The Psychotherapy of Rage:—Clinical and Developmental Perspectives1

RAGE IS A COMMON CLINICAL PROBLEM for which there has been little agreement on an effective therapeutic approach. Perhaps no issues in psychotherapy have divided different schools and different therapists so deeply and so consistently as have their approaches to anger and aggression in psychotherapy and their clinical prescriptions for the treatment of rage. Some therapists see the experience of rage as inherently harmful to the growth of the patient and to the goals of psychotherapy and would treat it as a problem to be met at all times with vigorous confrontation and vigilant limit-setting. Others describe the expression of rage in psychotherapy as intrinsically curative and a therapeutic goal in itself, the "primal scream" therapy of Janov (1970) being the extreme example. Even among psychoanalytic writers there have been profound differences of approach to the treatment of rage. Although many of these differences are rooted in fundamentally divergent concepts of psychopathology and may be irreconcilable, the function and sources of rage in personal development, its meaning in the therapeutic context, and the problems of a therapeutic response to rage have seldom been jointly and systematically considered. To clarify our therapeutic options the integration of developmental and clinical perspectives is essential. In this paper I will address this task in a preliminary way.

I will offer a critical review of some contemporary psychoanalytic theories of the developmental role of rage and aggression in psychopathology, in particular those of Kernberg, Kohut, and Winnicott, as well as some recent work of Modell, Epstein, Maltsberger,