[First of all, I'd like to enlist everyone's support in identifying a possible Trojan horse virus on my website. I was alerted by one of my readers, as well as a directory website, that such a virus had been detected. I believe I found and deleted the infection; at the same time I changed all my passwords. Going forward, if you get a warning from your anti-virus software that my site contains a threat, please send me an email at once, and tell me exactly the threat message you received. Thanks.]

Because chemical imbalance and cognitive-behavioral theories dominate my profession, any approach that addresses unconscious sources of anger receives virtually no attention. For example, I was reviewing this brochure about anger management techniques on the official website of the American Psychological Association; it repeats the familiar CBT methods for defusing anger or learning appropriate ways to express it, but says nothing about the kind of anger that might be numbered among the defense mechanisms-- that is, anger whose role is to ward off some other, more threatening experience.

In an early post about disintegration anxiety, I described a client who would become enraged whenever she felt in danger of falling apart. She described herself as a drowning kitten: on an unconscious level, whenever she felt overwhelmed by her emotions, in danger of disintegrating under their pressure -- quite literally, on a felt physical level -- she often became explosively angry, lashing out and "clawing" at her partner in a way that held her together psychically. This is an extreme version of a process that many of us go through, where anger is secondary, a way of escaping some other emotion.

I've seen this process in many of my clients, but the freshest example comes from my own experience. Late last year, I wrote a post about panic attacks and my anxiety in coping with intense financial pressure. Since then, worries about my investments have slowly abated, but I've been working too hard -- pushing myself to do too much in too many directions. I get up very early to practice piano because it's the only time I can find to do what matters so very much to me. In addition to my practice, I've been developing and promoting this website since last summer, and struggling to keep up with the Movies and Mental Health blog. Now I'm writing a book under a deadline. I'm not complaining: I love doing all these things. But occasionally over this year, I've felt deeply weary and emotionally thin.

I've also been more grouchy and irritable than usual. I try very hard to keep this to myself, but occasionally, I've been snappish about something minor that normally wouldn't have bothered me. More often than is usual for me, I've become quite angry this past year about little things other people have done -- nothing deliberately hurtful or malicious on their part but more in the realm of insensitive behavior, the kind of casual slights we all have to deal with. You might say I've been overreacting. Mostly, I've managed to keep these overreactions to myself, but on a couple of occasions, I've spoken out and regretted it.

To me, the part of my anger that is an overreaction stems from my fatigue, my emotional thinness and my failure to take better care of myself. As a therapist, and also for my own unhealthy reasons, I tend to focus a lot on what other people need, often neglecting my own needs in the process. (I suspect that many therapists have a similar dynamic.) I also have some grandiose expectations of myself -- after all, there's that Carnegie Hall gig awaiting me, and I'd better practice as much as I can if I'm going to get there. While I'm not conscious of any disintegration anxiety, my run-down emotional state has depleted my usual coping skills and made me feel more vulnerable; looking back, I think my anger this past year has had a kind of "hardening" effect. I think you'll know what I mean when I say that anger can make you feel strong, even powerful, when you might be feeling too thin, scared or vulnerable to bear.

In the past two weeks, as I've finally emerged on the other side of my long investment crisis, achieved a major life goal by selling my book, and made some other changes in commitments and relationships that were draining me, I've noticed that I'm not so grouchy, and much less prone to anger. I feel much more able to "roll with the punches" than I have for a while now. I'm trying hard to take rest when I need it, sleep more and give myself time off from work; as a result, I'm feeling happier and more content with my life than I have in years.

So here are my personal anger management techniques for you to consider: 1. If you're angry and overreacting, take a look at your work load and social commitments; maybe there's a weary part of you that needs a rest and a good cry. 2. If you feel grouchy and like pointing the finger because someone was insensitive, maybe you're actually the responsible party and you need to take better care of yourself. 3. If you're raging in your thoughts, make use of all those good mindfulness techniques to quiet them; but in the silence, look around for the part of you that's scared and feeling way too vulnerable.

It would seem obvious that people decide to start psychotherapy because they want to change something about themselves. Maybe they're depressed and want relief. They might have some compulsive habits they need to break. Or they tend to over-react and want to gain control of themselves and their emotions. When clients consider changing, they invariably think about changing for the better; at least consciously, they view change in a positive light.

