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Cbt 600 - Anger Management

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Case Description

Henry is a fifteen-year old male who is in grade nine and is highly disruptive at home and at school. He is hostile and aggressive to younger students and to the female students in his class. His parents report having little or no communication with their son. Whenever they do speak to him, he is hostile and often swears at them. He seems to take delight in seeing others get hurt or angry. Henry went out last weekend and was physically abused and beaten by a group of boys from another school. He provoked them by calling them names for not stopping aside when he and a friend walked toward them. He then took a swing at the boy who brushed several stitches. The boy threatened they would do this again to him when they next saw him. He is afraid this will happen and has agreed to come for counselling after talking to the doctor and the hospital social worker.

Assignment

Develop an anger management program for Henry. The program should be based on cognitive behavioral counselling theories and should address general and specific goals of program and list required assessments, suggested strategies and techniques and the set of interviews with Henry and/or others. Rationale should be provided for selection of the recommended theories, goals, assessments, interviews, strategies and techniques.

Theories

I will employ the following theories to help him live a happier life:

Multimodal Therapy: among different theories presented in the course, I found multimodal therapy to be the most effective one in helping Henry overcome his problems. The main reason is that looking into different aspects of the problem given the comprehensiveness of the BASIC ID modalities. Different strategies such as assertiveness training, social communication skill training, relaxation techniques, mindful observation of body sensations, thoughts, emotions and behaviors, cognitive restructuring and anger management skills can be applied within this framework to address the problem effectively.

Mindfulness Based Cognitive Behavioral Therapy: mindfulness can increase Henry’s chance to overcome his problems, fulfill his dreams and live a happier life. I will apply meditation and mindfulness to him observe his body sensations, explore his feelings and thoughts (automatic, core-beliefs and others) and come up with better realization of his actions and analysis of available alternatives. Meditation will also be useful for relaxation, self-care and realization of the effectiveness of acceptance, compassion, forgiveness and unity.

Beck’s Cognitive Therapy and Ellis’s Rational Emotive Behavioral Therapy: I will apply techniques from CT and REBT to identify the typical cognitive distortions that impede Henry from having a rational analysis of different situations. These techniques include but are not limited to ABC technique, case conceptualization, cost-benefit analysis, value clarification, fallacies in arguments, considering alternatives and role playing both sides of a thought.

Social Cognitive Learning Theory: this theory has potential benefits to help Henry as emphasizes on self-regulation, self-control, self-reinforcement and self-evaluation and at the same time, emphasizes on the social aspect of modeling and learning behaviors from external and internal role-models.

Goals

The following set of goals are the ones that I came up with given the case description. However, I will establish a more accurate set after brainstorming with Henry on the second session. Henry and I will review these goals periodically and revise them over the course of time to ensure that we are moving in the right direction.

  1. Helping him become aware about his freedom of choice and responsibility to change his life
  2. Helping Henry understand anger, conducting anger assessment and knowing anger symptoms prior, on and after an anger-provoking situation and learning to accept anger
  3. Considering the familial background of his issues and directing change and support in family
  4. Teaching him mindfulness to help him observe his emotions, body sensations, thoughts to take conscious actions not reactive unconscious ones
  5. Identifying cognitive distortions that lead to disruptive emotions and maladaptive thoughts and helping him to use cognitive restructuring to change these patterns of thinking
  6. Teaching him anger control steps on preparing for the provocation and identifying triggers, confronting the provocation and recognizing the warning signs, coping with the arousal, and conducting self-evaluation after each incident
  7. Offering him the chance to follow an external role model or ideal internal one and encouraging him to imitate this role model in different situations  
  8. Teaching him acceptance, compassion, forgiveness and unity and helping him practice these
  9. Helping him express himself assertively instead of expressing himself passive-aggressively
  10. Helping him learn new social skills to better deal with his parents and his classmates and others
  11. Teaching him self-care and helping him choose a healthier lifestyle in terms of sleeping well, drinking enough water, doing physical exercises, having hobbies, studying passionately, taking breaks periodically, doing relaxation meditations and lightening up with humor
  12. Teaching him to assess the situations logically and learn either to accept the situation, change the situation or get out of a bad situation

Assessments

  1. Anger assessment based on one of these resources: Clinical Anger Scale (CAS)[1], the Miller-Patterson anger self-assessment[2] or Gary Chapman’s personal anger assessment[3].
  2. Personality Belief Questionnaire[4] 
  3. Leahy Emotional Schema Scale II (LESS II)[5]
  4. Freiburg Mindfulness Inventory (FMI)[6]

The selected assessments will help Henry become aware of his anger level, type of personality and the possibility of being passive-aggressive, common thinking schemas and his mindfulness level.

Interviews

The following chart highlights the structure of the sessions I will have with Henry and his parents. The purpose of interview(s) conducted in each session is also listed.

Session

Participants

Purpose of the Interview(s)

1

Henry

Introduction, setting norms, active listening to Henry to identify the set of problems he recognizes related to the problem

2

Henry

Briefing him about the set of problems he identified last session and presenting him the set of problems that has been reported by his family and coming up with a set of goals for counselling sessions

Identifying who can change the situation for Henry

3

Henry & Parents

Presenting the identified goals to Henry and his parents and asking for their feedback and getting their informed consent to start the counselling sessions

4

Henry

Teaching what anger is, conducting anger assessment and interviewing Henry to identify his anger symptoms prior, on and post anger-provoking situations

5

Henry

Exploring the familial background of Henry’s issues in terms of his family state, his position in the family, his parents’ relationship with each other and him, the history of Henry’s problems, the starting point of each of his problems

6-7

Parents

Interviewing Henry’s parents about the familial background of Henry’s issues and promoting change and support from family to help him overcome his problems

8-9

Henry

Practicing mindfulness to help him observe his emotions, body sensations, thoughts to take conscious actions not reactive unconscious ones

10-13

Henry

Reviewing cognitive distortions that lead to disruptive emotions and maladaptive thoughts and helping him to use cognitive restructuring to change these patterns of thinking

14

Henry

Reviewing his anger control steps and proposing a new way to apply

15

Henry

Identifying the external or internal role-model who Henry likes to follow

16-17

Henry

Post mindfulness meditation interviews to disclose the practiced meditations on acceptance, compassion, forgiveness and unity

18-20

Henry

Assertiveness vs. passive aggressive expression

21-22

Henry

Learning and practicing new social skills to avoid confrontation and have win-win communications

23-24

Henry

Figuring out his self-care habits and proposing new ones

25

Henry

Examining his situation analysis capability to decide to accept, change or get out of specific situations

26

Henry & Parents

Reviewing achieved goals and planning to trace the ones that Henry and his parents are interested to follow further

Strategies

...

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