Understanding Anger: CBT vs Narrative Therapy Approach with Real Case Scenario
I make myself rich by making my wants few
Henry David Thoreau
Modern man no longer communicates with the madman . . … and expels from the memory all those imperfect words, of no fixed syntax, spoken falteringly, in which the exchange, between madness and reason, was carried out.
Michel Foucalt, 1961, History of Madness
In this article we discuss ways in which different approaches can benefit in defining an issue, taking the example of anger. Anger leads to loss of equanimity.
The word equanimity comes from Latin roots meaning “even” and “mind”. Holding what passes through your mind in spaciousness to stay in balance, moving beyond the reactive mode is achieved by Equanimity. The chain of expectations, desires, wants, are broken leading to alleviation of suffering.
The following are some exercises which I have found useful in moving into Equanimity.
Write down ways in which one starts becoming less balanced.
A written record of the ways in which one starts going into the cycle of expectations, desires, wants, fears, greed, disgust can give a good opening into the habits of the heart and head. One way to sharpen this focus is to read a newspaper/news-site for 15 minutes and keep classifying under the headings of greed, fear, disgust the feelings evoked by the articles.
Developing Borders and Boundaries: Remembering Spencer (White, 1984; White, 2007)
Spencer, the young boy who had the issue of soiling (encopresis) was told to characterize in near and particular terms, how this issue is affecting and ruling his life. His parents were told to characterize how this issue rules and ruins their lives. Then Spencer was asked to give a name to this issue of Soiling. He called it Mr. Mischief. They went on to relate to this issue in a particular rather than general manner, and in a near rather than distant way, thus helping define the boundaries and borders of the issue, get a better handle on it and define their relationship to the issue.
This example of Spencer illustrates how to externalize and objectify an issue which is affecting one’s life, and then create a statement of position map, which can help one create a plan and monitor our process.
Creating personal peace places : Balance of the Lotus
Eastern traditions see the Lotus flower as an embodiment of purity, enlightenment and rebirth. The balance between beauty and adversity are shown in the growth process of the Lotus, as it emerges above mud and water. It symbolizes harmonious balance between earthly struggles and divine purity.
Nature walks and creating living symbols of these experiences has been a way to enhance balance in my life.
Creating Personal Peace Places: High Park-Toronto, Richard Memorial-Port Credit Misssisauga, Bayview St Augustine Church, Wellington park-Burlington are some of these in my journeys
Case Scenario: Anger seen through different counselling approaches (Narrative/CBT)
Mr. S, presents with anger, which has affected his work, relationships, standing in community
NARRATIVE THERAPY APPROACH
- Externalize – The history of anger, as if it is a creature outside of oneself waiting to get inside you
- Therapist Role-is on listening, accepting, non-judgmental, non-confrontational statements..to be like a Junior Partner, Investigative Journalist,
CONTRAST WITH CBT APPROACH
BASIC ID-
Behaviour- writes angry letters, throws plants
Affect feels humiliated
Sensations pounding heart
Imagery sees himself being taken away from grandson
Cognitions I am a middle aged man who is being deprived of my rights,
standing in unfair manner
Interpersonal angry at wife , sons, in-laws
Drugs takes alcohol to drown the pain
BRIEF NOTE ON CBT APPROACH: Using the above BASIC-ID, a CBT oriented approach would see the automatic thoughts, underlying assumptions, core beliefs. We would use the big 4 of CBT of Somatic Quietening, Progressive Muscle relaxation, Guided Imagery, Cognitive Restructuring
See https://www.cma.ca/sites/default/files/hub/STRIVE-Big-4.pdf
NARRATIVE THERAPY approach uses interventions like externalizing, metaphors, mapping to develop a near and particular relation with the issue.
Mr.S went into the history of anger, by asking to see it as a creature outside oneself who is thinking of ways to trick him into losing his calm.
The Early Years in Canada: Then the Bullied became the Bully
Mr. S told of his early years of immigration from Bombay, India to Canada, how he saw his mother being beaten by his alcoholic father, his being bullied in school. As he became a teenager, he stopped these things as best as he knew. The “Bullied became the Bully”.
