Behaviors that undermine a culture of safety

Intimidating and disruptive behaviors can foster medical errors,(1,2,3) contribute to poor patient satisfaction and to preventable adverse outcomes,(1,4,5) increase the cost of care,(4,5) and cause qualified clinicians, administrators and managers to seek new positions in more professional environments. (1,6) Safety and quality of patient care is dependent on teamwork, communication, and a collaborative work environment. To assure quality and to promote a culture of safety, health care organizations must address the problem of behaviors that threaten the performance of the health care team.

Intimidating and disruptive behaviors include overt actions such as verbal outbursts and physical threats, as well as passive activities such as refusing to perform assigned tasks or quietly exhibiting uncooperative attitudes during routine activities. Intimidating and disruptive behaviors are often manifested by health care professionals in positions of power. Such behaviors include reluctance or refusal to answer questions, return phone calls or pages; condescending language or voice intonation; and impatience with questions.(2) Overt and passive behaviors undermine team effectiveness and can compromise the safety of patients.(7, 8, 11) All intimidating and disruptive behaviors are unprofessional and should not be tolerated.

Intimidating and disruptive behaviors in health care organizations are not rare.(1,2,7,8,9)  A survey on intimidation conducted by the Institute for Safe Medication Practices found that 40 percent of clinicians have kept quiet or remained passive during patient care events rather than question a known intimidator.(2,10) While most formal research centers on intimidating and disruptive behaviors among physicians and nurses, there is evidence that these behaviors occur among other health care professionals, such as pharmacists, therapists, and support staff, as well as among administrators. (1,2) Several surveys have found that most care providers have experienced or witnessed intimidating or disruptive behaviors.(1,2,8,12,13) These behaviors are not limited to one gender and occur during interactions within and across disciplines.(1,2,7) Nor are such behaviors confined to the small number of individuals who habitually exhibit them.(2) It is likely that these individuals are not involved in the large majority of episodes of intimidating or disruptive behaviors. It is important that organizations recognize that it is the behaviors that threaten patient safety, irrespective of who engages in them.

The majority of health care professionals enter their chosen discipline for altruistic reasons and have a strong interest in caring for and helping other human beings. The preponderance of these individuals carry out their duties in a manner consistent with this idealism and maintain high levels of professionalism. The presence of intimidating and disruptive behaviors in an organization, however, erodes professional behavior and creates an unhealthy or even hostile work environment – one that is readily recognized by patients and their families. Health care organizations that ignore these behaviors also expose themselves to litigation from both employees and patients. Studies link patient complaints about unprofessional, disruptive behaviors and malpractice risk.(13,14,15) “Any behavior which impairs the health care team’s ability to function well creates risk,” says Gerald Hickson, M.D., associate dean for Clinical Affairs and director of the Center for Patient and Professional Advocacy at Vanderbilt University Medical Center. “If health care organizations encourage patients and families to speak up, their observations and complaints, if recorded and fed back to organizational leadership, can serve as part of a surveillance system to identify behaviors by members of the health care team that create unnecessary risk.

Root causes and contributing factors

There is a history of tolerance and indifference to intimidating and disruptive behaviors in health care.(10) Organizations that fail to address unprofessional behavior through formal systems are indirectly promoting it. (9,11) Intimidating and disruptive behavior stems from both individual and systemic factors.(4) The inherent stresses of dealing with high stakes, high emotion situations can contribute to occasional intimidating or disruptive behavior, particularly in the presence of factors such as fatigue. Individual care providers who exhibit characteristics such as self-centeredness, immaturity, or defensiveness can be more prone to unprofessional behavior.(8,11) They can lack interpersonal, coping or conflict management skills.

Systemic factors stem from the unique health care cultural environment, which is marked by pressures that include increased productivity demands, cost containment requirements, embedded hierarchies, and fear of or stress from litigation. These pressures can be further exacerbated by changes to or differences in the authority, autonomy, empowerment, and roles or values of professionals on the health care team, (5,7,16) as well as by the continual flux of daily changes in shifts, rotations, and interdepartmental support staff. This dynamic creates challenges for inter-professional communication and for the development of trust among team members.

Disruptive behaviors often go unreported, and therefore unaddressed, for a number of reasons. Fear of retaliation and the stigma associated with “blowing the whistle” on a colleague, as well as a general reluctance to confront an intimidator all contribute to underreporting of intimidating and/or disruptive behavior.(2,9,12,16) Additionally, staff within institutions often perceive that powerful, revenue-generating physicians are “let off the hook” for inappropriate behavior due to the perceived consequences of confronting them.(8,10,12,17) The American College of Physician Executives (ACPE) conducted a physician behavior survey and found that 38.9 percent of the respondents agreed that "physicians in my organization who generate high amounts of revenue are treated more leniently when it comes to behavior problems than those who bring in less revenue."(17)

Existing Joint Commission requirements

Effective January 1, 2009 for all accreditation programs, The Joint Commission has a new Leadership standard (LD.03.01.01)* that addresses disruptive and inappropriate behaviors in two of its elements of performance:

EP 4: The hospital/organization has a code of conduct that defines acceptable and disruptive and
inappropriate behaviors.

EP 5: Leaders create and implement a process for managing disruptive and inappropriate behaviors.

In addition, standards in the Medical Staff chapter have been organized to follow six core competencies (see the introduction to MS.4) to be addressed in the credentialing process, including interpersonal skills and professionalism.

