Counselors are trained to help clients get through critical points in their lives in dealing with addictions and traumatic events. Working in a highly charged environment where emotional issues are being dredged up and dealt with brings its own set of pressures and stress for both client and counselor. This can lead to frustration and even anger from one or both parties.

After all, counselors are people, too. So, to achieve a better understanding of anger issues and how they can adversely affect the work counselors are trying to do, we talked to three different counselors, who graciously provided their professional insights on dealing with anger in the therapeutic environment.

Understanding countertransference
Howard Rosenthal, EdD, MAC, Professor and Program Coordinator of Human Services at St. Louis Community College at Florissant Valley, is a frequent contributor to Counselor and author of the Encyclopedia of Counseling. According to Dr. Rosenthal, counselors are often so preoccupied with their clients’ emotions that they are oblivious to their own responses related to dysfunctional anger. Rosenthal insists that the notion of countertransference is often responsible for a counselor’s inappropriate anger.

“Countertransference is an old psychoanalytic concept that in today’s world basically suggests that the helper has unresolved issues that prevent him or her from being objective,” Rosenthal states. “Countertransference is fueled by the counselor’s needs (brought out by certain clients) rather than the helpee’s needs.”

“For example, if there is a client in your caseload who you dread seeing, then you are most likely a victim of countertransference,” he states. “Perhaps you even miss work that day or find yourself hoping that the client will cancel. This is the client you will attempt to prematurely terminate as rapidly as possible.”

Ironically the opposite also is true, according to Rosenthal. That is to say, exaggerated positive thoughts or feelings of attraction can also be indicative of this pernicious affliction. “If you are on the edge of your seat waiting for a certain client’s appointment and you find yourself livid when the client misses or cancels, then you are also a victim of countertransference,” he says. “You may even obsess about this client between sessions and spend an inordinate amount of time working on his or her case. You may keep thinking of reasons not to terminate the client even though he or she has made superb progress.”

Rosenthal refers to countertransference as the sworn enemy of objective treatment, and warns that counselors who suspect they are plagued with countertransference would do well to immediately inform their supervisors. If that doesn’t work, Rosenthal suggests the counselor might wish to secure some help by undergoing a little therapy.

If treatment is conducted via co-therapists or co-leaders in a group setting, the therapist who is not plagued with countertransference can deal with the client in question whenever possible. Rosenthal further emphasizes that the ego defense mechanism of displacement can cause problems for therapists.

“According to the notion of displacement, a person who is angry takes his or her anger out on a safe target who cannot retaliate,” Rosenthal states. “Hence, a counselor who is angry with a client might well take out his anger on his children.”

Rosenthal points to two key difficulties that typically arise from displacement. First, the displaced anger can cause problems in a therapist’s family or social life. “Say a counselor yells at his teenage daughter when he is actually mad at a client,” Rosenthal states. “The teenage daughter is most likely baffled by the interaction and thinks something like, ‘I did the same thing yesterday and my dad thought it was fine.’”

“The other fallacy of resorting to displacement is that you can yell at your wife, scream at your teen-age daughter, and kick the family dog (Hopefully, the animal will have the good sense to kick you back.), and it will never change the situation with your client one bit,” Rosenthal declares. “The counselor who is harboring this anger, absolutely, positively must deal with the client who is causing it. Needless to say, a healthy dose of diplomacy is often called for when confronting situations of this nature.”

Kolleen L. Simons, MSW, LCSW, is in private practice, working with adolescents and adults, including crime victims and rape survivors. Like Rosenthal, Simons points to the damage that can occur in the relationship between counselor and client when countertransference takes place.

Hepworth, et al. (1997) contends that a counselor who has not successfully developed strategies within their own life to deal with anger may be uncomfortable when clients express anger.

“Sometimes we can listen to a client and the more they talk, the more anger or frustration we feel,” Simons says. “These feelings can be manifested within the therapeutic relationship.”
Simons offers several suggestions to counselors who are reacting negatively to certain clients. First, the counselor should explore the purpose or cause of such feelings by asking, “What makes me so angry with this client? What is going on inside me that I am not able to work with this person?”

“To overcome these reactions, we can use the same strategies we recommend to our clients,” Simons states. “For example, keeping in mind what we have been taught about cognitive theory may help to remind us how our thoughts impact our interpersonal behavior and the subsequent responses to others.”

Specifically, counselors should keep in mind that entering a session with a particular mindset can make it difficult to work effectively with a client.

Simons further suggests developing a good social support network, which may include a colleague that you can talk to after a difficult session.

In addition, like our clients, we also need boundaries. Simple strategies that can help, include not overbooking your schedule, and allowing time for taking care of yourself.

“Often, I find that when I begin to feel stressed or overworked it can be hard to empathize with clients,” Simons says. “This is a cue to myself that I need to take a ‘time out’ and do something nice for myself.”

According to Simons, we encourage our clients to relax and take each day as it comes; we should do the same. By properly identifying and recognizing our reactions can help us better identify which reactions are potentially unhealthy. As counselors we must direct our words and actions to conform to our code of ethics of the profession, knowledge base, and the purpose of our clients. Not all negative feelings toward clients are countertransference reactions. Each session is new and each client is unique. It can be a disservice to any client if we take out on them something that occurred at home or that is unresolved within us.

