Recognizing Your Anger

When people come in for counseling, they're often asked, "Have you ever tried to stop the violence on your own? What did you try?" A response that we frequently hear is, "Yes, I tried to work it out on my own; I tried not to get angry."

People often confuse anger and violence. They sometimes think that anger, or any intense feeling for that matter, means violence. There's a difference, however, between anger and violence. Anger is an emotion and violence is a behavior that can express that emotion. It's normal and natural that throughout life there will be times when you feel irritated, annoyed, angry or even enraged.

Anger tells us when something is "not right" with us. We're upset with something we're doing, hearing or seeing. Like physical pain, anger can be a way our body and mind alerts us to the situation around us.

Violence on the other hand, is just one expression of anger. In addition, it has a long list of negative consequences. It may mean losing the love and trust of your partner, your children being fearful of you, separation,divorce or being arrested and it definitely means not feeling good about yourself afterwards.

There are many ways to deal with anger so that you can get your point across. These ways can feel good to you, your partner and your family. Trying to hold back your anger, or any feelings, most of the time may actually lead to explosive outbursts of violence if you haven't learned to modulate intense emotions.

When anger is expressed as it comes up, in a direct non-intimidating manner, there's not the buildup or pressure cooker effect that may lead to you feeling overwhelmed. The problem is that many men don't realize when they're feeling angry.

It creeps up on them and they become overwhelmed by the intensity of their emotional reaction to the situation. One reason for this is that many people were taught as children that anger is a "dangerous" emotion to express. As a result, many men don't pay attention to their own anger and if they do, they try to keep it inside.

Because many abusive individuals learned to be so intolerant of anger, it often is expressed in unhealthy ways. Physical violence is one of these ways, but there are others. Remember the last time you did a slow burn at home, or gave your partner the cold shoulder? Do you think your partner got the message that you were angry? We also often express anger by blaming or trying to make our partner feel inferior. In fact, most of us are very creative about finding indirect and hostile ways of expressing our anger.

The first step in learning to control your anger is to recognize when you're feeling it at low levels; that is, in the early stages before it gets more difficult to contain.

For most people, the body begins to "feel angry" long before their mind realizes that they're angry and what they're feel angry about. Many men have come into our groups stating that they have to understand why they're feeling angry before they express their feelings.

This can be a big mistake. It may take you quite a long time (for some it may take hours, days or even years) before you realize just what it was that you were feeling angry about. In the meantime, if you don't express yourself you could turn into a walking time bomb. How can we tell that we're angry? Start with your body, it doesn't lie.

What are your body signals to anger? Most men feel tension. This tension may be in the chest, the arms, the legs, the forehead, the face, the back of the neck or their stomach. Some men state that they get cold while others may sweat. Your heart may start pounding and you may breathe faster. Some men breathe lighter or slower. You may get a headache or a backache.

1. Distress vs. Silence: A common notion about distress is that it's associated with some sort of demonstration. Sobbing. Yelling, Shivering, etc., the outward evidence of inward turmoil - a sound of some kind.

Thus, when a client sits quietly, even calmly and is silent, it's quite possible for the therapist to assume all is well. The client is taking time to think about what's been said (possible), isn't feeling like talking at the minute. Also possible and also possible is the therapist filling in the gap by talking.

Not helpful if true mulling over things is happening. One can't think clearly about personal events and insights with someone talking, even if it's connected to the subject.

There's, for me, a silence that allows my client to absorb, process, seek understanding and so on but this isn't distress.

However, there's a silence that's deep distress. Not a sound comes forth. Not even a hint of a sigh or sob, but distress, never-the-less.

There's a real difference between Silence and Silencing.

The useful Silence mentioned above is productive.

Silencing is harmful and results from many things. A number of people have told me how they've been silenced by their therapists. I've silenced people too and here are some of the ways we, as therapists, can do it.

Our clients: Being told they're trying to get attention, imagining things and are having false memories. Told how they're feeling, what they're thinking, why they behave as they do - all beautifully interpreted by the voice of Authority informed by our Theory of choice.

Their voice is taken away by disbelief, paternalism, no time given for their needs to be spoken. An impatient look, (includes clock watching. This small act doesn't go unnoticed), the therapist shows discomfort and can't sit with raw emotions so none are allowed out.

Therapist changes the subject and what the client has on their mind is disregarded and flies out the window. (This one is very common & deadly for silencing).

There are many more ways we silence our clients, but the point I wish to get over is this:

Distress isn't only emoting in some audible fashion.