Other Joint Commission suggested actions

1. Educate all team members – both physicians and non-physician staff – on appropriate professional behavior defined by the organization’s code of conduct. The code and education should emphasize respect. Include training in basic business etiquette (particularly phone skills) and people skills.(10, 18,19)

2. Hold all team members accountable for modeling desirable behaviors, and enforce the code consistently and equitably among all staff regardless of seniority or clinical discipline in a positive fashion through reinforcement as well as punishment.(2,4,9,10,11)

3. Develop and implement policies and procedures/processes appropriate for the organization that address:

o “Zero tolerance” for intimidating and/or disruptive behaviors, especially the most egregious instances of disruptive behavior such as assault and other criminal acts. Incorporate the zero tolerance policy into medical staff bylaws and employment agreements as well as administrative policies.

o Medical staff policies regarding intimidating and/or disruptive behaviors of physicians within a health care organization should be complementary and supportive of the policies that are present in the organization for non-physician staff.

o Reducing fear of intimidation or retribution and protecting those who report or cooperate in the investigation of intimidating, disruptive and other unprofessional behavior.(10,18 ) Non-retaliation clauses should be included in all policy statements that address disruptive behaviors.

o Responding to patients and/or their families who are involved in or witness intimidating and/or disruptive behaviors. The response should include hearing and empathizing with their concerns, thanking them for sharing those concerns, and apologizing.(11)

o How and when to begin disciplinary actions (such as suspension, termination, loss of clinical privileges, reports to professional licensure bodies).

4. Develop an organizational process for addressing intimidating and disruptive behaviors (LD.3.10 EP 5) that solicits and integrates substantial input from an inter-professional team including representation of medical and nursing staff, administrators and other employees.(4,10,18 )

5. Provide skills-based training and coaching for all leaders and managers in relationship-building and collaborative practice, including skills for giving feedback on unprofessional behavior, and conflict resolution.(4,7,10,11,17,20) Cultural assessment tools can also be used to measure whether or not attitudes change over time.

6. Develop and implement a system for assessing staff perceptions of the seriousness and extent of instances of unprofessional behaviors and the risk of harm to patients.(10,17,18 )

7. Develop and implement a reporting/surveillance system (possibly anonymous) for detecting unprofessional behavior. Include ombuds services(20) and patient advocates,(2,11) both of which provide important feedback from patients and families who may experience intimidating or disruptive behavior from health professionals. Monitor system effectiveness through regular surveys, focus groups, peer and team member evaluations, or other methods.(10) Have multiple and specific strategies to learn whether intimidating or disruptive behaviors exist or recur, such as through direct inquiries at routine intervals with staff, supervisors, and peers.

8. Support surveillance with tiered, non-confrontational interventional strategies, starting with informal “cup of coffee” conversations directly addressing the problem and moving toward detailed action plans and progressive discipline, if patterns persist. (4,5,10,11) These interventions should initially be non-adversarial in nature, with the focus on building trust, placing accountability on and rehabilitating the offending individual, and protecting patient safety.(4,5) Make use of mediators and conflict coaches when professional dispute resolution skills are needed.(4,7,14)

9. Conduct all interventions within the context of an organizational commitment to the health and well-being of all staff, (11) with adequate resources to support individuals whose behavior is caused or influenced by physical or mental health pathologies.
10. Encourage inter-professional dialogues across a variety of forums as a proactive way of addressing ongoing conflicts, overcoming them, and moving forward through improved collaboration and communication.(1,2,4,10)

11. Document all attempts to address intimidating and disruptive behaviors.(18 )

References

1.) Rosenstein, AH and O’Daniel, M: Disruptive behavior and clinical outcomes: Perceptions of nurses and physicians. American Journal of Nursing, 2005, 105,1,54-64

2.) Institute for Safe Medication Practices: Survey on workplace intimidation. 2003. Available online: https://ismp.org/Survey/surveyresults/Survey0311.asp (accessed April 14, 2008 )

3.) Morrissey J: Encyclopedia of errors; Growing database of medication errors allows hospitals to compare their track records with facilities nationwide in a nonpunitive setting. Modern Healthcare, March 24, 2003, 33(12):40,42

4.) Gerardi, D: Effective strategies for addressing “disruptive” behavior: Moving from avoidance to engagement. Medical Group Management Association Webcast, 2007; and, Gerardi, D:  Creating Cultures of Engagement: Effective Strategies for Addressing Conflict and “Disruptive” Behavior. Arizona Hospital Association Annual Patient Safety Forum, 2008

5.) Ransom, SB and Neff, KE, et al: Enhancing physician performance. American College of Physician Executives, Tampa, Fla., 2000, chapter 4, p.45-72

6.) Rosenstein, A, et al:  Disruptive physician behavior contributes to nursing shortage:  Study links bad behavior by doctors to nurses leaving the profession. Physician Executive, November/December 2002, 28(6):8-11. Available online:  http://findarticles.com/p/articles/mi_m0843/is_6_28/ai_94590407 (accessed April 14, 2008 )

7.) Gerardi, D: The Emerging Culture of Health Care: Improving End-of-Life Care through Collaboration and Conflict Engagement Among Health Care Professionals. Ohio State Journal on Dispute Resolution, 2007, 23(1):105-142

8.) Weber, DO: Poll results: Doctors’ disruptive behavior disturbs physician leaders. Physician Executive, September/October 2004, 30(5):6-14

9.) Leape, LL and Fromson, JA: Problem doctors: Is there a system-level solution? Annals of Internal Medicine, 2006, 144:107-155

