“I can see your bald head”
Christian Conte: Dr. Howard Kassinove, how did anger management became a central focus for you?
Howard Kassinove: When I went to graduate school, the central focus seemed to be anxiety, and the physiological or biophysical aspects of emotion. So we studied heart rate, sweating, pupillary response to light—but all with regard to anxiety. I then went out to study with Joseph Wolpe and of course his major area was anxiety. But he really put me in touch with this notion of approach versus avoidance behaviors—moving towards, moving against, or moving away from. I was also trained by
Albert Ellis and he was very interested in emotionality in general.
But with that background, once I went into private practice what I discovered was that lots of my patients were angry at each other. Husbands angry at wives, parents angry at children, adolescents angry at their parents, and I had been ill trained. I really didn’t know much about it, because anxiety was the major focus of my training. So I began to study and read and my practice moved along. But then in about 1992, I really decided I had to get some kind of a handle on this. So with my then Ph.D. graduate student Christopher Eckhardt, now a professor at Purdue, he and I just started cold calling people in the field of anger: Charlie Spielberger, Jerry Deffenbacher and a range of figures. We put together an edited book, which included all aspects of anger from Spielberger’s measurement to Sergei Tsytsarev and Junko Tanaka-Matsumi’s cross-cultural perspective, and this was the beginning of me becoming centrally involved.
Then I started doing more cross-cultural research—in India, Russia, Romania and many other countries. We collected data on anger in all these other countries and I did a number of doctoral dissertations on anger. One of the most important was with my colleague Chip Tafrate, who of course is doing books with me and did the video released this month by psychotherapy.net. He did a very interesting study in which we would try to insult people—“I can see your bald head!”—and Chip would ask people to respond in different ways. One was, “How could you say that to me? That’s terrible. I can’t stand it!” And the other was, “It’s unpleasant that you’re saying that. I wish you weren’t saying it, but I can tolerate it.”
CC: The old Albert Ellis stuff.
HK: Albert Ellis, exactly. We even had a controlled condition where I would kind of insult you like that, and you would say things like, “A stitch in time saves nine.” What we found was that both the Ellis rational ideas and the distracting statements led to anger reduction.
CC: So for you it centers on cognitive behavioral techniques—on changing the thoughts around and having people learn different forms of self-talk.
HK: Yes, but my original training was at Adelphi University, which is a very psychodynamic place. One of my great heroes always was Karen Horney, because she spoke about the tyranny of the shoulds well before Ellis did. She spoke about moving against, moving away from, and moving towards people. So I also have that background.
What Exactly is Anger Management?
CC: Obviously anger has been around as long as there were human beings, but in the news over the last several years it seems like anger management in particular is getting more attention than it has in the past. From your perspective, what exactly constitutes anger management?
HK: Let’s go back to the beginning of modern anger management—Ray Novaco’s 1975 book, Anger Control. Prior to that we were not really dealing much with anger management. Ray came on the scene and became a major figure, but the word “control” has kind of disappeared and now we talk about “anger management.”
I think of it as developing less intense disruptive responses to aversive stimuli. The fact is that we live in a world where there are lots of aversive stimuli:
People take our parking spots, students tell us we’re lousy teachers, our wives and husbands tell us that we didn’t mow the lawn correctly. We are kind of bombarded with this aversive stimulation environment. Lots of good things occur in the environment, of course, but the bombardment with the aversive stuff leads us either to be angry—”How dare you say that to me?! You know you don’t have any right! You should treat me with more respect!”—and it can also lead to anxiety, when we’re being threatened by someone in authority or someone with a knife or gun.
CC: Sure.
HK: So I think that anger management in a broader sense is emotion management or emotion regulation. I try to live my life in the most mellow way possible. Most of the time these days I succeed. But it’s not only anger or annoyance I want to bring under control; I also want to bring anxiety under control. This is where Rational Emotive Behavior Therapy (REBT) has played such a central focus in my own life. Lots of abrasive events occur in life that are overwhelmingly unpleasant. These days I try and leave them there—whether it’s difficulties with my own children or difficulties with my students or my car or whatever. So in the broader sense, it’s emotion management.
CC: That’s exactly the word I use: emotional management. You’ve developed what you call the “anger episode model.” Can you talk a little bit about the evolution of that?
HK: As the years were going by, I found myself becoming kind of disgusted with the notion that kids are lazy, people are stupid—this kind of broad overarching condemnation of people. Instead, because I became more and more of a behaviorist as time went along, I wanted to speak about how people behave in particular situations. You might become angry at your wife, let’s say, when she does something wrong, and you might yell at her and maybe even demean her verbally in some way. But I bet you wouldn’t do that if you were at a state dinner with President Obama, because in that environment you’re going to behave very differently.
So I found myself moving away from the notion of “he’s an angry person,” “she’s such an angry woman,” to the idea of—how can we deal with individual situations? We started to develop the notion that people have “anger episodes” and that led to the anger episode model. The more episodes we can help them bring under control, the more likely it is they will become more generally controlled.