Therapists and anger – the human element
According to author Jane Middelton-Moz, MS, who is a trainer, consultant and community interventionist, experiencing anger is common in therapy. However, a large number of therapists still feel apprehensive about acknowledging their feelings, Middelton-Moz says.
As far back as the late forties and early fifties, therapists have been encouraged by pioneers in our field (Winnicott, 1949 and Heimann, 1950) to acknowledge and explore their feelings of anger. Yet in a recent research study conducted by Pope and Tabachnick, although 80 percent of the 285 therapists in the study acknowledged experiencing anger in therapy, a large percentage of respondents rated their graduate training as either non-existent or poor as it related to dealing with uncomfortable feelings such as fear and anger.

Middelton-Moz contends that many of these therapists likely still believe that healthy, effective therapists are “neutral blank slates” and experiencing anger is “bad.” According to Middelton-Moz there are many reasons why a therapist may experience anger in a session: parallel process; projective identification; vicarious traumatization; live triggers from past traumas or unresolved grief; or simply because we are human beings, not machines.

For instance, a therapist may have had an unresolved argument with his/her
significant other before coming to work in the morning, the same issues are brought up in a couple’s session that day and the therapist feels angry at the member of the dyad who seems to be wearing his/her significant other’s face (parallel process). Or, a client presents as charming, calm, cool, and collected yet has an underlying rage and before the end of the session, the therapist feels angry (projective identification).

Perhaps, a therapist’s caseload is comprised of a large number of clients who have been sexually abused and the therapist becomes enraged at all offenders (vicarious traumatization). An anger trigger could be a client who is verbally abusive in the same manner the therapist’s parent was (unresolved triggers). Another client knowingly gives their partner the AIDS virus (we are human).

Acknowledging and exploring anger
The bottom line, Middelton-Moz says, is that therapists do experience anger. What is crucial to good clinical practice and the therapist’s wellness is the ability to acknowledge angry feelings as they occur, fully explore them, and work them through, she says.

“Knowing that we are holding the disowned anger of a client can increase our understanding of that individual,” Middelton-Moz explains. “Experiencing and working through anger regarding violence and abuse can increase our empathy for both victims and perpetrators. Knowing and understanding our anger triggers can increase our understanding of the behaviors of our clients.”

Middelton-Moz offers some necessary steps therapists can to take to effectively deal with their anger:

1. Acceptance of anger as part of the therapeutic process: It is imperative that graduate schools and licensing boards include required curriculum that aid therapists and potential therapists in acknowledging and effectively dealing with anger, fear, sexual attraction and other countertransference issues.

2. Continual debriefing: Too often we take better care of our computers than we do of those providing service in our field. Debriefing with a team or peer support group should occur at least weekly. When I have supervised therapists who work intensively in programs with children, criminal justice populations, victims or perpetrators of sexual assault or sexual abuse, war survivors, victims or perpetrators of domestic violence, etc., I required team debriefing daily in order to prevent vicarious traumatization, burnout, and the possibility of the therapist bringing feelings from work into their personal lives.

3. Ongoing consultation: It is important for therapists to receive ongoing consultation in order to identify and process their anger, triggers and countertransference issues.

4. The importance of setting boundaries and maintaining balance: We are not therapists 24 hours a day. It is important that therapists pay attention to the balance in their lives emotionally, physically, mentally and spiritually.

5. Staying in Good Physical Health: “Claudette recalls, ‘In my 50 years as a social worker, I really lost my cool a few times in the office — I was way out of line. Every time, I’d had more than three cups of coffee.’ Just as anger affects your body, chemicals in your body affect your emotions” (Middelton-Moz, Tener, and Todd, 2005). It is important to take care of your physical body: get plenty of rest; pay attention to nutrition and the intake of sugar; pay attention to tension, fatigue and cravings; and get regular exercise.

6. Continual Stress Reduction: The emotion of anger in itself does not harm the body. It’s the tension and the way we hold anger and continued stress of long-term, unhealthy anger that tends to cause negative effects. Doing exercises that decrease stress regularly such as physical exercise, meditation, visualization, progressive relaxation is absolutely necessary. Practice your “angerobics.”

7. Who Cares for the Caregivers: It is important for mental health professionals to receive their own counseling at times of high stress or when triggers become charged. Sometimes we pay far more attention to the mental wellness of those we work with than our own.

Stephanie Muller is the editor of Counselor, The The Magazine for Addiction Professionals.

References
Heimann, P. (1950) “On Countertransference”, International Journal of Psycho-Analysis, 31:81 – 84.
Hepworth, D., Rooney, R. & Larsen, J. (1997). Direct Social Work Practice: Theory and Skills. (5th ed). Brooks/Cole Publishing: Pacific Grove, Calif.
Middelton-Moz, Tener and Todd. (2005). The Ultimate Guide to Transforming Anger. Health Communications, Inc. Deerfield Beach, Florida.
Pope and Tabachnick. “The Therapist as a Person”, Professional Psychology: Research and Practice, Vol. 24, issue #2, pages 142-152.
Winnicott, D. (1949). “Hate in the Countertransference”, International Journal of Psycho-Analysis 30:69 – 74.

This article is published in Counselor,The Magazine for Addiction Professionals, April 2006, v.7, n.2, pp.60-62.

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