10.) Porto, G and Lauve, R: Disruptive clinical behavior: A persistent threat to patient safety. Patient Safety and Quality Healthcare, July/August 2006. Available online:  http://www.psqh.com/julaug06/disruptive.html (accessed April 14, 2008 )

11.) Hickson, GB: A complementary approach to promoting professionalism: Identifying, measuring, and addressing unprofessional behaviors. Academic Medicine, November 2007, 82(11):1040-1048

12.) Rosenstein, AH: Nurse-physician relationships: Impact on nurse satisfaction and retention. American Journal of Nursing, 2002, 102(6):26-34

13.) Hickson GB, et al: Patient complaints and malpractice risk. Journal of the American Medical Association, 2002, 287:2951-7

14.) Hickson GB, et al; Patient complaints and malpractice risk in a regional healthcare center. Southern Medical Journal, August 2007, 100(8 ):791-6

15.) Stelfox HT, Ghandi TK, Orav J, Gustafson ML:  The relation of patient satisfaction with complaints against physicians, risk management episodes, and malpractice lawsuits.  American Journal of Medicine, 2005, 118(10):1126-33

16.) Gerardi, D: The culture of health care: How professional and organizational cultures impact conflict management. Georgia Law Review, 2005, 21(4):857-890

17.) Keogh, T and Martin, W: Managing unmanageable physicians. Physician Executive, September/October 2004, 18-22

18.) ECRI Institute: Disruptive practitioner behavior report, June 2006. Available for purchase
online: http://www.ecri.org/Press/Pages/Free_Report_Behavior.aspx (accessed April 14, 2008 )

19.) Kahn, MW: Etiquette-based medicine. New England Journal of Medicine, May 8, 2008, 358; 19:1988-1989

20.) Marshall, P and Robson, R: Preventing and managing conflict: Vital pieces in the patient safety puzzle. Healthcare Quarterly, October 2005, 8:39-44

* The 2009 standards have been renumbered as part of the Standards Improvement Initiative. During development, this standard was number LD.3.10.

http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_40.htm

Published in:

• Anderson & Anderson

                                                                             - Victor Frankl

A. The Four Agreements.

According to Don Miguel Ruiz, author, The Four Agreements:  “Everything we do is based on agreements we have made - agreements with ourselves, with other people, with God, with life.  But the most important agreements are the ones we make with ourselves. In these agreements we tell ourselves who we are, how to behave, what is possible, what is impossible. One single agreement is not such a problem, but we have many agreements that come from fear, deplete our energy, and diminish our self-worth."

The Four Agreements exposes self-limiting beliefs and shows how to strengthen emotional intelligence:

1.  Be impeccable with your word.
2.  Don’t take anything personally.
3.  Don’t make assumptions.
4.  Always do your best.

I.  Be Impeccable with Your Word

“Speak with integrity. Say only what you mean. Avoid using the word to speak against yourself or to gossip about others. Use the power of your word in the direction of truth and love.”

“Impeccable” literally means “faultless.” Honesty is the first interpretation of this agreement.  Being honest with yourself is a necessary component of self-awareness. Being honest with others is a necessary component of relationship management. But impeccability goes beyond simple honesty.

Impeccability Expanded. How we use our words to communicate with others was covered previously in the lessons on communication. Being impeccable with our word also means using our self-talk in a healthy way. “Self-talk” refers to the inner monologue/dialogue we have with ourselves all the time, frequently without noticing.

Self-Talk. Often, self-talk is negative and hurtful:

“Oh, I’m such an idiot to have done that again!”

Self-talk may be aimed at others and lead to anger:

“What a jerk he is! Is he too stupid to use his turn signal?!”

Being impeccable with our word is learning to reframe self-talk.

Positive Self-Talk. His positive self-talk broke the cycle and led the way towards higher self-esteem. Positive self-talk is honest, but non-judgmental. It is being impeccable with your word.  Frequently it is a challenge to develop positive self-talk.

Can you think of some positive self-talk you can give yourself right now?

More Positive Self-Talk. Did you notice the courage and perseverance you have shown to get this far in an anger management course that asks you to look carefully at yourself and your behavior?  Having the courage to examine yourself, including your self-talk, is something you can always    remind yourself of. The process of noticing and reframing your self talk is an aspect of self-awareness and self control – both crucial to emotional intelligence.

It is clear the future holds opportunities – it also holds pitfalls. The trick will be to seize the opportunities, avoid the pitfalls, and get back home by 6:00.

                                                                         - Woody Allen

2. Don’t Take Anything Personally.

“Nothing others do is because of you. What others say and do is a projection of their own reality, their own dream. When you are immune to the opinions and actions of others, you won't be the victim of needless suffering.”

When we look at the situations that trigger our anger, we often blame others for our anger. What really makes us angry is thinking angrily about things that happen to us! Basically, we are not upset by things, but by our thinking about the situation. When somebody treats you poorly or acts aggressively toward you, don’t take it personally. Their behavior came from their upset thoughts, it is not about you, but about them.

When Somebody Else is Angry.  When somebody else is angry, don’t     let emotional contagion trigger your anger:

  •  Take a cleansing breath.
  •  Stay calm and focused.
  •  Use self-talk to reinforce that you will be OK
  •  Use active listening (Lesson 6) or assertive communications (Lesson 7)
  •  Take a time-out.

Don’t Be Your Own Victim.  Remember, you don’t want to suffer the health effects of anger. You are responsible for your own mental state. Don’t give away that responsibility or your power to an angry person! It will only cause you unhappiness. When somebody is angry, they are suffering.  Draw on your empathy to understand. Do not try to control the other person’s emotions, focus on your own thoughts and feelings. Keep yourself safe.

