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Treating Borderline: Frustration & Anger
 Borderline Personality Disorder: Treating Frustration & Anger - 10 CEUs

Section 29
Appendix: Reproducible Client Worksheets

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Psychologist CEs, Counselor CEUs, Social Worker CEUs, MFT CEUs

Switcheroo
Replay CD track 2 for more information on this technique.
Client asks him or herself these questions to increase empathic awareness.

  1. What needs influence him or her to act this way?
  2. What beliefs or values influence him or her to act this way?
  3. What aspect of his or her history influences this behavior?
  4. What limitations influence this behavior?

Anger Journal (Basic Entry)
Replay CD track 4 for more information on this technique.
Client follows the following guidelines for entering a basic entry into his or her Anger Journal.

  1. The number of times the client got angry in the last 24 hours.
  2. How aroused the client felt when he or she was his or her angriest during the last 24 hours.  I ask the client to use a scale of 1 to 10, where 1 is minimal arousal and 10 is the most anger arousal he or she has ever felt.
  3. How aggressively the client acted when he or she was at his or her angriest during the last 24 hours.  Again, I ask him or her to use a 1 to 10 scale, where 1 is minimal aggression and 10 is the most aggression he or she has ever displayed.

Anger Journal (Four Questions)
Replay CD track 4 for more information on this technique.
Client answers the following four questions when considering an incident during which the client lost his or her temper.

  1. What stresses preexisted my anger?  Prior to the moment of anger, were you aware of any painful feelings such as hurt, anxiety, sadness, or guilt?  Did you experience any sense of threat, frustration, or uncomfortable physical sensations?
  2. What trigger thoughts did you use?  What were the thoughts that ignited your feelings?  Can you identify the point where the trigger thoughts turn your stress into anger?
  3. Were you angry or were you feeling some other kind of stress before the trigger statements? 
  4. Was some of your preexisting stress blocked or discharged by the anger?  Did the anger give you even a few seconds of relief?

Anger Journal (Specific Incidents)
Replay CD track 4 for more information on this technique.
Client reflects on past incidents and answers the following questions in his or her Anger Journal.

  1. What stress underlay my anger? 
  2. What were my trigger thoughts? 
  3. Are there more effective strategies than anger for reinforcing others to meet my needs? 
  4. What can I do to meet my own needs? 
  5. Can I find other sources of support, nourishment, or appreciation besides the person with whom I feel angry? 
  6. What limits do I want to set but feel afraid to acknowledge or insist on? 
  7. How can I negotiate for what I want?
  8. How might I eventually let go?

Scanning the Body
Replay CD track 7 for more information on this technique.
Client follows steps to increase awareness of tension in his or her body.

  1. Begin by paying attention to your feet and legs.  Start by wiggling your toes, then rotating your feet and relaxing them.  Not any tension in your calves and let go of this tension.
  2. Now focus on your lower torso.  Become aware of any tension or pain in your lower back.  Relax as fully as you can.  Notice if you have tension in your hips, pelvic area, or buttocks.  Relax these areas.
  3. Move your focus to your diaphragm and stomach.  Take a couple of deep breaths, breathing slowly in and out.  Feel yourself relaxing, more and more deeply.  Notice any tension that you are experiencing in this area.
  4. Become aware of your lungs and chest cavity.  Search for tension in this part of your body.  Take a couple of slow, deep breaths and relax.
  5. Next, pay attention to your shoulders neck and throat.  Swallow a couple of times and notice any tension or soreness in your throat and neck.  Roll your head around clockwise a few times.  Now reverse and roll your head the other way.  Shrug your shoulders and become aware of any tension in this area and then relax.
  6. Begin at the top of your head and scan for tension.  Look for pain in your forehead.  Perhaps there is a band of pain around the top of your head.  Maybe there is pain or tension behind your eyes.  Notice any tightness in your jaw.  Check for locking or grinding of teeth and taut lips.  Be aware of your ears.  Go back over you head and relax each part.
  7. Now go back and scan your entire body for any remaining tension.  Allow yourself to relax more and more deeply.

Stop and Breathe
Replay CD track 7 for more information on this technique.
Client follows steps for a breathing relaxation exercise.

