[xperiential Conceptualization and Treatment of Anger

Sandra C. Paivio
University of Windsor

An emotionally focused conceptualization and treatment of anger is

described and illustrated using the case examples of Celeste and David.
This approach is based on ongoing assessment of different anger pro-
cesses and states. Five sources of information for emotion assessment are
outlined. Assessment distinguishes between environmentally directed and
self-directed anger, between overcontrolled and underregulated anger,
between painful emotion and bad feelings, and between primary, second-
ary, and instrumental anger. These different processes and states call for
different intervention strategies. The three-phase process of emotionally
focused therapy for problems with anger also is illustrated using the case
examples. Intervention with David emphasized accessing overcontrolled
adaptive anger, whereas the emphasis with Celeste was on exploring sec-
ondary rage to access more vulnerable experience of hurt, fear, and
shame. © 1999 John Wiley & Sons, Inc. J Clin Psychol 55: 3 1 1 - 3 2 4 ,
1999.

Experiential therapies long have emphasized the centrality of emotion in human func-
tioning and psychotherapeutic change. The fundamental assumption of current emotion-
ally focused approaches (Greenberg & Paivio, 1997) is that the emotion system plays an
organizing role in an individual's experience of reality, sense of self, and orientation
toward others. It is only through accessing emotion and emotional meaning that partic-
ular problems, such as those described in the case examples, can be cured. The basic
organizing structure for generating subjective emotional experience is a complex synthe-
sis of affective, cognitive, motivational, and physiological information that provides each
individual with an integrated sense of himself or herself and the world. Emotionally
focused intervention, therefore, is closely attuned to the individual's moment-by-moment
subjective experience and involves deciding which experience to focus on in order to

• Correspondence and requests for reprints should be sent to Sandra C. Paivio, Department of Psychology,
University of Windsor, 401 Sunset Avenue, Windsor, ON, Canada N9B 3P4.

JCLP/In Session: Psychotherapy in Practice, Vol. 55(3), 311-324 (1999)

© 1999 John Wiley & Sons, Inc. CCC 0021-9762/99/030311-14
312 JCLP/In Session, March 1999

activate core emotion structures. Once this guiding structure is activated, we experience
our emotions and simultaneously access the associated multimodal network of informa-
tion. This information then is integrated into current construals of self and reality, and
maladaptive components of the emotion structure are thus available for exploration and
change (Greenberg, Rice, & Elliott, 1993).
Anger—in particular—is a powerful emotion that has a profound impact on self-
organization and social relations. Problems with anger frequently involve its overcontrol
(which disrupts orientation and produces stress) and its underregulation (which disrupts
interpersonal relations). These anger-regulation problems are illustrated respectively in
the cases of David and Celeste. Emotionally focused interventions typically emphasize
accessing overcontrolled adaptive anger and exploring secondary or defensive anger in
order to access underlying hurt, fear, or shame. These case examples also illustrate the
complexity of emotion assessment, because—along with a whole range of other feelings—
many different anger states and processes are frequently present in a single case of ther-
apy. Appropriate intervention depends entirely on accurate assessment.
Three basic types of emotion have previously been discussed by experiential theo-
rists (for example, Greenberg et al., 1993). These are: (i) primary emotion, (ii) secondary
or reactive emotion, and (iii) instrumental emotion. The following describes, with spe-
cific reference to anger, the distinctions between these emotion types, and different inter-
vention strategies as they apply to each different type or state.

Primary Emotion. Primary emotions are viewed as immediate and direct responses to the
environment, with attendant orienting information that guides behavior (Fridja, 1986).
Each primary emotion is associated with a unique pattern of physiological activity or
"action tendency," that readies the organism to act in a particular way. An emotion is
considered adaptive when the attendant information serves to protect the individual. Pri-
mary adaptive anger, therefore, is an immediate and direct response that serves to defend
against attack or intrusion. Appropriately expressed anger at violation promotes self-
empowerment, assertive expression of need, and interpersonal separation and boundary
definition.

Secondary Emotion. Secondary or reactive emotional responses differ from primary emo-
tion because they are obviously secondary to some other cognitive or affective process.
Maladaptive secondary anger is recognized in therapy as the end result of an obvious
sequence of thoughts and feelings that can be observed or inferred from other sources of
information. One frequently occurring example is anger as a reaction to fear or shame or
following attributions of malicious intent.

Instrumental Emotion. The third type of emotional response serves some instrumental
function—and this is more often the focus of psychodynamic therapies. Instrumental
anger is frequently used to intimidate or control others, or to force others to give us what
we want or need. Usually the individual is unaware of the instrumental function of the
emotion.
Again, differentiating among these types of emotion is essential for appropriate inter-
vention. Thus, in the case examples, treatment needs to explore Celeste's rage in order to
access the underlying causative factors, and to validate, but not heighten, her legitimate
anger at being unfairly maligned. As well, therapy may require teaching her more effec-
tive anger management strategies. Likewise, therapy will need to help David express his
suppressed anger (and other feelings) about his wife's affair and explore his chronic
angry fantasies and anxiety. Changing his passive-aggressive behavior also may require
 Experiential Treatment of Anger 313

confronting or interpreting the interpersonal function of his anger (for instance, to punish
his wife), and alleviating his hypertension may require teaching stress-management
techniques.

