Therapy for Managing Anger Issue – Case Study

Recently, I received a call from VS (name changed), who was feeling stressed and overwhelmed due to her anger issues, which were spoiling things and relationships in life. She was not sure whether therapy would help her or if she needed to see a psychiatrist. After an initial phone conversation, we planned a consultation session.

Case Study on Manager Anger with Cognitive Hypnotic Psychotherapy Approach

Initial Consultation or pre-therapy session: 

In the initial session, VS started describing in detail the problem she had mentioned on call:

“I am married with two children, 10 yrs old daughter, and 3 yrs old son. My husband is having extramarital affairs and each time I come to know about them through his phone. I get into extreme anger because of it, and that leads to my going into depression. I am afraid that I might harm my children or myself in this rage of anger.”

To illustrate, she told me of the last anger rage that she had:

“7th March 22 came to know of a dating app on my husband’s phone. Plus, I caught some chat which indicated his having an affair. We had a fight. He left the house, telling me that I was mad. In a fit of rage, I burnt the center table and sofa.

My 10 years old daughter called my father, who took me and my children to his house.

Earlier also, this had happened, but each time my husband used to apologize and, in spite of my parents telling me not to go back to him, I would go back.”

According to VS, her anger issue was only with her husband. Otherwise, she is a very happy-go-lucky kind of person, and I could see that too. She had her parent’s support completely as they believed that the husband was good for nothing fellow who did not care for VS or her children. He had also taken a lot of money, as a loan, from the family.

Though earlier, she had always gone back to her husband, this time, she was sure that she will listen to her parents and not go back.

I did understand VS’s concerns if she separated from her husband:

• The kids grow up without the father
• Finance was a problem as she was not earning
• She would be dependent on her parents and younger brother.
• Her brother was not married yet and was concerned about what would happen after his marriage.
• Will the husband give back the money taken from her relatives as a loan?

Though VS had told me that the anger issue was only because of her husband, to be sure, the core issue needed to be reached if there was any.

VS was not able to take a stand for herself. She lacked confidence. In spite of being educated, she was not able to decide on what kind of job to do. She had her parent’s support in everything but was not comfortable depending on her parents. 

Therefore, I began by psycho-educating VS about the core concepts behind the process I follow. I suggested Cognitive Hypnotic Psychotherapy (which is an eclectic approach to Psychotherapy). Then I walked her through the pre-coaching process. 

After helping her understand the therapy process, I added that in her case, once we have defined the current problem and outcome, I will help her-

1. Defining the Existing problem clearly
2. Defining the expected outcome from the sessions clearly
3. Understanding the kind of future she would like to create for herself
4. Understanding the different tasks she is currently required to do and assessing how they are related to the desired future
5. Identifying the various triggers that lead to her anger.
6. Help her deal with the triggers one by one.
7. Identifying the Crore issue underlying this problem of anger 
8. Restructuring the thoughts and reconditioning the emotions that are bothering her or stopping her from being able to do the required tasks effectively

Session 1: Defining Challenge and Desired Outcome

We did a recap of the 0 session

I showed her the document and had a quick glance at what we discussed the last time.

In this session, she had a lot of venting to do against her in-laws and husband. I let her vent out. 

I asked her what help she needed from me, as a therapist.

VS: I need help in taking a decision and sticking to it. I am not able to decide what is right or wrong for me.

I used the SOFT SEA Framework in combination with Meta Model Question for helping VS define her current situation, desired outcome, and expected sensory-specific future. 

Using the SOFT SEA Framework, I asked VS to summarize the current challenge she was facing and wanted to overcome via therapy in her own words, in one sentence.

S-Challenge / Problem:

I asked VS to reframe his problem statement using the following format:

I feel ………… about ………… when …………

VS: I feel Irritated about My Married Life when I Look at my parents and my kids.

I asked VS to read the statement a couple of times and tell me what the desired outcome that she wanted to achieve at the end of these sessions in the format

I wish ……………………….

VS: I Wish to have a happy life.

I asked how will she know that she is happy, to which she replied -when I am free of my anger 

I asked VS  to describe the dream future that she would love to work towards.

VS  said that she has never thought about the future as she was not sure whether she wanted the future with this present husband or with some other husband or to live life alone. 

My question was: did she want her life’s happiness to depend on others?

She said: No

So I told her to think of a future where she has confidence and is self-dependent, irrespective of the partner. And I asked her if that was possible for her to think about.

She said: Yes

Me: So let’s work towards it.

And I asked her to list things that she would like for herself and her kids in the future.

FUTURE:

A Permanent Address of her own

A Job and Earing for herself

Earning enough to take care of all the needs of the children and herself.

She was not sure if her present husband featured anywhere in the future or not.

Since she was not sure, I helped her do a PROS AND CONS to help her write a sensory-specific, detailed, and descriptive  future and for that, I started questioning her:

What is your life like when you are with your husband?

Hell

Do you want to continue living in hell?

No, but the kids need their father.

Is he there when they need him?

No, he drinks a lot.

So?

My daughter is growing up and understands everything now.

And?

