 We demystify what goes on behind the therapy room door. Join us on this voyage of discovery and co-creative conversations. This is The Therapy Show, behind closed doors podcast, with Bob Cook and Jackie Jones. Welcome back to episode 41 of The Therapy Show, behind closed doors with Bob Cook and myself, Jackie Jones. And this week, we're going to be talking about how do we work with the angry client. Interesting. It is, it is. This was one of my big fears, I think, when I first started working in private practice from home. Yeah, yeah, I understand that. Yeah, I've never come across anything untoward while I've been practicing psychotherapy, but I must admit it was one of my main concerns. Well, yeah, I can understand that. I think having your own office provides us a level of safety and security. Yeah, new way. Yeah, I always felt safe when I was practicing from lip, yeah, because there was always somebody else in the building. That's right. Yeah. Okay, let's look at these types of clients. Now, when people talk about expression of anger or lack of emotional regulation, so the person, I've got something in my mouth. The most important thing to bring out, I think, is the contract you have with the client in the first place. Yeah. So, you know, we get many people who phone up or over the years want to deal with anger issues. That's absolutely fine. And that's addressed in the contract. Now, I know anger can come out in the third boutique process and there's other contracts, but quite often people come because they have anger issues or feel overwhelmed with anger issues. And so there's a contract around that. Yes, yeah. And built into that contract, as I hope with the therapist, is what's acceptable and what's not acceptable and spelling out boundaries before they even begin. I have that in my contract, definitely, yeah. How much do you have? There's something about no physical contact or, you know, damaging property and things like that. I have been known on the odd occasion to let a client lob a cushion down me hallway. But yeah, no physical contact whatsoever, basically. Yeah. And that's really in any contract, I think, especially if it won't take anybody on who's dealing with so-called anger issues. I'm glad you said so-called anger issues because a lot of people that come for me with anger issues, they actually say it themselves. Do you know what I mean? I have anger issues and it's been anxiety or fear that's been underneath. It comes out as anger and aggression, but I've not found them to be angry at all. Yeah, well, you're probably talking about a piece of theory. I mean, you trained as a transactor analyst, so you may think this way, I think. The way you're talking anyway, it's about rackets. Yeah, yeah. Now, for those people listening who aren't TA therapist, might not know what rackets mean, but in the world of TA, a racket is a substitute feeling. Yeah. So, if you weren't feeling angry, what would you feel instead? It might be a question you would ask at the contracting stage. Yes, yeah. For example. Yeah. So, quite often, it isn't the presenting anger is the underlying issues. The anger is the racket or the substitute feeling. And what's underneath that might be sadness, fear, anxiety, frustration. Yeah. Any of these underlying processes. So, that's where you need to get to. Yes. That's what I've found with people that actually come themselves and say, I've been told I've got anger issues and I need to come and, my wife has said, I need to come and speak to somebody because I've got anger issues. So, in the contracting, contracting is important though. Yeah. Oh, definitely. Yeah. In terms of keeping yourself safe and what's acceptable or not acceptable boundaries written into your contract are here as yours about. And most of it is actually about keeping themselves safe and what's acceptable and what's acceptable. So, that's really important. And anybody comes with anger issues. I think the contracting stage is important in that sense. Yes. Another aspect about people who may express anger as their major emotion and the other emotions are missing is an inquiry into a person's history in terms of what's been modelled down to them. Yeah. Because if anger was the major currency of the day in the family of origin. Yeah. And they may have taken on that modelling as a way of making contact or solving problems or in fact as a way of being. Yes. They may not have any permission to be sad or to be frustrated or to be frightened or anxious and being angry was the major port of call which is why I think the theory of rackets is really interesting in TA. Yeah. Because if somebody's got a prominent emotion, whatever it is, we're talking about anger here, then it's the missing emotions which you need to get to. Yeah. I love the back-it system. I use that an awful lot with clients. Yeah. And I relate to it personally as well. You know, as a parent, often we say to our kids, don't be angry, don't be sad. So it's like, okay, I can't be sad and I can't be angry. So what can I