Posted on Tue, Dec. 07, 2004

Tempering tempers

There's no shortage of anger these days, and of classes and consultants to help tame it. What's lacking is evidence that they work.

By Jeff Gammage
Inquirer Staff Writer

Before Indiana Pacers forward Ron Artest went crashing into the stands, touching off an ugly chair-tossing brawl and a vociferous national debate, he spent time in a program designed to prevent just such an eruption:

Anger management.

Today, a few short years after it simmered to prominence, anger-management training has become widely accepted and zealously applied, embraced by Fortune 500 companies selling anything from produce to propane and federal-government agencies supervising anyone from probationers to postal workers.

It's a favorite tool for judges who want to avoid packing more people into overcrowded prisons, for corporate bosses who want their executives to please stop shouting, and for sports directors from pee-wee to pro who wish their grown-up players, fans and coaches would behave like, well, grown-ups.

But the enormous popularity of anger-management training raises a single pressing question:

Does it work?

The drop-out rate is high. Proponents concede no 12-week program can cure a lifetime of anger issues. And in many high-profile cases, the bruising answer is plainly no.

It didn't help Artest, who underwent court-ordered treatment in 2002 after a fight with a former girlfriend.

Colorado teenagers Eric Harris and Dylan Klebold attended anger-management sessions before they killed 12 students, a teacher and themselves at Columbine High School in 1999.

And prickly British supermodel Naomi Campbell had training after she used a cell phone to pummel an assistant, then later threw a fit when she was made to wait outside an exclusive London boutique.

"Anger management does work," insists Chicago anger-management guru Leonard Ingram, who has trained teachers, police officers and prison workers. "But like anything else, it takes practice."

In that case, there's plenty of opportunity.

Today, anger management isn't just a movie. (The film of that name stars Jack Nicholson, who once used a golf club to refashion the hood of another driver's car.) It's a multi-million-dollar industry, fueled by sales of audio tapes, videos, board games and CDs, and served by a host of entrepreneurs and experts eager to share the secrets of self-control.

On Ingram's Web site, www.angermgmt.com, people can buy tapes such as Managing Anger in Relationships - $12.95 for a two-cassette set or $59.95 for the complete program. Those too agitated to wait for the mail can dial up over-the-phone counseling at $45 an hour. In bookstores, the shelves bear titles such as Anger Management in a Week, and, for kids, Don't Rant and Rave on Wednesdays!

Yet, despite the amount of money changing hands and the number of people seeking help, the field is largely unregulated. Programs differ in duration, scope and curriculum.

In most places, practically anyone can call himself or herself an "anger-management counselor," and while some hold doctorates in psychology or even medical degrees, others have never been to college. Even skilled practitioners can have divergent ideas on how to help.

And there's little formal research on whether their efforts do any long-term good. Studies have tended to focus on narrow questions within specific populations.

For instance, a 1999 study by Canadian prison authorities found that anger counseling dramatically reduced the chance that inmates would commit violent crimes upon their release. In 2001, research by California psychiatrist Patrick Reilly suggested the training could help cocaine addicts stay clean - important because anger can trigger use of the drug.

Whether anger-management training will help somebody who defecates in the aisle of an airliner, tosses a stranger's dog into traffic, or beats another parent to death at a youth hockey game - true incidents all - depends on a thousand factors. Including the makeup of the perpetrator.

"I had hit my wife," is how Terry begins. "I had hit her and pushed her down before, but this is when she finally went to the police."

Terry - who agreed to be interviewed if he was not precisely identified - said the blow he struck in 2001 led him to Menergy, a Philadelphia counseling program. And that changed his life.

"One of the things I've learned in Menergy is you have to respect people," the Montgomery County banker says. "At no time do I have the right to put my hands on anybody or hit them, even though they say things that are rude or whatever."

Terry, who is in his mid-40s, says he hasn't struck his wife again. But he didn't simply complete the course and return to his old life. Three years later, he continues to attend weekly sessions. He says it's like having a drinking problem. Maybe once you're sober you don't need to keep going to Alcoholics Anonymous meetings. But maybe you better not take the chance.

The anecdotal evidence, say front-line counselors and legal officials, is training works best - perhaps solely - for people who sincerely want to change their behavior.

Says Superior Court Judge Seamus McCaffrey, who as "Eagles Court" judge saw plenty of bad conduct: "I'm not so sure anger management would really be helpful to people who see themselves as being above the law."

And that category includes too many professional athletes and entertainers.

The celebrities who have been ordered into anger-management classes make up a lengthy roster of the rich and fractious: Sean "P. Diddy" Combs, Courtney Love, Tommy Lee, Shannen Doherty, Kareem Abdul-Jabbar, John Rocker, Tonya Harding, and Bobby Knight.

The dust-ups of the stars make headlines. But how many everyday people slip quietly into anger-management training? Hard figures are difficult to come by. But in Philadelphia alone, the number is probably in the 10,000s.

Philadelphia Community Court, which handles quality-of-life offenses such as vandalism, estimates that 3,342 defendants have been sent to anger-management or behavioral programs since 2002. The Menergy counseling center alone sees more than 2,000 court-referred clients a year.

And those cases represent a fraction of the 70,000 criminal prosecutions and 15,000 protection-from-abuse orders that are processed each year - which routinely generate referrals.

Part of the problem in judging the effectiveness of anger management is the term has become a catch-all, used to encompass a variety of programs and techniques.

"When I hear 'anger management,' I don't know what that means," says psychologist Frank Gardner, director of the Center for the Treatment and Study of Anger and Violence at La Salle University. "In some instances it's treatment, in some cases it's classes."

If experts can't agree on a definition, they surely can't agree on a remedy.

Gardner, an experienced sports psychologist who heads the university's doctoral program in clinical psychology, says classroom sessions are a waste of time. Would you send someone suffering from depression to "depression management" and expect the person to get better?

But listen to George Anderson, a Los Angeles consultant whose firm has contracts with court systems, colleges and hospitals across the country.

"It should be a class," he says. "Anger is not a medical or psychiatric or nervous disorder. You don't want to offer a medical or psychiatric intervention."

Faced with that sort of dichotomy, a lot of judges opt to send hot-headed defendants to programs with good reputations, and hope for the best.

Many courses teach self-awareness, believing a key to holding your temper is realizing you're about to lose it. They may draw on techniques of meditation, deep breathing, and cognitive-behavior therapy.

"I've seen it be very, very helpful," says Joel Fish, director of the Center for Sports Psychology in Philadelphia. "On the other hand, if there are difficulties in the stability of the personality, you can go to the class and not really get anything out of it."

Just ask Paul Bukovec, the founder and director of Menergy. Every week, he sees about 65 men and half a dozen women, three quarters of whom have been physically abusive.

Their biggest problem? A belief that they possess an inalienable right to retaliate. Surrendering that conviction, Bukovec says, can take longer than the standard 13 weeks. He prefers they sign on for a second 20-week term.

After that, can they control their anger?

"They can," Bukovec says. "But do they want to? Some guys don't want to."

Contact Inquirer staff writer Jeff Gammage at 215-854-2810 or jgammage@phillynews.com.