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The Schema Therapy Bulletin

The Official Publication of the International Society of Schema Therapy

Face to Face with "Anger Modes," Sturdy and Secure 

in the Treatment Room

by Wendy T. Behary, The Cognitive Therapy Center of NJ

The NJ-NYC Institutes for Schema Therapy

Whether it’s the ornery cynicism launched by the obnoxious narcissist, defiantly refusing to engage in your “silly emotional strategies”…. Or the patient who flips into a desperate angry child mode, hurling guilt-activating blame at you for daring to call it ‘vacation time’ when she knows you are really ‘looking forward to getting away from the hopelessly pathetic and forgettable person that she is, and that you are just like everyone else in her life who doesn’t care’ … Or perhaps it is the partner in your couple’s treatment who offends his significant other (and you) with contemptuous rants of “I’ll show you” and “I don’t need you” bullying statements and gestures… Or it might even be the patient who nods and “yes’s” your every word in a somewhat mechanical mode of compliance, and then proceeds to arrive 20 minutes late to each session that ends with an agreement to engage in emotional work “next time we meet”… and when you inquire about any hidden anger, frustration, or resentment tow

ard you (perhaps linked to feelings of subjugation, shame, or mistrust) for confronting blocking modes, they become punitively self-critical for being such a “loser and a waste of your time”.  

We struggle to keep a sturdy posture when ANGER enters our treatment rooms.  Whether the anger is directed at us, at an attending partner, or through an unabashed reenactment of a recent event: “… and then I got really mad when… and then I showed him! I just let him have it!!” we may find ourselves overwhelmed – dazed with fear, glazed in apologies, hazed with resentment, or simply amazed by the speed with which the deep red hue of humiliation arrives on our faces. 

However, when responding from our healthy adult mode… we become harnessed in an awareness of the “importance” of anger modes and the underlying experience. We hear the anger as a siren, a blaring emergency vehicle that alerts us to the message that “someone is in trouble” or simply “help is needed”!  From a sturdy mode we hear the siren and empathically listen for cues to distinguish between an angry childlike helpless mode, a rebellious teen-like bully, or a demandingly entitled, resentful, or defiantly detached adult.  Only from this mode can we discover and be reminded of the patient’s unmet needs for: safety, limit setting, empathy, acceptance, and/or attachment.  We appreciate the internalized experience imbedded in a story of fractured attachment and communicate to our patients how a seemingly “important” message seems to have gotten lost in the delivery. From the healthy adult mode we are better equipped to confront or embrace angry modes with the effective and targeted strategies founded in the Schema Therapy approach… be it imagery, mode dialogues, limit-setting, or empathic confrontation.

It is essential to label the Anger Mode with a personally customized descriptor, in order to fully capture the motivating driver behind the mode – one of helplessness, resentment, fear, or rejection – linking it to early experience, EMS, coping styles, and hypothesized temperament.  The personal label may also be helpful for linking the physical experience, as identified by the sensory system, i.e., locating the feeling in the body at onset and during escalations. The personal mode descriptor may also serve to remind us, as well as our patients, to mindfully anticipate (and review in the aftermath) the precipitating condition(s): those most likely to activate the anger mode, such as: being teased, ignored, controlled, or betrayed. Customized anger mode labels may be designed like this: “Bully Joe”, “Pressure-Cooker Peter”, “Seething Sue”,  “Little Angry Laura”, or simply “Tough-Guy”… “Stormy”… or “Cranky Pants”.

Given the nature of our species and the architecture of the primitive brain, most humans are likely to experience some degree of anger, agitation, frustration, and aggression – whether in the naturalearly years of development when frustration and discomfort is expressed in the form of wailing cries, moaning monologues of sounds and words, or even physical aggression. Differentiated in the treatment room, schema-driven anger is identified as marked intensity of reaction to stimuli (not necessarily loud or violent) typically linked to an overestimation of a  “threat” to their emotional survival, linked to the patient’s longstanding unmet needs and self-defeating reactive patterns of defiant detachment, controlling-demands, attacking-criticalness, internalized punitiveness, or desperate efforts to satisfy the need to aggress frustrations safely, as we find with BPD patients in the angry child mode.

Anger can cause great distraction for therapists, causing us to flip into our own maladaptive modes in order to protect us from sensed threats and schema-activated discomfort.  These modes thwart the sturdiness and realness that is necessary for the healthy adult caregiving role. When triggered, receptivity and accessibility for attunement and attachment healing is impacted, thus compromising our ability to help patients navigate the challenging freedom journey from prevailing maladaptive modes. Being stuck in our “lost adult” and maladaptive-reactive modes also impedes our capacity to model and co-construct adaptive, flexible, coping stances – necessary for engaging patients in getting their needs met in a healthy way.

Keeping a few (child and adolescent) photographs of your patient in the chart can act as healthy adult fortifiers for us, helpful reminders in session (as you look into the faces in the photos) and recall the stories of these suffering and vulnerable parts that lie beneath (noisy, obnoxious, cynical, raging) angry over-compensators, defiantly detached protectors, bully, controlling, and demanding modes; and to also remind us of the anger that lies trapped within the child who was not only deprived, abused, or abandoned, but also suffered the absence of the natural relief that comes from the freedom to naturally express frustration without harming or neglectful consequences… anger that is met with embrace, empathy, and healthy constructive discipline.  

The ongoing maintenance of our wellbeing as caregivers is imperative to the effective discernment and engagement with this important emotion when it shows up in our treatment rooms. Self-therapy, supervision, and personal therapy are a few of the ways we can remain steadier (not robotic) and also informed by our humanness (our own vulnerability) and thereby appreciative of the impact the patient’s anger may be having on others in deleterious ways.  

Sturdy and secure in our Healthy Adult caregiver modes, and with a keen conceptualization of schemas, modes, and unmet needs of our patients, we are better able to extract the meaningful messages imbedded in the anger that is being used to block emotions… maintain rank/status… protect against shame/loss/abuse… aggress punishment in the name of injustice, control, or impulse… or simply release frustration in a safe place.  

Coming Soon – Paper in Press:

Beyond the Angry Child: A New Conceptualization of Anger Modes and Their Treatment by Dr. John Gasiewski and Wendy Behary

Why Schema Therapy?

Schema therapy has been extensively researched to effectively treat a wide variety of typically treatment resistant conditions, including Borderline Personality Disorder and Narcissistic Personality Disorder. Read our summary of the latest research comparing the dramatic results of schema therapy compared to other standard models of psychotherapy.

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