ORIGINAL PAPER
Problem Anger in Psychotherapy: An Emotion-Focused
Perspective on Hate, Rage, and Rejecting Anger
Antonio Pascual-Leone • Phoenix Gilles •
Terence Singh • Cristina A. Andreescu
Published online: 24 May 2012
Ó Springer Science+Business Media, LLC 2012
Abstract This paper explores applies emotion-focused
theory, for the ﬁrst time, to the emotions of hate, rage, and
destructive anger. The general case formulation proposed
in this paper is that these emotions are always an elaboration
of secondary anger. The body of the paper describes
three clinical case formulations. First, problem anger is
described in terms of an individual’s self-criticism. Second,
we present a form of secondary anger, in which hostility
and rage are reactive feelings to avoid more vulnerable
(primary) experiences. An unfortunate example of this is
has been described as a common underlying process in
domestic violence. A alternate manifestation of secondary
anger results from the deterioration of what may have
initially been adaptive anger; thus, excessive arousal and
the loss of meaning or focus that one’s anger embodied
also leads to rage or destructive anger. Finally, the experience
and expression of hate is described as a primary
maladaptive and/or instrumental anger. This appears insession
particularly among those with certain personality
disorders. The paper highlights implications for research
and practice.
Keywords Anger Á Rage Á Hate Á Case formulation Á
Emotion-focused therapy Á Personality disorder
Introduction
Hate, rage, and rejecting or destructive anger, as forms of
problem anger, are an exceedingly important phenomenon
that present in psychotherapy. However, despite these
being squarely among the most unsettling emotional
experiences presented by some clients in session, there is
an alarming paucity of papers on making clinical formulations
around emotions like ‘‘hate’’ and there is also little
discrimination between other terms that describe problem
anger. Indeed, despite a sizable amount of research dedicated
to the study and measurement of anger as such, it
seems that clinical formulations of problem anger would
beneﬁt from a taxonomy of emotion that can accommodate
distinct layers of emotional processes as they apply to a
client in a given moment. Moreover, the implications for
relevant case formulation tends to be limited to mainly
behavioral (e.g., Deffenbacher and McKay 2000) and also
classic psychodynamic (e.g., Volkan et al. 2002) interpretive
frameworks. Meanwhile, humanistic/experiential
therapies have offered relatively little to psychotherapists
for conceptualizing the range of psychogenetic dynamics
that contribute to this darker side of human experience
(Hoffman 2009).
Thus, the contribution of this paper is to apply emotionfocused
theory to help conceptualize the all too often
unaddressed emotions of hate, rage, and destructive anger.
In doing this, however, it is important to recognize that
emotion terms such as these (i.e., hate, rage, destructive
anger, rejecting anger, etc.) are often used loosely in
clinical parlance, either interchangeably, or with overlapping
referents, or with authors’ idiosyncratic nuances of
differentiation. While some authors have made particular
distinctions (e.g., that ‘‘hate’’ is more ruminative than
‘‘anger’’; Blum 1997), others have added qualiﬁers or
adjectives to these emotion labels, creating parallel conceptual
frameworks (e.g., ‘‘ruminative anger’’ is a special
aspect of the broader phenomenology of anger; Sukhodolsky
et al. 2001). We do not pretend to resolve this
A. Pascual-Leone (&) Á P. Gilles Á T. Singh Á C. A. Andreescu
Department of Psychology, University of Windsor, 401 Sunset
Avenue, Windsor, ON N9B 3P4, Canada
e-mail: apl@uwindsor.ca
123
J Contemp Psychother (2013) 43:83–92
DOI 10.1007/s10879-012-9214-8
nomenclative issue, and instead refer to these as variations
of problem anger, for which there are several case formulations.
Our contribution is to explore an emotionfocused
framework for understanding problem anger in
psychotherapy. In doing so, we consider various case formulations
to assist psychotherapists in understanding clients
who present with these kinds of problematic feelings.
The general formulation we will propose is that hate and
other forms of problem anger are usually an elaboration of
secondary anger, of some sort—whether as a reactive state,
a characterological trait, or an instrumental means to some
other end.
An Emotion-Focused Theory of Emotions
One of the hallmarks of the general model of Emotion
Focused Therapy (EFT) is a highly differentiated perspective
on emotion, which can be used to support a
dynamic and layered approach to clinical case formulations.
Greenberg and colleagues (Greenberg and PascualLeone
2006; Greenberg and Paivio 1997; Greenberg and
Watson 2006) introduced to our ﬁeld a taxonomy of different
kinds of emotion and associated emotional processing
difﬁculties. From this perspective, emotion should
be considered in terms of clinically relevant types of
affective-meaning experiences: Primary (adaptive or maladaptive),
secondary, and instrumental emotions.
Primary emotion describes a basic genuine emotional
response. Emotions of this kind are a person’s most fundamental,
direct and initial reactions to a situation. However,
primary emotions may be either adaptive or
maladaptive. In addition to being a fundamental response,
primary adaptive emotions are feelings that change
dynamically in response to changing circumstance or
simply when they are being suitably expressed. Moreover,
they provide adaptive directions for solving personal
problems, like feeling sad as a process for recovering from
a loss, or feeling angry as part of asserting oneself against
some speciﬁc violation.
In contrast, primary maladaptive emotions are learned
responses, often developed through traumatic experiences.