  1. When you begin to feel like the outside world is against you and you have to take it out on somebody, go into an empty room and tell yourself out loud and firmly, "Stop."
  2. Now shift your attention to your breathing.  Take slow, deep breaths into your belly.  Put a hand on your abdomen to make sure you’re breathing properly.
  3. Begin to count your breaths, counting each time you exhale up to four.  Each time you reach four, start over again.
  4. Empty your mind and stay focused on your breathing.  Continue this exercise until you feel relaxed.

Warning Signs
Replay CD track 10 for more information on this technique.
Client uses following signs to determine if he or she is suffering from parataxic distortion.

  1. Responses with a fast reaction time.  If your anger is suddenly elevated by a single tone or gesture, this could indicate a habitual knee-jerk reaction closely linked to past situations.
  2. Black and white thinking.  If you’re immediately labeling someone as "for or against me", this is another sign that you’re responding to more than just what the other person is feeling, but rather the gesture itself.
  3. A familiar physical feeling.  If you remember having a lump in your stomach or a tight chest as a commonly recurring theme when you get angry, this might indicate that this somatic complaint is related to something else.  For example, if your head always starts to hurt when someone criticizes you, you may have experienced the same reaction when someone from your past criticized you.

Tips for Surviving Criticism
Replay CD track 12 for more information on this technique.
Client follows tips to prevent angry outbursts when faced with criticism.

  1. Limit the damage.  This is in reference to an abusive situation.  If someone verbally batters you by calling you names or labeling you, it is your responsibility to leave the situation.  Do not react to the verbal abuser by escalating the conflict.  Take a time-out.  Also, remind yourself that this is just one person’s opinion about one aspect of your behavior, not a judgment of your character or who you are.  Finally, accept the fact that perfection is impossible.  Even if you are extremely competent in what you do, there is always room for human error which can be the result of various factors:  exhaustion, distraction, or feeling rushed. 
  2. Probe.  This is in reference to constructive or valid criticism.  During this kind of criticism, the best way to grow as a human is to get every piece of advice from the person that you can in order to avoid future mistakes.  Make sure you know exactly what the critic means, but ask them in a neutral tone of voice, without sounding defensive or aggressive.  Most importantly, do not intimidate the other person with anger.  Also, if the criticism feels to heavy or hard to take, you can still remove yourself from the situation and come back later to solve the problem.
  3. Deflect. Clouding is one deflection technique.  This involves agreeing in part with the criticism without accepting it completely.  Listen carefully to the critic, agreeing with the parts that are accurate.  Also agreeing in probability is another way to deflect criticism by using statements such as "It may be…" or "You could be right…".  One last technique for deflecting criticism is assertive preference.  In this technique, you agree to the criticism, but state that you prefer to do it your way anyway.  Acknowledge the difference of opinion and move on.

Guidelines for All Response Choices
Replay CD track 14 for more information on this technique.
Client follows guidelines to choose a more appropriate response other than anger.

  1. Memorize the response choice statements.  Each response choice comes with a specific statement that can be filled in by the client.  I ask my clients to memorize each statement so that when the time comes to use them, he or she does not have to make an effort, but rather does so naturally. 
  2. Whenever possible, rehearse in advance active responses 1 and 3.  These are the expressing a need and ultimatum response choices.  Refer back to track 12 to read further about these response choices.  These active responses might require you to express your feelings.  Decide whether you wise to include your feelings about the situation.  Then formulate your request and your fallback position.  Make sure that your request is behavioral and specific.  Also, try to generate a self-care response.  Ask yourself how you can take care of the problem without the other person’s cooperation.
  3. Continued anger or escalation are your signals to switch responses.  Don’t get stuck if a response isn’t working.  Move on to what you feel intuitively is the next best option.
  4. Don’t be afraid to repeat responses.  You may wish to return several times to questions that get more information.   You may wish to acknowledge what you’re learning about the other person’s experience.  And as the discussion progresses you may wish to invite another round of negotiation.
  5. If you don’t know what to do next, try shifting from active to passive responses (or vice versa).  If you’ve been focusing on getting information, try expressing your own needs now.  If you’re stuck in fruitless negotiation, consider asking for information.
Keep shifting among responses until the problem feels resolved or further communication appears pointless.  If you’re still angry and stuck, go to one of the exit responses.  Stop talking and physically leave the situation.
 
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