Use motivational interviewing techniques toward clarify the client stage of change, moving the client toward the action stage in which he/she/they agree to take specific actions to more effectively conceptualize and manage anger (see Motivational Interviewing by Miller & Rollnick).
Verbalize an understanding of how angry thoughts and feelings can lead to increased risk of addiction. (13, 14)
Use guided discovery (e.g. Socratic questioning) to educate the client about his/her/their tendency to engage in addictive behavior as a means of relieving uncomfortable feelings; develop a list of several instances of occurrence.
Teach the client about high-risk triggers of substance use including strong negative emotions, social pressure, interpersonal conflict, strong positive emotions, and other stressors; discuss examples of how triggers can lead to substance use, the consequences of this pattern, and the availability of alternatives in preventing and managing the risk.
Agree to learn new alternative ways to recognize and manage anger. (15)
Confirm with the client that he/she/they agree to try to learn new ways to recognize and manage anger.
Cooperate with a medication evaluation for possible treatment with psychotropic medications to assist in anger control; take medications consistently, if prescribed. (16, 17)
Assess the client for the need and willingness to take psychotropic medication to assist in control of anger; refer him/her/them to a prescriber for an evaluation and prescription of medication, if needed.
Monitor the client's psychotropic medication adherence, side effects, and effectiveness; confer as indicated with the prescriber.
Keep a daily journal of persons, situations, and other triggers of anger; record thoughts, feelings, and actions taken or not. (18, 19)
Ask the client to self-monitor, keeping a daily journal in which he/she/they document persons, situations, thoughts, feelings, and actions associated with moments of anger, irritation, or disappointment (or supplement with “Anger Journal” in the Adult Psychotherapy Homework Planner by Jongsma & Bruce); routinely process the journal toward helping the client understand his/her/their contributions to generating his/her/their anger.
Assist the client in generating a list of anger triggers (or supplement with “Is My Anger Due to Feeling Threatened?” or “Is My Anger Due to Unmet Expectations?” in the Addiction Treatment Homework Planner by Lenz, Finley, & Jongsma); process the list toward helping the client understand the causes and expressions of his/her/their anger.
Verbalize increased awareness of anger expression patterns, their causes, and their consequences. (20, 21)
Convey a model of anger that involves different dimensions (cognitive, physiological, affective, and behavioral) that interact predictably (e.g. demanding expectations not being met leading to increased arousal and anger leading to aggression), and that can be understood and changed (see Anger Management by Kassinove & Tafrate; Overcoming Situational and General Anger by Deffenbacher & McKay).
Process the client's list of anger triggers and other relevant journal information toward helping the client understand how cognitive, physiological, and affective factors interplay to produce anger and lead to increased risk of maladaptive behavioral consequences (e.g. verbal and/or physical aggression, unassertiveness and resentment, or passive aggression).
Verbalize an understanding of how the treatment is designed to prevent or manage anger, enhance functioning, and improve quality of life. (22)
Discuss the rationale for treatment, emphasizing how functioning can be improved through change in the various dimensions of anger; revisit relevant themes throughout therapy to help the client consolidate his/her/their understanding (see Overcoming Situational and General Anger: Therapist Protocol by Deffenbacher & McKay; Anger Management by Kassinove & Tafrate; Understanding Anger and Anger Disorders by DiGiuseppe & Tafrate).
Read a book or treatment manual that supplements the therapy by improving understanding of anger and anger control problems. (23)
Assign the client to read material that educates him/her/them about anger and its management (e.g. Overcoming Situational and General Anger: Client Manual by Deffenbacher & McKay, Of Course You're Angry by Rosselini & Worden, The Anger Control Workbook by McKay & Rogers, or Anger Management for Everyone by Kassinove & Tafrate); process and revisit relevant themes throughout therapy to help the client consolidate his/her/their understanding of relevant concepts.
