Six Anger Management Strategies for Clients ~ Transformasi Kaunseling Kesihatan

Six Anger Management Strategies for Clients

This article was published on Monday, March 5th, 2012

“Kassinove and Sukhodolsky (1995) defined anger as a felt emotional state. This private state varies in intensity and duration, as well as frequency, and is associated with cognitive distortions, verbal and motor behaviours, and patterns of physical arousal. Although anger may emerge spontaneously, another person is typically seen as the cause of anger. And it usually includes a perception of blameworthiness.
Anger is not a form of aggression, and most often does not lead to aggression! Rather it is a felt experience that typically follows unwanted, aversive interactions with close friends, colleagues, and family members. Although anger is common, and sometimes useful, it can become an independent problem with many negative consequences, requiring treatment in the context of individuals, couples, or family therapy in private practice or institutional settings.” (Kassinove & Tafrate, 2002, p.12)
Anger is not aggression, hostility or violence (although these may result from the experience of anger); rather anger is an internal event, a feeling, a physiological reaction. For this reason, some clients may find it challenging to articulate their experience. ‘Feeling angry’ can manifest in a variety of ways. Two clients may state that they feel angry, yet the variation between their experiences may be as broad as the intensity difference between mild irritation and frenzied rage.
In this article we explore six anger management strategies counsellors can utilise with clients.
Strategy One – The Anger Episode Record
To begin the management of anger, both counsellor and client require an understanding of the client’s expressive patterns. This can be achieved by encouraging clients to complete an Anger Episode Record. This is a record of each trigger, appraisal, experience, expressive pattern and outcome the client encounters during an established time period.
Trigger:
The target for my anger was…
The situation surrounding my anger was…
Appraisal:
The thought I had about the trigger was…
Experience:
The intensity of my anger was (a scale of 1 to 10 can be used to define intensity)…
Outcome (positive):
A list of positive short-term outcomes…
A list of positive long-term outcomes…
Outcome (negative):
A list of negative short-term outcomes…
A list of negative long-term outcomes…
The sample template (above) is an example of how a client might record this information. Recording information in this way fosters self-reflection and promotes personal awareness. Additionally, this information can act as a foundation on which cognitive approaches can be launched.
The anger episode model illustrates the linear process from the experience of a trigger through to the final outcome. The cycle of anger presented below (see figure below), demonstrates how this linear process is embedded within a continuous cycle of learning.
Cycle of Anger: http://www.counsellingconnection.com/wp-content/uploads/2008/01/anger-cycle.gif
Source: Williams, E. & Barlow, R. (1998). Anger Control Training. London: Winslow Press.
Our role as counsellors is to effectively thwart the momentum of this learning cycle by assisting clients to modify their response at one or more of the key points within the cycle. Through the completion of the anger episode record (strategy 1), it is anticipated that clients will have an enhanced awareness of their personal triggers, appraisals and expressive patterns. Awareness, of course, will do little to alter behaviour if clients are not encouraged to engage in corresponding action.
It is therefore essential that any increase in awareness be coupled with appropriate strategies for initiating desired change.
Strategy Two – Challenging Thoughts / Appraisals
Once appraisals of triggers have been identified, it can be beneficial for both counsellor and client to consider the appraisal and evaluate its validity. This can be achieved through a number of questioning techniques below).
Examining the evidence:
What is the evidence to suggest that the appraisal is accurate?
What is the evidence that supports the appraisal?
What is the evidence against the appraisal?
Looking for alternatives:
Is there an alternative explanation?
Questioning the effect:
What is the effect of my believing this appraisal?
What could be the effect of changing my thinking?
Action planning
What should I do about it?
Double standards
What would I tell________ (a friend) if he or she were in the same situation?
Source: Adapted from Beck, J. (1993). Cognitive therapy: Basics and beyond. New York: Guilford Press.
Example Transcript:

Rachel (client): At work the other day I got so mad at Don. He kept interrupting me. It was infuriating!
Counsellor: Yes…
Rachel: It’s because he doesn’t respect what I have to say. He thinks I’m stupid.