EMOTION ASSESSMENT

Sources of Information

Assessment of therapeutically relevant emotional processes is grounded in five basic

sources of information: (i) information from empathic attunement to client feelings and
meanings, (ii) information from client nonverbal cues, (iii) knowledge of human emo-
tional responses, (iv) knowledge of the particular client's emotional makeup and person-
ality history, and (v) knowledge about different personality styles and disorders.

Empathic Attunement. First, emotionally focused assessment is a bottom-up, in-session

process beginning with information from therapist's empathic attunement to client feel-
ings and imaginative entry into the client's world (Bohart & Greenberg, 1997). During
session one with Celeste, for example, an important piece of information is the client's
ambivalent feelings about therapy. This implies that she feels conflicted, both wanting
help and perhaps fearing aspects of therapy. This conflict is evident again in session three
when Celeste states that she wants help and "some peace" from her interpersonal con-
flicts and, at the same time, expresses hopelessness about achieving her goals. Attune-
ment to these feelings reveals more vulnerable feelings of distress, powerlessness, and
victimization in addition to anger.
Celeste's anger, on the other hand, appears to be a reaction to feeling that important
goals are threatened and to feeling attacked or criticized. In the situation that precipitated
therapy, she felt both angry at being unfairly maligned and worried about losing a pro-
motion she had worked hard to achieve. The action she took to avoid that loss had a
desperate quality to it, which suggests that her self-worth depended on the promotion and
failure to achieve it would be devastating. Her anger at the therapist for suggesting that
she contributes to her own interpersonal problems again indicates hypersensitivity to
feeling unfairly blamed or criticized. The defensiveness of Celeste's angry reaction indi-
cates that the comment felt like a personal attack that "cut to the quick." This suggests
vulnerability to feelings of shame and a fragile sense of self-worth that needs to be
fiercely protected. It is likely that her anger partly serves this purpose.
In the case of David, empathic attunment to the desire to hurt his wife implicit in his
fantasies and behavior, the "tension" in his hypertension, and his intellectualization of the
affair (for example, "everyone's human"), suggest suppressed or disavowed hurt and
anger at his wife's betrayal. At the same time, meaningful information comes from his
ownership of somehow contributing to his own bad feelings. This suggests an initial
sense of agency that can be further developed in therapy. His expressed need to "get some
peace" suggests that his avoidant behavior, including past alcohol abuse, is a way of
coping with negative feelings and conflict. This coping strategy, however, has deprived
him of close interpersonal relationships. During the second session, David's report of
ongoing anger and tension communicates both concern and a desire to achieve symptom
relief, and skepticism, hopelessness, or perhaps fear that he won't receive help in therapy.
His response to the therapist's silence suggests reactive anger at perceived dismissal of
his concerns that is expressed indirectly and tends to push others away. This has impli-
cations both for the therapeutic relationship and for understanding his marital conflict.
314 JCLP/ln Session, March 1999

Nonverbal Cues. The second important source of information for emotion assessment is
nonverbal cues, such as breathing, vocal quality, posture, and facial expression. Celeste's
sarcastic tone, for example, is an attacking stance that underscores her feelings of defen-
siveness and tends to elicit hostility from others. More vulnerable self-experience is
evident in her sigh and in her irregular speech pattern in the final excerpt. Her sigh is an
important indicator of momentarily relaxed defensiveness following therapist acknowl-
edgment of her experience, and emergence of powerlessness, resignation, or a sense of
victimization. Her irregular speech quality conveys feelings of confusion, agitation, and
distress about her interpersonal problems and perhaps about being in therapy. These
feelings appear to be closely associated with her anger and need to be explored.
David's sarcastic tone while expressing his concerns about therapy is likewise an
attacking stance, and his loud, demanding voice at the therapist's silence indicates increased
efforts to have his concerns attended to. Once again, however, these indirect expressions
of anger are maladaptive because they tend to increase distance in the relationship and
therefore interfere with getting his needs met (in this case, his need to receive help).

Knowledge of Human Emotion. A third source of information for emotion assessment is