The paradox of our anger is, in our attempt to overcome feelings of vulnerability through the explosion of the strong feelings of anger, we become our own victim and diminish our humanity in the eyes’ of others as  well as in ourselves!

3. Don’t Make Assumptions.

“Find the courage to ask questions and to express what you really want. Communicate with others as clearly as you can to avoid misunderstandings, sadness and drama. With just this one agreement, you can completely transform your life.”

To “assume” makes an “ass” out of “u” and “me.” An assumption is a judgment without the benefit of the facts. Frequently, assumptions can lead to angry thoughts and feelings. Use communication skills to gather more information about the situation. Stay open to others’ points of view and practice empathy.

4. Always Do your Best.

“Your best is going to change from moment to moment; it will be different when you are healthy as opposed to sick. Under any circumstance, simply do your best, and you will avoid self-judgment, self-abuse and regret.”

Most of us have grown up with terrible examples of anger management and little guidance in emotional intelligence. We live in an angry society full of vengeful images; a society that frequently claims that anger leads to power. Doing your best means accepting the process of learning to manage anger better. It does not mean becoming instantly “perfect.”

Tom Wentz, Ph.D., C.A.M.F.
Anderson and Anderson Faculty Member

Violence is particularly acute for taxicab drivers, convenience store clerks and other retail workers, security guards, and others working in industries with high percentages of minority workers. These deaths often go unnoticed or are not chronicled in the media as other more sensational act of co-worker violence.

According to the National Institute for Occupational Safety and Health, workers are most at risk if their jobs involve routine contact with the public or exchange of money. Employees are also at increased in situations such as working alone or in small numbers, working very late or very early hours, or working in high crime areas. Other factor include, having a mobile workplace such as a taxicab or police cruiser, working with unstable or volatile persons in health care, social services, or criminal justice setting, guarding valuable property or possessions and working in community-based sittings.

“We have been viewing the problem of workplace violence too narrowly, and in so doing, we’ve not been able to get on top of it. It’s not just a crime issue, or a private industry issue, or a labor issue. It is a much broader public health problem.’ Said Dr. James Merchant, Dean of the University of Iowa’s College of Public Health.

Public health care professionals need training and anger management, stress management, assertive communication and emotional intelligence. They need to educate the public and their own colleagues on how best to stem workplace violence.

Certified anger management providers must take a more active role in advocating for violence prevention in addition to services for perpetrators of violence. Person-directed violence occurs in a variety of settings and is not limited to any particular profession, economic, or racial/ethnic group. All of the data show that it affects persons across the board and is not related to socioeconomic status.

George Anderson, MSW, BCD, CAMF, CEAP
Diplomate, American Association of Anger Management Providers
Anderson & Anderson®, The Trusted Name in Anger Management
http://www.andersonservices.com/
http://www.aaamp.org
http://www.linkedin.com/in/geoanderson
www.anger-management-resources.org

Disruptive physicians — the kind who insult nurses, throw tantrums and toss scalpels around — have always been a problem for hospitals and their employees. But the threat is looming larger given new developments, such as mandates that call for greater physician-coder/nurse interaction on issues that aren't purely clinical (e.g., present on admission (POA) reporting, hospital-acquired conditions payment restrictions, Medicare-Severity DRGs) and the government's push to link quality and payment. It's hard for a coder to team with a physician to make decisions about POA indicators if that particular physician tells the coder she's incompetent. And the hospital may struggle to thrive under value-based purchasing if a physician's contemptuousness leads to high nurse turnover.

As hospitals grapple with disruptive physicians, a new trend has emerged, making a stubborn problem even more resistant to improvement, says Pittsburgh attorney Henry Casale. Some disruptive physicians are trying to evade consequences for their behavior by claiming that they are not disruptive at all. Rather, they are whistle-blowers exposing hospital noncompliance and poor quality, but the hospital is trying to retaliate against their complaints by branding them troublemakers, he says.

"We are seeing this more and more," says Casale, who is with the law firm of Horty, Springer & Mattern. "Disruptive physicians raise specious claims that have no validity in an attempt to justify their disruptive behavior. Hospitals want to know legitimate compliance concerns, but if there were never any underlying compliance concerns, then lodging fictitious complaints is just another act of disruptive behavior. It's a very difficult issue, being made more complex and being obfuscated by claims that the disruptive behavior is part of some whistle-blowing activity."

Notwithstanding the distraction, the urgency for a solution remains. The Joint Commission requires hospitals to manage disruptive physicians. The code of conduct that hospitals must adopt for Joint Commission accreditation includes a standard for providing a "culture of safety and quality." That means "leaders set expectations for behavior" in the workplace, according to its Web site.

"Safety and quality thrive in an environment that supports working in teams and respecting other people, regardless of their position in the organization. Undesirable behaviors that intimidate staff, decrease morale, or increase staff turnover can threaten the safety and quality of care," the Joint Commission says.

Given the stakes, hospitals should consider ways to help disruptive physicians change their behavior, experts say. One approach is to do what hospitals do for any other outlier: confront physicians with data. Physicians respond to concrete information, even if it is about their own behavior, says Miami psychologist Larry Harmon, Ph.D. He runs a teamwork improvement program for disruptive physicians around the country.

Disruptive physicians are the kind who make life miserable for the people with whom they work — their health care team — with belittling remarks (e.g., "Are you a moron?"), sarcasm (e.g., "It's hard to believe you even have a nursing degree!"), yelling and screaming when things don't go their way and throwing things around the room.

