An Apology For Anger ManagementMark Dombeck, Ph.D. Updated: Nov 4th 2003NPR recently ran a news story about Anger Management, a recent form of psychotherapy that has sprung up to offer a treatment-based alternative to jail for persons caught displaying overly aggressive behavior. That radio story took a skeptical tact towards the subject, pointing out that courts are increasingly viewing anger management programs as an alternative or adjunct to jail, and raising the important question of how such a practice could be justified when there is a lack of compelling evidence that such programs actually work. This is a good question I think, deserving of an answer. But it is also a loaded question that (in my mind at least) tries to reduce the issue to a yes or no answer ("Do Anger Management programs work or not?"). Answers to questions about treatments for human problems are never so simple. There are lots of treatments in the world, but few of them are truly cures for particular human problems. Instead, most of the time, we judge the effectiveness of a treatment based on its probability of being helpful. Radiation and chemotherapy are quite useful interventions that physicians use to help kill off patient's cancers. Such interventions work much of the time, but sometimes they don't and people die. No one would suggest that radiation and chemotherapy should not be used in the fight against cancer simply because they do not always produce a positive result. Treatments for out-of-control anger can be seen as analogous to treatments for cancer and should be held to basically the same standards. An effective treatment for anger problems should: 1) lessen anger problems in some reasonable percentage of cases and do this more consistently than other humane interventions, 2) not make anger problems worse, 3) be cost effective to deliver. In my experience, today's anger management programs meet these criteria fairly well. They certainly do not 'cure' people of anger problems, and they probably don't even reduce acting-out behavior in a good chunk of the people who participate in them. However, anger management's positive message that behavior change is possible and the detailed instructions it provides for how to achieve this change do get through to some participants and change their lives (and the lives of those around them) for the better. Regardless of the argument you prefer (that anger management is more humane; that it is less expensive to deliver than jail), it only makes sense to funnel 'angry' offenders through anger management programs a few times before finally jailing them (when that is ultimately necessary) in the hopes that some of them will see the light. At the risk of setting up a 'straw-man' argument, anger management is more humane and less expensive than jail. Anger, basic emotion that it is, is largely provoked by social situations; it is often a reaction to feelings of powerlessness, feeling taken-advantage-of or feeling disrespected. Anger management programs provide a positive message to participants that behavior change is possible, and that further problems are avoidable. This message is provided in an inexpensive therapy setting; there is no need to provide for costly meals or housing or security as is the case when jail is involved. This positive intervention contrasts sharply with incarceration which basically suggests to people that they are bad-to-the-bone criminals from which society must be protected. Which message do you think is more likely to fuel feelings of powerlessness, being taken advantage of and being disrespected? Which message has a better chance of dissolving such feelings? How Your Basic Anger Management Program Works There is no fixed definition of what treatments an anger management program should contain. However, most anger management programs are built around well-understood cognitive-behavioral approaches to behavior change which are known based on scientific evidence to work well for helping people to deal with out-of-control emotions (e.g., anxiety, depression). While such approaches may not be thoroughly understood as they apply to anger just yet, their pedigree is impeccable. The basic cognitive behavioral approach (whether applied to anger or anxiety or depression) goes like this. - The therapist invites the patient to view their problem as a behavior somewhat separate from themselves. In this way, patients are freed from feeling bad about themselves as people and can focus on their behavior in a more dispassionate way.
- Over multiple sessions, the therapist teaches the patient to become increasingly conscious of how their problem behavior manifests.
- Thoughts and actions that lead up to the problem behavior are identified and mapped out so that the whole typical chain of events that leads up to their getting into trouble becomes visible.
- Thoughts and beliefs that trigger the problem behavior (e.g., "I must defend my honor at all costs") are identified and systematically challenged.
- Situations that are associated with problem behavior are identified (e.g., "You tend to get into fights while drunk - so work on getting sober or at least stay away from bars")
- Feelings that may have been 'unconscious' before are identified and systematically charted. It is not uncommon for angry people to be unaware of carrying around a lot of resentment and irritability.