knowledge of universal human emotional responses to prototypical situations. In Celeste's
case, anger, anxiety, disappointment, and perhaps a sense of defeat are typical responses
to feeling unfairly maligned, having important goals threatened, and one's failure to
achieve important goals despite one's best efforts. As well, perceived criticism and blame
are generally experienced as injuries to self with attendant painful feelings of hurt, shame,
embarrassment, or humiliation that need to be defended against. These feelings in the
shame family are associated with a tendency to hide shameful aspects of self, thereby
protecting oneself from being exposed. Expression of anger is a common reaction to
feeling humiliated or shamed.
The minority group status of Celeste's family may be meaningful. Individuals who
have repeatedly been the brunt of racial or cultural denigration can develop a sense of
inferiority. It is possible that her father's drive to "make it big in America" was a way to
gain acceptance in the dominant culture, to break out of his "second-class citizen" status.
Celeste, therefore, may have internalized this implicit sense of inferiority, along with
standards and values emphasizing achievement, fears about negative evaluation, and vul-
nerability to feelings of shame. From this perspective, threats to Celeste's "making it big"
are threats to her self-worth because they activate a core sense of inferiority. Again, anger
is a secondary emotion that commonly masks such painful feelings.
In David's case, extramarital affairs are commonly experienced by the partner as
profound betrayals of trust. They typically elicit anger, as well as hurt, sadness, humili-
ation, and insecurity from threatened loss of attachment. Not only are these feelings
universally painful and difficult to allow, but also, in many cultures, there are strong
injunctions against expressions of vulnerability in men. Thus suppression of painful or
threatening emotion is a commonly learned coping strategy that may be part of David's
cultural and familial heritage.

Knowledge of Particular Client. The fourth source of information for emotion assess-
ment is knowledge of the particular client's emotional makeup and personality history.
Celeste's history of impulsivity and volatility indicates longstanding problems with under-
regulation of emotion in specific situations. Thus her anger problems could stem from a
combination of temperamental emotional lability and maladaptive cognitive-affective
sequences or meaning construction that play a role in escalating anger or turning other
 Experiential Treatment of Anger J75

emotions into rage. From this perspective, in situations where she "sees red," she feels
hurt and ashamed, perhaps like a nobody or a failure as a person. Her vulnerability to
negative evaluation across many circumstances suggests a fragile core sense of self-
worth rather than simply internalized values and standards about achievement. Feelings
of hurt and shame are followed by anger. This anger, when coupled with temperamental
emotional lability, skills deficits, and cognitive processes (for example, attributions or
rumination), escalates into rage.
The information that David has a history of few close interpersonal relationships
suggests an introverted personality style, such that he is reserved, content with solitude,
and tends to cope with stress by withdrawing. It is possible that in a loud, chaotic, and
competitive family environment he felt ignored or dismissed, coped by becoming even
more self-reliant, and dealt with his negative feelings and family conflict through avoid-
ance. This becomes a negative cycle in which avoidance further decreases the likelihood
of being attended to, and the individual feels resentful that his or her concerns are
dismissed—which produces more suppression and avoidance, and more distance in rela-
tionships. The recent situation with David's marriage is an example of how such a neg-
ative cycle is exaggerated in times of extreme stress or conflict. From this perspective,
David's intellectualization of his wife's affair indicates emotional disavowal and avoid-
ance; his aggressive fantasies, passive-aggressive behavior, and hypertension stem from
suppressed hurt and anger; and his anxiety reflects both threatened attachment needs and
the emergence of threatening feelings.

Knowledge of Personality Styles. A final source of information for emotion assessment is

knowledge about different personality styles and disorders. Celeste's anger, for example,
has a narcissistic quality that serves to protect a fragile self that is easily and deeply
wounded (Benjamin, 1996). Celeste also is a blamer or externalizer—when criticized,
she angrily attacks and pushes others away rather than blame herself or become depressed.
David's personality history has the quality of an avoidant attachment style (Bowlby,
1988). This could be a result of temperamental introversion combined with early learning
in an unresponsive family environment. Avoidance as a strategy for coping with negative
feelings and interpersonal conflict results in insecure attachment that persists into adult-
hood (Bartholomew, 1993). The individual is cut off from the orienting information in
their own emotional experience and from others. Avoidant individuals are overly self-
reliant rather than interdependent; they are emotionally detached; and they have weak
affective bonds with others. David's chronic anger and anxiety can be viewed as stem-
ming from threatened or unmet dependency needs, accumulated tension from emotional
overcontrol, and an inability to express his needs.
In summary, the information from these sources suggests two main types of anger
problems for each of these clients. Celeste's problems are largely a result of the under-
regulation and intensity of anger, as manifested in her maladaptive aggressive behavior.
Second, her anger appears to be a defensive reaction to feeling criticized or blamed and
to having her achievement needs and self-worth threatened. Thus her anger appears to
mask more vulnerable experiences of fear/anxiety, hurt, and shame. David's anger prob-
lems stem, first, from an avoidant coping style and suppressed feelings (including anger)
about his wife's affair. This results in tension, interpersonal distance, and unmet needs.
His second anger problem is indirect expressions of anger that increase interpersonal
distance and marital conflict. For both clients there appear to be no contraindicators for
emotionally focused therapy. However, hostile elient distance and anger that covers more
vulnerable experience, if not reduced, could interfere with the development of both ther-
apeutic relationships.
316 JCLP/In Session, March 1999