Although these kinds of responses may have been adaptive
in the past (e.g., in an unhealthy context), they are no
longer adaptive and often create distress and dysfunction in
the present. Thus, maladaptive emotions are often old
familiar ‘‘bad feelings’’ that occur repeatedly and are
resistant to change (Greenberg and Paivio 1997). For
example, feeling ashamed about being an inherently bad,
unlovable, or incompetent person, or feeling chronic fear
that one is in danger (when one is not), are both common
examples.
Secondary emotions are a type of emotion quite apart
from primary emotions. Although they are not inherently
maladaptive, they may be difﬁcult to regulate, and they
often interfere with adaptive and ﬂuid emotional functioning.
In short, secondary emotion describes a reactive
emotion that is in response to some other, more basic
(primary) feeling. As such, secondary emotions may serve
a defensive purpose or they may reﬂect more complex
reactions to some other, more central, process. For example,
when a client feels guilty about her resentment toward
a parent, guilt is secondary in that it is a reaction to (primary)
underlying anger. Similarly, a man may respond
angrily to some social rejection, but the anger itself is a
secondary, defensive response to his genuine and direct
feeling about the injury, which might be pain, hurt, shame,
etc.
Finally, instrumental emotion describes the use (either
within or outside of awareness) of feeling and expression
as a means toward some end. For example, purposefully
raising ones voice in order to dominate others in a conversation
is an instance of instrumental emotion (Greenberg
and Paivio 1997). While the issue of emotion’s
potentially instrumental role has received relatively little
attention from experiential and emotion-focused researchers
this issue has been discussed more in behavioral case
formulations (see e.g., Linehan 1993, for a discussion of
the issue that instrumental impacts may be outside a client’s
awareness). However the case, the overall theoretical
framework of EFT has been useful in conceptualizing
emotion as being either primary, secondary, or instrumental;
this taxonomy has garnered empirical support in
psychotherapy process and outcome research, and it continues
to have important implications for clinicians working
with emotion (Greenberg and Watson 2006; Greenberg
and Paivio 1997; Paivio and Pascual-Leone 2010;
Greenberg and Goldman 2008).
‘‘I Hate Myself’’
Perhaps the most common expression of hate in psychotherapy
is when it is directed toward oneself. While one
may debate that self-hate is more of a ‘‘depressive’’ than
‘‘anger-related’’ process, the fact remains that psychotherapists
are often confronted with what can only be described
phenomenologically as a client’s angry and hostile
expressions (toward the self). Self-hate entails pervasive
criticism coupled with a tone of contempt or disgust. The
individual not only criticizes his/her performance, but does
this with harshness, contempt, or caustic disgust towards
oneself and one’s perceived failure (e.g., ‘‘How could I
even think I might do a good job?! I’m a useless slob and I
always will be!’’). Such piercing comments leave an
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individual feeling hopeless, helpless, and empty, which can
further fuel one’s self-loathing. Greenberg and Watson
(2006) noted that certain forms of depression arise as a
result of the harsh criticisms formulated by clients towards
themselves. Similarly, there is strong empirical support for
self-hate as a predictor of onset, severity, and relapse of
numerous other mental disorders including eating disorders
(Fennig et al. 2008), substance abuse (Blatt 2004) and
social anxiety (Cox et al. 2004).
Conceptualizing Problem Anger as a Self-Critical
Process: ‘‘I hate myself because I deserve it’’
Self-criticisms are a reﬂection of personal values that are
incorporated into emotion schemes, which operate at an
automatic level (Greenberg and Watson 2006) and become
activated when an interpersonal or existential need arises.
When unhealthy (i.e., depressogenic) conﬂict emerges,
individuals usually experience a bind between parts of
themselves, reproaching themselves and sometimes even
feeling ashamed of their needs (e.g., ‘‘I missed him so
much, but I should have known better than to have let him
back into the house!’’). It follows that self-hate/anger/
loathing can be conceptualized as a caustic, emotional
expression of self-criticism, in which people hate themselves
for their faults and errors rather than attending to
unmet personal needs. For example, a client might grit her
teeth and says, spitting in disgust ‘‘I’m such a loser! I hate
myself for being so pathetic. I don’t know why I never
stand up for myself! I’m like a worm the way I always let
myself get stepped on….’’ The bitter contemptuousness of
this example is a hallmark of self-hate. However, a closer
look at the vitriol in this expression highlights at least one
core self-criticism (i.e., in regards to passivity, weakness,
or perhaps vulnerability) and also an unmet need which has
been implied but not yet explored (i.e., the need to ﬁght for
one’s rights, to be assertive, and to have a healthy sense of
entitlement).
Self-criticism and its extreme affective expression—
self-hate—can be conceptualized as a secondary (and
maladaptive) process (Greenberg and Paivio 1997). In their
book on treating complex trauma, Paivio and PascualLeone
(2010) explain:
Self-criticism, especially when delivered in a harsh
affective tone, can reﬂect a deeply rooted hostility
or contempt toward the self. This self-critical process
can be understood as resulting from the activation
of a core sense of self as shamefully bad or
broken and therefore deserving of criticism (p. 60,
italics added).
So, situations that produce low self-esteem, in essence,
do so by activating a core sense of self as defective, a sense
of shame—and this is a primary maladaptive emotional
experience. In the absence of sufﬁcient personal resilience,
some clients react to their deeper primary experiences of
shame with punitive self-hate—a secondary response to a
deeper primary experience. The clinical formulation of
self-hate as secondary anger is illustrated in the top-left of
Fig. 1. One reason for ‘‘coping’’ with shame in this selfdestructive
way could be that it offers an active alternative
to shutting down.