The Dragon and the Donkey
On being asked to give a name for Mr. Anger he came up with two metaphors. He first called Mr.Anger the “Dragon”. However, on reflection he said, “If I am still riding this creature and getting taken for a ride in my seventh decade of life, then I am riding a Mr. Donkey”.
FIVE NARRATIVE INTERVENTIONS –
After establishing rapport, agreeing that anger-related issues are worth exploring and addressing, we set about seeing how Mr. S has constructed his life around anger by
1- Externalizing anger
2- Deconstructing anger narratives
3- Re-authoring personal stories
4- Exploring values and intentions
5-Creating alternative responses
1- Externalizing anger
Encouraging Mr.S to treat Mr. Anger as a separate entity or character helped distance himself from anger and view it as something outside of his core identity. Be doing this he gained a new perspective on his anger, started seeing how his life would be without anger and create a map to challenge the dominance of anger in his life.
2- Deconstructing anger
We explored the stories and meanings Mr. S attaches to his anger. Through telling these stories we were able to examine the underlying beliefs, assumptions, and cultural influences that contribute to his anger. For example, as he recalled the weekend discussions which turned into angry arguments in his family of origin, he became clearer about how issues of safety, and the way to deal with un-ease through lashing out or suppressing became a dynamic in his life. This has in different forms played out in his family of creation, and he can now see this pattern even in his interactions with the in-laws of his sons. Deconstruction helped gain insight into the origins and maintenance of anger.
Scripting of the scenarios which continue to trouble him in is life in the present, helped develop alternative interpretations. Through role plays, we started developing better results.We refined these approaches through counselling and keeping an Anger Journal (He called it Riding with Mr.Donkey journal)
3- Reauthoring personal stories:
The scripts made through externalization,deconstruction tools above helped Mr.S gain the power to rewrite his narratives, explore alternative perspectives and be more aware of how his prejudices and projections are affecting his relationships. New stories began to emerge which offered new ways of understanding and creating his experiences.
Shifting from being defined by anger to seeing himself as capable of change and growth, and being a channel of peace, understanding, and kindness has helped Mr S and his family be very different from where they were a year ago.
4- Exploring values and intentions:
As Mr.S evolved from a “Head over Water” Survival level recovery to a more wholesome bigger version of himself, he began to examine his values and vulnerabilities, intentions and impact regarding anger. As we explored pivotal life moments, the purpose anger has served in his life, he changed his way of looking at his teenage years, and also his work, family and community. This led to a deeper understanding of his emotional experiences.
This exploration paved the way for aligning anger with personal values, he rebuilt his relationship with his estranged wife and children, and has started exploring healthier ways of expressing his needs, feelings, situations and story.
5- Creating alternative responses:
The list of alternative responses to Mr.Anger (Dragon/Donkey) helped challenge the dominant narrative that aggressive or destructive behaviours result from anger. He started developing new strategies to harness anger constructively. His strengths, resources, alternative stories enabled him to respond to anger in ways more in life with desired outcomes.
Key points and summary
Creating balance through understanding the borders and boundaries of an issue helps one come up with creative ways to enhance life. Through keeping a written record of the way issues like anger speak in one’s life, how they disturb equanimity, we saw two different approaches to this issue- a classic Cognitive Behavioural therapy (CBT) approach and a Narrative therapy approach (NT). Creating a positive journal of values, symbols and metaphors (Lotus, dragon, donkey, map, territory, journey) helped co-create better life options.
Exercise
Do you have an issue which you need to see through a different lens? Write how it has spoken to you in your life and discuss as appropriate. Alternatively, write a letter to the issue.
References
White, M. (1984). Pseudo-encopresis: From avalanche to victory, from vicious to virtuous cycles. Family Systems Medicine, 2(2), 150–160. https://doi.org/10.1037/h0091651
White, M. (2007). Maps of narrative practice. WW Norton & Company.
Prashant Bhatt's notes 