Professional Documents
Culture Documents
In the United States, approximately 9 million people are released from jail each year
(NRRC Facts & Trends, 2017). By the end of 2015, approximately 4.7 million people were on
probation or parole (Probation and Parole in the United States, 2015). If an individual has served
a prison sentence for a violent crime and is now under community supervision, there is a high
probability that they have been mandated to attend an "anger management" (AM) course as a
condition of their parole. However, while AM is widely accepted as one of the most commonly-
used interventions among offenders, its effectiveness is debatable. Among the studies that have
applied AM programs to offender populations, there is little evidence to validate claims that AM
courses reduce recidivism and reconviction, particularly among "violent" offenders. In their
and Saini (2005) found no consensus in regard to the most effective AM treatment method.
If we can't agree on best practice or substantiate its implementation, this begs the
question: why do we still mandate it? While this paper does not argue that AM programs are
futile efforts, it does stress the need for further research, empirical evidence of effectiveness and
the establishment of research-based guidelines. Very few studies have examined its
effectiveness and those that do often evaluate outcomes such as program retention and self-
reported success rates rather than levels of anger or recidivism of violent offenses. Further,
studies that employ more meaningful measures report inconsistent results and point out the
minimal effect that a very short-term, educational program can have on ambivalent, mandated
clients.
of anger include an increased risk of heart attack or stroke, weakened immune system, high
blood pressure, anxiety, depression, and even decreased life expectancy (Department of Health
& Human Services, 2014). Our current approach presents several issues, including 1) the limited
capacity of a treatment that is court-mandated, 2) the high complexity of programs that are very
than practicing skill implementation. This paper will explore the impact of these factors on the
effectiveness of “anger management” treatment as we know it, and potential interventions that
“Anger”
According to Howells (2005), incarcerated individuals present anger scores higher than
those of the general population, which has been linked to prison adjustment issues, disciplinary
issues, assault, and violence. To confound the issue, Zamble and Porporino (1990) found that
anger tends to increase in relation to time spent in prison- in other words, anger levels and time
Saini (2009) claims that there is no agreed-upon definition of anger, a term that is often
and mistakenly used synonymously with aggression and violence. Mandated AM operates under
the assumption that anger is causally related to violence and that by managing anger, we can
manage violence. However, not all acts of aggression are anger-based, and anger certainly does
not always manifest itself as aggression. Violence is a learned coping strategy that often serves a
purpose for incarcerated individuals who are devoid of almost all control and constantly under
physical threat. AM further implies that someone who has committed a violent offense years ago
is going to violently re-offend, not taking situational influences or brain development into
consideration.
Treatment as a mandate
In order to successfully complete parole, the vast majority of people under parole
supervision are ordered to complete a set of mandates. This list may include substance abuse
treatment, mental health treatment, and domestic violence prevention courses. AM treatment is
yet another mandate applied to the overwhelming expectation that people under parole
supervision will obtain meaningful employment, abide by a curfew, find and maintain stable
housing and provide family support. This extensive list of obligations only increases the
likelihood that an individual will violate parole stipulations and consequently return to prison.
Half of all people under parole supervision are sent back to prison for a violation, 60% of whom
are violating terms of parole rather than criminally re-offending (Feldman, 2016). This constant
churn of prisoners has disproportionately affected people of color, devastating and destabilizing
the communities where many of the arrests are concentrated. Take Harlem, for instance:
according to the Justice Mapping Center, a one-mile area of East Harlem has "the highest
concentration of formerly incarcerate males in New York City" (one in twenty men) (Justice
Atlas of Sentencing and Corrections, 2017). Additionally, 75% of inmates in New York State
prisons come from seven neighborhoods in New York City, one of them being East Harlem (Our
Communities). Creating more and more stipulations for people under parole supervision only
The therapeutic effectiveness and ethics of court-mandated treatment often come into
question. In a study conducted by Sanderfer and Johnson (2015), 74.1% of participants agreed
that the use of legal force or coercion to enter treatment is not ethical, and 73.3% indicated that
court-mandated AM is a form of punishment. Level of motivation and readiness for treatment is
found to be a strong predictor of improvement in Howells et. al's (2005) study, but a mandate to
attend treatment is often met with resistance, jeopardizing client growth and retainment of
learned skills. Renwick et. al (1997) note that this frequent motivational issue is fueled by
Notably, AM programs have greatly benefited from the use of treatment as a mandate.
Anger management fits under the umbrella of “group therapy”, and is therefore paid for by
multiple foundations and local governments delegate funding to programs that provide AM. This
calls into question the true motivation behind AM mandates; treatment programs stand to
financially benefit from providing to more clients, without being held accountable for providing
support for its effectiveness. For instance, In New York City, about 3,000 people a year are sent
to a one-day, $95 AM class run by a private, nonprofit agency, Education and Assistance
Corporation (Lewin, 2001). This ineffective, blanket mandate simply perpetuates the ongoing
cycle of parole and re-incarceration. Moreover, the funding that is funneled into the AM
industry and the clinicians involved in the programs are resources that could be directed towards
strong therapeutic alliance between the client and the practitioner and by placing less importance
improved in anger knowledge scores compared to those not receiving treatment, these
individuals did not demonstrate a statistically significant change in state anger, anger control or
anger expression. Further, the difference in anger knowledge between the controls and the
treated group was marginal. It appears that knowledge attainment does not necessarily translate
to behavioral change.
