The Addiction Treatment Planner. Группа авторов

and blames others for aggressive and abusive behavior.

      15 Uses aggression as a means of achieving power and control.

       

       

       

       

       

       

LONG-TERM GOALS

      1 Maintain a program of recovery that is free of addiction and violentg behavior.

      2 Learn and implement anger management skills to reduce the level of anger and irritability that accompanies it.

      3 Increase honest, appropriate, respectful, and direct communication using assertiveness and conflict resolution skills.

      4 Develop an awareness of angry thoughts, feelings, and actions, clarifying origins of, and learning alternatives to aggressive anger.

      5 Decrease the frequency, intensity, and duration of angry thoughts, feelings, and actions and increase the ability to recognize and assertively express frustration and resolve conflict.

      6 Implement cognitive behavioral skills necessary to solve problems in a more constructive manner.

       

       

       

       

       

       

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SHORT-TERM OBJECTIVES	THERAPEUTIC INTERVENTIONS
Work cooperatively with the therapist toward agreed-upon therapeutic goals while being as open and honest as comfort and trust allow. (1, 2)	Establish rapport with the client toward building a strong therapeutic alliance; convey caring, support, warmth, and empathy; provide nonjudgmental support and develop a level of trust with the client toward his/her/their feeling safe to discuss his/her/their anger control issues and their impact on his/her/their life.
	Strengthen powerful relationship factors within the therapy process and foster the therapy alliance through paying special attention to these empirically supported factors: work collaboratively with the client in the treatment process; reach agreement on the goals and expectations of therapy; demonstrate consistent empathy toward the client's feelings and struggles; verbalize positive regard toward and affirmation of the client; and collect and deliver client feedback as to the client's perception of his/her/their progress in therapy (see Psychotherapy Relationships That Work: Vol. 1 by Norcross & Lambert and Psychotherapy Relationships That Work: Vol. 2 by Norcross & Wampold).
Identify situations, thoughts, and feelings associated with anger, angry verbal, and/or behavioral actions, and the targets of those actions. (3)	Thoroughly assess the various stimuli (e.g. situations, people, thoughts) that have triggered the client's anger and the thoughts, feelings, and actions that have characterized his/her/their anger responses.
Complete psychological testing or objective questionnaires for assessing anger expression. (4)	Administer to the client psychometric instruments designed to objectively assess anger expression (e.g. Anger, Irritability, and Assault Questionnaire, Buss-Durkee Hostility Inventory; State-Trait Anger Expression Inventory); give the client feedback regarding the results of the assessment; readminister as indicated to assess treatment response.
Cooperate with a complete medical evaluation. (5)	Arrange for a medical evaluation to rule out nonpsychiatric medical and substance-induced etiologies for poorly controlled anger (e.g. brain injury, 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. (6, 7, 8, 9)	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 attention-deficit/hyperactivity disorder [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).
Explore the consequences of anger, motivation and willingness to participate in treatment, and agree to participate to learn new ways to think about and manage anger. (10, 11, 12)	As part of exploring the client's decisional balance to engage in treatment, 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 supplement with “Alternatives to Destructive Anger” in the Adult Psychotherapy Homework Planner by Jongsma & Bruce.
	As part of exploring the client's decisional balance to engage in treatment, ask the client to list and discuss ways anger has negatively affected his/her/their daily life (e.g. hurting others or self, legal conflicts, loss of respect from self and others, destruction of property); process this list.