Differential Emotionally Focused Assessment

Emotion assessment involves distinguishing between different processes and types of

emotion for the purpose of accurate intervention. In emotionally focused therapy, assess-
ment is always subject to clarification and revision based on new information. Therefore,
the intervention strategies suggested in the case examples are appropriate only assuming
that the initial assessment is accurate. The following emotion nosology is a useful heu-
ristic for guiding differential emotionally focused intervention.
The first distinction is between emotion that is directed at the environment or directed
at the 5e//(Goldman & Greenberg, 1995). Both David's anger at his wife's affair and
Celeste's anger at being maligned by her coworker, for example, are externally related
and, as such, need to be expressed. Expression accesses the information associated with
anger experience (such as a sense of empowerment or entitlement to respectful treatment
from others), and this aids in adaptive functioning. On the other hand, emotion that is
self-related needs to be explored for its meaning. This is the case when clients are angry
at themselves for not living up to expectations, or are anxious about the emergence of
anger or other threatening emotional experience. Thus David's fear and avoidance of his
feelings (including anger) and Celeste's implicit shame at failure need to be explored for
their meaning.
The second distinction is between emotion that is underregulated and results in mal-
adaptive behavior and emotion that is stifled, inhibited, or overcontrolled. Accordingly,
Celeste's rage and aggressive behavior need to be explored for their underlying constit-
uents, and need to be managed in order to improve interpersonal functioning. David's
suppressed anger at betrayal, on the other hand, needs to be accessed in order to relieve
tension, enhance self-empowerment, and facilitate assertive expression of needs.
The third distinction is between different types of emotion. First, it is therapeutically
useful to distinguish between painful emotion (for example, sadness from the death of a
loved one) and bad feelings (for example, chronic depression). Celeste's hurt and shame
can be considered painful emotions. These commonly are avoided but need to be accessed
for their orienting information. Helping clients like Celeste to tolerate emotional pain
involves gradual exposure so the individual becomes desensitized to the pain and learns
that they can tolerate the emotion. Thus Celeste learns to tolerate, rather than avoid, her
feelings of hurt and shame, and the orienting information (for example, a need for com-
fort or acceptance) can guide adaptive behavior. In contrast to painful emotions that are
avoided and need to be lived through, bad feelings, such as David's hostility and anxiety
and Celeste's rage, usually are all too evident and need to be eliminated or changed.
Finally, it is useful to distinguish between the three basic types of emotion discussed
earlier. Recall that these types are primary, secondary, and instrumental emotion. Prob-
lems with primary adaptive emotion concern its inhibition or overcontrol. David's hyper-
tension, aggressive fantasies, passive-aggressive behavior, and intellectualization are
examples of problems that stem from suppressed primary adaptive anger (as well as other
feelings) about his wife's affair.
The aim of emotionally focused intervention with overcontrolled primary adaptive
anger is to access and express the anger. In this way the associated sense of empowerment
and readiness to assert one's needs and limits can be integrated into current meaning
systems. It also then can be appropriately communicated to others in order to effect
change in the environment. In therapy, this can require considerable preliminary work to
minimize avoidance of emotional experience through exploration and heightening aware-
ness of motivations, beliefs, and fears about anger expression. In David's case, avoidance
of anger appears to be associated with a more generalized avoidant coping style. Thus
 Experiential Treatment of Anger 317

exploring anger avoidance likely will access a core self-organization developed through
early learning.
Emotionally focused exploration of anger avoidance differs from psychodynamic
approaches in its emphasis on presently-emerging overcontrolling processes rather than
the developmental origins of avoidance or defensive patterns across situations. Emotion-
ally focused intervention also differs from the cognitive-behavioral approach of challeng-
ing maladaptive cognitions about anger expression. Interventions, such as directing client
attention to internal experience or exaggeration of injunctions against expression, are
intended to heighten client experiential awareness of the immediate negative effects of
emotional overcontrol. Once these effects are fully experienced and verbalized, a shift
occurs in which associated and alternate healthy internal resources emerge spontane-
ously. These resources are supported by the therapist and act as challenges to maladaptive
cognitions that produce overcontrol. In David's case, fully experiencing the tension, iso-
lation, and powerlessness of suppressing his anger could access a desire for tension release,
to stand up for himself, or to communicate his needs and concerns. These needs and in-
tentions can be integrated into his view of himself and used to motivate adaptive behavior.
Celeste's anger at being maligned also could be considered primary and adaptive
because it is an immediate and direct response that serves to defend against being attacked.
This anger at maltreatment needs to be validated because it is an adaptive, self-protective
resource. However, Celeste's problem is not one of overcontrolled anger that needs to be
intensified and accessed. The problem is her maladaptive and immature coping strategy—
that is, the way she acts on her anger and, possibly, the intensity of her anger. Here ex-
ploration and management of her rage are more appropriate intervention strategies.
Finally, some primary emotions no longer serve an adaptive function. An example
would be anger as a conditioned phobic response to intimacy, a result of early boundary
intrusions (such as incest). In therapy, the most frequently occurring primary maladaptive
emotions are fear/anxiety and shame. Often these feelings are produced by the activation
of a core sense of self as worthless or insecure developed through early learning. As
noted earlier, these emotional responses are considered primary when they are not reduc-
ible to some preceding emotion or cognition, such as self-criticism producing guilt or
catastrophic expectations producing anxiety. As well, primary maladaptive responses tend
to be activated across many situations rather than being situation specific.
The activation of primary maladaptive fear/anxiety or shame commonly is observed
in clients who chronically "feel" insecure or afraid even though they "know" there is
nothing to be afraid of. Or they may feel inferior, unlovable, or dirty, even though they
know they are successful, loved, or innocent. Appropriate intervention does not involve
accessing and challenging maladaptive cognitions because cognitions do not play a pri-
mary role in generating the feelings. Clients usually cannot identify specific cognitions
associated with the feeling; rather the feeling is experienced as a holistic bodily felt sense
of self as insecure or bad. Changing such primary maladaptive emotion requires access-
ing the core sense of self and simultaneously accessing some alternate self-organization
and/or providing a corrective interpersonal experience with the therapist. For example,
intervention with Celeste would involve the client's accessing her sense of herself as
inferior (with associated painful feelings of shame) and simultaneously accessing an
experience of herself as acceptable. One of the difficulties in changing such a core self-
organization is that painful feelings in the shame family usually are fiercely defended
against, and therefore are difficult to access. The intervention challenge is to get beyond
the anger which commonly masks feelings of shame.
Thus secondary emotions generally are bad feelings that need to be eliminated or
changed. These secondary reactions are the end result of a sequence of thoughts and
318 JCLP/In Session, March 1999

