Jeff, a man in his late thirties, has come to the Center complaining of low self-esteem, insecurity in his relationships, being cut off from his feelings, and anger. He has a long history of depression. An injury has forced him to leave his former work in construction, and he is considering going back to college in social work. His therapist, Tim, is a second year graduate student; Jeff is Tim's first therapy case. Although the first two sessions of treatment have gone fairly smoothly, Jeff arrives at the third session furious at his wife, who he feels is pushing him out of her life by going out with her friends instead of spending time with him. His anger has been building all weekend, and by the time he gets to his session with Tim on Monday morning, he is beside himself with fury. He rails against his wife, her friends, and her family. He makes oblique threats about what he might do to his wife's friends, so "they would know what it feels like to have the rug pulled out from under them." In a rambling diatribe he blames everyone he can think of, including the government's affirmative action programs. Jeff tells his therapist that he "might as well be dead, for all anyone cares." Although he denies any suicidal plans, and has no history of suicide attempts, he does express a desire to be dead ("at least then it wouldn't hurt so much").
Jeff's anger is so intense and disjointed that Tim wonders if his client is becoming psychotic; he fears that Jeff may be a danger to himself or others. After discussing the possibility of hospitalization with the client, he secures a promise from the client to return for another session two days later and to contact the local crisis phone line if he becomes suicidal in the meantime. Not knowing quite what to do, he urges the client to get medication, "to take some of the edge off of what you're feeling." Tim's regular Process-Experiential (PE) therapy supervisor is out of town, so he seeks consultation from another, nonexperientially-oriented, supervisor. This supervisor views the videotape of the session, and describes the client as "scary" and "paranoid."
On his return, the PE supervisor also reviews the session tape. In contrast to the student therapist and the nonexperiential supervisor, the PE supervisor immediately hears the client's anger as secondary reactive anger, meaning that it is caused by another, more important feeling. Jeff is terrified that his wife is going to leave him, and he is in a panic as he imagines this impending abandonment, which he feels powerless to prevent. His anger is more accurately understood as fear. Furthermore, the supervisor is impressed that whenever the therapist responds briefly with empathy and prizing ("I guess your relationship with your wife means a lot to you."), Jeff's anger momentarily softens into fear, as well as sadness at the anticipated loss. Jeff is not psychotically angry, just terrified. Empathy from the therapist and reassurance from his wife are enough to calm him down, and he is doing much better by the next session.What could the therapist and the nonexperiential supervisor have changed in their initial formulation and what could they have done differently to help the client deal with his anger? In general, they needed to recognize this as secondary anger. Then, they needed to ask how the therapist could help the client contain the intensity of his rage, while still being able to use it in order to access more central feelings and meanings. In PE therapy there are many different answers to this question. At various times, the therapist might have: