I have been more and more impressed recently how valuable it is to see people as a kind of sandwich with an adult layered on top of a very active child. It is surprising when one starts to think that way, to see how much of what we say and do comes from the child. Many if not most of the problems that are solvable through psychotherapy are best understood as the inner child making an appearance and crying out for solutions to issues from long ago. The key to helping these troubled inner children is a readiness to work with them as a compassionate and understanding adult. Let’s take a look at what that means.
When children are troubled by an unmet need, they know that the solution is to get the adult to understand and solve the problem. In adulthood, if the need still hasn’t been met and the shortfall isn’t fully accepted, that means the child has experienced the original caregivers as unwilling to take care of what should have been their responsibility. So the need is still there, and with it is anger, hurt, frustration, and some hope that someday, some grown-up may understand and finally take care of business.
This situation is a set-up for a roller coaster of hope and disappointment. The child within finds hope that somehow the need will at last be met, then it turns out that the grown-up who had been identified as the one to solve the problem is not going to solve it. Then anger starts to boil. Just as it was long ago the child realizes that the responsible adult is not accepting responsibility. The anger has no where to go, so it shows up as helpless rage. Maybe it gets directed at people who don’t really deserve it. Maybe it gets turned against the self, and maybe it gets covered up and buried. When the latter happens, the rage turns into destructiveness. As a therapist, when I see rage and/or destructiveness that is causing tremendous harm but can’t seem to be stopped, I think of an adult temper tantrum.
The best tip-offs that a temper tantrum might be taking place are anger that fails to dissipate and destructiveness that seems to keep going even when it is obviously dysfunctional. These hallmarks are no different from those of a two-year-old tantrum. In fact, I have come to believe that what is going on, outside of awareness, is exactly the same. So let’s start by examining the anatomy of a two-year-old temper tantrum.
Why Tantrums are Life-And-Death Struggles
The reason tantrums appear during the “terrible twos” is that before that point in development, toddlers are not cognitively equipped to see the danger in a power struggle with Mom. They see the world as revolving joyously around them. Mom’s will (or that of the primary caregiver) is perfectly aligned with the child’s will. When I want something, Mom wants it for me. When I don’t, she is on my side, too. The world is indeed the toddler’s oyster. Yes, of course there are times when Mom says, “No, you can’t have that,” but somehow it doesn’t break through the blissful harmony of the relationship. Mom says no, and the child somehow lets go, and no one is the worse for the wear.
Rather suddenly, around age two, this changes. Now, the two-year-old becomes intolerant of disagreement on Mom’s part. To my mind, the best explanation has to do with cognitive development. Before, the Mom who was smiling and agreeable was a different Mom, from the one who said no. Furthermore, the self who was told no, was a different self, so there wasn’t any clash between the two self-other pairs. According to this theory, what happens developmentally is that cognitive advances lead to a realization that the two are actually the same. The mother who says yes and the one who says no are the same mother. At that point, disagreement with the mother who says no becomes a threat to the vital attachment to the one who says yes.
For this reason, from the child’s point of view, the only solution to a disagreement is that Mom has to change. The child experiences rage, then helpless rage, that Mom has to give in and why doesn’t she? Why is it that Mom is the one who must change? Giving in feels like a complete loss of self. It seems like a loss of everything that made the self cherished and lovable. So the child has no choice but to put up a life-and-death fight to get Mom to change her mind. The stakes are not simply the thing being fought over, but life itself. If the child loses the battle, then, like the gladiators of Rome, he or she will die.
How Tantrums are Resolved
The healthy resolution of a tantrum is this. Mom scoops up the child in her arms, preventing the child from doing any damage to self or to her. The child continues to flail for a while, screaming things like “I hate you, Mommy.” It is very fortunate that two-year-olds are small and not very strong, so preventing them from doing harm and staying physically close is pretty easy. After a while, the child stops thrashing and begins to cry. Soon the tears turn to clinging and the rage runs its course, allowing mutual feelings of love to return, expressed in the holding and maybe soothing words given by Mom and accepted by the child.
According to the theory, what has just happened, is an incremental fusion of the two internalized relationships, the loving mother and self and the angry mother and self. In other words, the child has begun to learn from experience, that you can lose a battle and still be lovable. That is huge. It is what allows us to survive our failures and mistakes and to allow ourselves to admit failure and accept being forgiven. More simply, repeated many times, we learn to lose battles gracefully. On the other hand, when these abilities are missing, we can imagine that the inevitable temper tantrums were handled differently.