In the above transcript, the client has identified both a trigger and an appraisal of her anger. The trigger is Don’s interrupting behaviour which the client has appraised as an indicator that he thinks she is stupid. As conversation continues, the counsellor decides to challenge the client’s appraisal.

Counsellor: Tell me, Rachel, if Don interrupted Gail [Rachel's respected manager], what reason would you give me for why that occurred?
Rachel: Gee, if Don interrupted Gail I would say that he was trying to impress her by dominating the meeting and appearing to be full of ideas.
Counsellor: Right…

The counsellor has used the double standards technique in this example.
Strategy Three – Using Self-Calming Statements
“What we think affects the way we feel. Distorted thinking can increase the likelihood of negative emotions such as anger, while calming or challenging thoughts can reduce the impact of these feelings. Self-calming statements are thoughts that can be (1) prepared in advance to anticipate and cope with a situation or trigger; (2) used to cope with the situation or trigger when it arises; and (3) used to calm ourselves down after the situation or trigger has passed.”
Distorted thought – “He’s getting at me”
Self-calming statement – “Don’t take it personally”
Source: Williams, E. & Barlow, R. (1999). Anger control training: The anger control training guide (part 3). London: Winslow Press (p. 83).
Formulating self-calming statements: Self-calming statements can be formulated to assist clients in each stage of responding to a trigger (before provocation, during provocation and after provocation). When an anger-provoking event can be anticipated, clients can formulate self-calming statements that enhance coping skills.
For example, a statement such as – “Remember, this is a fair request. You’re doing the right thing by standing up for yourself” – may effectively act as a calming force for an individual about to enter into a confrontational discussion or negotiation.
A statement such as – “I don’t have to feel intimidated” – can act to calm a client during the discussion or negotiation. And statements such as – “I handled that well” – can reassure the client after the event has passed.
Strategy Four – Relaxation
The body tends to respond in an innate flight or fight response when faced with an anger-provoking situation. That means that reactions within your body call you to ask yourself whether you should leave the situation (flight) or use your newly produced adrenalin and cortisones to get through (fight).
The body often responds to anger by:

Increasing sweating to help cool the body
Slowing digestion to preserve energy for a fight/flight response
Increasing blood pressure to maximise oxygen production
Tensing shoulders and back muscles to ready the body for action
Dilating pupils to maximise focus on the threat

Because of the state of high tension the body endures during an anger experience, clients may benefit from the use of relaxation strategies. When you are in a relaxed state, your body responds in a number of ways:

Metabolism slows, as do physiological functions such as heart rate and blood pressure.
Muscle tension decreases.
Brain wave patterns shift from the faster waves that occur during a normal active day to the slower waves, which appear just before falling asleep or in times of deep relaxation.

Not all relaxation exercises suit everyone. It is important, therefore, to try a number of techniques to find one which suits your client. The following selection of exercises have been included because they take only a few minutes to perform and may be used almost anywhere.
Technique One – Erasing Stress: Erasing stress is a visualising technique. It allows you to visualise the thought or situation which is constantly on your mind or inciting anger and helps erase it from your thoughts.

Sit or lie in a comfortable position. Breathe slowly and deeply.
Visualize a situation, a person, or even a belief (such as, “A situation at work which is confronting” or “A home renovation which is causing disruption in the household”) that causes you to feel angry.
As you do this you might see a specific person, an actual place, or simply shapes and colours. Where do you see this stressful picture? Is it below you, to the side, in front of you? How does it look? Is it big or little, dark or light, or does it have a specific colour?
Imagine that a large eraser, like the kind used to erase chalk marks, has just floated into your hand.
Actually feel and see the eraser in your hand. Take the eraser and begin to rub it over the area where the stressful picture is located. As the eraser rubs out the stressful picture it fades, shrinks, and finally disappears. When you can no longer see the stressful picture, simply continue to focus on your deep breathing for another minute, inhaling and exhaling slowly and deeply.

