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ASAM Dimension 3 – Emotional/Behavioral Conditions

Contributor: Yvette McBride Thomas

Dimension 3:  Emotional/Behavioral Conditions

Problem (need)

  • Patient reports evidences of possible depressive symptoms
  • Patient reports unresolved loss/grief issues due to deaths in immediate family
  • Patient has a history of poor anger management
  • Patient has a history of illicit behavior which has led to legal problems
  • Patient reports difficulty coping with loss of child custody
  • Patient exhibits very low frustration tolerance
  • Patient’s current functioning affected by history of verbal/sexual/physical abuse
  • Patient experiencing grief due to divorce/desperation
  • Patient experiencing difficulty coping with loss of significant relationship
  • Patient seems unable to keep schedule of structured recovery activities, showing erratic or irresponsible behavior.

Goal (I will)

  • Patient to address unresolved loss issues
  • Patient to increase frustration management skills
  • Patient to increase anger management skills
  • Patient to cease illegal behaviors
  • Patient to develop alternative to illegal behavior
  • Patient to increase communication skills
  • Patent to address emotional needs of family
  • Patient to increase responsible time/task  management skills

Intervention (Objective)

  • Patient to complete mental health symptoms questionnaire with counselor within ___ weeks
  • Patient to examine situations precipitating frustration and anger and discuss nonaggressive responses to address and discuss in counseling sessions and monitor  progress on anger/frustration.
  • Patient to contact anger management group with in _______weeks and attend as scheduled, following up with primary counselor (pc)
  • Patient to process the loss of loved one in counseling sessions and progress on grief management to be monitored with with grief support group within ______ of referral
  • Patient to process feelings over possible loss of child custody
  • Patient to explore  ways to cope with emotional affects of serious illness
  • Patient is to discuss progress on avoiding arrest and illicit activities


Behavioral Definitions

  • History of explosive aggressive outburst out of proportion to any precipitating stressors leading to assaultive acts or destruction of property
  • Overreaction of hostility to insignificant irritants
  • Body language of tense muscles (clenched fist/jaw, glaring looks, or refusal to make eye contact)
  • Consistent pattern of challenging or disrespectful treatment of authority figures using verbally abusive language

Long term goals

  • Decrease overall intensity and frequency of angry feelings and increase ability to recognize and appropriately express angry feelings as they occur.
  • Develop an awareness of current anger behaviors, clarifying origins of and alternatives to aggressive anger
  • Come to an awareness and acceptance of angry feelings while developing better control and more serenity.
  • Become capable of handling angry feelings in constructive ways that enhance daily functioning.

Therapeutic Interventions

  • Identify targets of and causes of anger
  • Verbalize increased awareness of anger expression patterns
  • Verbalize how influential people in growing up have modeled anger expressions
  • Identify pain and hurt of past or current life that fuels anger
  • Utilize relaxation techniques to cope with angry feelings
  • Verbalize increased awareness of how past ways of handling angry feelings have had a negative impact
  • Verbalize increased awareness of and ability to react to hot buttons or anger triggers in a nonaggressive manner
  • Write  an angry letter to target and process this letter with counselor/therapist
  • Write a letter of forgiveness to perpetrator of past or present pain and process letter with therapist/counselor
  • Assist patient in identifying ways key life figures have expressed angry feelings and how positively  or negatively these experiences have influenced the way patient handles anger
  • Assign patient to list the experiences of life that have hurt and led to anger
  • Ask patient to list ways anger has negatively impacted his/her daily life. Process list in counseling  session
  • Ask patient to write an angry letter to parents, spouse, or whomever, focusing on the reason for his/her anger toward that person. Process letter in counseling session
  • Ask patient to write a forgiveness letter to target anger as a step toward letting go of anger. Process letter in session.
DYI! Get ready with me.Samantha DeLint - Youtube Channel

DYI! Get ready with me.
Samantha DeLint – Youtube Channel

Reference used: Jongsma, A.E. Jr and Peterson, L. Mark The Complete Adult Psychotherapy Treatment Planner 2nd edition
Suggested readings
 Roselline, G., and Worden, M (1986) Of Course You’re Angry. San Francisco: Harper Hazelden
Runin, T. I. (1969) The Angry Book. New York: Macmillan
Weisinger, H. (1985) Dr. Weisinger’s Anger Workout Book. New York: Quill.
Smedes, L. (1991). Forgive and Forget: Healing the Hurts We Don’t Deserve. San Franciso: Harper
Lerner, H. (1985) The Dance of Anger: a Woman’s guide to Changing the Patterns of Intimate Relationships. New York: harper Perennial
Other Resources
http://www.kap.samhsa.gov/products/manuals/pdfs/angermanagement_manual_0508.pdf – 2012-09-10

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