Some physicians behave this way partly because of the milieu in which physicians are trained and practice, Harmon says. "Learning medicine is not a team activity," he says. "They spend much of their time learning technical skills, not teamwork skills." Also, physicians are what Harmon calls "feedback starved." The more prestigious the specialty (e.g., surgeons), the less likely someone will call the physicians on their behavior, he says. As a result, disruptive physicians may be highly skilled and passionate advocates for their patients, but nightmares as colleagues.

Physicians Respond to Feedback

So Harmon developed an educational program designed to get disruptive physicians to stop mistreating the health care team by giving them feedback they lack and helping them see themselves through other peoples' eyes.

There are three phases. First, there is assessment. Harmon sends personal e-mail surveys to the people who work with the disruptive physician. They are asked to answer, anonymously, a series of motivating (positive) questions and discouraging questions.

Examples of positive questions: To what extent does the physician treat team members with respect? To what extent does the physician adapt to changing policies? To what extent does the physician respond to conflict by trying to work out solutions? To what extent does the physician handle difficult team members effectively? To what extent does the physician point out mistakes in a helpful way? To what extent does the physician communicate clear expectations?

Examples of discouraging questions: To what extent does the physician talk down to team members? Overreact when little things go wrong? Yell and swear? To what extent does the physician get sarcastic or angry when asked important questions?

Avoidance, Favorable Comments Most Effective

Harmon summarizes the responses from the physician's team members and prepares a summary report and recommendations for the physicians. "Most [physicians] are surprised how negative the feedback is," he says. However, hearing the truth about how they are perceived "is necessary to break through the denial and defensiveness and to help the physician understand that his or her behavior is having a negative impact on others."

Disruptive physicians are particularly responsive to two kinds of feedback: (1) avoidance comments, such as when nurses state on the surveys that "I call in sick to work when I know you are scheduled [to perform] surgery" and "I am trying to get a job in another part of the hospital so I don't have to work with you"; and (2) favorable comments, such as "You're a great surgeon (even though I can't stand working with you)" and "I would take my mother to you for surgery." In other words, they are deprived of the compliments because of their demeanor.

Once all the feedback is in, Harmon analyzes it to home in more specifically on the disruptive physician's problem behaviors. That way, education can be tailored to the physician. There are education modules on frustration management, conflict management, people management and time management. For example, a physician who yells and screams a lot probably has an anger management problem.

Physicians then watch a video tailored to the triggers of their disruptive behaviors. It's designed to help the physicians change their behavior and work better as part of the health care team. They have to take an online test afterward to ensure they understood and absorbed the content, Harmon says.

Finally, Harmon monitors physicians for a year or so after the training to ensure the changes are sticking and bad behavior doesn't re-emerge. "We do periodic surveys [of the health care team] until the physician had had a sustained period of improvement," he says.

Harmon says that over the next five to 10 years, hospitals will emphasize "getting professionalism back. It will become routine." In fact, medical schools are already are addressing the importance of giving behavioral feedback to doctors-in-training. Harmon provides his program to all the medical students at the University of Miami, Miller School of Medicine. "Periodically giving and receiving feedback" is essential, he says. "You can't change what you don't know."

Reprinted from REPORT ON MEDICARE COMPLIANCE, the nation's leading source of news and strategic information on false claims, overpayments, compliance programs, billing errors and other Medicare compliance issues.

Emotional Intelligence and Anger.

The real test of our ability to understand, respond to, and manage our emotions is the way we handle anger.

1.  Do we use it in productive or counter-productive ways?

2.  Does our anger lengthen or shorten our lives?

There are several important things to remember when speaking of anger.

Anger is:

•  A powerful survival tool.
•  A source of energy.
•  A secondary emotion.
•  When angry, our brain “downshifts” to the primitive and instinctual level preparing for “fight, flight or freeze” response and higher level thinking momentarily ceases.
•  Anger that lasts for a long time is harmful.
•  Anger held-in is also very unhealthy.
•  Anger is a universal emotion everyone shares.

Anger is an Energizer. Anger is a natural emotional state and is designed to help us stay alive. Anger sends signals to all parts of our body to help us fight. It energizes us and prepares us for action. Often, the perceived need to protect ourselves comes from what amounts to psychological attacks from others.

Use Anger Wisely. When we feel energized by anger, it is smart to ask ourselves how we put this energy to its most productive use. How we wish to channel this energy. As with the use of other forms of energy, we want to use anger effectively and efficiently, not wastefully.

Anger is a Secondary Emotion. Beneath anger is always a primary emotion, such as fear, frustration, or sadness. The primary emotion comes from an unmet need. Our anger can become a signal to look for our unmet needs and care for them.

Anger – Its Role.

Anger, as a secondary emotion, rises out of some primary emotion, such as fear or loneliness, that signals an unmet human need, such as the need for connection.

Anger – The Visible Emotion.

Anger tends to feel powerful at the time. It gives us an illusory sense of control. It blinds us to our primary emotions, since they tend to feel weak and uncomfortable. We rarely notice what lies
beneath our anger.

Primary Emotions Are Signals.

We rarely notice our primary emotions. We quickly move through them and into anger. Becoming aware of our primary emotions gives us the choice of proceeding to anger or examining our needs.

“Negative” Primary Emotions.

When we feel angry, our primary emotions are “negative” emotions. “Negative” means that they come from unmet needs: An unmet need for connection to other people may give rise to loneliness, a negative emotion.

