CBT and the Angry Client:
Engagement, Assessment, and Treatment

Raymond Chip Tafrate, Ph.D.
Chairperson, Professor, and Clinical Psychologist
Department of Criminology and Criminal Justice
Central Connecticut State University
Program Overview

Although certainly a common and universal human experience, the topic of anger has been long neglected by clinical researchers. Anger has become the forgotten emotion. Yet, descriptive data show that problematic anger reactions are quite common and that practitioners across a wide range of treatment settings routinely encounter clients with anger difficulties. For many, anger experiences have contributed to significant loss and suffering. Anger is connected to an assortment of maladaptive problems such as negative verbal responding, physical aggression, weaker social connections, substance use, poor decision making, and severe medical problems such as cardiac disease. This 2-day workshop will focus on conceptualizing anger as a legitimate clinical problem.

A brief overview of several underlying issues of concern to practitioners, such as definitional and diagnostic confusion, common comorbidity patterns, and guidelines for distinguishing everyday anger experiences from more pathological reactions, will be discussed. Since angry clients are frequently coerced into treatment by employers, family members, or the criminal justice system a high percentage of adults and adolescents with anger problems are ambivalent or outright resistant to the idea of making their anger experiences the target of treatment. This workshop will address and demonstrate, through brief video-taped demonstrations and experiential exercises, several initial approach strategies designed to increase client awareness of the costs associated with anger episodes. Participants will learn how to conduct a structured Anger Episode Model interview and how to provide feedback on standardized anger scores. Both strategies incorporate Motivational Interviewing skills that encourage clients to verbalize the negative aspects of their anger episodes.

Since a one-size-fits-all model of treatment is impractical, due to the variability of client characteristics and settings in which anger treatment is delivered, a flexible menu-driven approach will be proposed. After more than three decades of treatment outcome research, an assortment of CBT techniques has begun to form the foundation of an evidence-based approach and ‘what works’ in terms of interventions will be reviewed. Several novel and promising interventions, acceptance and commitment therapy, the use of exposure-based methods, and incorporating forgiveness strategies into treatment, will also be covered in detail. Techniques and strategies will be modeled through live demonstrations and video-taped examples.

Program Objectives
During this two-day workshop, participants will:
  • Better understand how important issues related to anger such as --- definitional and diagnostic concerns, current scientific status of the anger area, common comorbidity patterns, and distinguishing everyday from pathological anger reactions --- influence treatment
  • Learn skills to approach reluctant and coerced clients so that they make their own arguments for changing anger reactions
  • Become aware of available standardized assessment instruments that measure anger in adolescents and adults
  • Be able to provide feedback on assessment results in a way that enhances awareness of problematic anger reactions and increases motivation for change
  • Learn to conceptualize anger reactions in terms of a 5-stage sequential anger episode model (triggers, appraisals, experiences, expressive patterns, & outcomes)
  • Be able to conceptualize interventions across stages of the treatment process: preparation, change, accepting/adjusting, and maintenance
  • Become familiar with a comprehensive menu of treatment strategies to use for the remediation of problematic anger reactions
  • Learn about evidence based – traditional – CBT interventions for clients with disruptive anger
  • Become familiar with novel approaches to anger treatment such as acceptance and commitment therapy (ACT), exposure and rehearsal of new responses, and forgiveness
Program Outline
Day #1
Anger Basics
  1. The scientific neglect of anger and what this means for practitioners
  2. What is normal? -- Adaptive versus disruptive anger reactions
  3. Ubiquitous and intangible: The problem of defining anger
  4. Comorbidity and collateral issues (e.g., substance use, psychopathy, criminal thinking, intimate partner violence, & other concerns)
  5. Should anger be considered a disorder? -- If yes, homogeneous clinical problem or complex subtypes
  6. Proposed diagnostic criteria for anger disorders
The Initial Approach
  1. Common roadblocks with angry clients
  2. The importance of engagement, awareness, and motivation
  3. Client centered versus active directive presentation style
  4. Motivational interviewing primer/ refresher
Assessment: Understanding Anger Patterns
  1. Three-part assessment model
  2. Assessing comorbid problems
  3. Overview of standardized assessment tools for adolescents and adults
  4. Developing an anger profile using the Anger Disorders Scale
  5. Idiographic assessment using the Anger Episode Model (triggers, appraisals, experiences, expressive patterns, & outcomes)
Enhancing Awareness and Motivation Using Assessment Feedback
  1. Providing feedback on standardized test results
  2. The anger episode model interview
Day #2
Interventions for the Practitioner: Motivational, Cognitive, Behavioral, and Philosophical Approaches
  1. What works: What the treatment outcome literature tells us and what it doesn’t tell us
  2. Rationale for a flexible menu-driven approach
Scientifically Established/ Traditional Interventions
  1. Planning ahead to side step problems
  2. Reducing physical activation: Relaxation based approaches
  3. Skill building: Problem solving and assertiveness
  4. Seeing the world flexibly and realistically
Promising Innovative Approaches
  1. Acceptance and commitment therapy for anger
  2. Exposure and rehearsal of new responses
  3. Forgiveness as an anger reducing philosophy – process and outcomes
Questions, Comments, Final Thoughts…



This activity has been endorsed and will attract 14 Specialist Professional Development points for members of the following APS College: Counselling, Educational/Developmental & Forensic. Members of other APS Colleges and non-College members may claim the equivalent generalist points.





Dates and venues 2008:
  • Melbourne 7 & 8 July Holmesglen Conference Centre, Cnr Warrigal & Batesford Roads, Holmesglen 3148
  • Sydney 10 & 11 July Sancta Sophia College, 8 Missenden Road, Camperdown 2050
  • Brisbane 17 & 18 July O'Shea Inservice Centre, 19 Lovedale Street, Wilston 4051
Cost: $550 (cost includes GST) Early bird registration – prior to 1 May 2008 - $506.
Student Registration - $440


Click here for PDF Registration Form >>>>

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