- Also, the patient is encouraged to become increasingly conscious of the consequences of their acting out and to break through any 'denial' they may have as to their invulnerability. For example, that continued aggressiveness may result in jail time, and that no, jail time is not worth the brief rush of aggression-related pleasure.
- The patient's increased awareness of how they get themselves into trouble (assuming it grows) helps them to anticipate trouble earlier and earlier and enables them to take steps to avoid it. For example, it may dawn on the angry person that going out and getting drunk in a bar where they have been in fights before may be a bad idea, or that they don't have to become personally offended when someone cuts them off while driving.
My own experiences helping to deliver a cognitive behaviorally informed anger management therapy suggest to me that this type of therapy, designed as it is to help open up a space in the patient where self-regulation can occur, does indeed help some people even as it goes in "one ear and out the other" for some others. I recall one man (incarcerated several times previously and looking to avoid that fate again) who listened attentively to our presentations, even as I recall another man in the same group who stuck to a macho posture and rejected most everything we said. I don't know that we helped either of these men for sure, but I suspect we helped the first guy move along just a bit in his path towards a less aggressive life. Letting Go Of Anger And Aggression Is Difficult I respect the idea of anger management and definitely think it is what we should be offering angry people, even as I myself don't hold out hope for it being a perfect therapy that helps all participants. This is because it is really hard to get even motivated people to change how they handle anger. There are multiple reasons for why this is so. - Anger is a seductively attractive emotion to have. In many cases it feels good to be angry. It involves a positive "rush". When you're rushing, you aren't much aware; you're too full of yourself to be aware at that moment. This rush, this lack of awareness (certainly lack of awareness of the larger implications of your angry outburst) is what needs to be overcome when treating the angry patient. Because these feelings are intoxicating, and because some people lean on anger as a crutch so that they don't have to feel shame, it is particularly hard to get people to let go of their angry displays.
- Anger often involves a feeling of righteousness; of being more powerful than your opponants by virtue of your being more right. Many aggressively angry people know when they are behaving badly but don't care too much about it because they believe they have a right to act that way because they are more right than the people they are aggressive towards. Anger management protocols ask angry people to give up that rush of righteousness for sober rationality that says to them, "give up your aggressive displays so that your life will become less contentious over the long haul". This is essentially an argument for delaying gratification in the service of a better life. But a lot of angry people don't want to delay gratification. They want gratification now and they think they have a right to it.
- Anger is a social emotion deeply bound up with identity and therefore with power relationships between people. Anger can be sparked in relatively powerless people as an alternative to feeling powerless. In this sense anger becomes a life-raft for self-esteem. And if some people take anger too far into aggression to the point where they becomes a threat to society, this doesn't change the fact that the angry person will work to hold on to their anger so long as they see anger as the best prop available to hold up their self-esteem and shield them from uncomfortable emotions like shame.
- There is also an epidemic of people out there who don't know how to be angry without being aggressive at the same time. In my experience, many people learn from their social environments that one is either passive or aggressive, either acted upon, or an actor. Given such stark alternatives, it is little wonder that some people opt to become aggressive. It's a lot to expect that an anger management treatment can be effective when one is working with someone who cannot even conceive of a non-passive (e.g., assertive) alternative to aggression.
