Adapted from the Adult Psychotherapy Treatment Planner
Wiley Publishing
Client agrees to work cooperatively with the therapist to identify and catalog the situations, thoughts, emotional experiences, and body sensations associated with their anger, angry verbal and/or behavioral actions, and the targets of those actions.
- Clinician will develop a level of trust with the client
- Clinician will provide unconditional positive regard, support, empathy and compassion, and encourage the client to feel safe in expressing their angry emotions.
- Clinician will ask client to share what impact the anger expression has had on different areas of their life as the interview focuses on the impact anger has had on the client’s life.
- As the client describes their history and nature of anger issues in client’s own words, clinician will thoroughly assess the various stimuli (situations, people, thoughts) that have triggered the client’s anger and the thoughts, emotions, physical sensations, and actions that have characterized their anger responses.
Client agrees to consider completing outcome measures, psychological assessment testing or objective questionnaires for assessing their anger expression.
- Clinician will administer to the client: psychometric instruments designed to objectively assess anger expression (Anger, Irritability, and Assault Questionnaire; Buss-Durkee Hostility Inventory; State-Trait Anger Expression Inventory)
- Provide the client feedback regarding the results of the assessment; re-administer as indicated to assess treatment response.
Cooperate with a medical evaluation to assess possible medical conditions contributing to anger control problems.
- Refer the client to a physician for a complete medical evaluation to rule out medical conditions or substances possibly causing or contributing to the anger control problems (e.g., brain damage, tumor, elevated testosterone levels, stimulant use).
Provide behavioral, emotional, and attitudinal information toward an assessment of specifiers relevant to a DSM diagnosis, the efficacy of treatment, and the nature of the therapy relationship.
- Assess the client’s level of insight (syntonic versus dystonic) toward the “presenting problems” (e.g., demonstrates good insight into the problematic nature of the “described behavior,” agrees with others’ concern, and is motivated to work on change; demonstrates ambivalence regarding the “problem described” and is reluctant to address the issue as a concern; or demonstrates resistance regarding acknowledgment of the “problem described,” is not concerned, and has no motivation to change).
- Assess the client for evidence of research-based correlated disorders (e.g., oppositional defiant behavior with ADHD, depression secondary to an anxiety disorder) including vulnerability to suicide, if appropriate (e.g., increased suicide risk when comorbid depression is evident).
- Assess for any issues of age, gender, or culture that could help explain the client’s currently defined “problem behavior” and factors that could offer a better understanding of the client’s behavior.
- Assess for the severity of the level of impairment to the client’s functioning to determine appropriate level of care (e.g., the behavior noted creates mild, moderate, severe, or very severe impairment in social, relational, vocational, or occupational endeavors); continuously assess this severity of impairment as well as the efficacy of treatment (e.g., the client no longer demonstrates severe impairment but the presenting problem now is causing mild or moderate impairment).
Cooperate with a medication evaluation for possible treatment with psychotropic medications to assist in anger control; take medications consistently, if prescribed.
- Assess the client for the need and willingness to take psychotropic medication to assist in control of anger; refer him/her to a physician for an evaluation and prescription of medication, if needed.
- Monitor the client for prescription compliance, effectiveness, and side effects; provide feedback to the prescribing physician.
Keep a daily journal of persons, situations, and other triggers of anger; record thoughts, feelings, and actions taken.
- Ask the client to self-monitor, keeping a daily journal in which he/she documents persons, situations, thoughts, feelings, and actions associated with moments of anger, irritation, or disappointment (or assign “Anger Journal” in the Adult Psychotherapy Homework Planner by Jongsma); routinely process the journal toward helping the client understand his/her contributions to generating his/her anger.
- Assist the client in generating a list of anger triggers; process the list toward helping the client understand the causes and expressions of his/her anger.
Verbalize increased awareness of anger expression patterns, their causes, and their consequences.
- Assist the client in re-conceptualizing anger as involving different dimensions (cognitive, physiological, affective, and behavioral) that interact predictably (e.g., demanding expectations not being met leading to increased arousal and anger leading to acting out) and that can be understood, challenged, and changed.