feelittgs. In Celeste's case the sequetice could be one of anxiety (about failure) or hurt and
hutniliation (at being criticized), followed by anger, followed by a cognitive process that
in turn escalates her feelings into rage. Other types of secondary emotional reactions are
cotnplex states, such as depression or anxiety; one commonly observed generating con-
dition for both of these secondary states is constricted primary anger. Such could be the
case with David, whose anxiety partly is generated by the emergence of threatening anger,
followed by injunctions against anger experience and attempts to suppress his anger.
The intervention strategy with secondary emotion is to explore or "unpack" the
cognitive-affective sequence (for example, the thoughts and feelings behind Celeste's
rage); or to explore the complex affective meaning behind secondary reactions (such as
David's anxious reaction to anger experience). The ultimate goal is to access the more
core emotional response so that the associated network of thoughts, feelings, desires, and
physiological activity can be integrated into and modify current meaning systems. In the
case examples, this means accessing David's anger and Celeste's fear, hurt, and shame.
Maladaptive cognitions that play a role in generating bad feelings, or in escalating anger
into rage, can also be examined and modified during the exploration process.
In the case of instrumental emotion, the intervention goal is to help the client under-
stand the function of the emotion, change the behavior, and find more adaptive expres-
sions of feelings and needs. The typical emotionally focused intervention is empathic
conjecture, similar to interpretation or confrontation, at points when this type of emotion
expression occurs. For example, when David describes his passive-aggressive behavior,
the therapist could empathize with his anger and desire to punish his wife for hurting him
and further suggest, "I guess, at this point, it would be really hard to tell her directly how
much she hurt you, to trust her enough to risk doing that."

THE PROCESS OF EMOTIONALLY FOCUSEO THERAPY

The overarching intervention principle in emotionally focused therapy is attention to the
client's present subjective experience. The goal is to bring situations, including past events,
experientially alive in the present. As well, the focus is on in-depth exploration of a single
experience rather than drawing connections across a broad spectrum of situations or
times in the client's life. Of course, the therapist is responsive to the client's spontaneous
connections to other situations, and this type of generalization usually occurs in the final
integration stage of therapy. Interventions balance empathic responding to present
experience—following^wilh directing the experiential process—leading.
Provision of safety and support throughout the process is a crucial feature of emo-
tionally focused therapy. This reduces interpersonal anxiety so the individual can attend
to internal experience; it can also provide a corrective interpersonal experience with the
therapist when necessary. In both case examples, safety and support would be expected to
reduce defensive anger and allow the necessary accessing and exploration of more vul-
nerable experience. As well, safety is required to help clients such as David express
anger, so they feel confident it will be accepted and contained. For clients like Celeste,
whose problems stem from a fragile sense of self-worth, a corrective interpersonal expe-
rience with the therapist is likely to be a primary mechanism of change. Internalization of
therapist validation, acceptance, and soothing presence helps to strengthen a fragile sense
of self. This in turn makes clients better able to accept and support themselves, less
vulnerable to experiences of hurt and shame—thus less defensive and more open.
The process of emotionally focused therapy can be conceptualized in three phases:
(i) establishing the alliance, (ii) evoking core emotion and exploring bad feelings, and
(iii) restructuring maladaptive emotion structures and integration of new information.
 Experiential Treatment of Anger 319

