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The Coalition of Behavioral Health Agencies, Inc. Coalition Briefs
An electronic newsletter of the Coalition's Center for Rehabilitation and Recovery

Elizabeth Saenger, PhD, Editor
No. 105, July 2014

The Center for Rehabilitation and Recovery provides assistance to the New York City mental health provider community through expert trainings, focused technical assistance, evaluation, information dissemination and special projects.

Don’t Get Angry, Get Even!

Elizabeth Saenger, PhD

If you want to live a long and happy life—or even just a long life—don’t get angry. Get even, get alternatives, get empowered—but get rid of your anger.

A meta-analysis published this year finds that temper tantrums are associated with increased odds for a stroke, heart attack, or other cardiovascular problem within two hours after your outburst. Although the absolute risk is small, it is significant, and amounts to a nearly four-fold risk of stroke, and nearly five-fold increase in heart attacks or acute coronary syndrome.

On a personal level, this suggests that cardiovascular health is linked not only to depression, an idea which has been in the literature for a long time, but to anger as well. If the usual suspects for anger management, such as yoga, meditation, massage, or your favorite comfort food, do not pacify you when your supervisor demands you miss a party to work overtime, why not try a new way to bear the slings and arrows of outrageous fortune?

Get empowered!

I once had a psychotherapy client whose insurance company was paying erratically for services. The company typically ignored the statements I sent, and when I called for payment, I invariably ended up waiting on hold. Once, when I managed to get through, the clerk told me she knew the company had someone with my client’s name who had a thick file, but she didn’t know where that file was. Another time, a clerk told me she knew the company had received my latest bill, but she couldn’t find it.

Clearly, it was time for a new tack. I typed up a statement, and under the charges, I added that there would be a $500 late fee if payment were not received in two weeks. There would be a second $500 late fee if I had not received payment within a month. Finally, I gave the company a third deadline, after which I would report it to the state Commissioner of Insurance. Then I mailed the statement by certified mail, return receipt requested.

After about a month, I received full payment for my sessions, and a check for $1,000. I was almost sorry this company reformed, and never gave me another occasion to send it a certified letter.

Follow up

Where can you go from here? How can you build on this $1,000 experience? How can you use your anger constructively, and perhaps reduce your cardiovascular risk in other situations? As with many situations, the answers begin with repeating effective actions, generalizing from them, and adding new techniques to your repertoire.

Repeat. This company learned its lesson—and so did I. Before winding up my practice, I sent out a few more certified letters to insurance companies.

Generalize from it. I also sent certified letters for other reasons, for example, when a hospital violated patient confidentiality wholesale because it had foolishly tried to save money on its computer system.

Certified letters constitute a paper trail. For that reason, write them as if they will be read by the hospital’s risk management department, small claims court, or whomever will ultimately receive your correspondence if you take your complaint to another level.

Add to your repertoire of techniques. Supplement certified letters with four principles from the Harvard Negotiation Project, described below.

The best revenge really is living well, and living long.


Use Four Principles from the Harvard Negotiation Project to Improve Your Life

Elizabeth Saenger, PhD

Some concepts, such as gravity, appear so self-evident, I narcissistically believe I could have dreamed them up myself. The four principles from the Harvard Negotiation Project are like that. They are so simple you may think you could have come up with them yourself.

At the same time, it is easy to overlook the many ways these principles can improve situations, and relationships, if you only apply them. Consequently, you may want to overlearn them so that you can access them even if you are stressed or angry. In preparing for serious negotiations about possible malpractice, a future raise, a premature request for discharge, and so on, you might want to go through the list of principles, and brainstorm about how each one might apply to your current quandary.

Separate the people from the problem. It is easier to have a productive, working relationship with clients, supervisors, board members, managed care officials, and others if you separate the people from the problem. For example, you may find the new protocol for intakes cumbersome, and resent your supervisor for increasing paperwork. However, it is more useful to realize that, like you, he may be trying to improve service for clients. He may just be responding to a different set of constraints, from new regulations to the needs of other stakeholders.

Focus on interests, not positions. If you identify, and focus on, the interests underlying someone’s position, it is easier to find a mutually satisfactory solution because positions are usually broader than interests. For example, an inpatient might demand discharge (a position) because he wants to relieve his boredom (an underlying interest). By uncovering why he wants to leave the hospital, it is possible to explore a variety of alternative options, from a special activity to a day pass, that might work.

Invent options for mutual gain. Brainstorm to figure out how to maximize the benefits all parties derive from an agreement. For example, remember in hiring negotiations that some elements of a compensation package may be worth more to one employee (or employer) than another. Flexible hours, job titles, extramural supervision, training opportunities, and other variables can be adjusted to maximize what parties gain.

 Insist on using objective criteria. If you are buying a building for a new facility, consider what buildings similar in size, condition, location, and so on cost. Ditto for other circumstances in which measurements and professional evaluations are possible.

For more information, see Getting to Yes: How to Negotiate Agreement Without Giving In, and other books from researchers at the Harvard Negotiation Project.


The opinions expressed in RECOVERe-works do not necessarily reflect the views of the editor or the Coalition of Behavioral Health Agencies.

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