associated with anger.The client makes demanding expectations of others.The client tends to generalize labeling the targets of their anger.The client tends to have anger in reaction to perceived slights.As treatment has progressed, the client displays decreased patterns of cognitive biases associated with anger.4 Evidence of Physiological Arousal (4)The client displayed direct evidence of physiological arousal in relation to feelings of anger.The client displays indirect evidence of physiological arousal related to feelings of anger.As treatment has progressed, the client's level of physiological arousal has decreased as anger has become more managed.
5 Explosive, Destructive Outbursts (5)The client described a history of loss of temper in which they have destroyed property during fits of rage.The client described a history of loss of temper that dates back to childhood, involving verbal outbursts as well as property destruction.As therapy has progressed, the client has reported increased control over their temper and a significant reduction in incidents of poor anger management.The client has had no recent incidents of explosive outbursts that have resulted in destruction of property or intimidating verbal assaults.
6 Explosive, Assaultive Outbursts (5)The client described a history of loss of anger control to the point of physical assault on others who were the target of their anger.The client has been arrested for assaultive attacks on others when they have lost control of their temper.The client has used assaultive acts as well as threats and intimidation to control others.The client has made a commitment to control their temper and terminate all assaultive behavior.There have been no recent incidents of assaultive attacks on anyone, in spite of the client having experienced periods of anger.
7 Overreactive Irritability (6)The client described a history of reacting too angrily to rather insignificant irritants in daily life.The client indicated that they recognize that they become too angry in the face of rather minor frustrations and irritants.Minor irritants have resulted in explosive, angry outbursts that have led to destruction of property and/or striking out physically at others.The client has made significant progress at increasing frustration tolerance and reducing explosive over-reactivity to minor irritants.
8 Physical/Emotional Abuse (7)The client reported physical encounters that have injured others or have threatened serious injury to others.The client showed little or no remorse for causing pain to others.The client projected blame onto others for aggressive encounters.The client has a violent history and continues to interact with others in a very intimidating, aggressive style.The client has shown progress in controlling aggressive patterns and seems to be trying to interact with more assertiveness rather than aggression.
9 Verbal Abuse Toward Significant 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
