Other (7)The client has reported incidences of verbal abuse against a significant other.The client showed little or no remorse for causing emotional pain to others.The client projected blame onto others for aggressive encounters.The client continues to interact with others in a verbally abusive style.The client has shown progress in controlling verbal outbursts and abuse and appears to be treating others with respect.
10 Harsh Judgment Statements (8)The client exhibited frequent incidents of being harshly critical of others.The client's family members reported that the client reacts very quickly with angry, critical, and demeaning language toward them.The client reported that they have been more successful at controlling critical and intimidating statements made to or about others.The client reported that there have been no recent incidents of harsh, critical, and intimidating statements made to or about others.
11 Angry/Tense Body Language (9)The client presented with verbalizations of anger, as well as tense, rigid muscles and glaring facial expressions.The client expressed anger with bodily signs of muscle tension, clenched fists, and refusal to make eye contact.The client appeared more relaxed and less angry and did not exhibit physical signs of aggression.The client's family reported that they have been more relaxed within the home setting and have not shown glaring looks or pounded their fists on the table.
12 Passive-Aggressive Behavior (10)The client described a history of passive-aggressive behavior in which they would not comply with directions, would complain about authority figures behind their backs, and would not meet expected behavioral norms.The client's family confirmed a pattern of the client's passive-aggressive behavior in which the client would make promises of doing something but not follow through.The client acknowledged that they tend to express anger indirectly through social withdrawal or uncooperative behavior, rather than using assertiveness to express feelings directly.The client has reported an increase in assertively expressing thoughts and feelings and terminating passive-aggressive behavior patterns.
13 Violent Rages (11)The client described several incidents of suppressing angry feelings, then exploding in a violent rage.The client described several episodes of loss of control over angry feelings that they had previously guarded closely.The client reported gaining greater control over aggressive impulses, although verbal aggression is still present.The client reported successful control over aggressive impulses, with no recent incidents noted.The client identified situations in which assertively expressing feelings has helped to gain successful control over aggressive impulses.
14 Overreaction to Disapproval (12)The client described a history of reacting too angrily to situations in which they perceive disapproval, rejection, or criticism.The client indicated that they recognize that they become too angry in the face of perceived disapproval, rejection, or criticism.The client's perception of disapproval, rejection, or criticism has led to explosive, angry outbursts, destruction of property, and/or striking out at others.The client has made significant progress at increasing frustration tolerance and reducing explosive over-reactivity to perceived disapproval, rejection, or criticism.
15 Verbal Abuse as Intimidation (13)The client reported verbal threats of aggression toward others, name-calling, and other verbally abusive speech.The client showed little or no remorse for harming or intimidating others.The client projected blame onto others for verbal outbursts.The client continues to act in an aggressive, intimidating style.The client has shown progress in controlling aggressive patterns and seems to be trying to interact with more assertiveness than aggression.
16 Blaming Others (14)The client described several incidents during which they believe that others were to blame for their behaviors.The client identified a pattern of blaming others for their own problems.The client has begun to accept responsibility for their own behavior and problems.
17 Aggression to Achieve Power and Control (15)The client described an inclination to try to dominate social, family, and other situations by using aggressive means.The client has been alienated from others because of the client's dominating and controlling manner.The client has become more considerate of others’ opinions and feelings and has reduced the degree of aggression.The client has yielded control to others and has decreased the need to maintain power and control.
INTERVENTIONS IMPLEMENTED
1 Build Trust and Establish Rapport (1)*Caring was conveyed to the client through support, warmth, and empathy.The client was provided with nonjudgmental support, and a level of trust was developed.The client was urged to feel safe in expressing anger symptoms.The client began to express feelings more freely as rapport and trust level have increased.The client has continued to experience difficulty being open and direct about the expression of painful feelings; the client was encouraged to use the safe haven of therapy to express these difficult issues.
2 Focus on Strengthening Therapeutic Relationship (2)The relationship with the client was strengthened using empirically supported factors.The relationship with client was strengthened through the implementation of a collaborative approach, agreement on goals, demonstration of empathy, verbalization of positive regard, and collection of client feedback.The client reacted positively to the relationship-strengthening measures taken.The client verbalized feeling supported and understood during therapy sessions.Despite attempts to strengthen the therapeutic relationship, the client reports feeling distant and misunderstood.The client has indicated that sessions are not helpful and will be terminating therapy.
3 Assess Anger Dynamics (3)The client was assessed for various stimuli that have triggered anger.The client was assisted in identifying situations, people, and thoughts that have triggered anger.The client was assisted in identifying the thoughts, feelings, and actions that have characterized anger responses.
4 Administer Anger Expression Assessment Instruments (4)The client was administered psychological instruments designed to objectively assess anger traits.The client was assessed with the Anger, Irritability, and Assault Questionnaire (AIAQ).The Buss-Durkee Hostility Inventory (BDHI) was used to assess the client's anger expression.The State-Trait Anger Expression Inventory (STAXI) was used to assess the client's anger expression.Feedback was provided to the client regarding the results of the anger expression assessment.The client declined to complete the psychological instruments designed to objectively assess anger expression, and the focus of treatment was changed to this resistance.
5 Refer for Medical/Physical Examination (5)The client was referred for a complete medical/physical examination to rule out organic contributors (e.g., brain damage, tumor, elevated testosterone levels) to anger.The client has complied with the medical/physical examination and the results were shared with the client.The medical/physical examination has identified organic contributors to poor anger control and treatment was suggested.The medical/physical examiner has not identified any organic contributors to poor anger control, and this was reflected to the client.The client has not complied with the medical/physical examination to assess organic contributors and was redirected to do so.
6 Assess Level of Insight (6)The client's level of insight toward the presenting problems was assessed.The client was assessed in regard to the syntonic versus dystonic nature of their insight about the presenting problems.The client was noted to demonstrate good insight into the problematic nature of the behavior and symptoms.The client was noted to be in agreement with others’ concerns and is motivated to work on change.The client was noted to be ambivalent regarding the problems described and is reluctant to address the issues as a concern.The client was noted to be resistant regarding acknowledgment of the problem areas, is not concerned about them, and has no motivation to make changes.
7 Assess for Correlated Disorders (7)The client was assessed for evidence of research-based correlated disorders.The client was assessed in regard to the level of vulnerability to suicide.The client was identified as having a comorbid disorder, and treatment was adjusted to account for these concerns.The client has been assessed for any correlated disorders, but none were found.
8 Assess for Culturally Based Confounding Issues (8)The client was assessed for age-related issues that could help to better understand their clinical presentation.The client was assessed for gender-related issues that could help to better understand their clinical presentation.The client was assessed for cultural syndromes, cultural idioms