Motivation Is Key To Change So there are a lot of reasons why people cling to anger even when it doesn't work for them. Any therapy that is going to tackle such a stubborn problem needs to be understood as something that will work best when patients are motivated to change, and will work worst when they aren't. Therapy isn't like dog training or jail. When training a dog or dealing with a prisoner, you can impose fairly tight outside control over rewards and punishments. Reasonably smart dogs and prisoners learn the rules and figure out how to behave in order to gain reward and avoid punishment. In therapies like anger management, however, the only real control over behavior is owned by the patients themselves. Patients are horses that are led to water; only their own hunger will determine if they will 'drink'. My sense is that anger management will turn out to be about as effective as are programs for helping drug and alcohol addicts to kick their habits. People going through a drug rehab program aren't really expected to become clean and sober their first time through. It is pretty much expected that they will relapse. But when they do relapse they can get back to rehab, and in the process of repetition more and more of the wisdom of 'sobriety' tends to become apparent. Some people don't see why they should give up drinking or druging until they have sustained major losses and are facing jail time. Others never see. As is the case in drug rehab, many angry patients probably won't 'get it' the first time through an anger management program. However, this doesn't mean that such people can't be helped. Experience with consequences will help their motivation, as will the availability of second chances and repetition of therapy. I'm sounding negative on anger management's ability to be helpful and I don't mean to be perceived that way. I think anger management is a great thing and that the principles (at least those taken from cognitive behavioral therapy) will prove to be sound. No treatment is perfect. I'm confident that anger management programs will undergo an evolutionary process so that they will become more effective therapies. But to expect them to be cures for inappropriate anger and aggression, now or at any time in the future, would be unrealistic. A lawyers take on the shift to non-custodial sentences - Ahmed Uzair - Mar 30th 2009
Harmony for sentences of similar nature handed down by the Judiciary is governed by Judicial Studies Board guidelines. The truth is the nature of sentence is widely governed by government policy. For instance these days knife crime by a youth, even if he/she is a first time offenders would warrant a custodial sentence these days because of the proliferation of knife crime.
Secondly there is a wide belief amongst the judiciary, as well as the government that custodial sentences don't work. Repeat offenders rarely mend their ways on their own even if they are given heavier custodial sentences. And hence the consequent prison over crowding.
A few years ago there was a report that pointed to this fact and thereafter a decision was made to hand down non-custodial sentences wherever possible. It is not a question whether sentences such as Anger Management Classes works or not, it is whether it is likely to be better than a custodial sentence. The answer, as proved by the report is always yes and for this reason the probation service never suggests custodial sentence.
Barrister Ahmed Uzair Is there any hope for me? - - Oct 3rd 2008
Greetings all, To make a long story short, I am in self imposed anger management therapy in order to get some help with a nasty written overreaction towards "big brother" Not pretty, not entirely justified, not the way to solve a problem, but I did it, and I don't want to do it again. And I now have alot of trouble that I do not need. My question is the following; is it normal to be made out to be a perpetually deeply angry and dysfunctional person when involved in therapy? I actually have to come up with weekly examples of how I got angry and how I dealt with my unjustified angry emotions, what I had learned from the experience, but the problem is that I don't regularly "pop a cork" or get upset at the drop of a hat. I actually have a fairly routine and good life. So now, I am viewed as hiding something or being uncooperative etc, and I truly want to participate. Making up stories would be unethical. I cannot blame anything on my upbringing or social circumstances, but this seems to be the theme of the therapy. I have attempted to explain but to no avail, that lingering suspicion of the Dr Jekyll and Mr Hyde stereotype still manifests itself...... If anyone can provide any insight, please do. Perhaps it will help me sort out my newly confused state of mind. Thanks Response to poor treatment of son in Anger management class - Ari Novick, Ph.D. - Jun 6th 2007
I suspect that your son was in a class with an instructor that was not trained well or had little to no training at all in anger management. I am the co-founder of Century Anger Management, one of the leading anger management certification organizations in the nation, and I can tell you we do not train providers to behave this way. I also know that other training organizations in anger management do not teach their trainers to behave this way either. While there is no excuse for this rude and inappropriate behavior, it is likely that he (your son) will not encounter this again if he attends a class by any anger management professional that has had 40 hours of certification training, uses a structured curriculum, and gives a pre and post assessement. Ari Novick, Ph.D.