It’s kind of like an incremental model. I don’t think we can really change broad-spectrum personality. If I define personality as the cross-situational stability of behavior, then what I’m trying to do is change behaviors in a number of situations with the hope that eventually through generalization people become less angry.
CC: That’s fantastic.
HK: We needed a very specific and relatively simple model that we could teach to our patients.
Triggers
CC: I really identify with what you’re saying. You put people in different situations, they respond in different ways. I say to people all the time, “If I gave you a million dollars, would you respond in the same way?” They say, “Well, I don’t know if I’d be that angry if somebody cut me off in traffic if I knew I was getting a million dollars.” So we really get at the heart of those thoughts.
You talk about triggers, and I wondered does it always, from your perspective, take an outside trigger to set someone off into an anger episode?
HK: I wouldn’t necessarily say it takes an outside trigger. Something has to initiate the sequence, but it can be an inside trigger. It can be a memory of what you did to me yesterday, how you treated me as a colleague or as a student or as a professor yesterday. I remember when you gave me the mid-term examination and you were unfair then. I’m quite sure you’re going to be unfair now. That’s an inside memory. But most of the time, I still see anger as a social, interpersonal process.
Most of the time, I’m going to become angry at a person or a group of people because of something that I perceive they did wrong. Let’s face it—I’m looking around in your office right now; I bet you don’t get angry at your bookcase.
You don’t get angry at your doorknob. You don’t get angry at your carpet. But you might get angry at your wife or your children or something like that. It’s always the social, interpersonal process. But it could be what the kids are doing today, or it could be you’re lying in bed and remembering what they did yesterday.
CC: That’s so powerful. I’ve specialized in working with people convicted of violent crimes and people are always really fascinated by the intense experiences I’ve had. I wonder if you could recall for us memorable and intense situation you encountered throughout your years in anger management.
HK: That’s an interesting question. I run an anger management program at Hofstra, and it’s housed in a generic building that has little children who are learning how to read, people who are having marital problems, and kids who are there all day as part of a child care center. So we’re always worried—is there going to be an intense anger problem? I’m always worried about my students, who are upstairs behind closed doors with anger patients, many of whom come from the probation department, and they’ve been convicted of anything from pushing and shoving to murder. They have histories. I’m always concerned. But I have to tell you that in the last nine years, we have had zero intense anger problems.
CC: Many new therapists are intimidated whenever it comes to working with angry patients. They’re scared of dealing with angry people, so I have my own approach to orienting them to the work. What’s something that you teach new therapists to do if they find themselves intimidated by the anger of their clients?
HK: Well, look at how I approached you, Christian, before we started this interview. I even made fun of your bald head.
CC: Yes, you did.
HK: Right? This is really important. The interpersonal therapeutic relationship, for me, is critical. You have to know how to not make every interaction into the most serious problem in the world. Most people, I find, are willing to kid around with me. They’re willing to take my barbs, my probes, my jabs, and that’s really what I say to students. Let your clients know that you’re in their corner. You know, “I understand you have been sent by your wife, sent by your husband, sent by the judge, from the probation department, and I’m going to be as respectful of you as I can, but I’m also going to jab you a little bit.” Then I ask, “Christian, would it be okay if I jabbed you a little bit? Can we play together like that?”
I think the only way people really get better is if we engage in reinforced practice in the office. So if I’m going to consider you as my patient for a moment, I might say things like, “Well, Christian, we’ve learned a bit about your life. You’re married and you have two children, and I know that you’re having troubles with your wife, who sometimes calls you lazy. Would it be okay if I called you lazy?”
The Comeback
HK: I’d talk to you a bit about that, and then I’d say, “Well let’s start off with some deep muscle relaxation.” I would make sure that you and I are on the same page, but then I would think about some kind of a hierarchy of insults. I’d start off with, “Well, Christian, take a deep breath. Just let your body relax. Consider what a nice day it is. I can see the sunshine behind you there. It’s really a nice day. Are you ready?”
CC: Yes.
HK: Here it comes. “You know, Christian, you seem very immature today. Take a deep breath in, and out.” So that was very mild.
CC: Very, yes.
HK: As the weeks go along, it’s going to escalate to, “Christian, you’re damned immature. Do you know that?” Then I’m going to go up to, “Christian, what the hell is wrong with you? How could a man of your age be so goddamned immature?”
CC: That’s awesome.
HK: And we’ll do two things. One, I’m going teach you to engage in those cognitive coping responses. So for example, say it to me.
CC: All right. Howard, you seem awfully immature.
HK: I understand what you’re saying. Thanks for sharing it with me.
CC: So you’re kind of putting me off there. That’s a sure sign of immaturity. You seem really immature.
HK: You have a real firm impression. It’s unpleasant to hear it, but I do want to thank you for sharing with me. It shows we have an honest relationship. Thank you.
CC: That’s great. That was a good comeback.
HK: What I’m trying to do is teach the patient a way of responding that, first of all, does not inflame, because—actually come at me again.
CC: Howard, you seem awfully immature.
