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 of distress, or culturally based perceived 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