I don’t think I want her and my son, to see my husband and me fighting.

So?

I think I want to separate from him.

What is stopping you?

Nothing, he apologizes and I go back to him- this has happened a few times earlier.

I have my parent’s support and they want me to leave him.

And?

My brother-in-law has given a loan of Rs 2 Crores to my husband which the family feels will not be recovered if I separate from my husband.

Have they said so?

Yes, my brother-in-law has and he told me that I should have control over my anger to work out situations.

What is your take?

Maybe they are right, I should control my anger.

Was your anger justified?

Yes 

We worked on the PROS of staying in the marriage:

1. Financially I don’t have to fend for myself at present and I can be a housewife, looking after the needs of my children
2. In society, the family will be seen as one unit
3. My relatives will be happy that I have adjusted to my married life.

And the CONS of staying in the marriage:

1. My kids will be bought up in a -ve environment
2. He will not change so the everyday drinking will continue
3. As life progresses and he continues to borrow money, we might come to a tight crunch 
4. My kids will have to suffer his absence, in spite of the fact we are living with him, as he is not home most of the time.
5. The kids will be brought up in an environment of parents fighting most of the time.
6. I will not have peace
7. I might start having health issues
8. In the rage of anger, I might harm myself and my kids, the consequences of which might make us suffer throughout our lives.
9. My parents will be worried about the safety of me and my children all the time.
10. We will be living in a toxic environment

We worked on the PROS of staying and leaving the marriage:

1. I will be at peace
2. I will not get into a destructive anger
3. My kids will have a healthy environment to be brought up in
4. I will be able to take care of my children better, as I will be in a better mental health
5. My parents will not be worried about me and my children

And the CON of leaving the marriage:

1. I will be dependent financially on my parents till I am able to earn my own living
2. My kids will not have a father figure in their life

So there were more cons than pros in staying with their husband And that made him decide that she wants to leave her husband.

H.W.

I asked VS to maintain a journal listing down all the triggers where she felt angry and also to narrate the specific thoughts she has in mind with each trigger.

Session 2: Preparing the Primary Task List and Action Plan

Recap: Went through the H.W. given 

Not once did she feel angry with anyone (except felt a little irritated with her grandmother). The only time the anger surfaced was when she thought of her husband. He had not tried to contact her or the kids from the time she was at her parent’s house.

VS mentioned that since last week, she had talked to her parents also about her situation and they were not wanting her to go back to her husband. They were ready to support VS in every way. 

From this point of view, we started working on the future for VS if her wish was granted:

• A permanent address of her own
• A job and an earning for herself
• Earning enough to take care of all the needs of the children and herself.

After writing the above pointers for the future we wrote 3 tasks that needed to be done next week which would help to take VS more toward the future.

• Talk to her parents regarding her future
• Start taking tally classes so that she can start a job with a skill set
• Concentrate more on her children than thinking of her husband

Realizing the anger issue she had towards her husband and in-laws, I did the Transformational metaphor and HO’PONOPONO with her. Anchored confidence as that is what she stated was required for moving forward.

After this process, she was able to give me her WISH STATEMENT clearly

I WISH to have a happy life away from my present husband.

H.W.

Told her to continue maintaining the journal

Session 3: Future as per her wish statement

Started working on the future as per her wish statement- helped her restructure her thoughts and, to get rid of her pent-up emotions, did hypnodrama and cord-cutting with her husband.

RECAP

In the third session, VS reported that she had started feeling better in the past week. 

She was a lot calmer than she had felt for a long time, though there was still a little anger towards the husband

As confidence was what we had anchored during the Hoponopono process, she was feeling more confident to take decisions and no longer felt embarrassed when meeting people.

She gave me some more pointers about her FUTURE:

• I am tension free
• My Focus is more on me and my kids
• My life is good- my bonding is good with the kids
• I am able to think of making my future on my own
• I am happy

Last week’s tasks:

• Talk to her parents regarding her future- she was able to do so openly without any hesitation and the parents fully supported her decisions.

• Start taking tally classes so that she can start a job with a skill set

She was still not able to start the tally classes as at present her financial needs were being fulfilled by her parents and she was procrastinating, but she did want to start taking classes as she needed to be financially independent. She asked me for help. 

On the basis of the H/W given in session 1, I used Thought restructuring with her to help her change her thoughts associated with the identified triggers.

I explained to her how would the new thoughts become more automatic, by giving him the following example :

What comes to your mind immediately when you hear “HARI”?

VS replied “OM”

To which I said this is how the new automatic thought would work.

I asked to practice the thought restructuring technique daily to make the new thoughts more automatic.

Old thought: When I think of my future and am not able to start taking tally classes then I know my parents are there to look after me and I can learn tally later.

New thought: When I think of my future then I know to be financially independent, I need to learn tally.

SHE CHANGES IT TO:

When I look at my children then I know I need to be financially independent by taking Tally classes.

• Concentrate more on her children than thinking of her husband- she was having difficulty stopping to think about her husband, as she felt she and her children were unfairly treated by her husband.

 I did –Hynodrama with Husband, along with Cord cutting.

