A clinician I consult with asked me a question. I asked him if I could post his question and my reply (without confidential information).
What he asked:
“I know you have worked a lot with students so I have a couple of questions for you regarding a current client. He is in elementary school and came in for “anger issues.” He seems to be disruptive at school a lot, gets in trouble, and is also known as a bully around the school. Any thoughts on working with a kid with anger issues.”
First, when I see “anger” in one child in the family, I rarely see him in isolation, because he can then become the scapegoat. Even if he is the “bad” kid in the family, he’s reacting to something within the family. I’ve tried a number of things, if the family is willing to do a family session “to help” him, you may get some insight into the family dynamics. You could do it and tell the parents that you want to see how the youth reacts.
Within the family session, I would do a few experiential activities.
Second, when I am seeing someone that is younger, I usually keep the parents in for all or part of the session. Often the parents have not set clear boundaries and need to improve their own parenting abilities. Also, it makes it a “family issue” not a “whatever the kid’s name is- issue”. By session 3-4 I usually try and complete a treatment plan that outlines the specific behavior that we’ll work on. For example (I’m going to use the name “Mikey” for the kid’s name):
Treatment Plan Ideas
Mikey will follow his parent’s instruction the first time without stomping his feet, rolling his eyes, or other behavior that is considered “inappropriate” by the parents.
Steps toward change:
1. Parents will seek to clearly define when a behavior is inappropriate using phrases such as, “Mikey, you are stomping your feet and crying when I asked you to take out the garbage.” This will assist in helping Mikey to learn specific behaviors that comprise “angry behavior.”
2. Parents and Mikey will create a system with therapist for him to excuse himself when he feels that he is getting upset. Within therapy, times/places will be defined to help Mikey know when/where it is appropriate to use this system.
3. Mikey will learn self soothing behaviors within therapy and track them outside of therapy through a worksheet provided by the therapist.
4. A nightly family meeting will occur for the weeks between sessions (until determined otherwise by the parents and therapist) where the parents describe two positive behaviors and one negative behavior of each child.
5. Parents and the therapist will create a behavior system that creates a family-wide system that includes a Job Jar for negative behavior and a Prizes Menu for positive behavior. This will be a family-wide intervention.
6. Mikey will think about specific behaviors that he wants to work on and discuss with therapist.
7. Within therapy, therapist will facilitate family activities to help identify Mikey’s triggers and ways that other family members can support him better.
Progress will be reviewed in each session, but on 7-20-12 the appropriateness of this goal will be reviewed as a family with therapist.
Then I say, “Now we’re all going to sign this. By each of us signing, we’re saying that we are going to work as hard as we can to meet these goals. I (therapist) am going to get resources and come prepared, your parents are going to work hard to help make the right choices easier for you and teach you what behaviors they want you to change, and you’re going to work hard at changing how you react when you are angry.”
In each Treatment Plan I usually only have 1-3 goals. I would rather see clear progress on one goal, than have 3 and lack focus. I hope that helps!
Joseph R. Sanok, MA, LLP, LPC, NCC is a therapist, counselor, psychologist, and owner of Mental Wellness Counseling www.mentalwellnesscounseling.com in Traverse City, MI. He helps angry kids, frustrated parents, and distant couples…and just about everyone else. He is a frequent speaker in the Traverse City area, Michigan, and nationally. He helps counselors in private practice through his blog www.PracticeofthePractice.com and through individual consulting.