Phase I: Estabtishing the Attiance

The first phase of emotionally focused therapy involves establishing the therapeutic bond,
collaboratively developing a focus on the conditions that generate disturbance, and col-
laborating on the goals of therapy and how they will be accomplished. Safety means
Celeste feels accepted by the therapist, trusts that she will not be negatively evaluated or
shamed, and can risk revealing vulnerable, unacceptable aspects of herself in the session.
Provision of support means that her perceptions, feelings, and needs are validated, under-
stood, and empathically responded to so she does not feel alone. The therapist also needs
to recognize and respond to Celeste's resources and strengths, such as her hard work,
numerous successes, and willingness to risk therapy despite her misgivings.
As well as providing support, interventions continually direct attention to client emo-
tional experience so that problems, goals, and therapeutic steps are conceptualized in
terms of emotional experience. In discussing the situations that trigger Celeste's anger;
for example, the therapist first needs to validate the client's primary anger about the
malicious letter, her perceptions of injustice, and her feeling of being misunderstood.
However, the therapist also needs to be particularly attuned and empathically responsive
to the emergence of more vulnerable experience of worry, disappointment, discourage-
ment, and attendant needs, desires, and behaviors. Responses such as "I hear how impor-
tant that promotion was to you, more important than anything almost" or "you must feel
so disappointed and defeated after all your hard work" provide validation, help the client
feel understood and less isolated, implicitly teach her to attend to and value her emotional
experience, and help activate core self-organizations, making them available for explo-
ration and change.
The primary intervention in emotionally focused therapy is empathic responding to
the client's presently emerging subjective experience. Empathic responses are more likely
than confrontations or interpretations to reduce interpersonal anxiety and defensive anger
and, thereby, help clients to acknowledge and disclose vulnerable aspects of self and
painful feelings underlying secondary rage. Again, a critical marker in the case example
is Celeste's "sigh" following therapist acknowledgment of her feeling misunderstood.
This sigh indicates relaxed defensiveness and a possible window for activating more vul-
nerable experience. Appropriate intervention would involve simultaneously communicat-
ing understanding of her experience, directing attention to, and helping her symbolize the
meaning of her sigh. For example, the therapist could tentatively respond to the client's
sense of "how hard it must be to be constantly dealing with these interpersonal conflicts"
or the client statement about how she "really would like peaceful relations but somehow
it seems impossible."
Because Celeste tends to blame others for her bad feelings, interventions in the early
stages of therapy also need to promote agency and ownership in order to enhance greater
self-control. This needs to be done in a way that does not imply blame and thereby trigger
the kind of defensiveness that was observed in the beginning of the case transcripts. One
strategy might be to empathically exaggerate the implicit sense of resignation and power-
lessness in her sigh with responses such as "it's like you feel like giving up, like there's noth-
ing you can do about it" or "a sense that things will never change, you're doomed to always
have these troubles." Again, heightened experiential awareness accesses associated—but
alternate—emotions and strivings, such as sadness at her isolation and a desire for con-
nection, or anger and empowerment to stand up for herself. These alternate experiences act
as challenges to maladaptive powerlessness and help motivate change. Collaboration could
mean establishing the ultimate goal of helping her find ways to meet both her achievement
and relationship needs. This can be accomplished by first understanding what gets in the
320 JCLP/In Session, March 1999

way. Because the client acknowledges that this is somehow connected to her anger and be-
havior, therapy can begin by exploring her experience in situations that make her angry. From
a skills-training perspective, the fundamental task is to develop emotion awareness skills.
Anger management skills are entirely dependent on the client's capacity to first recognize,
acknowledge, and accurately label her emotional experience.
With avoidant and distancing clients like David, the beginning phase of therapy
needs to establish trust that the client's feelings and concerns will be attended to. This
means validating and acknowledging David's bad week, his desire for symptom relief,
and his underlying concern that therapy won't help. From an emotionally focused per-
spective, the therapist response of silence (in the second session) is a therapeutic error
because it aggravates client hostile defensiveness and increases interpersonal distance.
Responding to David's concerns, on the other hand, will strengthen the bond, disconfirm
expectations about dismissal of his concerns, and reduce interpersonal distance so that
core material can be accessed. Safety also means that the client's interpersonal style is
respected. David's style, for example, may be reserved and unexpressive; he may be
uncomfortable with emotional expression and an evocative stance, and he may have a
tendency to withdraw. Thus he may be most responsive to an empathic but explicitly
problem-solving stance. As with Celeste, the therapist needs to support David's strengths
and resources—that is, his desire to save his marriage, willingness to seek help despite
his reservations and previous unsuccessful therapy, and his recognition of agency. Most
importantly, safety will mean helping him access and express threatening feelings at a
pace he can tolerate.
Empathic responding is the most effective intervention for accessing emotional expe-
rience with avoidant clients, because these individuals often have a limited emotion vocab-
ulary and have difficulty answering questions about how they feel. Such questions can be
experienced as frustrating, increase anxiety and defensiveness, and therefore increase
distance in the therapeutic relationship. Tentatively phrased empathic guesses (for exam-
ple, "that must have been very hurtful"), on the other hand, help avoidant clients feel
understood and, at the same time, implicitly teach them to label their emotional experi-
ence accurately. This reduces defensiveness and anxiety and increases clients' ability to
communicate.
Emotionally focused interventions with David need to direct his attention continu-
ally to his emotional experience—for example, by responding to and validating his feel-
ings of anger when he describes his aggressive fantasies. When he talks about feeling
anxious, the therapist needs to respond to his distress, sense of threat, and bodily expe-
rience of tension, as well as empathize with his struggle to suppress feelings and his
difficulty in expressing them directly. The early phase of therapy needs to validate the
client's distress and explicitly establish a collaborative focus on alleviating it, first by
understanding what internal processes are generating his bad feelings and symptoms.
Then the client will be in a position to exercise some control in changing them. David's
acknowledgment that "he makes himself feel upset" is a strength that can be developed
by exploring how he upsets himself. Such exploration will involve directing his attention
to internal experience (his thoughts, feelings, desires, sensations) during his fantasies or
passive-aggressive behavior.
Avoidant clients need to accept the connection between suppressed feelings and
symptoms, and the idea that symptom relief will be accomplished by overcoming avoid-
ance. This can be facilitated by explaining the negative consequences of emotional avoid-
ance, both in general terms and in terms specific to the client's circumstances. For example,
therapist empathic responses to David's intellectualization of anger can conjecture that he
wants to be understanding but, at the same time, his symptoms indicate that he is still very
 Experiential Treatment of Anger 321