Instrumental Anger
“I hate everybody…
because it works”
‘Primary’
Maladaptive Anger
“I hate everybody”
INCREASED
AROUSAL &
DYSREGULATION
HABITUAL OR
CHARACTEROLOGICAL
PATTERN OF SELF-
EXPRESSION
Defensive Reaction
Deterioration of
specificity in meaning
Self-Critical Anger
(Secondary emotion)
“I hate myself”
Primary Adaptive
(Assertive) Anger
“I’m fighting for…!”
Negative
reinforcement
(Remove/ displace pain)
Positive reinforcement
(Feel big, strong, dominant; feel
in control; get ones way)
REPEATED
REINFORCEMENT
(Functioning
often in tandem)
Rejecting Anger
(Secondary emotion)
“I hate you”
Primary Maladaptive
(vulnerable) emotions
Fear, Shame, Guilt…
Primary Adaptive
(vulnerable) emotions
Hurt, Grief, Love…
(i.e., “I’ve lost track of what I’m fighting for”)
Fig. 1 The psychogenetic pathways of problem anger: an EFT perspective
J Contemp Psychother (2013) 43:83–92 85
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The affective tone of criticisms is a particularly important
feature in expressions of self-hate. In fact, vulnerability
to depression has been linked to the harshness of a
self-criticism that an individual expresses, rather than its
content per se. This was evidenced in Whelton and
Greenberg’s (2005) study, in which participants were asked
to criticize themselves and then to respond to their own
criticisms in an imaginal dialogue with themselves. Participants
who were vulnerable to depression used signiﬁcantly
more insults and expressed more contempt when
delivering their criticisms as compared to healthy controls,
who were less vulnerable to depression. In addition, when
participants in the study attempted to respond or ‘‘ﬁght
back’’ against their own self-criticisms, those with a
diathesis for depression exhibited more submissiveness and
less assertiveness than their less vulnerable counterparts. In
short, the harsh nature of criticisms was also coupled with
responses of shame, sadness, lack of self-pride and conﬁdence,
and efforts to present excuses rather than assertive
responses. In contrast, less depressive participants did not
exhibit the same contempt and they were resilient to criticisms,
responding with self-afﬁrmation and assertive
anger (Whelton and Greenberg 2005). Thus, the selfcritical
process in depression tends to evoke a correspondingly
weak and helpless sense of self, in which the
individual is unable to formulate assertive counter-arguments,
thus collapsing into hopelessness (Greenberg and
Watson 2006) and self-reproach.
Interventions for Working Through Self-criticism
and Self-Hate
Changing the dysfunctional feelings and beliefs underlying
self-hate is accomplished in EFT through the creation of an
imaginal dialogue between two aspects of self: the critical
aspect, which is based on internalized values and often rigid
ideology versus the experiencing aspect, which often feels
berated and beaten down by constant internal criticism. This
intervention bears some similarity to the cognitive strategy
of generating evidence against dysfunctional beliefs,
although an EFT approach emphasizes affective arousal,
spontaneous emotional expression, and a dynamic exchange
between contradicting yet meaningful parts of the self. In
short, the individual expresses criticism and then responds
to this criticism, ideally with a meaningful emotional
response that conveys some tacit interpersonal or existential
need. These dialogical interventions, typical of EFT,
achieve two purposes: (1) increasing emotional awareness
of a personal conﬂict, and (2) working through that conﬂict.
Self-criticisms are not usually arbitrary and are most often
distortedexpressions of personal standards and values that an
individual has internalized (for better or for worse; Greenberg
and Watson 2006). Although benign self-criticism may
serve the function of upholding these values for an individual,
self-hate is an acerbic and maladaptive expression of
self-criticism. As we have seen, such caustic self-hatred is
often a secondary emotion to primary maladaptive shame
and a sense of personal weakness/inadequacy. Thus, the ﬁrst
purpose of the dialogue is for the client to learn to explore
unpleasant underlying emotions. An important prerequisite
to this is that the client has adequate emotion regulation and
distress tolerance skills, given that a focus on the experience
of shame is often more distressing relative to tolerating selfhate.
Following this, the imaginal dialogue allows for a full,
but controlled exposure to the raw and caustic criticisms
(Greenberg and Watson 2006). For those clients who can
tolerate and work through painful feelings effectively, the
task presents an opportunity to increase awareness of personal
conﬂict. As the values (manifest in self-criticism) and
unmet needs (manifest in distress) are each explored, the
client reﬂects on self-hate as stemming from self-criticism.
Therapist and client come to understand self-hate (anger
directed toward the self) as an emotion that is secondary to
deeper processes of maladaptive shame and dysfunctional
belief (e.g., the shame of feeling inherently unlovable,
incompetent, etc.). Eventually, resolution can be achieved
through an emotional transformation, as the maladaptive
feelings and meanings (beliefs) are reorganized and a better
balance is reached between the values and needs such that
each are experienced and acknowledged (Greenberg and
Watson 2006; Paivio and Pascual-Leone 2010).
