Case Study

Case Study

By W. Robert Nay

Stop the Merry-Go-Round
Strategies for angry couples

It's one thing to help an easily incensed individual learn to manage a too-easily-aroused temper. It's entirely another thing to help partners in a troubled relationship deal with the kind of anger that gets triggered primarily when they're with each other. Yet therapists often focus too narrowly on helping individuals manage their personal anger, rather than helping partners reduce the anger that repeatedly arises between them.

In chronically angry couples, differences of opinion rapidly become arguments, which escalate to raised voices, raised blood pressure, and sometimes raised fists. Repeatedly, the anger itself, rather than the initial disagreement, becomes the issue, shooting back and forth, intensifying with each volley. As the emotion rises, and as ordinary inhibitions fall away, the likelihood of verbal abuse and/or physical aggression grows. Aggressive feelings drown out any attempt at addressing the underlying conflicts or problems in the relationship.

Partners riding this merry-go-round of anger almost inevitably blame each other for the problem. Typically, one or both portray the other as having "started it," ignoring the fact that their conflict occurs within a system of two. The partners pass the anger back and forth like a shared virus.

My Way or the Highway

Adam and Sarah sought my help after what Sarah called "years of fighting over nothing," which had sapped the life from their marriage. Sarah, 38, told me her anger was triggered only by Adam's temper. "I'm fine with other people," she said, adding that the only time she got mad was when she felt Adam had invaded her space. "With him, it's always 'my way or the highway.' He gets extremely loud, intense, and sarcastic when we don't do what he wants, when he wants it."

When I asked her how she usually reacted when Adam got angry, she looked embarrassed. "Lately, I've been telling him off," she admitted. "I can't take any more of his loudness and aggression. Last week, I screamed at him to 'shut the hell up' in front of our children. I don't want to act this way, or for them to turn out like him!" I asked her if she'd be willing to be a part of the treatment, even though she believed Adam's anger was the main problem. Although she wasn't sold on this idea, she agreed when I told her that she needed to learn to change the way she reacted to Adam's anger to help defuse it early, and to feel better herself.

Adam, 41, informed me right away that he'd do anything to save his marriage. He came from a family of shouters, he said, and often listened to his parents argue well into the night. While he'd vowed not to be like them, he found himself all too often "losing it" with Sarah—yelling and saying things he later regretted. But he saw his wife as a big part of the problem: "If she'd just leave me alone when I get stressed out, I wouldn't get so mad. She needs to learn to back off." He blamed much of his anger on stress resulting from long hours working for a demanding boss at a large insurance company. By blaming his wife and his work, he externalized his feelings. Like most of my angry clients, deep down, he believed that his anger originated outside himself.

Strategies for Arousal Management

I met with Sarah and Adam individually for three sessions to identify their individual patterns of anger arousal—the physical sensations each experienced when anger was triggered. From there, the focus shifted to specific strategies to derail their arousal pattern before they became so angry that calming thoughts and self-control were difficult or impossible.

In my first individual session with each of them, I asked each one to keep an anger log, recording the situations when anger was experienced, the thoughts or "self-talk" that arose in their minds, their body sensations (tight shoulders, heat in neck and face, jaw tension), and the actions or words they used to express their animosity. The logs and my clarifying questions helped me identify their triggers: the actions or statements that seemed to instigate arousal. As partners become aware of specific triggers, they can "preview" an upcoming encounter to think ahead about how to manage their temper, if it arises.

To assess how each got triggered, I reviewed what I call the "Five S's"—life factors that contribute to instigating and intensifying anger arousal. These include: inadequate Sleep; ongoing life Stress; not eating properly, or inadequate Sustenance; use of Substances like alcohol, caffeine, or other drugs; and any health issue or Sickness that increases irritability (a bad cold, headache, lower back pain). Adam told me, for example, that he often stayed up until 1:00 a.m. to have some time alone, yet arose at 6:00 a.m., getting only five hours of sleep. He agreed to begin pushing his bedtime sequentially earlier by about 15 minutes a night, to work toward a 10:00 p.m. bedtime. We discussed making the bedroom extra dark to further aid sleep onset.

Adam's stress level was heightened by his feeling that he had to work late to avoid a threatened layoff. We discussed a variety of coping strategies, including work breaks, a power nap, relaxation techniques, and ways to challenge scary self-talk—"How will I support my family?" "What if I can't find another job?"—which fueled anxiety and sometimes contributed to insomnia. He told me he often skipped lunch or grabbed a snack from a machine, since he felt he was too busy for a meal. I encouraged him to take at least 30 minutes to eat a healthy lunch to sustain his blood-sugar level, since low blood sugar is related to irritability and general disinhibition.

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