Anger as a cover-up

An article in The Independent yesterday brought up for me yet again the question of anger in young people. (I’ve written about it before, here.) The article deals with the topic of how prevalent guns and knives are among groups of young people, and why. The author, Clare Dwyer Hogg, covers much current malaise that is of interest to the general reader, but as a therapist I can’t help but have half a mind to what is “really” going on. 

It’s quite beyond my frontiers to imagine how we will halt this escalation of violence on a societal level, but I do – often – consider it deeply in relation to individual clients who present with anger issues. We all know that unaddressed it will lead to big-T trouble.

Anger can be a cover-up for so many things that are harder to bear (Nick Luxmoore deals with this well). It can become a quick-fix relief for an emotional trigger-point, when perhaps another alternative would have more long-standing success but involve delayed gratification. It’s hard for kids to choose in favour of a later, pleasing outcome to the problem – it involves difficult work on themselves and a willingness to endure some unpleasant stuff on route. Much easier and nicer to explode and be done with it for a while. 

But they’re not always offered the choice, anyway. Take these examples: 

One child has sorted out some appropriate and satisfying behaviour for use in school, and become attentive and motivated. At home they are still outrageously acting out angrily with mum, to the extent that they are unmanageable. Without seizing the chance of working with mum and child together, a professional at CAMHS has decided to medicate the child. Now, there may be something I don’t know, but I fear for the side effects of medication on this child’s life at school. And does dosing a behavioural/relational problem ever really solve it, especially if the causes are not identified and worked on?

The second young person’s parents have become so worried at the angry outbursts at home that they have sought my help privately, in the hopes that therapy can prevent their worst fear happening: the child being put on ritalin. (I never mentioned the possibility – it came from their own lips – honest!) But it does give me a chance to test out, for the umpteenth time, my belief that if I attend to the whole story behind the angry child, trauma and all, it may be possible to diffuse the situation and bring about a better outcome. With the parents on board, this is a distinct possibility.

The issues in Clare’s article are much wider than this, of course – whole swathes of neglect, fear, attachment needs, self-defence, power imbalances etc – but I am only one person and I can only deal with angry individuals on a one-by-one basis. So how should I do it?

Ricky Greenwald, in his book The Child Trauma Handbook, gives a sound, detailed model of working with children who are acting out, as well as those who are showing other signs of distress after difficult events. (This book is not focused on EMDR although it is discussed, but rather on an exposure model.) He defines the word ‘trauma’, as used here, to apply to major trauma as well as loss and other adverse life events, as long as the event has had a traumalike impact on the child (one of which is a sensitivity to similar triggers, leading to all kinds of inappropriate behaviours). He then says something very significant: “When working with a child or adolescent with any kind of problem, we can’t afford to assume that trauma is not a factor.” (This contrasts strongly with the anecdotal medical advice of “when you hear hoofbeats, look for horses not zebras”.)

So, if I read Greenwald rightly, insead of going in with a scattergunning of techniques and a “try this, try that” attitude – anything with anger in the title if anger is the presenting issue – we should have in mind at the outset that anger can be a cover-up and that we may need to follow a trauma-focused approach. Indeed, we should have one in our repertoire.