Second, an imaginal dialogue presents an opportunity
for both sides to be expressed more fully. In most cases, the
experience of self-criticism and hate overwhelms the
experience of need, which leads to feelings of frustration
and unmet personal needs. However, an imaginal confrontation
(or two-chair task) puts the unmet need in juxtaposition
with the criticism. Increased awareness of
personal values and standards allows the client to evaluate
their usefulness and to determine their importance in
relation to core unmet needs. When individuals are ﬁlled
with self-loathing and have sufﬁcient emotion regulation
skills, then one way of working through these difﬁculties in
EFT is to articulate two parts of the self: on one hand, the
personal standards inherent in self-criticism (which often
drives punitive self-hate) and, on the other hand, the
underlying existential or interpersonal needs that seem to
be in opposition (Pascual-Leone and Greenberg 2007;
Paivio and Pascual-Leone 2010).
Case Example: Self-Hate
‘‘Alicia’’ is a 23-year-old who presented for therapy following
symptoms of depression which were affecting her
academic performance. Initially, her chief presenting
problem was a general feeling of hopelessness. Further
86 J Contemp Psychother (2013) 43:83–92
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exploration of these feelings revealed that she was highly
self-critical which she described as ‘‘disgust and hate for
what I have grown into.’’
Eventually the therapist asked Alicia to imagine she was
speaking to herself and to express some of the inner criticisms
related to hating herself. This came easily to her:
‘‘you are too dumb, you are just so stupid, nothing you do
is ever good enough.’’ Exploration of the criticism led to an
expression of shame at the perceived failure to reach the
standards she had set for herself. Although Alicia
acknowledged and agreed with her own criticisms and
believed she may indeed be a failure, it was important for
her therapist to circumvent discussions about the veracity
of her self-criticisms as such. Rather, true to an EFT
approach, it was more useful to persist in a discourse that
explored the emotional impact elicited by these harsh
criticisms. In this way, while Alicia initially found it hard
to focus on those softer feelings, she eventually was able to
identify feelings of hurt at the unfair and acute criticisms.
Once these feelings were articulated, Alicia then found it
easier to express her needs and wants and to contrast them
against the values and standards that drove her selfcriticism.
Speciﬁcally, she identiﬁed a need for interpersonal
support and conﬁdence in her abilities and efforts.
While the critical part of herself was adamant at ﬁrst, she
later came to see these stringent standards as essentially
expressions of concern, which she also then articulated in
an imaginary dialogue with herself: ‘‘I am afraid you will
hurt yourself if I don’t push you so hard and monitor every
step you take.’’ Alicia came to realize how she was actively
undermining her own efforts for fear of failure, i.e. of not
performing adequately, which invariably led to her feeling
hopeless. Further ‘‘dialogues’’ between her critical and
experiencing parts led to a resolution in which Alicia was
able to forgive herself for making the occasional error,
accepting mistakes as part of human nature.
‘‘I Hate You’’
Another common form of problem anger in psychotherapy is
rejecting anger directed outward, toward another individual,
as a defense against the experience of underlying (primary)
vulnerable feelings. The expression of secondary defensive
hatred is characterized by high arousal and limited awareness
of one’s more fundamental affective experience (Greenberg
and Paivio 1997). In essence, in this case reactive anger at the
outside world and others is a way of coping with, distracting
oneself from, or shielding oneself from primary (adaptive or
maladaptive) experiences of vulnerability (e.g., fear, shame,
emotional pain, etc.). The clinical formulation of hate, rage,
and rejecting anger as various forms of what is essentially
secondary anger, reﬂects an all too common phenomenon
and is illustrated in the top-center of Fig. 1.
When it comes to interpersonal relationships, this
defense reveals itself in the process of hating an unloving
other (i.e., ‘‘I hate you for not loving me’’). Unfortunately,
this also describes a common underlying process in
domestic violence (Pascual-Leone et al. 2011). Similarly,
in EFT theory, secondary forms of anger, such as hatred or
contempt, are often conceptualized as an automatic
defensive response to underlying vulnerable emotions such
as fear, shame, or emotional pain—feelings which may
very well be the result of not having ones needs met
(Greenberg and Goldman 2008). Although the vulnerable
feelings represent one’s primary, immediate response to
external events, they are eclipsed by secondary anger via a
rapid series of cognitive-affective processes that occur
outside of conscious awareness (Paivio 1999).
Conceptualizing Problem Anger as a Secondary
Process: ‘‘I hate you for not loving me’’
‘‘Defensive,’’ secondary anger is not a sustainable adaptive
strategy for self protection and development, however it is
illuminating to consider this kind of problem anger in terms
of its tacit functional aims, which are often very immediate
or short-term. By combining EFT and behavioral theories,
Korman (2005; who extending earlier work by Linehan
1993) explicitly highlighted the role of anger experience
itself as a negative reinforcer when it displaces painful and
more primary emotions such as hurt, fear, or shame. Furthermore,
in Korman’s clinical formulation, defensive
anger is described as having a potentially addictive process
in that it provides instant relief from intolerable and painful
affect. For example, an individual may express contempt
and re-focus attention on another person’s behavior,
thereby avoiding the emotional pain of facing one’s own
personal weaknesses. This two-step process formulation
helps explain the consistent positive correlations that have
been found between individuals’ proneness to shame and
their arousal of anger and aggression (see Tangney et al.
1992, paper Shamed into anger). In addition to this, when
considering the interpersonal domain, expressing hostility
seemingly reduces ones chances of being harmed by
another person because it tells others to ‘‘stand back’’ and
creates distance in the relationship. Finally, expressions of
rage and contempt can place one in a more powerful
position by belittling and shaming another person (Greenberg
and Goldman 2008), which consequently can provide
positive reinforcement to some people for their anger.