HK: What about you? I mean, look at that shirt that you’re wearing. It’s like something I would wear around the supermarket or something, and here we are being interviewed! There’s that come back. Or, I could teach you another comeback—try it again.
CC: Boy, Howard, you really are immature.
HK: Yes, Christian. I bought a new hard drive for my computer yesterday.
You don’t know what to do with that, right?
CC: No, that totally threw me off.
HK: In my therapy, I try to, first of all, focus in on in your particular family or life, what are the adverse verbalizations that you might be receiving? That’s what I want to hone in on. I try to teach you either to relax deeply and not respond, to say something that’s really totally silly like, “I got a new hard drive,” to thank you for being honest, to say, “It’s unpleasant. I don’t like to hear it, but I can tolerate it.” So I’m teaching a variety of responses, you know?
CC: That’s great. It’s fantastic. I love the immediacy of the role-play right there in the moment.
HK: It works pretty well. Not all the time, obviously. I’m so interested about your work in the criminal justice system. Some of those people are kind of tough cookies.
CC: Yeah. Some of them are tough to crack, but overall, even though we’ve never met before this interview, there are so many things that you’re saying that I’m putting into practice. It’s so fun to be even in a role-play on the other end of that for even just a moment. It’s just great.
Tell me about your co-author. How did you get involved with Raymond Chip Tafrate?
HK: That’s kind of a funny story. Chip was originally my PhD student, and he was just going to become a practitioner and open up a mental health center. But then when he and I did this dissertation together on anger, we started to form this close bond. He went on to become a professor in a criminology and criminal justice department in Connecticut. We just bonded. He’s a wonderful man. If there is one thing I’ve learned—I’m sure you’ve been a professor also—there are just lots of things I don’t think about. We are both experts in the field, but you and I can really learn from each other.
And I thought I could learn from Chip. He’s thoughtful. He’s grounded. He comes out of a literature base now in criminology, that’s a little bit different from mine. Even though I taught him originally about REBT or relaxation training, he also studied with Ellis and he taught me about motivational interviewing. He really turned me on to that. So it’s just been a synergistic relationship.
CC: Well the book you wrote together, Anger Management: The Complete Treatment Guidebook for Practitioners, is extremely well done.
What’s something that you know now that you wish you could go back and tell yourself as a new therapist?
HK: I think I’d tell myself to be happy with small gains. If I can just teach that person not to rebel when the boss says, “I’d like you to stay an extra two hours tonight,” and not to flip off the boss, I’m happy with that these days.
CC: I think that’s so deep for people to get and really understand. Those little things, when people have been thinking one way their entire lives and all of a sudden now they can go that extra two hours and look at it differently, I think that’s big. I think learning to appreciate that is really big.
HK: I’m kind of unhappy when I go to some of the professional meetings these days. I hear about one-session or three-session or five-session treatments for Disorder X. I think we have a lifetime of learning. We have all kinds of reinforcements and punishments and incentives that are with us all day long. You really need time, and that’s something I didn’t understand as a young person.
Many times the judges here will mandate people to come see us for twelve sessions, twenty-four sessions. It’s not enough.
CC: I totally agree.
HK: I have a cousin who is a family court judge in California, and she says she recommends people for fifty-two sessions. I said, “I’m praying for that.”
CC: I just moved back to Pittsburgh, Pennsylvania, a year-and-a-half ago, but I was a professor at the University of Nevada before that. I co-founded a center for violent offenders in South Lake Tahoe, California. So in California, if they commit a violent crime, they are sentenced to fifty-two weeks of anger management. That’s standard. But in Nevada, just on the other side of state line, if they get in trouble there they were only sentenced to twenty-six weeks. I found in my own research that people did not make the kind of changes in twenty-six weeks, not even close, to the ones who were sentenced to fifty-two weeks. So I am a big proponent of a long treatment. Here in Pennsylvania, I’ve have judges say, “If they need a session or two.” A session or two to change a lifetime of anger? That’s just funny.
HK: Sometimes we ask patients, “How much anger management did the judge tell you you need?” “Today, just today.”
CC: “I just need to come to this one class.”
HK: If there’s anything I’ve also learned it’s that change comes about not from a class, not from education, but from practice. I teach my students practice makes better. We have to get these people into our offices and practice better behaviors with them. I even had one case, one of my students, where we started to transition from kind of barbing him and insulting in the office and frustrating him in the office, to out in the real world. So this patient happened to have worked as a shoe salesman, and what my student did is he went to the shoe store and without the patient seeing, pushed over a whole batch of shoes. This guy used to respond with great anger, but we wanted to see if we had done anything. Indeed, he responded very well. So I think practice makes better, starting in the office, going to the natural environment. That’s one thing I’ve learned that I really didn’t fully understand as a beginning therapist.
CC: I wholeheartedly and really sincerely appreciate this interview and this time with you because it’s tremendous to listen and hear and say I agree. I mean, two people practicing in totally different parts of the country and our experiences sound so similar. To me, that’s grounded in truth. There’s an essence to that change that obviously is just there regardless of words.
HK: Thank you.
