causes that could help to better understand their clinical presentation.Alternative factors have been identified as contributing to the client's currently defined “problem behavior” and these were taken into account in regard to treatment.Culturally based factors that could help to account for the client's currently defined “problem behavior” were investigated, but no significant factors were identified.
9 Assess Severity of Impairment (9)The severity of the client's impairment was assessed to determine the appropriate level of care.The client was assessed in regard to impairment in social, relational, vocational, and occupational endeavors.It was reflected to the client that their impairment appears to create mild to moderate effects on the client's functioning.It was reflected to the client that their impairment appears to create severe to very severe effects on the client's functioning.The client was continuously assessed for the severity of impairment, as well as the efficacy and appropriateness of treatment.
10 Identify Positive Consequences of Anger Management (10)The client was asked to identify the positive consequences they have experienced in managing anger.The client was assigned the homework exercise “Alternatives to Destructive Anger” from the Adult Psychotherapy Homework Planner (Jongsma & Bruce).The client was assisted in identifying positive consequences of managing anger (e.g., respect from others and self, cooperation from others, improved physical health).The client was asked to agree to learn new ways to conceptualize and manage anger.
11 List Negative Anger Impact (11)The client was assisted in listing ways that explosive expression of anger has negatively affected their life.The client was supported while identifying many negative consequences that have resulted from poor anger management.It was reflected to the client that denial about the negative impact of anger has decreased, and the client has verbalized an increased awareness of the negative impact of their behavior.The client has been guarded about identifying the negative impact of anger and was provided with specific examples of how their anger has negatively affected their life and relationships (e.g., injuring others or self, legal conflicts, loss of respect from self or others, destruction of property).
12 Use Motivational Interviewing (12)Motivational interviewing techniques were used to help the client clarify their stage of motivation to change.Motivational interviewing techniques were used to help move the client to the action stage in which they agree to learn new ways to conceptualize and manage anger.The client was assisted in identifying dissatisfaction with the status quo and the benefits of making changes.The client was assisted in identifying level of optimism for making changes.
13 Educate About Addictive Behavior to Relieve Uncomfortable Feelings (13)The client was educated about the tendency to engage in addictive behavior as a means of relieving uncomfortable feelings.The client was able to develop a list of several incidences of how addictive behavior has been used as a means of relieving uncomfortable feelings.The client reported a decrease in the use of addictive behaviors as a means of relieving uncomfortable feelings; this success was highlighted.The client reported that they have not decreased the use of addictive behaviors as a means of relieving uncomfortable feelings and was provided with additional feedback in this area.
14 Teach About High-Risk Situations (14)The client was taught about high-risk situations (e.g., negative emotions, social pressure, interpersonal conflict, strong positive emotions, testing personal control).The client was taught about how anger, as a negative emotion, places them at a higher risk for addiction.Active listening skills were used as the client acknowledged the higher risk of addictive behaviors related to negative emotions, social pressure, interpersonal conflict, positive emotions, and testing personal control.The client was supported while acknowledging how anger places them at a higher risk for addiction.The client rejected the connections between anger and higher risk of substance abuse and was provided with additional feedback.
15 Engage in New Ways to Recognize and Manage Anger (15)The client was asked to learn new ways to recognize and manage anger.The client was reinforced for their agreement to learn new ways to recognize and manage anger.The client was uncertain about committing to any change about their anger pattern and was provided with additional feedback in this area.
16 Refer for Psychopharmacological Intervention (16)The client was referred to a prescribing clinician for the purpose of evaluation for a prescription for psychotropic medication to aid in reducing tension and improving anger control.The client has followed through on the referral to a prescribing clinician and has been assessed for a prescription of psychotropic medication, but none were prescribed.The client has been prescribed psychotropic medications.The client has refused a prescription of psychotropic medication provided by the physician.
17 Monitor Medication Effectiveness and Side Effects (17)As the client has taken psychotropic medication prescribed by the prescribing clinician, the effectiveness and side effects of the medication have been monitored.The client reported that the psychotropic medication has been beneficial, and this was relayed to the prescribing clinician.The client reported that the psychotropic medication has not been beneficial, and this was relayed to the prescribing clinician.The client has not consistently taken the prescribed psychotropic medication and has been redirected to do so.The client identified side effects of the psychotropic medications and was directed to consult with the prescribing clinician if the side effects persist or worsen.
18 Assign an Anger Journal (18)The client was assigned to keep a daily journal in which to document persons or situations that cause anger, irritation, and disappointment and to record the depth of anger, rating on a scale of 1 to 100.The client was assigned “Anger Journal” from the Adult Psychotherapy Homework Planner (Jongsma & Bruce).The client has kept a journal of anger-producing situations and this material was processed within the session.It was noted that the client has become more aware of the causes for targets of their anger, as a result of journaling these experiences on a daily basis.The client has not kept an anger journal and was redirected to do so.
19 List Targets of/Causes for Anger (19)The client was assisted in listing as many of the causes for and targets of their anger that they are aware of.The client was assigned “Is This Anger Due to Feeling Threatened?” or “Is My Anger Due to Unmet Expectations?” in the Addiction Treatment Homework Planner (Lenz, Finley, & Jongsma).The client's list of targets of and causes for anger was processed in order to increase awareness of anger management issues.The client has indicated a greater sensitivity to angry feelings and the causes for them as a result of the focus on these issues.The client has not been able to develop a comprehensive list of causes for and targets of anger and was provided with tentative examples in this area.
20 Convey Model of Anger (20)The client was assisted in understanding a model of anger as involving different components that go through predictable phases.The client was taught about the different components of anger, including cognitive, physiological, affective, and behavioral components.The client was taught how to better discriminate between relaxation and tension.The client was taught about the predictable phases of anger, including demanding expectations that are not met, leading to increased arousal and anger, which lead to acting out.The client displayed a clear understanding of this model of anger and was provided with positive reinforcement.The client has struggled to understand this model of anger and was provided with remedial feedback in this area.
21 Process Anger Triggers (21)The client was assisted in processing the list of anger triggers and other relevant journal information.The client was assisted in understanding how cognitive, physiological, and effective factors interplay to produce anger.The client was reinforced for their insight into anger triggers and the cognitive, physiological, and effective factors.The client struggled to connect anger triggers with cognitive, physiological, and effective factors and was provided with remedial information in this area.
22 Discuss Rationale for Treatment (22)The client was engaged in a discussion about the rationale for treatment.Emphasis was placed on how functioning can be improved through change in various dimensions of anger management.The concept of rationale for treatment and how functioning can be improved through change in the various dimensions of anger management was revisited.
23 Assign Reading Material (23)The client was assigned to read material that educates about anger and its management.The client was directed to read Overcoming Situational and General Anger: Client Manual (Deffenbacher & McKay).The client was directed to read Of Course You're