 At the end of the session, VS  looked quite happy and relaxed.

H.W.: Repeat the when then statement to herself many times during the day, till she starts taking the TALLY classes

Session 4: Healing the Inner Child

After EET ( to reach the core issue) did the inner child heal in a hypnotic state.

RE-CAP

In the fourth session, VS  told me she had started taking Tally classes and was enjoying it. Her father told her to join his business and look after his accounts, once the tally course was complete. 

She no longer felt angry when she thought of her husband or in-laws.

Though there was some anger in her towards her grandmother as she felt that her grandmother did not approve of her and blamed her for the situation. She did not have any clear indicators of this, though, but resulted in her not being comfortable in the grandmother’s presence. 

With the help of  EET-DELAYERING, I tried to reach the core issue, which was insecurity as a child, as her grandmother used to scold her a lot when she was a child. By hypnotic process, I took VS  into a deeply relaxed state and helped her in healing her inner child. During the process, she cried a lot. 

Anchored peace for her.

Session 5: Future Writing

Recap

VS was able to talk to her grandmother about her married life and she realized that the grandmother also wanted her to be separated from her husband as she did not like his ways. VS was happy to learn this and was able to make peace with the grandmother, in the process becoming closer to her.

Now VS had the full support of the family – Her Father-Mother-Younger Bother-Grand Mother.

Next, when her brother-in-law called to tell her that her husband was not giving back his money and VS had done wrong in getting angry and leaving the husband’s house, she was able to ask him-“ did you ask me before giving him the money? If not how is it my responsibility to be living in that hell with my children just so that so get your money back?”

The brother-in-law was a little upset but as VS made him realize her point of view in a very confident and calm but firm way, he understood and told her that he will support her in every manner and will get his money back from the husband anyways.

Going through the earlier session recap I was once again reminded of her wish statement, which was :

I WISH to have a happy life away from my present husband.

• So I asked her how will she be happy.
• By being independent, earning my own living, and looking after the needs of my children and myself.
• So now what is your wish statement? 

I wish to be financially independent.

Let’s work towards the future once the wish is granted

Future:

• I feel confident and in control of situations
• I no longer feel destructive anger 
• My husband realized that I am no longer dependent on him, and has agreed to file for divorce on mutual consent.
• I have joined my father’s factory as an account in charge and am being paid a salary for it.
• I do not feel like an outsider staying with my parents
• I am able to take care of my children’s schooling and other needs all by myself. ( earlier I had to ask my parents for money)
• I have my own car and I drive myself to work
• My parents are a big help still but I do not feel like a burden to them.
• They have given the first floor to my younger brother to stay in so that after his marriage there is no friction due to my staying in their house.
• On the ground floor, I stay with my grandmother, my parents, and my children.
• My bonding with the children has become stronger as they know that I will look after all their needs.
• They are at peace as they do not have to listen to any abusive language and I am able to give them the life of my desire, in an environment of peace and happiness.
• I laugh more and it seems like the old VS is back.
• I do get angry with the kids at times, but this anger is not destructive anger -I do not try to harm myself or the kids, or the house in any manner. 
• I also handle accounts for 2 other companies
• The relatives have understood that the husband was at fault due to which I have left him and they also support me. I have my parents to thank for this, who helped in putting a stop to the wagging tongues.
• My children and continuing their education in the school of my choice.
• I drive my own car and feel more independent and self-sufficient doing so.
• Due to my bubbly nature, I have been able to make good friends, who are always ready to extend a helping hand.
• I also take care to nurture my friendship in a positive manner.
• My younger brother has started looking up to me for advice
• My grandmother is proud of me and it shows in her actions and speech.

H.W.

As homework, I told VS to finish writing her future as she would want it to be.

Asking the miracle question:

One day, when you get up in the morning, and you realize that your wish has been granted -describe that one day in your life, making it very very sensory-specific.

Session 6: Future Pacing

In the sixth session, I could see a bubbly and happy VS.

With the help of a hypnotic process, I took VS into a deeply relaxed state and asked her to imagine how the activities she is doing now are eventually helping her create her desired future.

VS took 8 sessions and felt more in control of her life and confident about managing the activities. The seventh and eighth sessions were to be sure that all was going well and if she still needed help with any underlying issues.

VS stayed in touch with me over the phone for another 4 weeks reporting her feelings and progress.

I am happy to observe that the processes I did with VS helped her take control of her life. Where she was feeling overwhelmed and stuck in a situation, she was now confident and knew exactly what path she was to take, work on it step by step and move forward in spite of the responsibility of her children solely on her, with no expectations from her husband.

My Observation:

Imagination can play a very important role in therapy but the counsellor needs to be skilled to understand which imagination process should be used in what context.

References for techniques used:

1. SOFT SEA
2. Meta Model
3. Garden metaphor and Ho’ponopono along with Anchoring
4. Thought Restructuring
5. Hypnodrama and Cord Cutting 
6. EET and Inner child Healing

The concepts and techniques discussed during this case study are based on the topics covered during the Cognitive Hypnotic Coaching® Diploma and the Cognitive Hypnotic Psychotherapy™ Diploma