In all of these instances, problem anger like this ultimately
serves as a short-term form of emotion regulation
(albeit an unhealthy one) for staving off more painful
experiences. Moreover, the regulatory function of this twoJ
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step sequence is usually outside of one’s awareness. When
primary vulnerable feelings become intolerable, a surge of
powerful secondary emotion such as hatred dispels vulnerability
and seemingly empowers the individual. Because
of the reduction in distress (a negative reinforcer) and the
experience of power (a positive reinforcer) the defensive
strategy of experiencing and expressing rage and hate can
become a conditioned response cued by experiences of
shame or fear (see middle of Fig. 1; Korman 2005).
For many clients, the short-term gain of defensive,
reactive hatred (i.e., immediate relief from painful vulnerability)
comes at the expense of healthy social and
emotional functioning in the long-term (see for example
Korman et al. 2008). Although hatred is ‘‘helpful’’ in the
short-term management of primary fear and shame, it
mutes clients’ awareness of their unmet needs for interpersonal
security and acceptance (Paivio 1999). In sum,
resorting to secondary anger and spite in response to
feelings of rejection or threat, although momentarily
empowering, does nothing to address an individual’s basic
interpersonal or existential needs. In fact, because defensive
hatred is more likely to alienate others than to draw
them closer, secondary anger as a long-term strategy is
inevitably counterproductive to soothing the underlying
vulnerability.
Interventions for Working with Defensive Anger
In EFT, the intervention approach for working through
defensive secondary anger is to ﬁrst provide a supportive
relationship in which one acknowledges and validates the
client’s immediate experience of anger. Second, therapists
must move beyond the validation of anger in an effort to
deepen emotional experiencing, using empathic reﬂections
to explore emerging tendrils of associated feelings,
thoughts, and needs. In individual therapy, this process is
achieved through empathic afﬁrmations based on therapist
attunement to client experiencing (Paivio 1999; Paivio and
Pascual-Leone 2010; Greenberg and Watson 2006). In
couples therapy, the validation of clients’ primary feelings
is accomplished when the supportive responses of one’s
partner disconﬁrms one’s negative expectations and helps
regulate one’s feelings (Greenberg and Goldman 2008;
Johnson and Greenman 2006). In both case, therapists help
clients develop an awareness of the defensive nature of
their anger and then, given a safe relationship, empathically
guide clients into the deeper exploration of more vulnerable
emotional processes.
Case Example: Defensive Anger as Secondary Emotion
‘‘Brian’’ and ‘‘Carol’’ came to therapy when they were on
the brink of ending their relationship, which had become
cold and spiteful. Brian had often felt ashamed as a child
stemming from his emotional neglect and physical abuse,
and at the time of therapy he was responding with defensive
bitterness or rage if, for example, Carol rejected his
sexual advances. However, Brian’s hostility toward her
only led Carol to withdraw further, increasing his
expressed contempt and escalating the conﬂict between
them. Brian’s experience of rejection by his wife activated
primary feelings of fear and shame and the belief that, ‘‘I
am being abandoned, I am unlovable.’’ For Brian, enduring
this feeling was intolerable and it was immediately
supplanted by his sudden waves of contemptuous rage.
Indeed, Carol described him as ‘‘out of control’’ and
‘‘emotionally abusive,’’ and cited Brian’s temper as the
main source of problems in their marriage. During a particularly
poignant moment in session, Brian blurted out: ‘‘I
only lose my temper when she ignores me!!’’ More often
than not Carol would tense her jaw but would say nothing.
As treatment progressed, Brian’s dominating, intrusive
hostility and Carol’s silent withdrawal led the therapist to
identify a cycle, in which Brian pursued Carol for intimacy,
reassurance, and sex and Carol distanced herself
from Brian’s advances. The therapist noticed an uneasy
quality underlying Brian’s harsh tone, which at times
revealed core feelings of fear and insecurity beneath his
contempt.
In using EFT to work with Brian’s defensive hostility, one
of the therapist’s main objectives was to help Brian access,
explore, and express the primary vulnerable feelings and
associated unmet needs, which he harbored beneath his
contemptuous exterior. Eventually Brian acknowledged that
other feelings were highly aversive for him, so they had to be
approached tentatively and in the safety of a strong therapeutic
(and marital) alliance. In an especially productive
session, the therapist observed: ‘‘I can see how frustrating it
is for you when Carol isn’t ready to respond to you, it just
shuts you down.’’ The therapist then tentatively suggested
that, ‘‘a lot of men actually ﬁnd it kind of painful if their
wives don’t want to be physically intimate. I don’t know if
that’s something you’ve ever experienced…?’’ ‘‘I don’t
know. Maybe I used to,’’ replied Brian. This partial
acknowledgement of vulnerability indicated signiﬁcant
progress toward a new avenue of deeper exploration. In
response to Brian’s disclosure, the therapist validated
Brian’s core insecurity, reinforcing his courage in staying
with and disclosing his feelings. The therapist then asked
Brian if there were speciﬁc instances when Carol’s withdrawal
was particularly painful for him. As they explored
Brian’s memory of these interactions, the therapist focused
him on his visceral experience of emotional pain to facilitate
his expression of primary hurt (Greenberg and Goldman
2008), opening the way for a reparative dialogue in the
couple.
