The Adult Psychotherapy Progress Notes Planner. David J. Berghuis

Negative Anger Impact (11)The client was assisted in listing ways that his/her/their explosive expression of anger has negatively impacted his/her/their life.The client was supported as he/she/they identified many negative consequences that have resulted from his/her/their poor anger management.It was reflected to the client that his/her/their denial about the negative impact of his/her/their anger has decreased and he/she/they have verbalized an increased awareness of the negative impact of his/her/their behavior.The client has been guarded about identifying the negative impact of his/her/their anger and was provided with specific examples of how his/her/their anger has negatively impacted his/her/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 his/her/their stage of motivation to change.Motivational interviewing techniques were used to help move the client to the action stage in which he/she/they agree to learn new ways to conceptualize and manage anger.The client was assisted in identifying his/her/their dissatisfaction with the status quo and the benefits of making changes.The client was assisted in identifying his/her/their level of optimism for making changes.

      13 Refer for Medication Evaluation (13)The client was referred to a prescribing clinician to evaluate him/her/them for psychotropic medication to reduce anger symptoms.The client has completed an evaluation by the prescribing clinician and has begun taking medications.The client has resisted the referral to a prescribing clinician and does not want to take any medication to reduce anger symptoms; his/her/their concerns were processed.

      14 Monitor Medication Adherence (14)The client's adherence with the clinician's prescription for psychotropic medication was monitored for the medication's effectiveness and side effects.The client reported that the medication has been beneficial to him/her/them in reducing his/her/their experience of anger symptoms; the benefits of this progress were reviewed.The client reported that the medication does not seem to be helpful in reducing anger symptoms; this was reflected to the prescribing clinician.The therapist conferred with the prescribing clinician to discuss the client's reaction to the psychotropic medication, and adjustments were made to the prescription by the physician.

      15 Assign Anger Journal (15)The client was assigned to keep a daily journal in which he/she/they will document persons or situations that cause anger, irritation, or disappointment.The client was assigned “Anger Journal” in the Adult Psychotherapy Homework Planner (Jongsma).The client has kept a journal of anger-producing situations, and this material was processed within the session.The client has become more aware of the causes for and targets of his/her/their anger as a result of journaling these experiences on a daily basis; the benefits of this insight were reflected to him/her/them.The client has not kept an anger journal and was redirected to do so.

      16 List Targets of/Causes for Anger (16)The client was assigned to list as many of the causes for and targets of his/her/their anger that he/she/they are aware of.The client's list of targets of and causes for anger was processed in order to increase his/her/their awareness of anger management issues.The client has indicated a greater sensitivity to his/her/their angry feelings and the causes for them as a result of the focus on these issues.The client has not been able to develop a comprehensive list of causes for and targets of anger and was gently offered examples in this area.

      17 Reconceptualize Anger (17)The client was assisted in reconceptualizing anger as involving different components that go through predictable phases.The client was taught about the different components of anger, including cognitive, physiological, affective, and behavioral components.The client was taught how to better discriminate between relaxation and tension.The client was taught about the predictable phases of anger, including demanding expectations that are not met, leading to increased arousal and anger, which leads to acting out.The client displayed a clear understanding of the ways to conceptualize anger and was provided with positive reinforcement.The client has struggled to understand the ways to conceptualize anger and was provided with remedial feedback in this area.

      18 Process Anger Triggers (18)The client was assisted in processing the list of anger triggers and other relevant journal information.The client was assisted in understanding how cognitive, physiological, and effective factors interplay to produce anger.The client was reinforced for his/her/their insight into anger triggers and the cognitive, physiological, and effective factors.The client struggled to connect his/her/their anger triggers with cognitive, physiological, and effective factors and was provided with remedial information in this area.

      19 Discuss Rationale for Treatment (19)The client was engaged in a discussion about the rationale for treatment.Emphasis was placed on how functioning can be improved through change in various dimensions of anger management.The concept of rationale for treatment and how functioning can be improved through change in the various dimensions of anger management was revisited.

      20 Assign Reading Material (20)The client was assigned to read material that educates him/her/them about anger and its management.The client was directed to read Overcoming Situational and General Anger: Client Manual (Deffenbacher and McKay).The client was assigned to read Anger Management for Everyone (Kassinove and Tafrate).The client has read the assigned material on anger management and key concepts were reviewed.The client has not read the assigned material on anger management and was redirected to do so.

      21 Teach Calming Techniques (21)The client was taught deep-muscle relaxation, rhythmic breathing, and positive imagery as ways to reduce muscle tension when feelings of anger are experienced.The client was assigned “Deep Breathing Exercise” in the Adult Psychotherapy Homework Planner (Jongsma).The client has implemented the relaxation techniques and reported decreased reactivity when experiencing anger; the benefits of these techniques were underscored.The client has not implemented the relaxation techniques and continues to feel quite stressed in the face of anger; he/she/they were encouraged to use the techniques.

      22 Explore Self-Talk (22)The client's self-talk that mediates his/her/their angry feelings was explored.The client was assessed for self-talk, such as demanding expectations reflected in “should,” “must,” or “have to” statements.The client was assisted in identifying and challenging his/her/their biases and in generating alternative self-talk that correct for the biases.The client was taught about how to use correcting self-talk to facilitate a more flexible and temperate response to frustration.

      23 Assign Self-Talk Homework (23)The client was assigned a homework exercise in which he/she/they identify angry self-talk and generate alternatives that help moderate angry reactions.The client was assigned “Journal and Replace Self-Defeating Thoughts” in the Adult Psychotherapy Homework Planner (Jongsma).The client's use of self-talk alternatives was reviewed within the session.The client was reinforced for his/her/their success in changing angry self-talk to more moderate alternatives.The client was provided with corrective feedback to help improve his/her/their use of alternative self-talk to moderate his/her/their angry reactions.

      24 Role-Play Calming and Cognitive Coping (24)The client was assisted in visualizing anger-provoking scenes, then using relaxation and cognitive coping skills.The client engaged in role-plays regarding the use of relaxation and cognitive coping in anger-provoking scenes.The client was gradually moved from low to high anger-inducing scenes.The client was assigned to implement calming techniques in his/her/their daily life and when facing anger-triggering situations.The client's experience of using relaxation and cognitive coping in his/her/their daily life was processed, with reinforcement for success and problem solving for obstacles identified.

      25 Assign Thought-Stopping Technique (25)The client was directed to implement a thought-stopping technique on a daily basis between sessions.The client was assigned “Making Use of the Thought-Stopping Technique” in the Adult Psychotherapy Homework Planner (Jongsma).The client's use of the thought-stopping technique was reviewed.The client was provided with positive feedback for his/her/their helpful use of the thought-stopping technique.The client was provided with corrective feedback to help improve his/her/their use of the thought-stopping technique.

      26 Teach Assertive Communication (26)The client was taught about assertive communication through instruction, modeling, and role-playing.The client was assigned Your Perfect Right (Alberti and Emmons).The client was referred to an assertiveness