The Official Publication of the
International Society of Schema Therapy
In This Issue
In this June Issue - Working with Strong Coping Modes in Schema Therapy by Lissa Parsonnet & Chris Hayes
Schema Mode Therapy: Working with the Overcontroller Mode by Susan Simpson (Scotland)
Should I stay or Should I go? Navigating the Angry Protector Mode with Forensic Clients by Kerry Bickley (UK)
Handling Overcompensation Modes by Dr Odette Brand-de Wilde & Maria Rocher (The Netherlands)
Behind the Pleasure - Working with Self-Soother Mode by Sergio Alejandro Morales Hernández (Mexico)
Should I stay or should i go?
NAVIGATING THE ANGRY PROTECTOR MODE WITH FORENSIC CLIENTS
Consultant Clinical Forensic Psychologist
Carholme Court (Clinical Forensic Psychology Service), UK
We think of the Angry Protector mode as a wall of anger the person uses to protect themselves from others who are seen as a threat. The person keeps others at a distance through varying forms of anger or hostility. The function of the anger is quite different to that of the angry child or bully attack mode. Ultimately, the mode just wants you to go away.
The expression of any type of anger in forensic settings creates understandable anxiety. All forms of anger are often associated (often wrongly) with an escalation in risk or is seen as offence paralleling behaviour (Jones 2004), in that it tells us something about the persons triggers for violence. For this reason, the angry protector mode can present challenges to the therapist, both in its management in therapy, or in an attempt to convey a different function to other clinical or custodial staff. There is often an assumption that such behaviours are to be punished or ignored, which only serves to reinforce the person’s early experiences of emotional abuse and neglect. For the schema therapist, it can be difficult to navigating ones way through to the Vulnerable Child without either triggering the patient into a compensatory mode, such as Bully Attack, or by attracting criticism from ones colleagues about placing oneself in a dangerous situation. The following two cases illustrate some of the challenges of working with the Angry Protector, but also the benefits of overcoming them.
Ray is a 45-year-old male with a life sentence for a violent offence, who had spent his entire adult life in custodial settings and maintained isolation from others. He had been subjected to physical, sexual and emotional abuse and neglect, both in the home and subsequent care settings. He presented with an inherent mistrust of everyone, and had no experience of being able to rely on others for care and protection. He was a large man, who had developed a very effective intimidating persona and had a history of using violence in situations where he felt threatened. I met Ray in a secure hospital setting. He had been transferred to hospital from prison for treatment of Schizophrenia. This had been well maintained for many years but features of Avoidant and Antisocial Personality Disorder remained. I was ‘warned’ that he was likely a psychopath and would not be amenable to psychological therapy. Ray made it very clear that he saw no value in psychological therapy. The staff were frightened of him and spoke about him in derogatory terms, suggesting that he’d be better placed back in prison. He was generally compliant with ward rules although engaged very little with staff, and was surly and uncommunicative when spoken to.
Ray agreed to meet with me, although maintained his lack of needs, and would either leave or ask me to leave within the first 15 minutes. I continually referred to his valid reasons to not trust keep and keep me at a distance, which he viewed as confirmation of why he should not see me. We remained curious about why he agreed to see me and I would refer to this in terms of ‘unmet need’ for attachment to another. Ray wanted to progress but did not feel supported by staff, but also did not want to return to prison. I extended the concept of limited re-parenting in terms of actively supportive of him in achieving his goal in order to build up some trust and credibility with him. This involved advocating for Ray on a regular basis and working with the team to ‘hold’ a different view of Ray. After a few months, Ray started to acknowledge my support of him, accepting that I wasn’t doing anything to harm him, which was contrary to how he saw my initial attempts to engage him in therapy. However, he was still quick to become critical and abusive towards me if he felt that he had been misunderstood or something didn’t go his way. It was important at such times to empathically confront Ray’s treatment of me at the same time as validating his fear of being harmed. Ray was not used to experiencing this type of interaction, as he had mainly been ignored or avoided. In short, I was both providing an experience of him being cared about but also inviting him to care about me. Our relationship strengthened, and the healthy side of Ray started to appear in sessions, where he could be warm and humorous. It became possible to address Ray’s trauma history through the use of imagery in particular and there were some special moments in therapy where Ray was really able to connect with his needs and allow me care for him. Once we had overcome Ray’s Angry Protector, it never returned to the same degree. I was able to support him in giving others the opportunity to connect with him in a way he would never have allowed previously. He was able to hold an understanding that people’s intentions towards him were not always malevolent and was less attacking and abusive in his response to perceived misdemeanours. Discharge was eventually achieved and although Ray had no interest in developing friendships, he acquired a puppy, whom he named Angel, and to whom he was able to attach to completely without fear of being harmed. Therapy ended a few years ago, but Ray will still call me when he needs something and we meet up for his birthday every year. He manages to live his version of a happy life, and no longer needs to use intimidation or violence to protect himself.
