HANDBOOK OF ANGER MANAGEMENT AND DOMESTIC VIOLENCE OFFENDER TREATMENT In the Handbook of Anger Management and Domestic Violence Offender Treatment, Ronald T. Potter-Efron consciously connects anger manage- ment and domestic violence, two long separated fi elds, and addresses treatment options and intervention methods that meet the needs of individual clients, couples, families, and groups. Therapists, counselors, social workers, and other treatment specialists will fi nd this book a useful overview and reference for anger and anger management techniques as well as domestic violence approaches. This new edition is split into three distinct sections: • A description of anger and domestic violence focused upon helping clients use the principles of neuroplasticity to dramatically alter their behavior. • Assessment for anger problems and/or domestic violence. • Group treatment or individual, couples, and family treatment for anger problems and/or domestic violence. Woven through this book is a fair and balanced treatment of gender issues, refl ected in the diversity of case examples that address jealousy, chronic anger, behavioral problems, group and individual counseling, and more. Readers are also shown how anger develops and can lead to verbal and physical outbursts, the fi ve types of rage reactions, and how to treat anger turned inward. Potter-Efron also details four different approaches to treating anger: behavioral, cognitive, affective, and existential/spiritual. Mental health professionals are provided numerous questionnaires and worksheets to utilize with their clients. The Handbook of Anger Management and Domestic Violence Offender Treatment is an essential guidebook that illustrates effective theory and practice. Ronald T. Potter-Efron, MSW, PhD, is Director of the Anger Management and Domestic Violence Center at First Things First Counseling in Eau Claire, Wisconsin. He is author of over fi fteen books on anger management and related topics. His books for the general public include Angry All the Time (2004) and Healing the Angry Brain (2012). This page intentionally left blank HANDBOOK OF ANGER MANAGEMENT AND DOMESTIC VIOLENCE OFFENDER TREATMENT Second Edition Ronald T. Potter-Efron Second edition published 2015 by Routledge 711 Third Avenue, New York, NY 10017 and by Routledge 27 Church Road, Hove, East Sussex BN3 2FA Routledge is an imprint of the Taylor & Francis Group, an informa business © 2015 Taylor & Francis The right of Ronald T. Potter-Efron to be identifi ed as author of this work has been asserted by him in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this book may be reprinted or reproduced or utilized in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Trademark notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identifi cation and explanation without intent to infringe. First edition published by Routledge 2005 Library of Congress Cataloging in Publication Data Potter-Efron, Ronald T. Handbook of anger management and domestic violence offender treatment / Ronald T. Potter-Efron. pages cm Includes bibliographical references and index. 1. Anger—Treatment. 2. Family violence—Treatment. I. Title. RC569.5.A53P67 2015 362.82’92—dc23 2014030929 ISBN: 978-0-415-71717-5 (hbk) ISBN: 978-0-415-71718-2 (pbk) ISBN: 978-1-315-87147-9 (ebk) Typeset in Sabon by Keystroke, Station Road, Codsall, Wolverhampton This book is dedicated to the newest member of the family, Cédric Alexandre Bertrand. This page intentionally left blank CONTENTS Preface xi Acknowledgements xiii PART I Anger, Domestic Violence, and the Brain 1 1 The Angry Brain 3 What is an “Angry Brain”? 4 Emotions 6 The Limbic System 8 Neuroplasticity 11 Ten Things to Know about the Angry Brain 17 Healing the Angry Brain 24 Summary 25 2 Anger, Threat, Feeling Unsafe, and Domestic Violence 27 The Stressed and Traumatized Brain: Fear and Anger 27 The Anger and Aggression Connection with the Stressed Brain 30 Attachment Theory 32 Anger, Domestic Violence, and Attachment Styles 36 Romantic Jealousy, Fragile Self-Esteem, and Attachment 38 Case Study: Excerpts from an Interview with a Jealous Man 40 Attachment Theory Related Treatment Strategies for Romantic Jealousy Concerns 42 vii CONTENTS Polyvagal Theory 44 Helping Clients Develop a Relatively Safe Sense of Themselves and the World 46 Summary 49 3 Rage: Predictor of Out of Control Anger, Aggression, and Domestic Violence 50 What is Rage? 50 Varieties of Rage 52 Five Types of Rage 58 Summary 62 PART II Assessment 63 4 Assessment for Anger and Aggression 65 General Concerns about Anger Assessment 65 Client Assessment 66 The Anger Styles Questionnaire 77 Anger Assessment as a Bridge to Treatment 82 Anger, Alcoholism, and Addiction 83 Case Study: Assessment of a Chronically Angry Client with Multiple Problems 87 Summary 90 5 Domestic Violence: Core Information and Assessment 91 What is Domestic Violence? 91 How Common is Domestic Violence? 93 Which Gender Commits Acts of Domestic Violence? 94 Is Domestic Violence Unidirectional or Bidirectional? 94 Reasons People Use to Explain or Justify Acts of Domestic Violence 94 Risk Factors 95 Anger’s Relationship with Domestic Violence 96 Theoretical Models of Domestic Violence 97 Assessment of Participants 106 Summary 110 viii CONTENTS PART III Treatment 113 6 Intervention Approaches in Anger Management 115 Intervention Philosophies and Approaches 115 Treatment Intervention Areas in Anger and Aggression Management 118 Behavioral Approach: Introducing Clients to an Objective Change Focus 119 Cognitive Aspects of Anger Management 126 Affective Anger Management Approaches 131 Existential/Spiritual Anger Management Approaches 134 Effectiveness of Anger Management Counseling 137 Case Study: A Woman Angry at the Universe 138 Summary 141 7 The Anger and Aggression Cycle: A Therapeutic Model 142 Phase One: Activation 142 Phase Two: Modulation 144 Phase Three: Preparation 146 Phase Four: Action 147 Phase Five: Feedback (Including Empathy Training) 148 Phase Six: Deactivation (Including Forgiveness) 153 Case Study: How to Go Through the Anger Cycle Very Badly 167 Summary 169 8 Group Treatment for Domestic Violence Offenders 170 Domestic Violence Offender Treatment Program: Educational Focus 171 Extended Domestic Violence Offender Treatment Program 174 Women’s Domestic Violence Offender Treatment Groups 179 Cultural Diversity: LGBT and Ethnic Minority Groups 181 Brain-Change Model for Domestic Violence Offender Treatment 182 Case Study: Domestic Violence Offender Brain- Change Program 192 Summary 195 ix CONTENTS 9 Alternatives to Group Therapy for Angry and Domestically Violent People: Individual, Group, and Family Therapy 196 Individual Anger and Domestic Violence Counseling 196 Case Study: A Man Who Benefi ted from Both Group and Individual Counseling 202 Couples Counseling with Angry or Violent Couples 203 Family Therapy Addressing Anger and Violence 211 Summary 217 10 Anger and Aggression Turned Inward 218 What is “Anger Turned Inward”? 218 Domestic Violence and Anger Turned Inward 220 Suppressed Anger 222 Case Study: The Lady Who Quit Smiling 228 Passive Aggression 229 Anger Directed at Self 232 What if Clients are High on Both Anger Turned Inward and Outward? 237 Summary 239 References 240 Index 250 x PREFACE This book is designed for treatment specialists in the areas of anger management and domestic violence offender treatment. There has been an unnecessary divide between these two fi elds for the last several decades. Unfortunately, that has often meant that anger management counselors were insuffi ciently trained to recognize or treat angry clients who were also domestic violence offenders, while domestic violence counselors were literally mandated in many states not to include anger management materials in their work with offenders. (The reason for this mandate will be discussed in chapter 5.) This artifi cial barrier is in the process of being broken down now and this volume hopefully will help connect these two long separated fi elds. A note on terminology. I avoid terms that I believe are judgmental in the area of domestic violence. For that reason I have avoided the term “perpetrator,” which casts one individual as chronically and seriously impaired and morally suspect. I also seldom use the terms “abuser,” as this term fails to take into account the great frequency of mutual domestic violence. Instead, I write about “domestic violence offenders,” a somewhat awkward phrase, but one I believe is less prejudicial than the others. This book is divided into three major sections. The fi rst part is on anger, domestic violence, and the brain. Here I present the research on what happens when people become immediately or chronically angry, how a central lack of physical and/or psychological safety makes people susceptible to anger and domestic violence, and how rage differs from anger and greatly increases someone’s propensity toward violence. The second part consists of two chapters on assessment, one for anger management and one for domestic violence offenders. I strongly urge readers to consume both chapters regardless of your specialty. Finally, the third part is about treatment. Two of these chapters provide guidelines for group treatment of anger management and domestic violence offenders