be? I can be scared or I can be happy. So we kind of, exactly like you say, we substitute one feeling or emotion for another one. Oh. Yeah. So I think that's really important. And in my experience, it's usually the hurt injury in the child where you get to the child ego state I'm talking about developmentally. Yeah. That is often covered up by expression of anger, which I need to get to. Now, as I said, it's really important the beginning here in terms of keeping yourself safe. So somebody lacks emotional regulation and starts getting angry in a very sort of outrageous way. Then the therapist needs to move to a keeping themselves calm and also feeding back to them. Yeah. What their behavior is. So even if you fed back, when you do, you know, I'm experienced your behavior is quite scary here. Do you know that? Yeah, example. Yeah. Because 10 to one, what they're doing with you, they'll be doing another relationships. And probably that's why they've come in the first place. Yes. Yeah. I think the only one that springs to mind, specifically, and it was it was anger, but it was specifically about road rage. That was the reason why he came was road rage. He just loses the plot if anything happens when he's on the road in the car. He was traveling long distances. If it was a traffic jam or if somebody cut him up or anything, he would he would feel himself get absolutely irate while he was driving. So you might do a bit of educative therapy there about teaching him how to regulate his emotions. Yeah. One thing if you want to do that. Another one would be if you weren't feeling angry in that car, what would you be feeling? And explore that. So I don't know which way you went, but you could do both. Yeah. I think we had lots of conversations. He was funny. I think I don't know if it was the last one or the one before that we were talking about art therapy. He was he was very reluctant to talk about a lot of things. It was like it was hard work with him. Let's put it that way. But yeah, I ended up saying because he traveled a lot and he was paid for traveling. So he got a daily rate. So it didn't matter how long he was sat in a traffic jam. He got paid. And that was where the conversation went in the end. I was saying but you get paid the same amount if you stood still in traffic or whether you're humping things up and downstairs. Have you ever thought about it that way that you're actually being paid by your employer to sit in traffic and listen to a radio or contemplate your navel or whatever you're doing? Yeah, that's an important technique reframing. Yeah. I think, you know, working with people who are often angry in the way you described it. It's a really important technique to reframe the way you did there. Yeah. Yeah. I think, you know, I have worked with many people with anguiduction. As I say, I usually think of rackets, go to substitute feelings, look at the developmental hurt and look into the feelings underneath the anger. Yeah. Okay. Do you just focus on the anger or do you focus on the situation around which they get angry? None of you always look at, well, they come together. Okay. So if you say, you know, tell me a little bit about, you know, when you particularly get angry or what triggers you in the here and now, where you feel so overwhelmed that you have to be angry and you can't control that anger, could you tell me a little bit about what triggers you in the here and now? Yeah. Like if that's what you might situate. That's particularly what I was thinking about, you know, certain triggers. I work with a lot of alienated parents where, you know, they haven't got access to the children and they're really angry towards their ex-partner and get triggered really easy around anything to do with that. Whereas, you know, in other walks of life, they're absolutely fine. So it's quite specific with some people. Yeah. So I suppose number one would be contracting. Yeah. Keep yourself safe, boundaries what's acceptable and what's acceptable. Yeah. Or contract around that. Number two, if a person starts to get angry, keep yourself calm. Yeah. Number three, if they continue to be angry, you need to feed back to them what their behavior is like and how it's impacting them. Yeah. And what's them to change that behavior and also link it in. Well, is this what you're usually like then? Yeah. So you're, you know, you're actually getting to some frame of reference in the process in terms of, well, what's happening here? Is that what's happening there? Yeah. And usually when you do that, people are able to move to their thinking or their adult place quicker because they put the two and two together. Yeah. Another thing I tend to do with them is ask them, how would I know if you got angry with me in the room? What would I see? That's a good question. Which kind of gets them to really think about the behavior and what goes on in the body or sort of thing. You know, like if I said something now and you were angry at me, what would happen? What would I see? Oh, that's right. So that's