“Positive” emotions come from fulfilled needs: When our need for connection is fulfilled, we may experience happiness or love, both positive emotions.

Working Effectively with Primary Emotions.

By ignoring our primary emotions and emotional needs, we may actually move further from fulfilling them: If we act out our anger, we tend to push others away from us. This leaves our need for connection unfulfilled and increases our loneliness. If we look beneath our anger, we can discover what we need and work to get our needs met: realizing that we need to connect, we can use appropriate communications to connect with a friend, or we can learn to soothe ourselves with self-talk, taking care of our unmet needs.

Unmet Needs – The Root.

By understanding our unmet needs we can develop a strategy to fulfill them. We can share them with people who are close. We can work to calm ourselves, self-soothe, to help ourselves positively instead of acting out.

Unmet Needs – A Time To Heal.

Often, when using the Anger Log, ABCD process (Beliefs, Feelings, Actions, Dispute), we discover that our beliefs are immature: “I want to do what I want to do, and I get angry when anybody gets in my way or I don’t get my way!”

If we don’t act out our anger, we practice changing our old habits by using self-control. We develop maturity! By using the Anger Pyramid to discover and fulfill our needs, we demonstrate to ourselves and others, our growth and maturity and we discover inner resources – strength, self-confidence, and trust in our abilities to cope with situations and other people. We discover more reasons to be positive and fewer reasons to act out.

Tom Wentz, Ph.D., C.A.M.F.
Faculty Member, Anderson and Anderson

Emotions Are Important. Our emotions are a critical source of information. Our emotions are necessary for us to make decisions. Studies show that when a person has an accident in which those structures of the brain that deal with emotions is damaged the  person cannot make even simple decisions. Why? Because the person has lost the capability to feel and thus, evaluate their decision. Social Neuroscience has demonstrated cognition requires emotion in order to complete the transaction of the decision-making process. Without emotion, cognition remains incomplete and unfulfilled.   

Our Bodies Talk. Our emotions help us communicate with others. Our facial expressions, for example, can convey a wide range of emotions. If we look sad or  hurt, we are letting the other person know that we need their help. If we are verbally skilled we will be able to express more of our emotional needs and thereby have  a better chance of filling them. If we are good at listening to the emotional needs of others, we are better able to help them feel understood, important, and cared about. The emotionally intelligent person is able to read, with some accuracy, the feelings conveyed non-verbally by those with whom he or she interacts.

Stress Reduces Our Ability to Feel. As our society has become more pressured and we are constantly overwhelmed by stress, our ability to recognize and respond to our own feelings and those of others is diminished. Overwhelming feelings of stress result in a reduced ability to manage intense feelings and an increase in stress-related disorders. Consequently, there is an increase in road rage, desk rage, air rage, voice-mail rage, verbal and physical aggression, violence against  others, substance abuse, and other inappropriate displays of anger.

Emotions Bring People Together. Our emotions are perhaps the greatest potential source of uniting all members of the human race. This is what makes us human and creates the potential for our humanity. Clearly, our various religious, cultural and political institutions have not united us. Far too often, in fact, they have even divided us. Emotions, on the other hand, are universal.

Emotions are Universal. The emotions of…

• Empathy - The ability to understand and share someone else’s feelings.

• Compassion - The ability to care about and give to someone else.

• Cooperation - The ability to work together to achieve a common goal.

• Forgiveness - The ability to pardon someone for a grievance against you or against someone one or
  something you care about.

All of these emotions have the potential to unite us as people. Our thoughts may tend to divide us, whereas our emotions, if given the chance, will unite us in our humanity.

Tom Wentz, Ph.D., CAMF
Faculty, Anderson & Anderson®
Trusted Name in Anger Management

Emotional intelligence is a relatively recent concept, which is related to the ability to understand one’s own feelings and behavior as well as the capacity to sense the feelings and needs of others and to utilize this information in a way that enhances interpersonal relationships. Emotional Intelligence is also the capacity to create positive outcomes in our relationships with others and ourselves. Positive outcomes include joy, optimism, and success in work, school, and life. Increasing emotional intelligence has been correlated with better results in leadership, professional and academic, performance, marriage, friendships, and overall health.

Recognizing as well as understanding our feelings and emotions and then, managing their impact on other people must be practiced to internalize the skills being taught. We believe that it is important to take an interest in people and learn to listen to their views, problems and concerns. As previously learned in The Practice of Control, listening is important in communication and is a skill that can be learned as well as improved upon.

Emotional intelligence (EI) encompasses four domains:

   1.  Self-Awareness.
    2.  Self-Control.
   3.  Social-Awareness.
   4.  Relationship Management.

Self-awareness facilitates both empathy and self-control. Empathy and self-   control combine to provide effective relationship management.

Self Awareness is the Foundation. Without self-awareness, we cannot be aware of our emotions. We cannot manage emotions we are not aware of, so our emotions will tend to be out of control. Out of control emotions impair our ability to experience empathy and to connect with others. When our emotions are out of control, our relationships suffer – we do not have social awareness or the ability for social management.

Emotions Are Our Guidance System. Nature developed our emotions over millions of  years of evolution. As a result, our emotions have the potential to serve us today as a guidance system. Our emotions let us know when any natural human need is not being met. For example, when we feel lonely, our need for connection with other people is unmet. When we feel afraid, our need for safety is unmet. When we feel rejected, it is our need for acceptance that is unmet.

