USING ANGER WELL
A Constructive Attitude Toward Aggression 
in a Milieu Setting

Michael Altshuler, CSW
Administrative Supervisor, Bronx REAL CDT (Bronx, NY)
Faculty, Jewish Board of Family and Children's Services (NYC, NY)
Email: micaltcsw@msn.com
August, 2000

The presence of this therapeutic attitude is, of course, no accident, and to give a full account of its origins would take more space than I have.  But one crucial element in preserving it, I believe, is the constructive attitude towards aggression that members of the community adopt (Spotnitz and Meadow, 1995).  Throughout their stay (which may be as short as a few months or as long as a dozen or more years) clients are vigorously encouraged to channel their aggressive impulses toward personal well-being and healthy relationships, rather than toward injuring themselves or others.    

We do this by proposing that clients think of anger as a vital form of emotional energy that will have good or bad consequences depending on how it is understood and used (Ormont, 1984).  This corrective attitude within the milieu accords well with the Modern Psychoanalytic view that emotional well-being is an lifelong process of learning to have all of one’s feelings, to know why one does, and to express them in ways that neither hurt oneself nor others (Sheftel, 1991).  Ultimately, how clients perform each of these critical developmental tasks is the difference between anger handled badly and anger handled well.

Establishing a therapeutic attitude towards a widely perceived “difficult” emotion such as anger is no small task.  Our clients have no “single story of suffering” (Breuer and Freud, 1893, p.6).  Yet as a group they share common histories of problems with anger, encounters with violence, and recurrent episodes of emotional, sexual and physical victimization.  And now in adulthood---whether “dominated by the aggressive drive” or by “defense[s] against aggression,” (Spotnitz & Meadow, 1995, p.2)---they present many forms of destructive coping and relating including chronic suicidal depression, self-neglect and self-harm, and habitual losses of control tending towards explosiveness. 

These pathological mechanisms of aggressive discharge are inevitably revived in the program.  When this occurs the progressive spirit of the milieu is invoked in the community dialogue that arises from any such event.  For example, an incident that disrupts (or that has the potential of disrupting) the emotional equilibrium of the program will become the subject of wide-ranging discussion among clients and staff.  Individually, in sub-groups and collectively, we reflect upon and address any act of aggression that undermines the vital feeling of sanctuary within the program. 

This dialogue of clients and staff takes place in a variety of contexts including individual therapy sessions, psychotherapy groups and Community meetings.  The discussion continues behind the scenes in staff meetings, supervisions and administrative meetings.  And finally the exchange of reactions spreads across the complex web of friendship and contact that exists between clients.  Whatever the setting, members of the community are encouraged to bear witness to any event that erodes the quality of life in the program. 

Underlying this community dialogue is a view that all emotional reactions deserve respect, and every effort will be made to acknowledge and verbalize them.  We do this because experience has taught us that community sharing and processing of the origin and impact of “treatment-destructive” behavior is critical to sustaining the psychological well-being of the milieu (Spotnitz and Meadow, 1995).  And while the manner and pace of response may vary, there is always one constant---namely, an abiding commitment to expressing in words the thoughts and feelings such events provoke. 

Our goal is not to blame or punish, but rather to learn and grow.  In our view optimal participation in milieu life is a form of therapeutic citizenship, which is reflected in each person’s engagement in learning about the self and others.  The individual and the milieu mutually benefit from the opportunity for self-study and large group self-reflection.  By collectively voicing our reactions to destructive aggressive behavior, we stimulate the observing ego of the milieu-as-a-whole and its individual members.  We learn together to face the inescapable presence of anger in daily life.  And over time clients (and staff) increase their capacity to respond constructively to the anger of others and to use their own anger well.  

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[1] Bronx REAL is located at 55 Westchester Square, Bronx, NY.  An outpatient site of the Jewish Board of Family and Children’s Services, the REAL provides long-term psychiatric, psychosocial and rehabilitative services to adults with Axis I diagnoses of psychotic and/or mood disorders, as well as adults with Axis II diagnoses of incapacitating personality disorders.    

REFERENCES

Anthony, W.   (1993).   Recovery From Mental Illness: The Guiding Vision of the Mental Health Service System in the 1990s.  In Mikal Cohen and Dean Mynks (Eds.), Compendium of Activities for Assessing & Developing Readiness for Rehabilitation Services (pp.95-102). Boston: Center for Psychiatric Rehabilitation.

Breuer, J. & Freud, S.  (1893).  Studies on Hysteria. Standard Edition, II. London: Hogarth.  Basic Books reprint.

Ormont, L.  (1984).  The Leader’s Role in Dealing with Aggression in Groups.   Intl. J. Group Psychotherapy, 34(4)  553-572.

Sheftel, S.  (Ed.).  (1991).  Just Say Everything: A Festschrift in Honor of Hyman Spotnitz.  New York: Association for Modern Psychoanalysis.

Spotnitz, H., & Meadow, P.  (1995)  Treatment of the Narcissistic Neuroses (Rev. ed.).  Northvale, NJ: Aronson.

Yalom, I.  (1995).  The Theory and Practice of Group Psychotherapy (4^th ed.). New York: Basic Books.