anyone else. The need to maintain a neutral position is critical when treating couples of violence. (Being neutral does not mean to be cold or unfeeling.) These couples are enemies living in a war zone; as part of their arsenal, they are seeking to get the worker to side with one against the other. Although it is natural to side with the obviously injured party, the worker must resist this tendency. The batterer feels he is wrong, and the worker’s siding with the woman confirms that feeling. A batterer cannot lend himself to treatment if he feels the worker is against him.

Observe Family Sequences
The worker can map out the hierarchy by observing the sequences that occur in a family; for example, when A tells B to do something, B consistently complies. The conclusion is that A is higher in the hierarchy than B. Sequences have a repetitive and cyclical nature; that the same pattern happens every time in the same way. For example, every time Susan tries to discuss how their money is being spent, it leads to an escalating argument, culminating in Jim’s becoming violent, which ends the discussion. Because it has been unresolved, the issue arises again. Jim gets angry again and escalates to violence, which ends the discussion—and the cycle begins again. The task for the worker is to change the sequence by intervening in such a way that the pattern cannot continue.

Agree to Control Anger
In couples with violence present, helping the batterer agree to control his anger rather than let it explode into violence is a major step in breaking the pattern of violence. Teaching couples when to table a discussion because the topic becomes too volatile intervenes in the repetitive and cyclical sequence. In addition, families collude to sabotage efforts at change in the service of maintaining the unconscious need for homeostasis. With couples where violence is present, the collusion often takes the form of broken agreements in the form of what I am calling a contract or not showing up for appointments. Workers need to take an active role in reviewing contracts and directing that they be enforced, as well as pursuing couples who have missed appointments.

Reluctance to Change
Understanding that families form hierarchies that they are reluctant to change, that change will be resisted through collusions and sabotage in order to maintain homeostasis, that families form coalitions and experience sequences that are repetitive and cyclical in nature, and that the task of the worker is to maintain neutrality and intervene in the dysfunctional patterns of behavior forms a foundation of how to approach fighting families.

- Geller, J. A., PhD. (2002). Breaking Destructive Patterns. The Free Press: New York.

Update
Effectiveness of Psycho-Religious
Sexuality Education upon Anger and Depression
of Iranian Female Adolescents: The Relationship
of Quality Family Relationships and Birth Order

- Gholizadegan Rayat, S., Nasseri, N., Fariborzi, E., & Saffariantoosi, M. (2023). Effectiveness of Psycho-Religious Sexuality Education upon Anger and Depression of Iranian Female Adolescents: The Relationship of Quality Family Relationships and Birth Order. Journal of religion and health, 62(2), 1070–1089.

Peer-Reviewed Journal Article References:
River, L. M., Borelli, J. L., Vazquez, L. C., & Smiley, P. A. (2018). Learning helplessness in the family: Maternal agency and the intergenerational transmission of depressive symptoms. Journal of Family Psychology, 32(8), 1109–1119.

Steinmann, R., Gat, I., Nir-Gottlieb, O., Shahar, B., & Diamond, G. M. (2017). Attachment-based family therapy and individual emotion-focused therapy for unresolved anger: Qualitative analysis of treatment outcomes and change processes. Psychotherapy, 54(3), 281–291.

Tsvieli, N., & Diamond, G. M. (2018). Therapist interventions and emotional processing in attachment-based family therapy for unresolved anger. Psychotherapy, 55(3), 289–297.

Wong, T. K. Y., Konishi, C., & Zhao, K. (2018). Anger and anger regulation among adolescents: A consideration of sex and age differences. Canadian Journal of Behavioural Science / Revue canadienne des sciences du comportement, 50(1), 1–8.

QUESTION 22
How does Haley describe the hierarchy of the family with problems? To select and enter your answer go to Test.

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