Perception Is Everything. The way we appraise (see) our environment at any given time is important in determining how we respond emotionally. If we appraise a situation as a threat, put-down, or an insult, we are more likely to respond with anger and negativity.

Thomas L. Wentz, Ph.D., C.A.M.F.
Faculty, Anderson and Anderson Anger Management

The Mental Health Foundation today released a report showing problem anger is left untackled in the UK, despite widespread concern about aggression, family breakdown and physical and mental health problems linked with anger.

The Boiling Point report says chronic and intense anger has been linked with heart disease, cancer, stroke, colds and flu as well as depression, self-harm and substance misuse. Higher levels of anger are related to lower levels of social support and higher stress levels. Anger is more likely to have a negative effect on relationships than any other emotion.

Problem anger goes largely untackled unless someone commits an aggressive criminal act, when a court may refer them to anger management training. The charity says we are intervening too late and could save many lives from being damaged if we tackled it earlier.

The report records interviews with GPs, psychologists and providers of anger management courses and therapies as well as a public attitude survey.  A literature review carried out for the report suggests anger studies and interventions for problem anger are in their infancy.

Anger is a vital emotion, and essential to our survival, but it can become entrenched in everyday life for some people, interfering with their thinking, feeling and behaviour and creating misery for themselves and others.

A public attitude survey carried out for the report shows widespread concern. Almost two thirds (64 percent) of participants in a YouGov* survey of just under 2,000 adults say that people in general are getting angrier. According to the poll almost a third of us (32 percent) have a close friend or family member who has trouble controlling their anger. More than a quarter (28 percent) of us worry about how angry we sometimes feel; and one in five (20 percent) of us say we have ended a relationship or friendship with someone because of how they behaved when angry.

Polling also found strong public support for tackling problem anger – 84 percent of us believe that people should be encouraged to seek help if they have problems with anger. But 58 percent wouldn’t know where to go.

Dr Andrew McCulloch, Chief Executive of the Mental Health Foundation said:

“In a society where people can get help for depression and anxiety, panic, phobia, eating disorders and a range of other psychological and emotional problems, it seems extraordinary that we are left to fend for ourselves when it comes to an emotion as powerful as anger. We need to be able to recognise when anger is damaging our lives, ask for help and receive it.

In the media and in mainstream life we hear a lot about road rage and many other types of rage. Our polling shows that the general public understands what’s going on. But as a society we have yet to tackle the issue. It is the elephant in the room in mental health. This is not about excusing bad behaviour, but about helping individuals and communities to take responsibility. Tackling it won’t be simple or straightforward, but the benefits could be enormous.”

The report says that problem anger is not a mental illness in itself but many of the everyday tools used in mental health - such as talking therapies - can be applied to help people cope better with anger. But the area has been neglected by researchers, clinicians and policy makers. Consequently people who might benefit enormously from learning how to manage their anger better are not encouraged to come forward, or when they do, they may be offered little or nothing in the way of useful support.

Boiling Point says that there are already a number of schemes run by public, private and voluntary sector organisations that are targeted at helping people deal with problem anger. But most of these are post-hoc interventions to which people are referred because they have already got into considerable trouble at home, work or with the police and criminal justice system.

Nancy Anderson

Nancy Anderson is the president of Anderson & Anderson, and the quiet impetus of its success. Nancy earned a Bachelor’s and two Master’s Degrees from UCLA, where she has also been a member of the clinical staff at the Neuropsychiatric Institute. She is licensed in Educational Psychology and Clinical Social Work in the state of California.

Currently, Nancy maintains a clinical psychotherapy practice at Anderson & Anderson and is available for consultation on educational or family issues that can not be addressed by an anger management program. She also works as an educational psychologist for The John Thomas Dye School in Bel Air. Although she is certified in anger management, her primary involvement at Anderson & Anderson has been as the CEO.

John Elder, MA, MFT, CAMF who is a long time Anderson & Anderson Faculty member will begin providing coaching in San Bernardino County and cities in easy commute from Loma Linda, CA.

John Elder, M.A., M.F.T.

Mr. Elder has been a facilitator and Anderson & Anderson Faculty for several years. John is one of the most interesting members of our faculty. He has assisted in writing most of our material and is a regular contributor to our blog and website. John is the author of the Anger Management Pyramid as well as the new meditation relaxation tape which will both be listed on our website very shortly. He is also the co-author of our new publication, “The Practice of Control".

Since the new JCHAO standards for “disruptive physicians” were imposed on all Health Care Organizations in April, 2008, Anderson & Anderson, Vanderbilt University Department of Psychiatry and the PACE Program at the University of California at San Diego have emerged as the principal providers of Executive Coaching/Anger Management for Physicians in the nation. Anderson & Anderson is the only nationally recognized provider to use a structured, non-psychiatric assessment tool for mandated and self referred physicians.

George Anderson, MSW, BCD, CAMF, CEAP
Diplomate, American Association of Anger Management Providers
Anderson & Anderson®, The Trusted Name in Anger Management
http://www.andersonservices.com/
http://www.aaamp.org
http://www.linkedin.com/in/geoanderson
www.anger-management-resources.org

They call it "shopping rage" but that trivialises something that is eating us alive - a willingness to resort to extreme violence at the slightest provocation.

Where someone would once have raised their voice, they now raise their fists. Incidents that would have, at the very worst, led to A&E now end in the graveyard, the court and jail. What is wrong with us? When did a country famous for its humour, patience and tolerance give itself over to this uncontrollable rage?