- Process the client’s list of anger triggers and other relevant journal information toward helping the client understand how cognitive, physiological, and affective factors interplay to produce anger.
- Ask the client to list and discuss ways anger has negatively impacted his/her daily life (e.g., hurting others or self, legal conflicts, loss of respect from self and others, destruction of property); process this list.
- Assist the client in identifying the positive consequences of managing anger (e.g., respect from others and self, cooperation from others, improved physical health, etc.) (or assign “Alternatives to Destructive Anger” in the Adult Psychotherapy Homework Planner by Jongsma).
Explore motivation and willingness to participate in therapy, and agree to participate to learn new ways to think about and manage anger.
- Use motivational interviewing techniques to help the client clarify his/her motivational stage, moving the client to the action stage in which he/she agrees to learn new ways to conceptualize and manage anger.
Verbalize an understanding of how the treatment is designed to decrease anger and improve the quality of life.
- Discuss the rationale for treatment, emphasizing how functioning can be improved through change in the various dimensions of anger; revisit relevant themes throughout therapy to help the client consolidate his/her understanding.
Read a book or treatment manual that supplements the therapy by improving understanding of anger and anger control problems.
- Assign the client reading material that educates him/her about anger and its management (e.g., Overcoming Situational and General Anger: Client Manual by Deffenbacher and McKay; Of Course You’re Angry by Rosselini and Worden; The Anger Control Workbook by McKay and Rogers; Anger Management for Everyone by Kassinove and Tafrate); process and revisit relevant themes throughout therapy to help the client consolidate his/her understanding of the treatment.
Learn and implement calming and coping strategies as part of an overall approach to managing anger.
- Teach the client calming techniques (e.g., progressive muscle relaxation, breathing induced relaxation, calming imagery, cue-controlled relaxation, applied relaxation, mindful breathing) as part of a tailored strategy for reducing chronic and acute physiological tension that accompanies the escalation of his/her angry feelings.
Identify, challenge, and replace anger-inducing self-talk with self-talk that facilitates a less angry reaction.
- Explore the client’s self-talk that mediates his/her angry feelings and actions (e.g., demanding expectations reflected in should, must, or have-to statements); identify and challenge biases, assisting him/her in generating appraisals and self-talk that corrects for the biases and facilitates a more flexible and temperate response to frustration. Combine new self-talk with calming skills as part of a set of coping skills to manage anger.
- Assign the client a homework exercise in which he/she identifies angry self-talk and generates alternatives that help moderate angry reactions; review; reinforce success, providing corrective feedback toward improvement.
- Role-play the use of relaxation and cognitive coping to visualized anger-provoking scenes, moving from low- to high-anger scenes. Assign the implementation of calming techniques in his/her daily life and when facing anger-triggering situations; process the results, reinforcing success and problem-solving obstacles.
Learn and implement thought-stopping to manage intrusive unwanted thoughts that trigger anger.
- Assign the client to implement a “thought-stopping” technique in which he/she shouts STOP to himself/herself in his/her mind and then replaces the thought with an alternative that is calming (or assign “Making Use of the Thought-Stopping Technique” in the Adult Psychotherapy Homework Planner by Jongsma); review implantation, reinforcing success and providing corrective feedback for failure.
Verbalize an understanding of assertive communication and how it can be used to express thoughts and feelings of anger in a controlled, respectful way.
- Use instruction, modeling, and/or role-playing to teach the client the distinctive elements as well as the pros and cons of assertive, unassertive (passive), and aggressive communication.
Learn and implement problem-solving and/or conflict resolution skills to manage interpersonal problems.
- Teach the client problem-solving skills (e.g., defining the problem clearly, brainstorming multiple solutions, listing the pros and cons of each solution, seeking input from others, selecting and implementing a plan of action, evaluating the outcome, and readjusting the plan as necessary)
- Teach the client conflict resolution skills (e.g., empathy, active listening, “I messages,” respectful communication, assertiveness without aggression, compromise); use modeling, role-playing, and behavior rehearsal to work through several current conflicts.