Heseltine et. al (2010) found congruent results. In their study of 51 individuals on parole
participating in 20 hours of AM, the only statistically significant result was an increase in
Absence of guidelines
Despite some evidence for treatment effectiveness in studies of AM, a glaring concern
among the literature is the huge variation in results and inconsistency in treatment delivery.
Interventions widely range in treatment length (from 20 hours to 330 hours), length and content
of clinician training and outcome measurement tools, and there is virtually no framework for
delivery or quality standards. In a New York Times article on the AM industry, the director of
the International Community Corrections Association is quoted: ''there are probably a hundred
curricula out there... what usually happens is the county probation department gets Beth, the
social worker down the road, to put together something for 10 guys on Tuesday nights, and her
friend takes another 10 on Thursdays'' (Lewin, 2001). Not only does this malpractice
compromise program integrity, but it this impedes researchers’ ability to make a direct
comparison of results. DiGiuseppe and Tafrate (2003) note that among the studies included in
their large analysis, “higher effect sizes on measures of aggression were significantly predicted
by the use of a treatment manual and an integrity check significantly predicted higher effect sizes
manuals.” The absence of a treatment manual leaves it to the discretion of the program to decide
the length of treatment, causing an enormous variation, from treatments that are as few as 8
hours total to treatments adding up to 330 hours. The researchers claim that the implementation
Implications
First, all critics point to the need for an accepted definition of anger and guidelines to direct
treatment. The use of manuals and fidelity checks would ensure consistency and maintain
standards.
Treatment length
Anger management programs can range from 8 to 330 hours (Henwood et. al, 2015), but
more often fall in the shorter, less intensive range. Howells et. al (2005) recommend that if AM
treatment is to occur, mental health professionals should conduct at least eight sessions of
treatment. Poor follow-up outcomes in several studies imply a need for lengthier, more intensive
treatment that allows participants the opportunity to apply their newly-learned skills. Heseltine
et. al (2010) argue that “it is expecting too much of a program of this brevity to expect it to
produce a change in actual experience or behavior in prisoners, who typically have long-term
and multiple psychological difficulties". The authors suggest that the disparities in length-of-
Individualized approach
Current AM programs have been further criticized for their “one-size-fits-all” approach.
Each act of anger-related violence involves a unique set of preceding events, complex
relationships, personal histories of trauma exposure and coping skills. DiGiuseppe and Tafrate
(2003) classify three different subtypes of anger that require improved “symptom-and-treatment
modality matching”. For instance, for individuals that primarily experience anger as a physical
sensation, relaxation techniques may be more impactful, while individuals who experience anger
largely as emotional distress may benefit from cognitive restructuring. Individuals who have
been referred to AM as a result of a domestic violence offense may be better suited for classes on
creating and maintaining healthy relationships. One amorphous “anger management treatment”
that is completely lacking programmatic research and validity should not be the agreed-upon
Given the many possible catalysts for violence and the lack of evidence to demonstrate a
relationship between anger and violence, the treatment of anger is not always appropriate for
violent offenders. Violence is often elicited for reasons unrelated to anger, for example, to
secure money, being under the influence of drugs or alcohol, exercising self-defense, appealing
to gang authority, or supporting a friend. Mandating clients to AM for the sole reason that their
crime was violent, despite being non-anger-related, is a recipe for resentful, ambivalent clients
who will likely perceive treatment as punishment. Further, convictions do not always accurately
reflect the behavior and it is common for convicted individuals to take a plea bargain despite
their innocence to reduce charges, avoid costs of going to trial, get out of custody, etc.
Alternatives
There is no shortage of studies that find absolute efficacy of AM treatments, meaning that
studies that illustrate relative efficacy- efficacy of AM in relation to other interventions. One
such intervention alternative is music therapy. A program conducted in the Netherlands applied
AM to forensic patients in a music therapy context under the reasoning that music is easily
accessible to most people. Music also has the ability to evoke strong emotions and cause critical
memories to surface. Haakvort (2002) claims that "music therapy helps patients to musically 1)
become aware of the causes of their anger, 2) discern the first symptoms of anger and 3) acquire
In this intervention, patients first practice recognizing physical symptoms of anger while
listening to or creating music. This prompts the individual to identify anger triggers and
experience anger in a safe, therapeutic setting, and then use music as a tool to cope with anger as
it emerges. The therapist will intentionally provoke a patient by playing anger-inducing music or
by imposing on their piano keyboard space. This set-up allows the client to experience anger or
frustration in real-time with the therapist, and employ music to communicate that feeling while
learning to tolerate it (Haakvort, 2002). A more recent exploratory study conducted by Haakvort
et. al (2013) randomly assigned “forensic patients” to TAU or an AM music therapy. Results
indicated that music therapy participants had a greater improvement in positive coping skills,
While this variation of treatment for AM requires further research with greater sample
sizes, the behavioral outcomes are encouraging and this intervention can be easily applied in
forensic settings.
Conclusion
Anger is a pertinent social issue and at a clinical level, can have serious mental and
physical health consequences and subsequent health care costs. However, it is unacceptable for
our system to require anger management program participation under the assumption that all
“violent offenders” suffers from an anger “disorder”, and further, that no standards exist for these
mandated programs. As AM curriculum creator, Dr. Barry Glick, states in an interview, ''The
problem is that we're usually looking for a quick fix...if it took years to get a person where he is
now, you can't expect to change it in six hours of class” (Lewin, 2001). In a country that is
“home” to the world’s largest prison population, the anger management industry should be
working towards reducing the prison number rather than contributing to its growth.
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