I continue to see Josh, a seven-year old sandy-haired boy who has Attention Deficit Hyperactivity
Disorder and Oppositional Defiant Disorder. One important thing to know is that the psychiatrist
changed Josh's medication. Josh has made some big changes in his life. He plays tag football and loves it.
He is better behaved at school and is not as quick to be oppositional. He does well in day care and listens
to his day care provider. Mom seems over well pleased.
Now this is not to say Josh does not have any problems. He is easily riled up. He continues to run around
the waiting room like a banshee. His mom still has little control over his behavior. This week I told him
he could not bring his drink back to my office. He got all whiny and refused to give his cup to his mother.
His mother took the cup and he said he was not coming back to my office. His mother dragged him back
to my office. What kind of session do you think I had with Josh?
You are right if you stated that he behaved very poorly throughout the session. He was oppositional in
every way possible even pointing toy guns at me and shooting me. You see he was angry with me
because I set a limit. When I told him that he does not like to follow the rules, he said I never follow the
rules. When I said that you are really angry with me because I did not let you bring back the drink with
you, he shrunk underneath my table. Most of the session was spent with "no" or "I don't know"
Josh was unable to tap into his feelings. He did not recognize that he was angry. He did not recognize his
physiological signs that he was becoming angry. He did not know the thought that caused him to be
angry, and he could not name the trigger or event that caused him to be angry. He just knew how to act
out his anger.
When we are looking at anger there are three things we need to be aware of. Once you do this, you can
then begin to work on your anger.
1. You need to be aware of what trigger's your anger. Saying "no" to Josh was a big trigger for his anger
to flare up. Maybe, I could have handled the situation differently. Sometimes this works. I could have
given Josh a choice and said that he could finish his drink or give his mom the drink until after the
session. In doing this I give him back the control he desperately wants over his life without using the
word "no." I am still setting my limit with him.
2. You need to be aware of what you are thinking just as the trigger hits you. I do not know what Josh
was thinking. I can only surmise he said something like "Nobody says no to me." It could have been he
did not like restrictions put on him by authority figures. Maybe he was acting out in front of mom to see
what her reaction would be and his final answer might be "I'll show you. I don't have to listen to you.
You're not my mom." Whatever it is, there is a little voice inside of you that speaks up when someone
pushes your anger button. You need to listen closely to this voice as this message we are sending to
ourselves, we want to change in order to turn down the flame on your anger button. We change it by
turning the negative thought in to a more calming thought.
3. You need to be aware of your physiological symptoms of anger. Does your heart race? Do you get
sweaty palms? Are there butterflies in your stomach? Do you clench your jaw? Do you roll your hands
into a ball and make a fist? Do you get a headache? Everyone has different symptoms. Knowing them
may help you stop in your tracks and prevent you from doing something you will later regret. When Josh
gets angry, he balls his fists and flails on the floor throwing a huge temper tantrum.
My job is to work with Josh to get him in touch with his anger and how it affects his mind, body, and
behavior as well as getting him to recognize what triggered the anger. If we checked ourselves every
time we began getting angry, I bet we would have a much kinder outlook on life.