another good way. I usually had developmentally, though. Yeah. I want to find out, well, you know, was it modelled to you to be angry? Yeah. To get your needs met. When you were angry, were other needs not seen? Yeah. Would you be angry to, you know, get heard and understood? If you weren't angry, what would happen? So I do a lot of developmental work and usually, as I said, the anger usually is a racket or it's modelled down to them as a way of getting their needs met. Yeah. And often anger sometimes and especially with borderline clients, for example, when there's a borderline switch, which is usually involving extra, you know, anger, you know, frustration or attacking transactions that are the therapist, it actually usually is a real desire to make contact, but they don't know how to do it. Yeah. I found that with a lot of the foster kids that we had. It was their only way of communication sometimes. I think it's really important for therapists to do that developmental work, but I do want to stress that if the if this person is getting an anger in their room, you know, in the room, I think it's really important for a therapist to say that transaction I said earlier, it's just the anger issues that you're talking about. You've come into this therapy to resolve because actually you're, who are you behaving now? I feel quite scared. Yeah. Are you aware of that? Yeah. So you're shifting them to thinking? Yes. Yeah. Yeah. Because touching on what you were saying then is a form of communication, you know, the strokes, any stroke is better than no stroke. So you can imagine a young child if they've got attention for being angry or having a tantrum or throwing something, that then becomes kind of internalised that that's if you're not listening to me, this is what I'm going to do to get your attention. That's right. And in the process, other needs can often be missed. Yeah. Yeah. And I think if one person, you know, comes to therapy with one expression of emotion, it usually means that other parts of the self or other emotions are hidden. Yes. So you need to get to what's beneath the anger. Yeah. When you get to the hurt part of the self and you start dealing with that, usually the healing happens there and then the anger can, well, the anger dissipates or because the real feelings get dealt with. Yes. Yeah. That's the developmental approach. If you stay in the here and now, you definitely, I think it's important to contract and keep yourself safe, keep yourself calm, reframe the process. If you're still having problems, go to supervision. Talk to the colleagues about it. And last analysis, if you still can't get through that process, you can always terminate the say, well, I find it quite hard to work with you because you don't listen to the contract we make. You keep doing XXX. It's quite scary working with you. Are you aware of that? And all those things don't work. Yeah. Pass them on. Yeah. Yeah. Again, that's it. And I think, you know, your own safety has to be paramount in that situation. You can't be putting yourself at risk exactly like you said in a therapy room. My experience, though, nearly always is if you go developmental, yeah, help them understand how the past affects the present. Yeah. You usually get to the feelings which are underneath the anger. Yeah. You didn't mention something I think also is really important and another tack as well is helping them identify the triggers in the present. So they can work out how the past affects the present and how the present affects the past so they connect the two. Yeah. Yeah. I think that's really important. Yeah. Definitely. There was something else I was thinking. Oh, yeah. I know we're talking about the angry client or clients who, you know, lack of emotional regulation, but there are some clients who find it really hard to express anger, which is completely the opposite. But it is an interesting one because you do get clients who come and say they have anger issues. Yeah. And when they walk in, you can tell they have anger issues because, how can I explain this to you, there's a sort of passive aggressive stance. Yeah. And the best way to, the best metaphor I can think about is a pressure cooker. Yeah. And usually I say to them, you know, you seem quite angry even though you're talking, you know, in a calm way or whatever way I say it, but you know, do you have a situation like a pressure cooker where there's a lot going on in your pressure cooker? Yeah. And you're attempting to keep it all in and then something could happen and then it comes out like an intense fury. Yes. And I help them, I help people look at what's in their pressure cooker because most people don't want to, I mean, the example you gave in the cars and interesting, but you know, people don't want to be angry. No. Usually they want to try and solve this. And I think, as I just said, the developmental way. Also, another interesting question to ask yourself is, whose anger is it? Yeah. Yeah. Particularly when you were talking earlier on about how it was