A man, woman or child who sits mute, possibly with a smile on their face, can be in the deepest distress for the causes stated above. Because we aren't mind readers we have no idea what a person is thinking.

If we aren't listening to what we're saying, really saying, i.e., from above, we make the accusation that some story of torture or sacrifice witnessed or participated in by a cult / group survivor is most assuredly a false memory or a desire to gain attention, it'll immediately close the mouth of our client from sharing anything else.They know it's going to be interpreted as fantasy or manipulative.

It doesn't even have to be that severe an event. I've heard it said that time and time again people have been silenced because they've felt disbelieved about seemingly ordinary things that hold far from ordinary meaning for them. But in silencing these, significant details are dismissed.

If we aren't listening, REALLY listening, we can change the subject wafting off on a train of enlightened thought we had about something our client said and anxious they hear our interpretation of it.

Or we associate what they're saying with another aspect of their life and completely silence the one who desperately needs to finish sharing what they're struggling with. If we make a helpful connection like this it can always be filed in our memory and returned to another time. It can wait!

When we err these ways, not only are voices silenced but we have lost important material that needs to be worked through. That they sit quietly before us while we talk can be the muteness of resignation. The futility of trying to be heard. It's the distress of the abuse survivor who has always been silenced and never allowed to show their hurt.

They've sometimes been told to smile to show their agreement with what's being told them - hence we mistake smiling as being a sign of agreement with our view of things.

So how do we counteract this error? We monitor ourselves within, taking note of what we're saying and why we're saying it, what we are doing and why we are doing it and we ask.

We ask how it is for our client. If there's anything that's being overlooked, changed for them, if we haven't heard something correctly and if so, what has been misheard and what's their meaning. We ask if they've finished what they wish to talk about and apologize for interrupting and changing the subject if we're alert enough to realize we've done so.

Many, if not most, survivors who have never been allowed to voice anything will be unable to say even when asked and if we realize this fact but haven't understood the distress beneath the calm, it's up to us, to recognize distress and gently inquire if perhaps there's something more they'd like to tell us but it somehow got cut off.

Bottom line, if we distinguish between silence and silencing we'll be better able to recognize the reenactment of how survivors have long ago learned how to hide their distress and present as having none.

2. Distress vs. Body Language: I've mentioned smiling. Perhaps because of my own experience with the falseness of smiles (people smiling in pretense of welcome immediately followed by complete ignoring of my presence). Smiles on the face of an abuser while they say they love us in rhythm to the beating. Talking about love while emotionally hurting and physically inflicting pain on another distorts love and any belief in the speaker's words. Hypocrisy at its worst. I question smiling.

So the one in the client's chair is smiling and we think all's right with the world. We don't realize or recognize the distress of compliance based in terror. It's even possible to be inwardly congratulating ourselves on having managed to help our client feel good about themselves! Wrong!

When I've observed a smile I ask the person what it means and this can lead to opening a wealth of material.

Tears. We all react to weeping differently depending on what they evoke in us. The mistake we can make in thinking tears are always about distress is in thinking they are. This isn't necessarily so, but can we recognize the difference?

Some tears are tears of relief. Something makes sense that has previously been a source of unvoiced terror. The "not knowing", now becomes, " I know".

Some tears can actually be joyful. A little victory won that the client recognizes and acknowledges. Instead of being told they have made changes in a certain area they see it for themselves & the tears flow.

Some tears are tears of forgiveness and not of distress. These tears aren't connected with the fear of and rage towards, the perpetrator of pain but the power of being able to be free of the influence and forgive the abuser. This doesn't mean forgetting, but the pushing them out of their previous seat of control.

Thus, we might do a disservice to our clients in not being able to distinguish between tears of distress and tears for other causes.

How good when we can recognize the source and instead of commiserating how we empathize with their distress and have them look at us blankly, "what are you talking about?" we're able to zero in on the true meaning and talk about that.

Physical vs emotional distress: When faced with a client who is suddenly writhing in their chair, a good therapist will always question if there's a physical cause for bodily discomfort. One needs to rule out this possibility (e.g. an acute attack of appendicitis), but it's amazing how commonly emotional or psychological distress isn't recognized.

The knowledge that there's drug use in a person's story might predispose the therapist to allot physical symptoms to drug reactions, or dwell on somatic pains rather than the underlying emotional or psychological distress that made the person turn to drugs to numb out the heart suffering, or relegate emotional &/or psychological distress into body symptoms. (Psycho-somatic)

Bowed head and shoulders, rigidity of body, clenched hands, shaking legs, downcast eyes, blatant and not so evident body gestures can also be misinterpreted as distress and in one sense this is accurate, but what kind of distress?

