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In the last section, we discussed challenges in helping clients recall their
emotions during their trauma: resistant clients, risks, and unresolved
grief and anger.
In this section, we will more closely examine aspects of
clients who are suffering from unresolved anger: how they articulate
anger, the targets at which they direct their anger, and forgiving their
in this section, we will relate PTSD resulting from combat and natural disasters.
♦ #1 Repression and Expression
First, we will examine how several clients articulate their
anger. Have you found like I that there are two different ways that clients
deal with anger: repression and expression? Everyone
represses anger at one point or another whether it is to save face or to prevent
harmful words from being spoken.
However, with PTSD clients, repressed
anger can hurt the more it is repressed. They
spend most of their energy suppressing the urge to "fly off the handle" so
that they can appear that they are acting like "normal people."
the other side of the spectrum, those clients who choose to express their anger
at the drop of a hat do so in a harmful way as well. Many times, this
over-expressed anger manifests itself through sarcasm, melancholy, frustration,
depression, and outright rage. This type of anger most directly affects
the client’s relationships with others.
Michael had suffered from near-fatal injuries during combat training for the
Corps. Because his wounds occurred during training and not actual combat,
many of his friends and family tended to undermine his condition, thus resulting
in secondary wounding which we reviewed in section 7. This resulted in
Michael acting out his anger through sarcasm. He felt
as though his sufferings meant nothing to his loved ones and as a result, began
to make harmful and sarcastic comments almost hourly.
to me one incident that occurred during dinner, "My mom had spent hours
on this chicken. I’m talking the whole day. When she finally
laid it on the table, I took a bite and said, "Jesus, mom, dry enough
for ya?" My dad was livid. He told me I should be grateful
for this "feast" my mom had taken all day to cook. Thankful,
yeah right. I’ll be about as thankful as they were to get their
son back medalless and combatless."
As you can observe, Michael
expressed his anger through sarcasm in an attempt to harm those he felt did
not give him due credit for his trauma.
Think of your PTSD client. Has
he or she been expressing their anger? Has he or she
been repressing their anger?
♦ #2 Targets of Anger
Second, we will discuss the targets at which many clients
direct their anger. Often, these targets take the form of people involved
in the trauma or secondary wounding, in Michael’s case. However,
if no one individual is responsible, clients will direct their
anger at broader groups such as insurance companies who refused
to compensate their clients; governments which failed to protect its citizens;
or even the client’s concept of God who seemed to have deemed it just
to afflict them.
Rachelle was living in New Orleans when Hurricane Katrina hit.
Rachelle’s anger, obviously, had many targets
1. The federal government for cutting the budget of the
levees and for apparent bias in their rescue time;
The local government for
not fighting for more funds to improve the levees;
FEMA for their delayed response
The national guard for shooting innocent civilians; and
The citizens of New Orleans for letting themselves succumb to chaos and anarchy.
stated, "We were left high and wet by those sons of
bitches in Washington. They’ll give parades for their white boys
over in Iraq suffering, but they don’t give a shit about black and poor
drowning. I lost my mother, my home, my neighbors, my job, and all FEMA
can do is sit around and scratch their ass." As you can see, Rachelle
verbally expressed her anger at a variety of targets.
Now, think of your client who is expressing
their anger. At what or at whom are they directing their rage?
♦ Technique: Gestalt Chairs
To help Michael and Rachelle reduce their anger with their targets, I asked
them to try the "Gestalt Chairs" technique. We
have already listed Rachelle’s targets, but Michael’s targets
were slightly more complex. Although Michael experienced some anger
for what happened to him, most of his sarcasm was directed at his family
as a direct result of their secondary wounding.
To help resolve your client’s
anger with their targets, I recommend having them complete the following
exercise either during a session or even in the privacy of their own home.
this exercise, the client will imagine themselves confronting the target
of their anger:
- Arrange two chairs... facing each other at an angle and have the client sit
- Ask the client... to take two, easy, deep breaths. Tell them to relax
and calm themselves as they prepare to touch honestly with their feelings.
- Tell the client to imagine... the target of their anger sitting in the other
chair. Ask them to notice what it is like being with this person. Michael
imagined his mother in the chair opposite him.
- Ask them to begin... a dialogue starting with a positive statement. Michael
stated, "Years from now, I want to have the relationship I once had
with you, but right now we don’t. I want to resolve this."
- Then ask them to move... on to explain what they want. Michael stated, "I
want you to hear and understand my pain. Don’t cut me off
with ‘I’m sorry’ or ‘I didn’t mean it’ before
hearing me out."
- Next, ask the client... to tell their target what they are thinking or feeling
by describing what happened and the impact of the offence. Michael
stated, "When I came back from the hospital, everything went on as
normal. Dad even cracked jokes about it. I was nearly killed,
and he made jokes like, "Well, at least you knew who was shooting at
you." That hurt me, but it hurt me more that you, mom, didn’t
stop him, and didn’t tell him that I need some time to heal. You
were always there for me before, but not then, when I needed you most."
- Now, ask the client... to change seats and ask them to voice the feelings
of the target. Michael stated, "I’m sorry, Michael. I’m
your mother and I let you down. I feel guilty, sad, and ashamed of
myself as a mother."
I have found this exercise helpful in getting clients to express their feelings
in a constructive way and not through anger.
♦ #3 Forgiveness
In addition to how clients articulate their anger and the targets of the client’s
anger, the third aspect of unresolved anger is forgiving. Through
forgiveness, the client may more fully release their burden of anger and blame. To
help Michael forgive the many people he felt anger towards, I found the "Letter
Writing" exercise helpful.
I gave Michael specific writing
formats for each person he felt anger for. For his first letter, I asked
him to describe his feelings and what that person did. For his mother,
he wrote, "Dear Mom, I felt angry when you
failed to defend me from dad’s jokes because I wasn’t
expecting my pain to be so undermined. I still feel angry
and hurt." In a second letter, I asked him to write about
Michael wrote, "Dear Mom, to the best of my ability,
I now choose to forgive you for all these hurts. I release my burden
of ill will toward you now, and free you and me to live." I then
asked him to sign it. I found this exercise helpful in aiding Michael
to release his past and present feelings of anger.
In this section, we more closely examined aspects of clients
who are suffering from unresolved anger: how they articulate their
anger, the targets at which they directed their anger, and forgiving their
In the next section, we will discuss the three levels of
grieving losses which include: grieving specific losses, grieving the
realization of powerlessness, and grieving mortality.
Peer-Reviewed Journal Article References:
Christ, N. M., Contractor, A. A., Wang, X., & Elhai, J. D. (2020). The mediating effect of rumination between posttraumatic stress disorder symptoms and anger reactions. Psychological Trauma: Theory, Research, Practice, and Policy. Advance online publication.
Diamond, G. M., Shahar, B., Sabo, D., & Tsvieli, N. (2016). Attachment-based family therapy and emotion-focused therapy for unresolved anger: The role of productive emotional processing. Psychotherapy, 53(1), 34–44.
Tsvieli, N., & Diamond, G. M. (2018). Therapist interventions and emotional processing in attachment-based family therapy for unresolved anger. Psychotherapy, 55(3), 289–297.
What are three aspects in addressing clients who are suffering from unresolved
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