modelled and how emotional regulation was modelled and things like that. Yeah. Totally. Yeah. So they may have been brought into an angry household that far uses anger as a way of getting control, for example, or solving problems. And then the child thinks that's the only way to, you know, act or behave or feel the situation. And they sort of take on the significant others, you know, actual anger. And it's not as anyway. Yeah. That's quite an interesting concept to try and explain to a client sometimes. It's a slow burn of that one, I find. Well, I think if people listening to this podcast think developmentally and help the person look at how the past effects are present. Yeah. Then you're going to get there, aren't you? Yeah. Yeah. Flashing of lights have started up here. Hello. It's like the illuminations. Yeah, they are. We're having a disco, Bob. What's going on? Yeah. One minute. I've got discos. Let's see if this is better. For those that are listening, they can't actually see it on the video. Bob's lights are flashing on and off. It's like there's a bit of a disco going on in his kitchen. Yeah. What's happened? Oh, I don't know. What's happened? Anyway, let's hope that solved the problem. I'm back again for the people who are watching me on people listening to me. Somebody who doesn't like you talking about anger. That's what it is. Yeah. I haven't got angry about it yet. No. So going back. So I think that developmental is really important to think about who's angry it is. Well, that's another road to go down. And usually, if those two connections add up, then the client can give back the anger that wasn't theirs in the first place. Yeah. Because learning how to regulate our emotions is a developmental thing. There is a period of time where we learn how to express our emotions appropriately. And if it's not handled well at that age, then how are we supposed to know what is okay and what isn't okay? Yeah. So you might actually, as they make those connections, teach them that. Yeah. So there's a lot to do in therapy, I think with people who come specifically with anger issues or and it comes up in the therapeutic process. Yeah. Yeah. And the end of the day, though, for people listening, the therapist's stroke counts the safety is paramount. So if you really can't get through this, whether to think of helping the person developmentally through this, taking the supervision, talking about the issues with them, then you need to, you know, not continue. You need to stick to the boundaries, the contract that you've set up. Yeah. That means referring on. It's really important you do that. Yeah. Definitely. Yeah. I don't know any statistics about anger towards clients. It's not something that I looked up before. I'd like to think there isn't many instances of actual physical aggression within the therapy room. No. I mean, I work for 30 odd years. And the other thing is, of course, you know, in many cases, their anger might be valid. You know, the other things, if you start, but you need to start tracing back to the context of all this. Yeah. So if you, you know, whether you work relationally or not, you know, might work relationally and say, well, what I do is that I feed back to the person in the relationship in the room. If they're starting to get to angry and unacceptable levels, but I'm feeling scared. And are you aware of this? And this is, and these are the issues that you come in the first place. And that can get perhaps to the here and now issues about failures in relationships and what they, you know, what they do in acting out and other circumstances. Or you can go developmentally. And as they start putting these two connections together and they start healing at the feelings which are under the surface, then the anger dissipates in the present or you can teach them triggers. But if none of those processes work and you feel you can't go any further, then you need to end it. Yeah. Yeah. For both parties, because if what you're doing isn't helping any, then it's, you know, it's obviously outside of your skill set. And it's only, you know, it's ethical really to refer on. Yeah. Emotions are very complex anyway. They're the best of time. Well, quite. And I always feel like with people who feel trapped and find it very hard to express any other types of emotions. So, you know, relationships break down, for example. I think it is important to come to therapy and explore them, but there needs to be a well worked out contract. Yeah. And not just to, especially with these clients, not just to, you know, go really nearly into it. Have a contract work out and see it all about. And that will give you the space to do the developmental work, to trace it back, look at the connections past and present, look at the triggers before going any further. You've got an actual contract in place. Yeah. And it's important to discuss that contract as well and why it's there, the purpose of it. Yeah. Absolutely. And you said something very important at the, right at the beginning. And that was