88 J Contemp Psychother (2013) 43:83–92
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‘‘I can’t remember why I’m angry… but I am!’’
Conceptualizing Problem Anger as the Deterioration
of a Primary Assertion
A very different manifestation of secondary anger results
from the devolution or unraveling of what may have initially
been adaptive anger. Simply put: excessive arousal
and the loss of meaning in the focus of what one’s anger
initially embodied, often also leads to rage or destructive
and rejecting anger (see top-right of Fig. 1). This conceptualization
is in keeping with hate as an unhealthy and
excessive culmination of frustration or aggression.
Primary adaptive anger is always in the direct service of
a need (e.g., for autonomy, support, etc.); however, the
mobilization of this assertive anger demands that one
implicitly balance two dialectically opposing facets of
assertion. On one hand, an individual must be aroused and
energized enough for the inherent confrontation entailed in
self-assertion but, on the other, he or she must also remain
level-headed enough not to lose focus in the heat of the
moment. It follows then that when ﬁghting for a cause, and
when arousal is increasingly heightened, one may easily
lose sight of the original purpose (i.e., meaning and need)
that ﬁrst propelled the adaptive anger. Here, it is as if the
experiential lens through which one is able to articulate
primary assertive anger spirals out of focus, blurring the
nature of the instigating concern. Mounting arousal that
precipitates a deterioration of meaning could be directly
related to the issue at hand (e.g., passion for a target issue,
intense feelings of outrage) and/or could also be fueled by
peripheral psychological or biological issue (e.g., feeling
overwhelmed, in pain, hungry, tired). From a moment-bymoment
perspective this leaves one in a state of high
arousal and low meaningfulness i.e., secondary undifferentiated
anger (Pascual-Leone and Greenberg 2007).
We offer a familiar example of this phenomenon although
it departs from the clinical setting. In social and political
demonstrations, protests usually embody well articulated
concerns and demands (e.g., for change, for certain rights,
etc.). However, when these demonstrations get more agitated
and affective arousal increases, it become more and more
likely that the well articulated premise of a protest will
deteriorate into destructive anger and violence. Similarly, in
psychotherapy, if a client is unclear (in the moment) about
what he or she is ‘‘ﬁghting for,’’ the presenting experience of
anger is not likely to be primary and assertive anger. We ﬁnd
other commonplace examples of this process when clients
begin with a key frustrating concern and then essentially lose
track of their main point of contention, or when the expression
of anger escalates into insults and attacks that are
increasingly less related to the presenting issue or concern.
Alternatively, the loss of meaning is also captured when a
client declares, ‘‘I’m so angry, I’m at a loss for words!!’’
Thus, primary adaptive feelings of assertive anger, in effect,
can deteriorate and unravel into secondary (in the sense of
more global and undifferentiated) anger.
Interventions for Working with Anger that has Lost Its
Purpose
A chief aim of emotion-focused therapists is to help clients
elaborate the tacit meanings associated with emotional
experience. However, when arousal goes beyond a certain
point, it interferes with adequate meaning making. While
this can be an ever present issue, when working with
emotions related to trauma (Paivio and Pascual-Leone
2010), it is similarly so with anger. Thus, when therapists
sense that important albeit unarticulated meaning is at the
root of a client’s anger, de-escalating and emotion regulation
are particularly important in helping clients to return
to a productive level of arousal. At ﬁrst, behavioral selfsoothing
strategies (such as using distraction, or the classic
‘‘time-outs’’ or ‘‘counting to 10,’’ etc.) will be more useful
here than any meaning exploration. However, clients can
also sometimes be regulated dyadically, by attentive and
empathic validations from the therapist. Next, rather than
attending to the affect of rage in general, therapists must
offer highly attuned support and offer a meaning-scaffold
(e.g., using persistent empathic conjectures), so that clients
can regain their footing and verbally articulate the key
issue that form the initial foundation of their protest. The
aim in this intervention approach is to help re-symbolize
the violation as a client regains his or her focus, such that
either productive assertion is restored or, at least, the client
develops some meta-awareness about his or her loss of
focus. In one case example, after being repeatedly
encouraged to slow down and explore the core issue at
hand, the client eventually exclaimed, ‘‘Well, look!! I can’t
remember why I’m angry, OK?? But I am!’’ This humorous
moment created an abrupt self-awareness and signaled to
both client and therapist the need for a more thoughtful
exploration of meaning.
‘‘I Hate Everybody’’
The experience and expression of hate as a habitual way of
engaging the world is a theme frequently explored in the
literary ﬁgure of the misanthrope. Gaylin (2003) has
described individuals experiencing primary maladaptive
hate as ‘‘true’’ or ‘‘raw’’ haters who, ‘‘live daily with their
hatred,’’ and may even appear to be, ‘‘obsessed with their
enemies, attached to them in a paranoid partnership’’
(pp. 4–5). This chronic style of hatred often presents in
therapy in individuals with cluster B personality disorders
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(e.g., borderline, histrionic, narcissistic, passive aggressive…)
or some anger-related personality disorder (not
otherwise speciﬁed), whose behaviors are dramatic, erratic,
or paranoid and who may either be particularly emotionally
vulnerable or callous (APA 2000). Chronic anger and
hatred can be conceptualized from an EFT perspective in at
least two different ways: Primary maladaptive anger or
instrumental anger, (or both). These conceptualizations of
problem anger describe pervasive patterns of responding
that interfere with healthy relationships and emotional
functioning.