Technique Two – Discovering Muscle Tension: Discovering muscle tension is an excellent technique for understanding the effects that stress or anxiety has on your body. This technique provides an opportunity to discover the difference between a relaxed muscle state and a tense muscle state. Identifying this can assist in acknowledging the level of stress in your muscles.

Lie on your back in a comfortable position. Allow your arms to rest at your sides, palms down, on the surface next to you.
Raise just the right hand and arm and hold it elevated for 15 seconds.
Notice if your forearm feels tight and tense or if the muscles are soft and pliable.
Let your hand and arm drop down and relax. The arm muscles will relax too.
As you lie still, notice any other parts of your body that feel tense, muscles that feel tight and sore. You may notice a constant dull aching in certain muscles.

Technique Three – Progressive Muscle Relaxation: Discovering muscle tension exercise is an excellent exercise to try before the Progressive Muscle Relaxation exercise.
Lie on your back in a comfortable position. Allow your arms to rest at your sides, palms down, on the surface next to you.

Inhale and exhale slowly and deeply.
Clench your hands into fists and hold them tightly for 15 seconds. As you do this, relax the rest of your body. Visualize your fists contracting, becoming tighter and tighter.
Then let your hands relax. On relaxing, see a golden light flowing into the entire body, making all your muscles soft and pliable.
Now, tense and relax the following parts of your body in this order: face, shoulders, back, stomach, pelvis, legs, feet, and toes. Hold each part tensed for 15 seconds and then relax your body for 30 seconds before going on to the next part.
Finish the exercise by shaking your hands and imagining the remaining tension flowing out of your fingertips.

Technique Four – Focusing: This exercise can be used to block out negative or intrusive or inflammatory thoughts. Focusing on one item slows your thought processes and helps to increase your concentration. At first, the focusing technique can be challenging, because the mind automatically starts thinking about other areas of your life.

Select a small personal object that you like a great deal. It might be a jewelled pin or a simple flower from your garden. Focus all your attention on this object as you inhale and exhale slowly and deeply for one to two minutes.
While you are doing this exercise, try not to let any other thoughts or feelings enter your mind. If they do, just return your attention to the object. At the end of this exercise, you will probably feel more peaceful and calmer. Any tension or nervousness that you were feeling upon starting the exercise should be diminished.

Strategy Five – Assertiveness Training
Assertiveness training is commonly reserved for individuals who find it challenging to express their anger rather than those who over-express it. Nonetheless, an awareness of assertive communication can assist in modelling suitable reactions and responses for clients who are uncertain about their ability to communicate appropriately in high-pressure or anger provoking situations.
Assertive communication demands the use of direct, honest and appropriate expression of personal opinions, needs or desires. By communicating assertively, you are more likely to achieve your purpose. Using more forceful strategies such as verbal attack or harsh criticism ignites negative responses from others and can cause relationship tension.
TIP – When formulating assertive responses it may be helpful to remember the use of “I” messages. Starting a sentence with “you” can come across as a judgement or condemnation of the other person. By focusing more on yourself, it conveys less blame and more personal ownership of your feelings. This might be a helpful formula – “I feel _________, when _____________.”
For example: Instead of saying, “You never do anything around the house”, try “I feel frustrated when I have to do so much around the house.”
Points to remember:

Be conscious of your body language
Try to ensure that your non-verbal messages reflect confidence – stand tall, maintain eye contact and try to relax
Use a firm tone but maintain a pleasant demeanour
Don’t assume the motives or thoughts of the other person, ask questions and try to understand their point of view
Remember to listen
Try to find a compromise.

