TIFT #46 Adult Temper Tantrums

This post was originally published six years ago and is updated here. As indicated in TIFT #1, I continue to be impressed with the value of seeing people as a kind of sandwich with an adult self layered on top and a very active child. Once open to the concept, it is remarkable how often one finds the child firmly in charge. More than we might imagine, what we say and do comes from the child. Many of the EMPs (subunits of pathology most relevant to psychotherapy), are best understood as the inner child crying out for resolution of problems from long ago. The key to helping these troubled inner children is a readiness to work with them in a compassionate and understanding way. 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. When we see indications that an early childhood shortfall remains open and hasn't been fully accepted, we can surmise that the need was experienced as essential and that the child experienced the original caregivers as unwilling to take care of what should have been their responsibility. So the felt need is still there, and with it anger, hurt, frustration, and some hope that someday, some grown-up may understand and finally "do the right thing." On some level, that same unwillingness is what our client is anticipating from us.

This situation is a setup 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 now identified as the one to solve the problem is not going to solve it. Under the surface, anger starts to boil. Just as 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. Or, maybe it gets turned against the self, or gets covered up and buried. With nowhere to go, rage turns into destructiveness, both as an expression of feeling and as a nonverbal communication that someone needs to do something. As a therapist, when I see rage and/or destructiveness that is causing significant harm but can't seem to be stopped, it is time to 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. The destructiveness may be subtle. Some clients hold themselves back from obviously self-defeating behavior. Even less obvious, might be procrastination or somehow not getting to important self-promoting or life-promoting tasks.

Anger and destructiveness can erupt as well, aimed at what the individual identifies as a legitimate outrage. Even there, we can observe a characteristic childhood lack of interest in solving the problem and turning to “big people” for solutions without realistically evaluating their promises.

In its underlying meaning, this destructiveness, subtle or overt, is little different from the raging of a two-year-old. In fact, what is going on, outside of awareness, is, for practical purposes, 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 consequences of a power struggle with Mom. They see the world as revolving joyously around the caregiver-child duo. Mom’s will 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; the child may cry for a bit, then gets distracted and lets go, with no one 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, (from Margaret Mahler) 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 connection with 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 absolutely must 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 reverse her decision. 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 relatively 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, embodied by mutual holding as well as 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/self and the angry mother/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 forms the roots of being able to survive losses and mistakes, admitting failure, and accepting forgiveness. More simply, repeated many times, we learn to lose battles gracefully.

Complete or near complete failure to merge good and bad "internalized object relations" leads to borderline and narcissistic personality pathology. Children who are overindulged are actually deprived because they always win. Failing to learn the art of “losing battles gracefully, some develop extraordinary abilities to win over others but can't accept losses. They may resort to the illusion that they have won and learn to "change reality." Children who are punished or rejected and isolated for their willfulness are no better off. Threatened with emotional death, they, too, experience a need to win every battle. These two conditions, and perhaps inborn factors, 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 the victim 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 theory, is the “borderline” solution, to keep the “good mother-good me” relationship distinct and separate from the “angry me-angry mother” relationship, clinging to an earlier cognitive level or stage. Those who keep the two relationships 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.

Short of these global consequences, many people experience failure to have early needs met. A third solution awaits those who get through the two-year-old power struggles, but still experience a shortfall in areas of vital need. These may be less dramatic and obvious, but are more common and, in the course of a lifetime, nearly as debilitating. With a bit more successful development, the solution is to endure, while holding onto the hope that someday a grown-up will, at last, recognize the shortfall and address it. Therapists, being understanding and helpful, are likely to be chosen for this role. What stays hidden for some time in therapy is that the inner child is braced for the therapist's unwillingness to respond. That is where ongoing self-destructive patterns may intensify, or may appear for the first time, calling out for someone to do something!

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 as it once was. Adult temper tantrums can last for years. As indicated above, the signs are raging and destruction that are harmful or self-defeating 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, business failure, and other destructive behaviors. As indicated above, the signs can be subtle procrastination or delay in doing important positive tasks. Overt rage might be the kind that won’t be calmed or healed. It may be justified by focusing on anonymous “bad people” or remote villains. The rage may be denied, "No, I'm not angry,” or aimed at an impersonal target "I guess I'm just angry at the world." The rage may also be buried or turned against the self. Energy spent on raging is also self-defeating, in that it takes, but does not give.

A metaphor for the treatment for adult temper tantrums is allowing a raging sea to crash repeatedly over an enduring rock on the shore. Eventually, the storm runs its course and the sun comes out. This is more feasible for a therapist 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, being the object of a client's rage takes an emotional toll. And, of course, the overt kind of rage only appears when the client can identify a plausible justification, such as a real or imagined error on the part of the therapist. Some therapists do well in this role and others may struggle. One common and real error is when therapists feel a tug and make implied or real promises they can't actually fulfill or sustain. Raging clients may not forgive, once again, being betrayed.

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. Expressing anger is healthy but it can merge into hurtfulness for its own sake. In that case or if there are 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 enough harm has been done. At times, hospitalization may be needed to achieve containment. Police or other authorities, or even family can intervene, putting a stop to the destruction. It is useful to be aware that containment, while it seems helpful on an adult level, may feel to the inner child like an unsurvivable defeat. In the process, just as with the young child, a developmental acquisition is being forged. In practice, getting through this phase can be extraordinarily challenging. It is so because the problem being resolved is a major one, kept as unfinished business for decades.

The second (and simultaneous) element is to reestablish empathy and connection. The person having the tantrum must feel both in need 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 before it is 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 perfectly expresses this ending.

Is Every Adult Rage a Tantrum?

I think the answer is no. Anger is not always the result of unmet early needs. However, any rage, once it comes to the surface, can heal like other emotions. It heals by what Freud called catharsis and which we can recognize as memory reconsolidation (See TIFT #3) in which the antidote is a safe and accurately empathic relationship.

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 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 such subtle distinctions may be hard to discern. After all, this is going on in the non-conscious part of the mind and, with exploration, may only give off a sense of resonance to indicate what it might be about. I think the answer should depend on whether the concept of the tantrum proves 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 spontaneous thoughts, working 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 the unfolding of 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) the client understanding and feeling the emotion with an empathic witness.

Jeffery Smith MD