The Interview Technique

What to know before you begin
· Enhancing the persons awareness as an angry being. We seldom think of ourselves as being an angry person. Even people who other's would describe as angry, seldom see themselves as such. Consequently the first step in beginning to deal with our anger issues is to some to an awareness of how we are with our own anger. How often in a week/day do we become or feel angry, even for a moment? Are we in denial of our angry feelings? How often do we laugh or smile in contrast to our moments of negativity or anger? From whom did we learn to react to anger?

· Anger can be a highly automatic, over-learned script. The therapist needs, to begin to help the client (or the individual needs to look introspectively), to become aware of their automatic anger responses, their learned script by asking about the both the external and internal factors.(Writing down your thoughts and feelings during this exercise has been shown in research to be the most effective way to complete this exercise).First examine your external factors... Ask yourself (or your client) the following questions:
a. What are the external, situational factors that trigger the anger?
b. What kind of conditions are there that makes the person more angry?
c. What keeps the person remaining in their script?
d. What are the reactions of others?

Then ask about the internal factors...
a. What are you thinking?
b. What are you feeling?
c. What do you do when angry or annoyed?
d. What is happening to you physiologically (i.e., sweat, heart rate, trembling, etc.)?
e. What kind of memories are evoked (remembering past feelings of anger, hurt etc.)?
f. What is your family, cultural and experiential background in regards to anger?

Most people have never thought about their process. However we become more competent in dealing with ours', and others' anger when we have answered these questions for ourselves. Knowing these answers for ourselves enables us to use more productive anger management skills and to experience other's anger toward us in healthier, less volatile ways.

Using the Interview technique to help clients get through this first step has been shown to be most productive (rather than attempting to think through the process by ourselves).

When one has a cold-emotional-state regarding anger, they are unable to deal with anger and are nearly unteachable because they are not in touch with their true processes. In this case the therapist must use other techniques first to evoke emotions which will eventually lead toward self awareness.

Self Monitoring

Most people don't monitor themselves, they just don't pay attention to their process. To help client's (or yourself) become more aware of their process invite them to list the answers to the following on a pad of paper - divided in half. One the left side list the answer to the following question:
What was the situation, its content?,- describe it in detail
On the right side list the answers to the se questions:
What was your reaction, feelings, experience?
What was going on leading up the point when you began having an anger reaction?

The therapist needs to help the client differentiate the emotional response and the physiological response, the cognitive response and the behavioral response. One way is for them to keep a self monitoring journal where the individual writes down their realizations and new understandings. Have them include their recognized habits, thoughts and reactions.

Relaxation Exercise and Treatment Outline

When dealing with clients the following session-outlines have been shown to be the most effective treatment for the reduction of anger reactions than any other modality. This Cognitive Behavioral treatment plan is briefly outlined below.

First session

In the first session there are 3 tasks.
1. Label the irrational link. Ask, "what has clamed you down in the past?" Help them design plans including proven ways (or similar ways) of calming themselves for use in the future. Share with the client other ways that they can learn to calm themselves down. (I.e. progressive relaxation, deep breathing, visualization, cued response). Finally, explain the intervention (the relaxation exercise and its purpose). Help them understand that although at first it may seem strange, the technique works if they are willing to put the effort into integrating it into their natural process.
2. Build the relaxation scene (if you have time, otherwise do this in session 2). Help the client choose an actual experience in their life when they felt truly safe, calm and peaceful (not a fantasy). - For those who have difficulty visualizing, have them think about it for a few days and come back and tell you what they were able to come up with. - It should not be a scene that is cluttered with other emotions such as a sexual memory or a wedding or any other time when there are mixed feelings and emotions. Interview them (as described above) to get as much detail as you can help them remember and relive the experience. Ask about the temperature, the sounds, the sights and all senses experience of the scene.
3. Using the relaxation scene teach them the classic relaxation exercise of deep breathing* and relaxing each section of the body until you are entirely relaxed. Describe the complete exercise to the client and model for them how they should proceed through it (i.e., show how to breath, what relaxation process looks and feels like etc.). *(3-5 slow, deep breaths, in through the nose - out through the mouth; used at the beginning of the exercise and again between each body segment (after lower section, mid section arms/hands and upper sections of the body).
· Ask the client if they are clear about what to do.
· Don't over control the client, i.e. eyes can be open or closed etc.
· Although many clients ask if they can have a tape of your voice talking them through the exercise, do not make them a tape for their at-home practices. A tape causes them to rely on you for their ability to relax rather than teaching them to rely on their own internal processes.