There's one distress that abuse survivors will rarely voice - it's the deep deep feeling of shame.

This distress will be shared only w/those therapists who are aware of its entrenched hold on their client's psyche and their immoveable conviction of being guilty, the cause of all the troubles, to blame, humiliated, feelings of self-loathing and self-hatred and the thought of contaminating others.

If this shame distress isn't recognized it'll be lost under the treating of the overlaid physical behaviors that could be and oftentimes are, connected to the more obvious feelings of terror, grief, rage and so forth.

Here, we as therapists, need to self-examine our own reactions to dealing with shame, both personal and that of others'. If we've truly faced this emotion we will not only be more open to working through it with our clients but we'll be much more likely to recognize the distress of shame and not miss it.

Shame is a subject in its own right and I'll no doubt be posting an article about it at some point.

One last little thought is this - can we, as therapists, honestly discern between our client's distress and our own?

My Article on Retraumatization, ( see: www.goessoftlyishere.com), speaks to the effects of not dealing with our countertransference distresses.

This ability to recognize what is our "stuff" and what belongs to our client is vital to the therapeutic process. Can we truly recognize our own baggage and claim it? It's crucial if we're to truly help our survivors survive.

If they, in their innermost being, (whether or not they tell us), feel we have recognized their distress and have put it where it belongs, we are building on solid ground and not chasing shadows.

I end with the question again, " Do we recognize distress when we see it?"

What are your signals to anger?

Exercise #1

Think about a situation recently where you felt angry. Picture the situation in your mind and remember what you were feeling and thinking. How did your body feel at the time? Can you feel any of those body signals right now? List four body signals you get when you are feeling angry:

Some people laugh or become humorous, some become sarcastic. Some become depressed, withdrawn or quiet. Sometimes people will not follow through with their commitments when they're angry. It isn't uncommon for some people to act out sexually when they're feeling angry; such as having affairs, visiting prostitutes or demanding sex with their partner as a way of avoiding emotional intimacy. Some will have difficulty sleeping or eating while others may want to sleep or eat more. Some people use alcohol or drugs when they're angry.

What are your anger behaviors?

1.

2.

3.

4.

These body and behavior signals of anger are cues as to when you should be taking your Time-outs with your partner. Many people believe that you take a Time-Out only when you think you may become violent. I suggest that in the early stages of counseling, (the first 12 weeks) you take a Time-Out whenever you feel anger. In this way you will begin to automatically think about walking away before you even get close to losing control.

Recognizing Guilt

Recognizing Guilt in Your Child

When considering whether your child suffers from feelings of guilt, remember that all of us experience these feelings for short periods of time as we go through life. Some children are more subdued, introspective and quiet than others. Parents may feel like there's something wrong with their child if these characteristics differ from their own.

Since most children will display these characteristics at one time or another, it falls to the parent to watch for the occurrence of 5 or more of these characteristics persisting as a pattern over a protracted period of time.

A child who is plagued by guilt may exhibit a number of these characteristics:

a) Lowered self-esteem and feelings of self-worth

b) Unrealistic self-expectations (too high)

c) Decreased spontaneity

d) Confusion

e) Self-blame

f) Shame

g) Withdrawal

h) Anxiety

i) Depression

j) Increased compliance or "people-pleasing" behavior

k) Highly manipulative actions

l) Secretiveness

Recognizing Jealousy in a Child

A child who is seriously troubled with jealousy acts like an unhappy victim. While all of us experience jealousy, a child who is troubled with it dwells on jealous feelings. S/he is one who hasn't learned to make choices for him/herself and who has lost, or is denied, the ability to create desired outcomes, experiences or opportunities.

A jealous child may exhibit a number of these characteristics

a) Sulking

b) Non-communicative

c) Fatigued

d) Partial to certain people

e) Stealing

f) Manipulative behavior

g) Unforgiving

h) Untruthful

i) Depressed

j) Unhappy

k) Low self-esteem

l) Focused on the past

m) Feelings easily hurt

n) Critical and negative about others

o) Hitting or hurting other children

p) Prejudiced about certain people or situations

Recognizing Caregiver Burnout

Caregiver burnout is a state of physical, emotional and mental exhaustion that may be accompanied by a change in attitude  from positive and caring to negative and unconcerned. Burnout can occur when caregivers don't get the help they need, or if they try to do more than they're able either physically or financially.

Caregivers who are "burned out" may experience fatigue, stress, anxiety and depression. Many caregivers also feel guilty if they spend time on themselves rather than on their ill or elderly loved ones.