Conceptualizing Primary Maladaptive Anger: ‘‘I hate
the world because it conspires against me’’
More often than not, the primary maladaptive experience of
anger represents a generalized pattern of rejecting anger/
hate/rage as some form of defensive secondary emotion—a
formulation that was already introduced in the preceding
section (see middle and bottom of Fig. 1). As we described,
these forms of secondary anger are self-reinforcing, in that
such feelings provide immediate relief from underlying
(primary) feelings of shame, fear, and vulnerability in
general (Korman 2005; Pascual-Leone and Paivio, in press).
While this kind of secondary, defensive, anger may remain
circumscribed to particular contexts or relationships (i.e., ‘‘I
hate you for not…loving me/soothing my pain/giving me
what I want’’), for some individuals the self-reinforcing
pattern eventually becomes generalized and intractable,
such that anger and hate become a characterological way of
being (i.e., ‘‘I hate everybody’’). So, in some sense, chronic
and ill-directed rage can be thought of as a ‘‘calciﬁed’’ form
of secondary defensive hatred, one that is produced through
repeated reinforcements for angry experiences.
Thus, although its origins may be a kind of secondary
emotion we ﬁnd it useful in EFT to conceptualize this
entrenched angry style as, nonetheless, primary maladaptive
because over time it has become an immediate and direct (i.e.,
primary) response to the environment that does not serve an
adaptivefunction(i.e.,itisnotrelatedtoanyrealgoal-directed
behavior; c.f. Greenberg and Paivio 1997). Thus, this form of
hatred represents an overgeneralized emotional style (i.e., a
hostile and paranoid emotion-personality scheme). Because
these angry responses are diffuse expressions that are also
overgeneralized, individuals with this angry disposition
sometimes present as chronically irritable (i.e., the perennial
grouch). Moreover, boththe display and intensity ofthis anger
is excessive and/or inappropriate.
It is common for individuals with primary maladaptive
anger to have histories of complex relational trauma
(Paivio and Pascual-Leone 2010; Pascual-Leone and Paivio,
in press). Perhaps for this reason, experiences of primary
maladaptive hatred are often tied to a broad sense of having
been ‘‘short changed’’ or jilted in life by an unjust world
(Korman 2005). Moreover, individuals who frequently
express hate and rage of this kind usually have poor
emotional awareness and, more often than not, poor emotional
regulation. Indeed, it is poignantly ironic that a
hallmark of people with chronic anger and hate usually
experience themselves as victims to others’ ill-will and
constantly make hostile attributions regarding the actions
of others (Korman 2005; Korman et al. 2008). They take
offense and see violations everywhere. From this somewhat
paranoid framework, they continually retaliate with
hate and anger, sometimes indiscriminately. The crux of
this irony is that angry people often have real difﬁculty in
asserting themselves in a way that is interpersonally
effective (Linehan 1993). Probably because of both poor
emotional awareness, and unregulated arousal, articulating
their concerns often unravels into incoherent and virulent
ﬁts of rage. This process of deteriorated meaning, which
we have already described (top-right of Fig. 1), also feeds
the chronic nature of maladaptive anger.
In essence, potentially productive anger never comes to
fruition and, spurred on by high arousal as well as some
instrumental functions (discussed later), angry feelings
spiral out of range of anything that could be effective or
productive. Greenberg and Paivio (1997) liken this process
to an unhealed wound that becomes hyper-sensitive and is
continually irritated by similar situations. Over time, raw
irritability becomes the norm rather than the exception,
consolidating into an entrenched angry personality style.
Case Example and Intervention Approach: Primary
Maladaptive Anger
‘‘Claire’’ entered therapy on the strong recommendation of
her employer in order to receive help with her ‘‘bad temper.’’
She described her coworkers as ‘‘miserable’’ and her
workplace as ‘‘completely unsupportive.’’ At work and in
her personal life, she expressed negative emotions towards
others by shouting obscenities, breaking things, and ﬂying
into rages whenever her needs for understanding and support
were not met. It became clear that she interpreted
others’ lack of support as a sign of rejection or abandonment
which ﬁlled her with a host of undifferentiated bad
feelings. With the help of her therapist she was able to
acknowledge that she was feeling lonely, unsupported, and
unlovable, as well as desperate and helpless to change her
situation. When in session she readily expressed anger
about her coworkers, but she also expressed primary anger
at her parents for her unmet needs and for not having
attended to her or taken her seriously as a child. Occasionally,
Claire also directed anger and hostility toward her
therapist with stinging hateful remarks.
90 J Contemp Psychother (2013) 43:83–92
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Claire and her therapist came to a shared understanding
that distress tolerance was a signiﬁcant challenge for her,
and that skills training in behavioral emotion regulation
would be a central treatment goal. Her therapist often
instructed her to make use of emotion regulation strategies
while at the same time encouraging her to tolerate and stay
with her upset feelings just long enough to make some sense
of them (for intervention examples, see Korman 2005).
During one session, the therapist reﬂected to Claire that her
anger at a coworker also appeared to elicit deep feelings of
hurt, shame, and loneliness. The process of exploring and
deepening the meaning of these emotional experiences had
to be carefully titrated with self-soothing to prevent Claire
from losing her focus and going into a defensive rage. In
this way, over many sessions, they began to bring into
awareness and ﬁnd words for some of the more vulnerable
feelings which were so often associated and conﬂated with
her more reactive, ‘‘knee-jerk’’ response of anger.