After you and the client have mastered this part of the experience, go onto the next step which is to help them build an anger scene, i.e., a moderate experience of anger they have had recently. Just as in the relaxing scene, help them describe it in detail,(using the interview technique), realizing the effects on all their senses except omit their inappropriate behavior. Stop the scene at the point where they were about to act out on their feelings of anger.

Homework:
· Have them visualize their relaxation scene every day when not angry.
· Have them practice the progressive relaxation exercise at least 4 times that week.
· Self-monitor their anger and responses in a personal journal, writing every detail they can remember.

Session 2

Continue the progressive relaxation technique. Combine it with the relaxation imagery. Introduce cued relaxation response exercise. This is where you help them teach themselves how to relax by closing their eyes (if they desire) and deep breath while visualizing their relaxation scene. Help them introduce a single word "cue," such as "relax" (either said aloud by you or thought by them), to instantly bring about complete relaxation just as if they had done the progressive relaxation exercise.

Help the client train themselves to cue relaxation by either visualization alone or by deep breathing, as explained above. Practice in session several times until they begin to feel competent.

Homework:
· Continue self-monitoring their anger and responses using their journal.
· Practice relaxation daily using cue
· Practice 1 relaxation coping skill (progressive relaxation, cue response or visualization) per day when not stressed
· Flush out (think of) a few other anger scenes that have been recently experienced, and write down experience, as explained before, in their journal.

Session 3

Choose a workplace anger scene that is of a moderate level to talk about and write down in session. Practice utilizing relaxation/visualization calming technique using cued response.

Homework:

The same as last week but begin using cued relaxation technique when angry. As soon as they begin to recognize their pattern and decent into angry mode, have them choose a relaxation technique previously learned to calm themselves with the intent of preempting the angry response.

Session 4

Have them self-relax. Then use 20-30 seconds to create the anger arousal while visualizing the angry event discussed in the previous session. The therapist begins talking about the anger scene, bringing out all the button pushing elements while the client focuses on the emotions felt at the time, as if s/he were in the situation again. This is intended to put the client back into the original anger state. Arousal should be brought to a moderate level only so that the individual does not feel overwhelmed and unable to control their response. Ask the person to signal you when they are sufficiently aroused, by lifting a finger or hand.

The therapist has to have a good amount of control over this session in order to keep client from getting too angry or abreactive. At this point, the therapist "turns off" the anger scene (saying "OK, STOP") and helps the client quickly evolve into their relaxation scene using their cue (20 seconds). Do this back and fourth - anger scene, relaxation, anger scene, relaxation, until the client is sufficiently comfortable with the level of anger being experienced and their ability to calm themselves before loosing control. The client begins to learn that they can be acutely aware of their anger process, and take control of it while in the middle of it, creating a clam temperament.

Next 5-7 sessions

In each session the therapist begins to ramp up the intensity of the anger a little more until the person feels confident that they can deal with any level of anger that might be provoked in any given situation (do this until they have worked through their worse case scenario).

Each session the therapist takes less control of the process, giving the client more control over how far to go and what technique to use. After each session the therapist must clear out the anger scene and diffuse any lingering emotion the client has by talking about it fully.

Further sessions

Once this technique is learned and the person is comfortable with it, they can begin learning to use it in other situations (i.e. scenes of anxiety, guilt, depression and more).

Cognitive Restructuring

1. This is when we become aware of our thinking processes. Begin by asking yourself (or your client) What is making this bad situation worse? Acknowledge the bad but also see how to think about it in a way that doesn't make it worse. In other words stop catastrofising the situation with your words. Accept the influences of our thoughts by realizing that our thoughts often make situations worse and that we can feel less hopeless if we can see the influence of our thoughts. For instance, if we say that we "can't make it through this situation," we will not have the motivation or the belief that it is possible to do so. This can result in a self fulfilling prophesy; we think we can't, therefore we don't.