www.ajnovickgroup.com
www.centuryangermanagement.com
www.angerclassonline.com Re: Is there Hope - Janet - Julie Christiansen - May 11th 2007
In response to Janet's question, "Is there hope?" - that doesn't depend on you so much as it depends on your boyfriend. You say he doesn't think he has a problem, and is not interested in therapy. That doesn't bode well for him changing his behaviour. Too often we women think that if we love someone enough, or we just do the right things, we can change our man. This is a fallacy that has been perpetuated for generations. The truth is that the only one who can change your man - is your man. I would suggest you think long and hard about whether or not you want to marry this man who has already demonstrated to you his inability to appropriately express his emotions, and his unwillingness to change. While you have a daughter together, that is no reason to compound issues by getting married. Your gut is giving you guidance - you should listen. I agree with the other contributors on this site - there is help for anger issues, and it does work given the right circumstances (a motivated, committed individual who is willing to do the work required to change, plus a qualified counsellor or coach with a proven system). So - yes, there is hope, but only if your guy is willing to make the change. Never an Excuse - John Elder, Marriage and Family Therapist - Apr 16th 2007
Regarding Verbal Abuse by instructor - Mary Fowler - Jun 14th 2005, there is never an excuse for this type of behavior. Anger management classes need to be facilitated by people who know their own anger, know their own buttons, and have learned to manage them. To behave aggressively and abusively to a student in a class violates professional ethics and common courtesy. It reveals an inept instructor who has not yet mastered even the rudiments of anger management. This is why it is so important that anger management facilitators be certified. Certification, such as completing the world-recognized Anderson & Anderson training program, ensures that a facilitator has at least learned minimum standards of professional behavior and is working with a proven curriculum. Years after completing my certification, I continue to do research, to read the latest articles, and to participate in continuing education classes. Although not everybody who facilitates anger management needs to be a licensed psychotherapist, those with licensure are bound to high levels of ethical and professional behavior. Mary, I'm sorry your son was abused in a class that should have instead modeled an effective way of managing and containing strong emotions. On behalf of the entire anger management community, I apologize. John Elder, MA, MFT, CAMF
Anger Management can work wonders - Shannon Munford M.A. - Mar 14th 2007
I've seen countless families put togehter because of anger management treatment. Teenagers have found a productive way to communicate to their parents and Couples realize destructive behavior patterns can be changed. The effectiveness of the program is determined by the instructors use of a sound program. Shannon Munford
www.daybreakservices.com Verbal Abuse by instructor - Mary Fowler - Jun 14th 2005
My 21 year old son went to anger management class last night and came home in tears. The instructor singled him out by cursing; calling him names and belittling him in front of others also told him he would not give any credit for his class. It was his first time there first offense and we do not know if this in normal for a class please help. Is There Hope - Janet - Dec 2nd 2004
Help! My boyfreind of two years has a severe anger management problem. On the beginning things were beautiful. Now all we do is fight. We have a 7 month old baby girl and I'm afraid of what she will learn as a result of his anger. He isn't and has never been physically abusive but the verbal abuse hurt just as bad. He proposed to me last year and we planned to get married. I'm now too afraid of what life will be with this man that I still love so much. He doesn't think that he has a problem and thepary - yeah, right! I don't know if there are any medications out there that will help him. I'm at a lose, but I want to make it work for him, for us, for our little girl. Is there hope? Anger Management IS Effective - John Elder - Sep 8th 2004
I facilitate anger management classes. I've authored and contributed to anger management curricula. My research has turned up a number of studies that point to effective outcomes for anger management classes: reduced second heart-attack rates, lowered blood pressure, and, with cognitive-behaviorally based classes, a strong effect in lowering volatility.
But beyond the studies, I know that anger management classes work. I'm an angry son of an angry son of an angry son of ... I stumbled into learning how to control my anger, not just in certain situations, in all areas of my life.
Whenever I facilitate a class, it changes me. I find myself applying what I teach more and more in broader situations of my life. My family greatly appreciates it. Other drivers have no idea how much they appreciate it. Most of all, I appreciate it.
Most of the people I've worked with have mastered skills in anger awareness, stress management, emotional intelligence, and respectful communication. They have reported changes in their lives.
Anger management, properly facilitated, makes a huge difference.
Read more at my Anger Management in Real-Time blog. My spouse is Living Proof - Sm - Jul 24th 2004
After years of abuse, mental, physcial and emotional after 2 tries at marriage counseling my spouse decided to go into Anger Mngmt counseling. Working with a AM Counseler in No. Va for a year I'm Happy to say that its been 6 years and all the above is gone. We have fallen in love again, we have been slowly changing the damage that was done to our children, now both young adults, my spouse handles difficult situations and stress in a much more positive way. Was it a 'cure all' or a 'quick fix'? NO. Does my spouse ever have a day where they are Grumpy? Yes, we all have bad days. Controlling ones self is a daily job for those with True anger issues but that program gave my spouse the understanding of where and why and the tools to control and express anger in a positive way. It saddens me to think of where we would be without the help that was recieved thru Anger Mngmt. A much needed response - George Anderson, MSW, BCD - Mar 24th 2004
I am one of the persons interviewed on the NPR program. I only wish that I could have provided this response while on the air.