At the same time, whenever possible, the therapist
provided validation for Claire’s sense of being wronged
and then instructed her in assertiveness training and the
appropriate anger expression (both in and outside the session),
which helped Claire to express her needs and her
sense of injustice without spinning out into a familiar ﬁt of
incoherent rage. Some of the difﬁcult feelings that Claire
explored were related to ‘‘unﬁnished business’’ between
her and her father. The therapist suggested that they ‘‘put
the anger where it belongs’’ and invited the client to engage
in imaginal dialogues where she confronted her father. On
one hand, imaginal (empty chair) dialogues were used to
explore the meaning of her painful feelings in relation to
signiﬁcant others (for detailed therapist operations see,
Paivio and Pascual-Leone 2010; Pascual-Leone and Paivio,
in press). On the other hand, behavioral role-plays were
used for the practice and rehearse of clear and controlled
self-assertion as related to current scenarios in her life.
Both of these (meaning making and behavioral training)
were key treatment interventions.
Conceptualizing Problem Anger as Instrumental:
‘‘…because if you don’t, I’ll hate you’’
According to EFT theory, instrumental emotions are used,
consciously or unconsciously,to manipulate or control others.
Although using anger to intimidate others, for example, is
strategic in some sense, instrumental emotions are not necessarily
false; they can entail very real affective experiences
with genuine arousal and in many instances individuals may
be unaware of the way they are ‘‘using’’ emotion.
Of course, this operantly conditioned experience and
expression of anger does suggest manipulative, antisocial
tendencies. But again the instrumental use of hate is often
learned outside of awareness (through positive
reinforcement and sometimes modeling) and it develops
habitually to the point that it is comes to be expressed
automatically (Korman 2005; middle and bottom-right of
Fig. 1). For example, in a simple case, hatred and anger
may be instrumental with the ‘‘effect’’ of dominating others
and with the ‘‘advantage’’ of avoiding responsibility.
Case Example and Intervention Approach: Instrumental
Anger
In a clinical illustration of instrumental anger, a middleaged
man who presented with anger problems described
feeling genuinely frustrated at his business meetings, often
responding with angry outbursts, shouting and pounding
his ﬁst when his demands were not met. However, the fact
that his outbursts usually resulted in him getting his way
provided repeated positive reinforcement for his angry
behavior and he was only vaguely aware of this conditioning
process. In cases like these, where the client does
not suffer from more acute antisocial tendencies nor from
other features of personality disorder (as did ‘‘Claire,’’
from the previous example), it may be sufﬁcient for a
therapist to help the client reﬂect on this emotional process,
in the hopes of increasing insight into the strategic nature
of expressing anger and hate (Greenberg and PascualLeone
2006; Korman 2005). Interpretation and exploration
should be used to help therapist and client alike, to
understand the interpersonal function of the expressed
emotion, and the possible secondary gains for the client.
Finally, these gentle confrontations should be followed by
teaching the client more adaptive ways of getting ones
needs met.
Concluding Remarks
Clinical Implications and Future Directions
The central aim of this paper has been to elaborate clinical
case formulations of problem anger by developing the EFT
conceptualization for emotion in psychotherapy. While we
believe this EFT-informed conceptualization of hate, rage,
and rejecting anger, is a unique contribution that will be
useful to clinicians working in a range of treatment
approaches, there is still considerable ground to cover in
the understanding of problem anger in psychotherapy. For
example, research and clinical work needs to develop
therapist-friendly criteria that could help direct clinicians in
assessing anger moment-by-moment, as it changes in session.
Indeed, researchers are just beginning to identify
speciﬁc observable features that distinguish productive
from unproductive anger (e.g., Pascual-Leone and Greenberg
2007). Similarly, further work is needed to elaborate
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the interventions that address difﬁculties with speciﬁc
types of hate and anger and this will likely require integrative
approaches to treatment (i.e., Korman et al. 2008;
Paivio 1999; Pascual-Leone and Paivio, in press).
A Return to the Relationship
Dysfunctional anger is a complex human experience
resulting from an underlying cognitive-affective dysfunction
and often resulting in a wide range of affective and
interpersonal difﬁculties. The therapeutic relationship is the
crucible of emotional processing. Particularly in the case of
anger, it is as if the therapeutic relationship acts as a
‘‘thermostat’’ for regulating the ‘‘ﬁre’’ of emotional arousal.
If the client feels overwhelmed and emotion is too
‘‘hot,’’ the relationship is soothing, validating, adaptively
regulating, and like an external thermostat its inﬂuence
lowers emotional activation (Greenberg and Pascual-Leone
2006). At the same time, clients who hate others and/or
themselves will also often hate their therapists (or others
they rely on), whether by subtle resentments, aggrandized
distain, or by outright hostility and contempt. As Blum
(1997) argued, ‘‘…the successful analysis of the conﬂicts
in which hate is embedded will usually reveal in the patient
at least a vestige of hope of loving and of being loved and
valued’’ (p. 374). Of course, working with anger in relationship
itself (i.e., in the ‘‘real relationship,’’ in addition to
transference and countertransference) represents an
important direction to develop in theory and practice.
Nevertheless, a better understanding of the psychogenetic
development of a client’s problem anger, as we offered in
this paper, may help guide well-intentioned therapists who
are being tempered and tested by the wrath of those they
are trying to help.
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