Case History for A.A.

Client Information:

 Name: A.A.

 Age: 24

Presenting Complaint: A.A.'s primary presenting complaint is intense and uncontrollable

anger that she experiences in social situations.

Symptoms: A.A. exhibits the following symptoms:

 Frequent outbursts of anger, particularly when interacting with strangers or in

crowded public settings.

 Avoidance behaviors, such as withdrawing from social gatherings or confrontations to

prevent anger episodes.

 Physical symptoms of anger, including increased heart rate, elevated blood pressure,
and physical tension.

 A recurring sense of irritability and agitation in social situations.

 Feelings of guilt and regret after expressing anger, which further exacerbate her social
anxiety.

Presenting Problem: The presenting problem is determined as a pattern of intense anger

responses in social situations. This anger serves as a protective mechanism, masking
underlying primary emotions related to fear and vulnerability.

Therapy Approach: Anatomy of Anger Theory and Emotion Regulation

Rationale for the Therapy Approach:

 Understanding Anger as a Secondary Emotion: The Anatomy of Anger Theory will

be applied to help A.A. recognize that her anger is a secondary emotion masking
primary emotions of fear, vulnerability, and frustration. By understanding the root
causes of her anger, she can work on addressing these underlying emotions.

Techniques:
1. Emotion Identification: A.A. will work on identifying and naming her primary
emotions (e.g., fear, hurt, frustration) that precede her anger responses in social
situations.

2. Anger Expression and Management: She will learn healthy ways to express anger
when appropriate and work on anger management techniques to prevent explosive
outbursts.

3. Communication Skills: A.A. will focus on effective communication skills to express

her needs and boundaries in social situations without resorting to anger.

4. Cognitive Restructuring: A.A. will work on reframing her thoughts and self-talk
related to social situations, reducing self-criticism, and cultivating self-compassion.

5. Resolution Strategies: The goal is to encourage A.A. to address the underlying

primary emotions that fuel her anger, seeking resolution and resolution-focused
behaviors in social situations.
Verbatim Script:

Therapist (T): Hey there, A.A.! How's it going today?

A.A. (Client): Hey. To be honest, I'm pretty frustrated. I lost my temper again in a social
situation, and it's getting old.

T: I get it, A.A. It can be really tough to deal with anger. I want to introduce you to a therapy
approach that might help. It's called the Anatomy of Anger Theory. Ever heard of it?

A.A.: Nah, never heard of it. What's it about?

T: It's a bit different. This approach sees anger as a kind of cover-up for other emotions, like
fear and vulnerability. We'll work on digging into those underlying emotions that trigger your
anger.

A.A.: Interesting. But why is anger not all bad?

T: Good question! Anger isn't all negative; it's like a defense mechanism. It helps us set
boundaries, speak up, and sometimes it's what gets us to fix things. But when it's out of
control, it can be a problem. We want to help you express anger in healthier ways.

A.A.: So, how are we gonna do this?

T: We'll follow a plan. First, we'll work on recognizing the primary emotions hiding behind
your anger. What do you think those might be?

A.A.: Well, I think it's fear and vulnerability. I get pretty anxious in social situations, and
when I can't handle it, I get angry.

T: That's a great start. We'll practice spotting those primary emotions. When you know what
they are, we'll work on expressing them and dealing with the root issues instead of blowing
up.

A.A.: And what about handling my anger in those moments?

T: We've got you covered. We'll teach you tricks to manage your anger, like deep breathing
and mindfulness, to help you stay cool. Plus, we'll work on your communication skills, so
you can talk about your feelings and needs in a healthier way.

A.A.: Seems like a lot to learn.

T: It can be, but we'll take it step by step. We'll keep a close eye on your progress, and we'll
adjust our game plan as we go. The goal is to help you understand your emotions, reduce
those blow-ups, and feel more at ease in social situations.

A.A.: I hope it works. I'm so tired of feeling this way.

T: I believe in you, A.A.! With your effort and us working together, I'm confident you can
make some real progress. It's a process, but we're here to back you up every step of the way.

Outcome Expectations:

Improved Emotion Regulation: A.A. should learn to recognize, express, and manage her
primary emotions effectively, reducing the reliance on anger as a protective mechanism.

1. Enhanced Communication: A.A. will develop better communication skills, allowing

her to express her needs, boundaries, and emotions in a healthier and more
constructive manner.

2. Reduced Explosive Anger Outbursts: The frequency and intensity of her anger
outbursts in social situations are expected to decrease, leading to more peaceful
interactions with others.

3. Increased Self-Understanding: A.A. will gain insight into her emotional responses
and develop self-awareness about the underlying primary emotions that trigger her
anger.

4. Social Confidence: With improved emotion regulation and communication skills,

A.A. is anticipated to experience increased confidence in social situations and reduced
social anxiety.