Please join our organization. American Association of Anger Management Providers:http://www.angermanagementproviders.com. I agree - Chrissy - Dec 5th 2003
I also agree with your statment that after anger management therapy some subjects tend to not be as physically violent but instead take their anger out in other forms of abuse such severe verbal abuse and mental and emotional abuse. My husband has gone through anger management and although he no longer breaks the house up or puts his hands on me he instead takes it out in other ways. He goes through verbal abuse and threatens or curses and belittles. I am not physically afraid of him and never was but I am greatful for the fact that he doesn't smash things anymore but not to sure if it was enough help. anger management and domestic violence - kathryn - Dec 5th 2003
As a provider of services to victims of domestic violence I often work with clients whose partners have been referred to "Anger Management" by the court system. My belief is that the term "anger management" is a misnomer in domestic violence situations. The courts are beginning to change their language to Domestic Violence Offender Treatment (DVOT)in recognintion of the fact that most perpetrators of DV are able to control their anger quite well when it suits ther purpose (for example when the police arrive.) The DV perpetrator is motivated by a need for power and control over their victim rather than a lack of control over their anger. I do not consider anger management to be an effective form of intervention in cases of domestic abuse, although some research indicates that offenders who complete treatment are less likely to end up back in court. The majority of victims that I have worked with report that their partners either do not respond at all to treatment or they simply modify their behavior (stopping physical abuse but increasing other forms of abuse.) However, until an effective alternative form of intervention is discovered, I support the use of court mandated offender treatment as a means of holding perpetrators accountable for their behavior. More Feedback - dianne - Nov 18th 2003
I've been facilitating an anger management group for the Department of Juvenile Justice for over five years, and while I do see some repeat offenders, overall those kids do not return to the class. In fact I often receive inquiry calls from people in the general community who have heard anger management success stories from friends, co-workers, even their childrens' teachers. This tells me that we must be doing something right. Maybe planting a seed of self-control with the youth of our country will prove to be a bit of preventive medicine. Positive Feedback - Ken Belmore - Nov 17th 2003
Hi Mark,
I too heard the NPR report recently on the effectiveness, (or lack of effectiveness), of anger management programs. And being in the business of delivering anger management treatment, I was both disheartened and intrigued. Your commentary puts this topic into focus. The analogy with drug and alcohol programs is certainly appropriate. Unfortunately, as we both know, those programs have only limited success with those persons who are motivated and almost no success with those who aren't. And you're correct: the same trend will prove to be true with the anger management programs. Still both types of programs have positively changed the lives of many people. Even a success rate of 20 percent means 2 less self-distructive persons out of 10. I'll take that percentage while we aim for better programs that might get us up to 30 percent. But to throw out the treatment of anger management because it hasn't achieved a success rate of say 50 percent- is simply looking for the silver bullet that can never be found. ANGER MANAGEMENT - felicia - Nov 8th 2003
i was highly disappointed in the realization that anger management programs have low long lasting results. this appears to be a area in adult behavior that needs to be addressed in order for all of the domestic violence to cease, or at least be greatly reduced. An Apology to the Mental Health Workers - Peter Sewall M.A. - Nov 8th 2003
All mental health programs will improve once society views mental health as a viable treatment. People expect to get better when they see a medical doctor. Expectation is a key factor to change. The mental health worker is vastly underpaid in relation to other professions and many of the best move on to greener pastures. We do not spend time in schools teaching children about mental health and generation after generation still sees receiving mental health as a social stigma. Besides, people are now losing their medical benefits because they have received mental health services. The true problem about anger management programs is that we have not developed a social expectancy to successfully treat others. | 
Mark Dombeck, Ph.D. is Director of Mental Help Net (a public service of CenterSite.Net - a provider of website and internet services and educational content to employee assistance and behavioral health organizations), and a licensed Psychologist in the state of Ohio (License #5698).