What are the symptoms of caregiver burnout?

The symptoms of caregiver burnout are similar to the symptoms of stress and depression. 

They include:

• Withdrawal from friends, family and other loved ones
• Loss of interest in activities previously enjoyed
• Feeling blue, irritable, hopeless and helpless
• Changes in appetite, weight or both
• Changes in sleep patterns
• Getting sick more often
• Feelings of wanting to hurt yourself or the person for whom you are caring
• Emotional and physical exhaustion
• Irritability

What causes caregiver burnout?

Caregivers often are so busy caring for others that they tend to neglect their own emotional, physical and spiritual health. The demands on a caregiver's body, mind and emotions can easily seem overwhelming, leading to fatigue and hopelessness and ultimately, burnout. Other factors that can lead to caregiver burnout include:

• Role confusion: Many people are confused when thrust into the role of caregiver. It can be difficult for a person to separate her role as caregiver from her role as spouse, lover, child, friend, etc.
• Unrealistic expectations: Many caregivers expect their involvement to have a positive effect on the health and happiness of the patient. This may be unrealistic for patients suffering from a progressive disease, such as Parkinson's or Alzheimer's.
• Lack of control: Many caregivers become frustrated by a lack of money, resources and skills to effectively plan, manage and organize their loved one's care.
• Unreasonable demands: Some caregivers place unreasonable burdens upon themselves, in part because they see providing care as their exclusive responsibility.
• Other factors: Many caregivers can't recognize when they're suffering burnout and eventually get to the point where they can't function effectively. They may even become sick themselves.

How can I prevent burnout?

Here are some steps you can take to help prevent caregiver burnout:

• Find someone you trust such as a friend, co-worker, or neighbor to talk to about your feelings & frustrations.
• Set realistic goals, accept that you may need help w/caregiving & turn to others for help w/some tasks.
• Be realistic about your loved one's disease, especially if it's a progressive disease such as Parkinson's or Alzheimer's.
• Don't forget about yourself because you're too busy caring for someone else. Set aside time for yourself, even if it's just an hour or two. Remember, taking care of yourself isn't a luxury. It is an absolute necessity for caregivers.
• Talk to a professional. Most therapists, social workers & clergy members are trained to counsel individuals dealing w/a wide range of physical & emotional issues.
• Take advantage of respite care services. Respite care provides a temporary break for caregivers. This can range from a few hours of in-home care to a short stay in a nursing home or assisted living facility.
• Know your limits & do a reality check of your personal situation. Recognize & accept your potential for caregiver burnout.
• Educate yourself. The more you know about the illness, the more effective you'll be in caring for the person w/the illness.
• Develop new tools for coping. Remember to lighten up & accentuate the positive. Use humor to help deal w/everyday stresses.
• Stay healthy by eating right & getting plenty of exercise & sleep.
• Accept your feelings. Having negative feelings such as frustration or anger about your responsibilities or the person for whom you're caring is normal. It doesn't mean you're a bad person or a bad caregiver.
• Join a caregiver support group. Sharing your feelings & experiences w/others in the same situation can help you manage stress, locate helpful resources & reduce feelings of frustration & isolation.

Where can I turn for help for caregiver burnout?

If you're already suffering from stress and depression, seek medical attention. Stress and depression are treatable disorders. If you want to prevent burnout, consider turning to the following resources for help with your caregiving:

• Home health services: These agencies provide home health aids and nurses for short-term care, if your loved one is acutely ill. Some agencies provide short-term respite care.

• Adult day care: These programs offer a place for seniors to socialize, engage in a variety of activities and receive needed medical care and other services.

• Nursing homes or assisted living facilities: These institutions sometimes offer short-term respite stays to provide caregivers a break from their care-giving responsibilities.

• Private care aides: These are professionals who specialize in assessing current needs and coordinating care and services.

• Caregiver support services: These include support groups and other programs that can help caregivers recharge their batteries, meet others coping with similar issues, find more information and locate additional resources.

• Agency of Aging: Contact your local Agency on Aging or your local chapter of the AARP for services available in your area such as adult day care services, caregiver support groups and respite care.

Recognizing the Warning Signs of Mental Illness

Mental illnesses are real, recognizable and treatable.

Early treatment may reduce the effects of a mental illness.

There is hope.

Help is available.

A mental illness is a disease that causes mild to severe disturbances in thought and/or behavior, resulting in an inability to cope with life's ordinary demands and routines. Mental health problems may be related to excessive stress due to a particular situation or series of events.