The second person who comes to mind is Simon. Like Ray, Simon grew up in a very abusive family environment where his father was particularly sadistic and violent towards him. He witnessed significant domestic violence, was physically and sexually abused within the family and led almost feral existence from his early teens. Unlike Ray, Simon spent most of his time in the community, apart from an eight-year sentence for kidnap. Simon was referred to the community forensic mental health team after attempting suicide. A few weeks prior, he had taken a chainsaw to his neighbour’s house and threatened to cut him up. He was not charged with this offence, but had informed his general practitioner who made the referral. He had been living as a virtual prisoner in his flat, considering this the only way to prevent him harming others due to the levels of anger and violent ideation he was experiencing.
The experience of being in the room with Simon was powerful. He presented in Self Aggrandiser mode, talking at length about his ‘occupation’ as a hitman and alluded to a number of people he had killed or seriously injured. He described his internal world as ‘psychotic’, and described seeing people, hearing voices frequently. He saw himself as broken beyond repair and an ‘animal’. Engaging him in therapy was a challenge. Simon desperately wanted help but also held the idea that he was ‘unhelpable’ and that his only form of defence was violence. Attempts to have more emotionally meaningful connection were met with an increase in his reported violent ideation. We tried connection exercises to explore our relational boundaries, for example, moving chairs to create proximity and distance. Simon was triggered by even the smallest increase in proximity, reporting visions of biting my nose off and was concerned that he would assault me. To me this was clearly the Angry Protector mode, not Bully Attack, as I experienced no sense of fear when he expressed such thoughts.
Simon was very resistant to the use of imagery and chairwork. His level of emotional detachment when imagery was attempted remained high, and it was important to safeguard against an intellectual battle when attempting in increase his motivation to engage in experiential work, or to become focused on his derision towards these techniques. Persistence with imagery in particular was helpful, as although Simon would often emotionally detach during exercises, he was increasingly able to talk about his unmet needs. The biggest barrier to experiential work was Simon’s fear that my proximity to him, physically and emotionally, placed me in danger, reaffirming his experience of self as a monster. This led to him being able to explore the power of the Punitive Parent mode in maintaining his sense of self, and limiting his opportunity to gain connection with and care from others. Simon made progress in his self-awareness, but his fear of hurting me remained a block to his full engagement. After eighteen months, there was something of a therapeutic impasse, and we decided to take a three-month therapy break. We remained in contact by text message.
During this time, Simon split from his long-term partner, and requested to come back to therapy. At the start of the first session Simon hugged me. This took me by surprise, given the level of emotional detachment and physical space he had insisted upon in sessions. The therapy break, coupled with the separation from his partner was significant in shifting Simon from a position of therapeutic ambivalence. For the first time, Simon was really able to acknowledge his vulnerability and strong feelings of defectiveness. Simon still had a tendency to use emotional avoidance and remained fearful of me being close to him, but was far more able to tolerate re-parenting. The wall had lowered to the point where we could work with the Vulnerable Child mode, leading to observable changes. By the end of therapy Simon had joined a snooker club, was regularly meeting up with friends and had applied to obtain his long distance lorry licence, after not working (legitimately) for many years.
Both clients were viewed by other professionals as ‘too risky’ to engage in therapy, and I was challenged for continuing to do so on several occasions. This was primarily due to the perceived function of the Angry Protector mode. The histories of the two clients were strikingly similar in terms of the complexity of the trauma that they had experienced. Both were hostile and threatening directly towards me although I never experienced it as such. I place great value in ‘feeling’ the modes in the room when making judgements about risk and function. In my experience, perseverance with the Angry Protector mode is usually very effective and leads to maintained changes in the person’s presentation. Extending ones limits in terms of working with clinical teams, increasing numbers of sessions, or tolerating the length of time which someone is primarily in Angry Protector mode can be helpful. One cannot emphasis enough the importance of supervision when working with clients who have proven histories of serious violence or sexual violence. I may have been viewed as cavalier in the work by some (non-therapist) colleagues, but I feel I can trust my clinical judgement in regard to personal safety having worked for many years as a schema therapist in forensic settings.
With no other coping mode do you have to ‘come alongside’ quite so much as you do with the Angry Protector. It is the mode I have had the most success with when working with forensic clients, where long-term trauma underpins the levels of hostility, withdrawal and isolation they experience. I try to help clients hold in mind the Vulnerable Child behind, and to understand that this mode is doing it’s very best to protect that child from any further harm. By making the mode your friend, as opposed to engaging in battle with it, we can hep the person take steps towards receiving the care and understanding they so desperately need.
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