about working at home. Yeah. Now, if any, if you don't want to see people with anger issues at home, don't. Yeah. That's not to people working offices, where there's people around. Yeah. And the other thing, which is, again, I don't know if you hear where you, perhaps can give me some information about this. But if I, if I was a supervisor and somebody worked at home, they would talk about working with some of the anger issues. I'd talk about, well, have you, you know, if you don't know this person, for example, and you haven't worked out contracts or even if you have, have you got, you know, have you got it worked out so people know that you're in the room working, that you've got a, maybe even a button that you could press and all these sorts of things. So the safeguarding of safety issues for yourself. Yeah. Are taken into consideration. Yeah. I was going to mention that about having a panic button, do you know what I mean? And things like that. But in the early days, when, when I was, you know, newly qualified and working from home, I think I was much more nervous about it than, you know, potentially what I am now apart from I'm only working online now. So that's not a problem. But yeah, I think as time goes on, you get more of a sense of the person when you meet them. Yeah. Yeah. Like that pressure cooker, you know, the sometimes I suppose it is anxiety when people are twitching and things like that. But you can usually tell when somebody's got that pressure cooker thing where they are starting to get quite angry with you. Yeah. And I think it's very good practice to tell peers where you are. Yeah. To, you know, if you, if you've been live alone, particularly I think it is good practice if you can have somebody panic button or some ways to talk to your supervisor about this. Yeah. Just work alone in your house with people with anger issues without these considerations being talked about with your supervisor. Are you right? I don't know. It's just the side of the probably very rare and they're really important to talk about with your supervisor. Yeah. And I think you again, you've raised a really valid point there that as psychotherapists, it's okay for us to pick and choose who we want to work with. It's okay for us to work with certain people and not with other people. And that's not to say that anybody can't get angry at any point, you know, so we can never be 100% sure. But it's okay to choose not to work with males that have got anger issues if you're a female working on their own at home. Absolutely. And of course, when you're working with clients, you know, as they're working developmentally, then those anger issues might come up, you know, as you go down the onion. And they're angry because of very valid reasons and help them, you know, express their anger in a safe way in a safe setting. Yeah, it's a different process because the, you know, the anger has come up in the therapy development, you've got a relationship and everything else. But for stranger walks in and says they want to work on therapy issues, I think you need to really think about it in terms of what we've just been talking about. Yeah. And again, you know, what you said then about, you know, the relationship, I think that's really important, you know, because it's a fine line in allowing a client to express the emotions freely in the room and know what isn't acceptable in the room as well. And I think that again is through the relationship that you build with your clients. And the contract. Yes. Yeah. So I really liked what you had in your contract at the beginning. I don't know whether you actually give them the contract on a piece of paper. Yeah, we assign it and they assign it. It's kind of a done deal. When you don't, you know, damage furniture, property, you don't, all the things we just talked about. Yeah, you've got a contractual process to be able to stop the process in a way. But I do think it's important to think, talk about these things with your supervisor. Definitely. Yeah, you're feeling comfortable or intuitively feel comfortable in any way at all. Yeah. Yeah. And trust your instincts. If you feel uneasy with somebody, then it's okay to not see them. It's, you know, it's a prohibitive that we have. Yeah. Thank you for that, Bob. That was really interesting. Place to stop. It is a good place to stop. Emotions and anger and things like that are perfectly human. You know, we can all do it at certain times. We've all experienced it. Yeah. So what we're going to be doing next time is silence. Silence. I was so scared of silence when I first started, Bob. The use of silence in the therapy. That was one thing that I really didn't, didn't sit well with me in the early days. So that's what we're going to be talking about the use of silence in therapy. Yeah. Okay, till next time. Thank you. Okay. You've been listening to the therapy show behind closed doors podcast. We hope you enjoyed the show. Don't forget to subscribe and leave us a review. We'll be back next week with another episode.