The Adult Psychotherapy Progress Notes Planner. David J. Berghuis

would make promises of doing something, but not follow through.The client acknowledged that he/she/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.

      12 Time Bomb (11)The client tends to passively withhold feelings, and then explodes in a rage.The client seems to be “adding up” slights and irritations, waiting until enough have been “banked” and then explodes into a rage.The client appears to have rageful feelings under the surface, but presents in a passive manner.As treatment has progressed, the client has improved in regard to being able to express his/her/their feelings appropriately, and has decreased the reactive rage episodes.

      13 Overreaction to Perceived Negative Circumstances (12)The client seems to overreact to perceived disapproval, rejection, or criticism.The client can become angry even when no disapproval, rejection, or criticism exists.The client tends to have a bias toward his/her/their experience of disapproval, rejection, or criticism.As treatment has progressed, the client has decreased his/her/their pattern of overreaction to disapproval, rejection, or criticism.The client has decreased his/her/their angry overreaction to perceived disapproval, rejection, or criticism.

      14 Verbal Abuse (13)The client acknowledged that he/she/they frequently engage in verbal abuse of others as a means of expressing anger or frustration with them.Significant others in the client's family have indicated that they have been hurt by his/her/their frequent verbal abuse toward them.The client has shown little empathy toward others for the pain that he/she/they have caused because of his/her/their verbal abuse of them.The client has become more aware of his/her/their pattern of verbal abuse of others and is becoming more sensitive to the negative impact of this behavior on them.There have been no recent incidents of verbal abuse of others by the client.

      15 Rationalization and Blaming (14)The client has a history of projecting blame for his/her/their angry outbursts or aggressive behaviors onto other people or outside circumstances.The client did not accept responsibility for his/her/their recent angry outbursts or aggressive behaviors.The client has begun to accept greater responsibility for his/her/their anger control problems and blame others less often for his/her/their angry outbursts or aggressive behaviors.The client verbalized an acceptance of responsibility for the poor control of his/her/their anger or aggressive impulses.The client expressed guilt about his/her/their anger control problems and apologized to significant others for his/her/their loss of control of anger.

      16 Aggression to Achieve Power and Control (15)The client appears to use aggression as a means to achieve power and control over others.The client uses veiled threats of aggression as a way to intimidate others.As treatment has progressed, the client has decreased aggression as mean of achieving power and control over others.

INTERVENTIONS IMPLEMENTED

      1 Establish Rapport (1)²Caring 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 his/her/their 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 his/her/their expression of painful feelings; he/she/they were 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 the therapeutic relationship, 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 his/her/their anger.The client was assisted in identifying situations, people, and thoughts that have triggered his/her/their anger.The client was assisted in identifying the thoughts, feelings, and actions that have characterized his/her/their anger responses.

      4 Administer Psychological Testing (4)The client was administered psychometric instruments designed to objectively assess anger expression.The client was assessed with the Anger, Irritability, and Assault Questionnaire (AIAQ).The client was assessed with the Buss-Durkee Hostility Inventory (BDHI).The client was assessed with the State-Trait Anger Expression Inventory (STAXI).The client was given feedback about the results of the assessment.

      5 Refer for Physical Examination (5)The client was referred for a complete physical examination to rule out organic contributors (e.g. brain damage, tumor, elevated testosterone levels) to his/her/their anger.The client has complied with the physical examination and the results were shared with him/her/them.The physical examination has identified organic contributors to poor anger control and treatment was suggested.The 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 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 his/her/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 his/her/their 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 his/her/their clinical presentation.The client was assessed for gender-related issues that could help to better understand his/her/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 his/her/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 his/her/their 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 his/her/their impairment in social, relational, vocational, and occupational endeavors.It was reflected to the client that his/her/their impairment appears to create mild to moderate effects on the client's functioning.It was reflected to the client that his/her/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 he/she/they have experienced in managing his/her/their anger.The client was assigned the homework exercise “Alternatives to Destructive Anger” from the Adult Psychotherapy Homework Planner (Jongsma).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