Other resolutions to the tantrum are not so good. Children who are overindulged cannot learn to lose the battle because they always win. Lacking the ability to accept losses, they feel an absolute need to win every time, or, more likely, give themselves the illusion of having won. Children who are punished or rejected and isolated for their willfulness are no better off. Threatened with emotional death, they, too, resolve that they must win every battle. These are the conditions that appear to promote development of a Narcissistic Personality Disorder. This is why I don’t recommend placating a child or putting him or her in a room alone. Resolving a battle at this age should be a very physical, personal encounter with a successful ending.
What if Mom acts hurt and isolates herself? Then the child will be afraid to have a battle and won’t learn to hold his or her ground, for fear of injuring the one person who is most important in their life. One way of coping with this, according to the theory, is the “borderline” solution, to keep the good mother-good me relationship distinct and separate from the angry me-angry mother relationship, holding onto an earlier cognitive stage. People who keep the two separate are the ones who suddenly switch between an idealized relationship and one of arch enemies. Obviously these whipsaw switches take a toll on close relationships.
The Adult Tantrum and its Treatment
Adults can and do slip back into the mode of a child having a temper tantrum, but it is not as immediate or obvious. Unfortunately, adult temper tantrums can last for years. As indicated above, the signs are raging and destruction that are clearly harmful but don’t stop. What may not be visible is what is being fought over. I have seen this in Binge Eating, Agoraphobia, alcohol and drug abuse, and other destructive behaviors. Overt rage might be the kind that won’t be calmed or healed. The rage may also be buried or turned against the self.
I have sometimes described the therapy for adult temper tantrums as having a solid and unmoving rock on the shore upon which the raging sea must crash over and over till the storm runs its course and the sun comes out. This is easier for a therapist to do than a parent, spouse or friend. Therapists don’t have to be there every minute and are compensated for their endurance. Furthermore, it may be easier for them to have some perspective on what is happening. On the other hand, even for therapists this is a hard thing to do. Not infrequently, the rage is turned directly on the other person. Being criticized, insulted or even threatened is not so easy for anyone to handle including therapists. Some therapists do well in this role and others may don’t. Hopefully the therapist knows and doesn’t raise hopes that he or she can’t fulfill.
Nonetheless, the elements of a successful outcome are the same as for the child. The first is containment of the rage. Destructiveness must be contained or it will continue to escalate. In the case of direct threats to the therapist or other person, limits must be set so the recipient is not in any real danger. In the case of other kinds of damage, the destruction may have to run its course till the adult patient decides that enough harm has been done. Sometimes police or other authorities, or even family can intervene, putting a stop to the destruction, but the individual must become ready to stop. This is a kind of “hitting rock bottom” where the non-conscious destructive wish is relinquished, and health takes charge. In practice, getting through this phase can be extraordinarily challenging.
The second element is to reestablish empathy and connection. The person having the tantrum must feel needy enough and safe enough to allow the self to be soothed. Accurate empathy is key, meaning that the therapist needs to have a real understanding and appreciation of the emotional issues and why acceptance is so hard to achieve. This empathic connection may have to be reestablished multiple times to be internalized along with the belief that the self, even if imperfect, can be forgiven and can still be loved. Rembrandt’s painting of the Prodigal Son expresses this ending perfectly.
Is Every Adult Rage a Tantrum?
I think the answer is no. Normal rage, once it comes to the surface, can heal like other emotions. It heals by the process I call Catharsis, that is, being fully felt in a context of empathic connection (See the Post on Mechanisms of Healing). But there are many situations where the mind is afraid to connect the dots and acknowledge what the rage is about and to whom it is directed.
Let’s look at rages and/or destructiveness that seem resistant to healing, should every instance be called a tantrum? In many of those situations, there is some major threat associated with the rage becoming conscious. If the fear is loss of self, then we should think of it as a full blown temper tantrum. Other possibilities are that holding onto rage has some kind of payoff and that the reason for resistance to healing is some other fear. But it may be hard to discern such subtle distinctions. After all, this is going on in the non-conscious part of the mind and may only give off a vague sense of resonance to indicate what it might be about. I think the answer should depend on whether the concept is useful in unraveling what is going on, getting the destruction under control and healing the rage.
What I do with my patients is to clarify that there is some kind of “NO,” some kind of refusal to let go of the rage and/or destructiveness. Then we can begin to explore what it might be using free associations, theories about past experience, intuition, etc. Fears of one’s own rage other than death of the self might produce a similar picture on the surface. As we become aware of the emotional work that must be done in order to let go of the feeling and behaviors, then we can focus on that very challenging work.
I have to say that this area is one I am gradually learning more about, but I am sure that I have not yet explored the entire breadth and depth of the issue. So I would encourage readers to share their knowledge and experiences, especially about working with a relatively intractable rage or destructiveness.
Whatever the details, the valuable take-home is that the concept of the adult temper tantrum coming from the child within leads very naturally to the important therapeutic goals of 1) containment, and 2) understanding and feeling the emotion with an empathic witness.