Consider the following scenario: You have just settled on the couch to watch your favourite TV show. Fifteen minutes into the program your partner arrives home and says, “Quick change the channel. The football is on!” and proceeds to grab the remote.
What would be a verbally aversive response to this situation?
What would be an assertive response to this situation?
Additional reading: Teaching Clients to Become Assertive
Strategy Six – Creating a Relapse Prevention Plan
“Relapse prevention began with the work of Marlatt and Parks (1982) and Marlatt and Gordon (1985) who noted that after success with the treatment of various behavioural problems – such as smoking, drinking, overeating, drug addiction, obsessive compulsive disorder and gambling – clients very often fell back into their old behaviours. In fact, between 50% and 90% of clients who are successful in the reduction of overeating, smoking and other problem eventually relapse.
Relapse is not the same as treatment failure, in which there is little or no progress at all. Rather, the terms “lapse” and “relapse” refer to slight or almost total increases in problem behaviours, after improvement has already been shown. In all likelihood, this occurs because we don’t focus formally on consolidating and maintaining treatment gains. Thus, an important final step in any anger management program is preparing clients, in advance, for the likely scenario that anger will reappear.” (Kassinove & Tafrate, 2002, p. 245-246)
A relapse prevention plan can assist clients in managing setbacks as they occur throughout the process of change. Relapse prevention is a form of self-management. Without such a plan, a ‘lapse’ may provoke a return to old behaviours. According to Parks & Marlatt (2000) the cornerstone of relapse prevention is the acquisition of effective coping skills. Coping skills enable the client to better understand and manage lapses as they occur. Coping skills can be developed via the following processes.
It may be helpful for clients to establish an initial awareness and understanding of the likelihood of lapses occurring throughout their change process. By acknowledging that lapses are probable and common, clients are less likely to catastrophise the lapse or abandon treatment due to a perceived lack of progress.
Clients can benefit from sharpening their awareness of high-risk triggers. Particular people, situations or environments are likely to be more challenging for clients who are seeking to manage their anger. By raising awareness of these triggers, clients can commit to engaging in pre-confrontational strategies. This means that clients can mentally and physically prepare for triggers, through relaxation, soothing self-talk and other cognitive strategies.
Cognitive distortions that lead to all-or-nothing thinking can challenge the client who experiences a lapse. As such, it can be valuable to work with clients on being able to acknowledge shades of grey. That is, to be able to experience a lapse without abandoning the long-term plan.
Caring for one’s self can play a vital role in the way in which a lapse is firstly perceived, and then managed. Clients who are well rested, healthy and have managed their time and priorities well are far better positioned to approach the management of a lapse with a confident mindset.
Tips for Managing Anger Relapses (Client Resource)
Everyday demands
Everyday stressors, such as work, children and tight schedules can heighten anxiety and contribute to feeling overwhelmed. When we are stressed, we are less likely to respond in a measured and considered fashion to provoking situations, choosing instead to respond with impulsive expressions of our immediate feelings.
To avoid this result, it can help to be mindful of your schedule. Avoid taking on responsibilities or favours that you don’t have time for. Use spare time to pursue leisure and relaxation activities. Prioritise your self-care and maintain a balanced lifestyle. Of course, the achievement of these aims can be difficult when the demands on our time are so great. Nonetheless, without paying careful attention to our lifestyle habits, we are vulnerable to the effects cumulative stress can have on our ability to manage expressions of anger.
Thinking only of short-term gains
A confrontational or provoking situation can ignite reactions in individuals that have far-reaching and long-term effects on relationships. This often occurs during the heat-of-the-moment as tensions and anxieties blind us to the longer-term consequences. It can therefore be highly beneficial to plan, plan, plan for an anticipated encounter.
An awareness of likely triggers enables you to predict which situations are likely to be challenging or confrontational for you. Imagine, for example, that you have just received another credit card bill in the mail – you have overspent and know that your partner will not be pleased. Instead of waiting for your partner to react before formulating your response, you could spend a few moments considering how you could best respond to this likely future event. You may, therefore, decide it is best to take accountability, to apologise and offer a commitment to lessen spending in the future. This, of course, is preferable to a response made in haste that is defensive, attacking, or derogatory.
Source: http://www.mentalhealthacademy.com.au/
http://www.aipc.net.au/articles/?p=305