angry. His feelings about the affair are like "unfinished business" that will continue to
plague him until they are expressed. Such a rationale also can include factual information
about the link between suppressed anger and hypertension and marital conflict (Pen-
nebaker, 1990). Once emotional overcontrol is accepted as the "fundamental problem,"
the early phase of therapy can establish the first therapeutic task of exploring what fears,
beliefs, or concerns stop him from expressing his feelings. The second task will be to
change this avoidant behavior and express previously constricted feelings, thus relieving
tension, accessing adaptive information, and resolving his marital conflict.

Phase II: Evocation and Exptoration

The second phase of emotionally focused therapy involves evocation of primary emo-
tions and exploration of bad feelings and interruptive processes. This middle phase of
therapy with Celeste would focus on exploring her anger and worry, as well as "unpack-
ing" the cognitive-affective components that underlie her secondary defensive rage—
particularly focusing on accessing vulnerable experience. This can be accomplished by
directing her to attend to her internal experience while recalling a specific situation that
produced anger. Interventions exploring the meaning of her anger at being unjustly accused,
or what the promotion meant to her, will access associated feelings, as well as standards
and values, fears, motivations, and beliefs about herself and others (for example, you're
nothing if you don't "make it big"). Attention inward also will access the cognitions and
processes that escalate anger into rage (for example, attributions of malicious intent,
name calling, and hurling insults).
Once Celeste experientially understands the connection between her internal pro-
cesses and resultant rage, she can learn strategies for calming herself down before the
process escalates, and learn to assertively express her anger. Thus explicit emotion reg-
ulation and assertiveness skills training (such as that used in cognitive-behavioral thera-
pies) can be incorporated into the exploration process. Exploration of bad feelings also
can access more vulnerable underlying experiences, such as fear of failure, disappoint-
ment about losing the promotion, and hurt and humiliation about being criticized. Empathic
responding can reduce defensiveness and help her recognize and label accurately the
feelings that precipitate her secondary anger—which is new information to guide her.
Acknowledging primary emotions of hurt, shame, anxiety, or sadness also can help access
her core fragile sense of self-worth, making it available for change.
The middle phase of therapy with David likely would entail exploring and overcom-
ing avoidance of his anger and other feelings about his wife's affair. Again, the two main
tasks of therapy are to reduce emotional overcontrol and to resolve issues with his wife.
A Gestalt-derived empty-chair intervention is particularly useful for helping clients express
constricted feelings (such as anger) and resolve issues with significant others (Paivio &
Greenberg, 1995). In this intervention the client engages in a dialogue with the imagined
other and is encouraged to express feelings and needs directly to the imagined other. This
intervention also can access avoidance processes, which can then be explored. For exam-
ple, at indicators of emotional avoidance (for example, shutting down, deflecting) while
dialoguing with an imagined other, the client would be directed to shift to a dialogue
between two parts of the self. Here the client would enact the struggle between the
controlling and experiencing aspects of the self in order to heighten awareness of the
overcontrolling processes.
As David, for example, begins to access his feelings, he would be encouraged to
express them directly to his imagined wife. Interventions first aim toward differentiating
322 JCLP/ln Session, March 1999

and helping him to fully experience each emotion separately in order to access the unique
adaptive information in each—anger for relief of tension and self-empowerment, hurt
and fear for sclf-sootbing and interpersonal comfort and connection. Interventions tbat
intensify arousal are appropriate with clients like David because tbey heighten awareness
to the point where tbe emotion can no longer be ignored. Again, empathic conjecture that
his passive-aggressive behavior represents a desire to punish his wife for hurting him can
access his more vulnerable experience of hurt and need for succor and comfort. Likewise,
empathic responding to indicators of anxiety can help bim acknowledge and express his
fear of abandonment and associated dependency needs and strivings for connection. It is
preferable tbat clients enact tbe otber's response to their expressed feelings and needs.
This can help the client empathically understand tbe otber's perspective and foster cbanged
perceptions of tbe other and tbe relationship. However, for clients who find it difficult to
engage in these active interventions (perhaps because of performance anxiety), alternate
techniques (sucb as empathic exploration) can be used. The principles and objectives of
intervention are the same regardless of the tecbnique used to accomplish them.

