Tuesday, February 05, 2008

Responding to Client Anger: Cooling the Client Out vs. Therapist Mentalizing Self-Disclosure vs. Relationship Dialogue

Entry for 3 February 2008:

As noted in my previous entry, Peter Fonagy endorsed appropriate, honest disclosure of immediate therapist experience as a way of modelling mentalization for clients. It was refreshing to hear such strong support for the use of appropriate self-disclosure (or transparency) by a psychodynamic therapist.

Cooling the client out. Peter then went on to criticize the common therapist response to client anger of calm description of the client’s angry state. Speaking softly and gently to an angry client about their anger seems to me to be an attempt to deflect rather than to engage the client in their sense of my having violated them in some way, so I certainly agree that this is not a particularly facilitative response, and in fact I have sometimes observed this sort of response in person-centred counsellors as an attempt to use seemingly empathic responding to avoid real contact with the client.

Therapist mentalizing self-disclosure. Instead, he advocated disclosure in the form of “It’s hard for me to think clearly when you are yelling at me.” This is of course another example of his use of self-disclosure as a therapeutic tool to help clients develop their ability to internally represent the therapist. Interestingly, it’s also the classic “defusing anger” response advocated in 1970’s assertion training (a blast from the past!: Alberti & Emmons, 2001 [8th edition]) . It is certainly true that in situations in which I can’t think straight because the client yelling is scaring me, then I would certainly want to think about a disclosure of the type Peter was suggesting, but limiting my response to this seems to me to be not fully relational either, because I am still not personally encountering the client in their immediate distress.

Relationship dialogue. Therefore, I would also want to go on to work with this alliance rupture marker by engaging in a relational dialogue with the client. That is, I would prefer a combination of empathy and contact, rather having to choose one over the other. Thus, my preferred response, other things being equal, would be to say clearly and firmly while looking the client in the eyes, “I hear that you are feeling angry with me right now. Can we look at what’s happening between us that you are so angry about?” To the extent that I am able, I want to meet the client in their attempt to contact me via their anger, even as I realize that it is likely to be secondary reactive or primary maladaptive anger. Knowing the relational dialogue task process, I would expect the ensuing encounter to provide plenty of opportunity for the client and I to each represent our subjectivity to the other and to experience that subjectivity being received by the other. And I would also expect that the client’s initial secondary reactive or maladaptive anger to evolve through our exploratory dialogue into a more contactful emotion such as primary hurt and sadness or fear (other emotions such as primary maladaptive shame might also be present)

And of course, it would be important for me to do personal work (in supervision, person therapy or on my own) on my issues around anger so that I can face productively without counter-attacking or going into a placating mode.

Alberti, R., & Emmons, M. (2001). Your perfect right: Assertiveness and equality in your life and relationships (8th ed.). Atascadero, CA: Impact.

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