- Conduct conjoint sessions to help the client implement assertion, problem-solving, and/or conflict resolution skills in the presence of his/her significant other.
Practice using new anger management skills in session with the therapist and during homework exercises.
- Assist the client in constructing a client-tailored strategy for managing anger that combines any of the somatic, cognitive, communication, problem-solving, and/or conflict resolution skills relevant to his/her needs.
- Select situations in which the client will be increasingly challenged to apply his/her new strategies for managing anger.
- Use any of several techniques, including relaxation, imagery, behavioral rehearsal, modeling, role-playing, or in vivo exposure/behavioral experiments to help the client consolidate the use of his/her new anger management skills.
Decrease the number, intensity, and duration of angry outbursts, while increasing the use of new skills for managing anger.
- Monitor the client’s reports of angry outbursts toward the goal of decreasing their frequency, intensity, and duration through the client’s use of new anger management skills (or assign “Alternatives to Destructive Anger” in the Adult Psychotherapy Homework Planner by Jongsma); review progress, reinforcing success and providing corrective feedback toward improvement.
Verbalize an understanding of relapse prevention and the difference between a lapse and relapse.
- Provide a rationale for relapse prevention that discusses the risk and introduces strategies for preventing it.
- Discuss with the client the distinction between a lapse and relapse, associating a lapse with an initial and reversible angry outburst and relapse with the choice to return routinely to the old pattern of anger.
Identify potential situations that could trigger a lapse and implement strategies to manage these situations.
- Identify and rehearse with the client the management of future situations or circumstances in which lapses back to anger could occur.
- Instruct the client to routinely use the new anger management strategies learned in therapy (e.g., calming, adaptive self-talk, assertion, and/or conflict resolution) to respond to frustrations.
- Develop a “coping card” or other reminder on which new anger management skills and other important information (e.g., calm yourself, be flexible in your expectations of others, voice your opinion calmly, respect others’ point of view) are recorded for the client’s later use.
- Schedule periodic “maintenance” sessions to help the client maintain therapeutic gains.
Identify the advantages and disadvantages of holding on to anger and of forgiveness; discuss with therapist.
- Discuss with the client forgiveness of the perpetrators of pain as a process of letting go of his/her anger.
- Assign the client to read Forgive and Forget by Smedes; process the content as to how it applies to the client’s own life.
Write a letter of forgiveness to the perpetrator of past or present pain and process this letter with the therapist.
- Ask the client to write a forgiving letter to the target of anger as a step toward letting go of anger; process this letter in session.
Participate in Acceptance and Commitment Therapy (ACT) for learning a new approach to anger and anger management.
- Use an ACT approach to help the client experience and accept the presence of worrisome thoughts and images without being overly impacted by them, and committing his/her time and efforts to activities that are consistent with identified, personally meaningful values (see Acceptance and Commitment Therapy by Hayes, Strosahl, and Wilson).
- Teach mindfulness meditation to help the client recognize the negative thought processes associated with PTSD and change his/her relationship with these thoughts by accepting thoughts, images, and impulses that are reality-based while noticing but not reacting to non-reality-based mental phenomena (see Guided Mindfulness Meditation [Audio CD] by Zabat-Zinn).
- Assign the client homework in which he/she practices lessons from mindfulness meditation and ACT in order to consolidate the approach into everyday life.
- Assign the client reading consistent with the mindfulness and ACT approach to supplement work done in session (see Get Out of Your Mind and Into Your Life: The New Acceptance and Commitment Therapy by Hayes).
Gain insight into the origins of anger control problems by discussing past relationships with significant others.
- Assist the client in identifying past relationship conflicts (e.g., with father, mother, others) that may have influenced the development of current anger control problems; discuss how these experiences have positively or negatively influenced the way he/she handles anger.
Identify social supports that will help facilitate the implementation of anger management skills.
- Encourage the client to discuss his/her anger management goals with trusted persons who are likely to support his/her change.