I’m reading up on anger this week.  This, because I have been thinking a lot about a very ANGRY young dual diagnosis client I worked with early in my training.  She would come into our clinic hissing like an alley cat, dropping F-bombs left and right. She would say vicious things without remorse and kept her cool – ALMOST – always.

This therapist can go down deep research rabbit holes.  Tonight’s reading is titled PREDICTING DRINKING LAPSES IN ALCOHOL USE DISORDER: THE TOXIC COMBINATION OF AGONISTIC STRIVING AND POOR ANGER REGULATION.*  It is interesting reading. It looks at the Social Action Theory (SAT) of chronic stress, which provides a framework to investigate which social stressors combine and interact with emotions and cognitions to trigger relapse. The SAT says that people who suffer stress related to Agonistic striving (i.e., seeking to control others) may be more likely to relapse than those who are working with two other kinds of striving “Transcendence striving (i.e., seeking to control the self) or Dissipated striving (i.e., lack of goal focus)”.

In trying to apply this reading to my client, I can see clearly that she was certainly challenged by Dissipated striving.  She lacked significant life skills and along with that confidence so it was hard for her to develop any sort of goal focus. Her desire for sobriety was weak and so then was her desire for Transcendence striving, to control herself. What was harder to see was that my client was also engaged in Agonistic striving; while at first it seemed the client was using her anger to control others at the clinic, it soon became clear this anger was more a part of her desperate attempts to control her parents. This client had loving parents yet they were in a dense holding pattern, dealing with many of their own challenges, so they had little energy left to focus on this client, whose acting out behaviors had become dangerous at times.  The client’s anger it seemed, was an effort to shake up her family system and demand that her parents get out of their rut so they could be more available to help her get out of hers.  According to the SAT theory, this kid may have been suffering from a triple whammy in over-striving.

The challenge in working with young people is that their worst behaviors are often closely linked to their critical strengths. Control for instance, can be an important protective skill for a young kid to develop if they are raised with significant real or perceived adversity. The energy spent trying to control others however can be exhausting. It was no surprise when one day my client, having relapsed again, finally collapsed, sobbing.  When she was finally able to get words out, she said nothing about her own pain, she only kept repeating that she didn’t want to keep hurting her parents.





*Journal of Social and Clinical Psychology, Vol. 35, No. 3, 2016, pp. 235-254

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