As with cancer, diabetes and heart disease, mental illnesses are often physical as well as emotional and psychological. Mental llnesses may be caused by feeling environmental stresses, genetic factors, biochemical imbalances, or a combination of these. With proper care and treatment many individuals learn to cope or recover from a mental illness or emotional disorder.

For others, it may be a lifelong challenge. There are more than 200 classified forms of mental illnesses. Some of the more common disorders are: depression, bipolar disorders, dementias, schizophrenia and anxiety disorders. Symptoms may include changes in mood, personality, personal habits and/or social withdrawal.

Warning Signs of Mental Illness in Adults Include:

• confused thinking
• prolonged depression (sadness or irritability)
• feelings of extreme highs and lows
• excessive fears, worries and anxieties
• social withdrawal
• dramatic changes in eating or sleeping habits
• strong feelings of anger
• delusions or hallucinations
• growing inability to cope w/daily problems & activities
• suicidal thoughts
• denial of obvious problems
• numerous unexplained physical ailments
• substance abuse

• changes in school performance
• poor grades despite strong efforts
• excessive worry or anxiety (i.e. refusing to go to bed or school)
• hyperactivity
• persistent nightmares
• persistent disobedience or aggression
• frequent temper tantrums

Warning Signs of Mental Illness in Older Children & Pre-Adolescents

• substance abuse
• inability to cope with problems and daily activities
• change in sleeping and/or eating habits
• excessive complaints of physical ailments
• defiance of authority, truancy, theft and/or vandalism
• intense fear of weight gain
• prolonged negative mood, often accompanied by poor
• appetite or thoughts of death
• frequent outbursts of anger

Worrying about what other people will think?

Often the warning signs of mental illnesses are ignored because of the stigma that persists. Some people may face ridicule or hostility from friends and neighbors. The insensitivity of others may add to feelings of loneliness and isolation and may stop a family from seeking help.

Wondering who's to blame?

Often, knowing what causes an illness helps people to accept the situation and move on to seeking treatment. With some mental illnesses, there are no immediate answers or obvious reasons why someone became ill.

Today, research tells us that many mental illnesses are caused by a variety of reasons. Find out all you can about your loved one's illness by reading and talking with mental health professionals.

How to Cope Day-to-Day

Handling unusual behavior

The outward signs of a mental illness are often behavioral. Individuals may be extremely quiet or withdrawn. Conversely, he or she may burst into tears or have outbursts of anger. Even after treatment has started, individuals with a mental illness can exhibit anti-social behaviors.

When in public, these behaviors can be embarrassing and difficult to accept. Try to be patient and remember that the person probably can't control his or her actions. Calmly try and move to a private location until the episode is over. The next time you and your family member visit your doctor, discuss these behaviors and develop a strategy for coping.

Establishing a support network

If you feel you can't discuss your situation with friends or other family members, find a self-help or support group. These groups provide an opportunity for you to talk to other people who are experiencing the same type of problems. They can listen and offer valuable advice.

Seeking counseling

It's likely that the family member with the mental illness is seeing a therapist or counselor. Therapy can also be beneficial for family members. The therapist can suggest ways to cope and better understand your loved one's illness. When looking for a therapist, be patient and talk to a few therapists so you can choose the person that is right for you and your family. It may take time until you're comfortable with the therapist, but in the long run you'll be glad you sought help.

Taking time out

It's common for the person with the mental illness to become the focus of family life. When this happens, other members of the family may feel ignored, annoyed and resentful. Some may find it difficult to pursue their own interests.

If you're the caretaker, you may need some time to rest. Schedule time away before you become frustrated or angry. If you schedule time for yourself it'll help you to keep things in perspective and you may have more patience and compassion for coping or helping your loved one.

You have feelings too

Remember, the burden of caring for a person 24-hours a day can be exhausting and unpredictable, even frightening. Take time for yourself, seek respite care and the support and help of family and friends.

Only when you're physically and emotionally healthy can you help others. It isn't always possible to be patient and giving all the time. There are times when you may be tired, angry, or resentful. Accept these feelings and go easy on yourself.

Inpatient care

There are many reasons why it may be necessary to hospitalize the family member with a mental illness. Medications may need to be adjusted under close supervision, or a different course of treatment may be necessary.

At these times it isn't only the individual with the illness who must make changes, but also the family. Take time to re-focus, develop a new routine and plan for your loved one's return.

Don't give up too soon

Recovery from a mental illness takes time, months or even years. Don't be discouraged by temporary setbacks and try not to blame yourself when things go wrong.