Phase III: Restructuring and Integration

The final phase of emotionally focused tberapy involves accessing core maladaptive
emotion structures (for example, a sense of self as worthless or insecure) and/or primary
adaptive emotion (for example, anger) so tbat new information can be used to modify
meaning. The therapist supports tbe emergence of adaptive needs/resources tbat function
to challenge dysfunctional beliefs and promote reorganization, a self-validating stance,
and creation of new meaning.
Tberapy witb clients like Celeste is a gradual process of helping them become more
open and more willing to disclose vulnerable feelings to tbe therapist. For example, fully
experiencing her devastation at losing tbe promotion can access Celeste's primary sad-
ness at loss. She then will be able to grieve the loss, let go, and move on to other concerns
or goals. This will reorganize the sense that she can't live without the promotion, her
sense of desperation, or of being a failure as a person. Fully experiencing the social
alienation caused by her aggressive behavior could access primary sadness about her
isolation along with a healthy desire for interpersonal connection and comfort. These can
change her perceptions of herself, balance her needs for acbievement, and motivate healthy
interpersonal relations. Accessing her pain at being unfairly blamed or criticized, or her
hurt and humiliation at her coworker's letter, will access needs for acceptance, belonging,
and approval, as well as for reassurance and comfort. This in turn can access resources
for soothing herself and shoring herself up. Thus therapy provides new experiences of
herself as feeling insecure and needing others, wanting respect and to belong, having both
strengths and weakness, and being acceptable and worthy of comfort and support despite
her shortcomings. Receiving the tberapist's acceptance, support, comfort, and soothing
presence during this process also will be new information to strengthen her fragile sense
of self-worth. Thus she can become less vulnerable to feelings of hurt and shame.
It is equally important for clients with anger management problems to have the
experience of acknowledging and expressing anger appropriately before it escalates. Thus
tbe later stages of tberapy witb Celeste could incorporate assertiveness-training strat-
egies. The new experience of expressing anger appropriately can contribute to her sense
of competence in terms of being able to stand up for herself appropriately, hold others
accountable for harm, and express her right to be treated fairly and witb respect. Overall,
the goal is to help her be better able to meet her own needs and to communicate them to
others.
 Experiential Treatment of Anger 323

For David also, fully experiencing and expressing anger toward his imagined wife in
the safety of the therapy session would relieve tension, enhance self-empowerment, and
facilitate assertive expression of needs (for example, needs for fidelity, honesty, or trust).
Through imaginal confrontation, he can be better able to fully experience his feelings
and, through the evocation of his empathic processes, be better able to imaginally expe-
rience his wife's response. Accordingly, expression of hurt to a loved one typically enhances
interpersonal connection and elicits comfort from them. Acknowledgment of fear also
elicits softening and soothing responses from an attachment figure and will foster con-
nection. A shift in perceptions of self occurs once new information from these emotions
is integrated into one's sense of self, and new perceptions of the other emerge through
imagining and enacting the other's response. Resolution and genuine forgiveness of this
type of betrayal requires believing that the other individual will hear and respond to
expressed need, and acknowledge responsibility for causing damage and breaking trust.
For example, imagining this acknowledgement from his wife can help David be less
defensive and, in turn, acknowledge and accept his role in contributing to his marital
conflict.
If necessary, David's therapy also can include stress-management techniques for
dealing with his hypertension. Imaginary dialogues also could lead to productive couples
therapy later on—and the healthy experience of being less avoidant could generalize to
other relationships.

CONCLUSION

Emotionally focused treatment of anger is based on assessment of different anger pro-

cesses and states for the purposes of appropriate intervention. This approach distinguishes
between environmentally-directed anger that needs to be expressed and self-directed anger
that needs to be explored for its meaning; it also distinguishes between overcontrolled an-
ger that needs to be accessed for its attendant information, and underregulated anger that
needs to managed; between painful feelings (such as shame underlying rage) that need to
be accessed for their information, and bad feelings (such as chronic anger) that need to be
explored and changed; and between primary adaptive anger that is a source of orienting in-
formation, secondary anger that is the end result of some cognitive-affective sequence, and
instrumental anger, the function of which is to control others. Based on emotion assess-
ment, intervention with David emphasized accessing overcontrolled adaptive anger, whereas
the emphasis with Celeste was on exploring secondary rage to access more vulnerable ex-
perience of hurt, fear, and shame. Emotionally focused therapy is intrinsically integrative
and, when appropriate, incorporates interventions from other traditions that address the par-
ticular anger problem.

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