In general, if we strive to change our lives, it's usually in order to improve them. Sometimes we'll work very hard to alter the conditions that prevent us from succeeding in our careers or being fulfilled in our relationships. Most of us like that kind of change and believe we want it. Why is it, then, that so few people actually do change? Why do so many people stay in unsatisfying jobs and unfulfilling relationships? Why don't more people who need it seek professional help?

As I discussed in this early post, part of the answer is that authentic change takes a lot of very hard work over time and usually involves facing pain. But another reason concerns the very nature of change itself, its unpredictability: while most of us want positive change, we also know that giving up the status quo means confronting the unfamiliar and all the
unknown feelings that might arise. There's no guaranty that change will be for the better; you don't know for sure how you're going to feel when your world changes. For this reason, many people have a strong fear of change; they cling to the familiar, even if it's not especially satisfying. I find that most of the people who seek out psychotherapy usually do so only because they're in so much pain they can't bear it, so much pain that it overcomes their fear of change. People with manageable amounts of pain or whose defense mechanisms work for the most part rarely come for treatment. They stick with the everyday unhappiness they know.

I've also found, with nearly every client I've seen over the years, that change unconsciously (sometimes consciously) stirs up an unpleasant awareness of time passing. We all understand that time is passing, of course; but most people live in a kind of denial about where that passage will ultimately lead us. You can't live every minute with the awareness that you're traveling toward death, so you repress it. Change, especially dramatic change, makes the awareness of time more acute and for that reason, unconsciously links up with the idea of death. In order to escape that knowledge, many people exist in a kind of stasis, as if time has stopped moving for them. Because they dread real change and where it will one day lead them, they cling to routines and repetition, as if every day were the same, as if time stood still.

One of the ways you can see the fear of change, even pleasant change, is by observing people's behavior when they travel. I've know many people, both men and women, who become constipated the day before they go on vacation. If it were during the trip, you might say it was their body's reaction to an unfamiliar diet or climate; but when it happens prior to departure, it has to be a psychological event. Consciously, they're looking forward to vacation; on another level, they fear the impending changes -- in routine, environment, etc. In the clients I've seen, their constipation always involved an (unconscious) attempt to gain control over those changes, as if by clenching tight, their bowels could stop anything unpredictable from happening. In my personal life, all the people I've known who suffered from pre-travel constipation had "control issues", you might say: two neat freaks, another compulsively well-organized woman, a man who has his emotional life under severe restraint.

All of these ideas came up for me again this last week when I was having dinner with a friend I hadn't seen in about a year. We were discussing his young children, and in particular, his oldest daughter who left her beloved pre-school this past summer and started kindergarten. A little girl who had formerly been cheerful and outgoing, who looked forward to school, loved her teachers and her classmates and was popular with everyone had become anxious and miserable at her new school. She seemed to have undergone a complete character transformation. Getting her dressed and ready to leave the house each morning has turned into an ordeal; she now "hates" her teachers and classmates and never wants to go to school. She feels worried and unhappy much of the time.

My friend was also telling me that they have two aging dogs, one of whom will likely die in the next few months. He and his wife have been trying to ready their daughter for this loss, preparing her for the grieving process (which already seems to be underway). At first, she wanted to have the dog stuffed and kept on permanent display in the house (a kind of denial of death); now they've settled on cremation, with the ashes to be enshrined in place of honor.

This little girl is struggling with both the unpredictable nature of change (how your world can suddenly alter and present you with an entirely different set of experiences), as well as with the passage of time and the inevitability of death. I was reminded of a night about 14 years ago when my oldest son came downstairs at around ten o'clock, sobbing to his mother and me that he didn't want to die. Lying in the darkness, the fact of his mortality had suddenly come over him. He was six years old at the time. As with my friend's daughter, it was a time of major changes for him, as well: we'd moved away from Los Angeles and he'd left behind everything he knew.

My friend and his wife have taken the whole family to a therapist who seems to be doing an excellent job, advising them on how to establish routines and predictability, helping their daughter to feel as if she isn't entirely helpless in the face of change, with some control over her environment. As for the issue of death, the dog will soon die and I'm sure it will be traumatic for her. But with the help of her parents, she'll get through and the anxiety about her own mortality will succumb to repression ... as it did for my own son, as it usually does for most of us.