Rage is our distinguishing feature now. And we know it can erupt at any moment. You see it everywhere. You risk your life if you object to anti-social behaviour.

Respect is a term we hear a lot of, but there is precious little of it for old people, for women, for children. It feels like all the old taboos have been discarded, all the old borders that made this a decent society have been torn down.

Where there was once indulgence for the old lady with her change in a shop, there is now impatience.

Where there was once tolerance for the ways of others, there is now murderous fury.
And where there was once politeness, there is now rudeness.
Something about us has coarsened. The man who died in Sainsbury's would not have perished even 10 years ago. The man who assaulted him would not so readily have resorted to extreme violence. This is not looking back at the good old days through rose-tinted contact lenses - we really were a gentler, more tolerant people.

I don't know how you get it back, that lost England where someone would behave on a train or bus just because someone rattled their newspaper. But I know it is gone.

We all feel the frustrations of the modern world and impatience with people who get in our way.

What has changed is the total lack of restraint. We have lost the fear of our father, of the police, of the courts, our fear of being punished.

So anger is allowed to erupt like a volcano because someone cuts us up at the lights, or looks at us the wrong way, or upsets our girlfriend at the checkout.

It's ironic that the generations who knew the suffering of war and poverty are less angry than the brats of peace and prosperity.

Reports suggest the man who died wasn't the one who jumped the queue. He was patiently waiting his turn.
The wrong man was punished for a petty crime.
But that's anger for you. When the red mist descends, all you can think about is violence. The brain switches off. And a man dies from massive head injuries because a woman was slighted and her boyfriend's response was immediate, uncontrollable rage.

And why? Because someone thought they might have to wait an extra 90 seconds to pay for their oven chips.
We have to get back to the old ways when respect was something you showed others, not something you furiously demanded yourself.

Where the old and the weak and the young were tolerated, not regarded with impatience.
And where a man could face the everyday frustrations of life without losing his rag.
Where there was once tolerance for the ways of others, there is now murderous fury. What is wrong with us?

Philo Holland
Senior Broadcast Journalist
BBC Radio Five Live
Manchester
Phone: x44290 (0161 244 4290)
Fax: 07921 648 298
E0mail:  [mailto:philo.holland@bbc.co.uk]
Mail: Room 1044, BBC, Manchester, M60 1SD 
          909 & 693 AM, digital radio & TV, & online at http://www.bbc.co.uk/fivelive

There are some crimes so abhorrent that they make us wonder what kind of society we're living in. One of these bouts of soul-searching was prompted last week when a man died after a violent altercation in a Sainsbury's supermarket in south London; a man and a woman have since been charged with the murder of Kevin Tripp, a 57-year-old engineer from Colliers Wood.

Shocked friends and neighbours paid tribute to Mr Tripp, who suffered from ME, and there were harrowing pictures of the grief-stricken mother of his five-year-old daughter. Several lives have been destroyed by an event that was over in seconds; and another child - like those of 47-year-old Garry Newlove, who was kicked to death in Warrington last August - now has to grow up without a father.

Mr Newlove was set upon when he challenged a group of youths who were damaging a car. Mr Tripp was attacked, apparently after a row over queue-jumping. What was especially shocking about these deaths is that none of us expects to encounter lethal violence in everyday life; we don't kiss friends and partners as they set off for Sainsbury's, crossing our fingers and desperately hoping they'll survive the trip. Crime surveys tell us that such extreme events are relatively rare, but the phenomenon they appear to highlight - an increase in aggressive behaviour - is causing great concern.

Evidence is accumulating that substantial numbers of people have never learned to handle anger and aggression, reacting with uncontrolled fury to minor setbacks and slights. Alcohol sometimes plays a part, but random flare-ups of hostile behaviour have become so common that we talk about road rage, air rage, even supermarket rage, as if they're a normal part of existence. Drive slowly when you're lost, and you may see the faces of other drivers contort with anger as they try to overtake. Politely ask the person in front of you on a plane not to slam their seat back, and they're likely to let loose a stream of abuse. Adults' behaviour affects children, and bullying is now a major problem in schools, where kids use text messages and the internet to persecute vulnerable classmates.

None of this is happening in a vacuum, and it's perverse to deny a link with popular culture. Everywhere I look, aggressive behaviour is egged on and validated, whether it takes the form of celebrities being encouraged to slag each other off or TV chefs haranguing their hapless assistants. Big Brother and its spin-offs choose contestants with poor impulse control and an infantile desire for attention, cynically pitting them against each other.

Nowhere is this more evident than on the internet. Many people who post messages seem to be in the grip of ungovernable rage, which they direct randomly at anyone who comes into their sights, like drunks lurching out of a pub in search of a punch-up.

The urge to insult, hurt and humiliate is clearly part of human nature. But it is more prevalent in some cultures than others, and its antidote is just as well-known. Civilised societies don't reward displays of petulance and anger. They certainly don't pretend that good manners are only for wimps.

Philo Holland
Senior Broadcast Journalist
BBC Radio Five Live
Manchester
Phone:  x44290 (0161 244 4290)
Facsimile: 07921 648 298
E-mail: [mailto:philo.holland@bbc.co.uk]
Mail: Room 1044, BBC, Manchester, M60 1SD 
          909 & 693 AM, digital radio & TV, & online at http://www.bbc.co.uk/fivelive

Each provider on the list has been trained by Anderson & Anderson to help clients address and manage the following five areas: Anger Management, Stress Management, Communication Styles, Emotional Intelligence (Empathy), and Orientation to Change. It is required that all providers on our list purchase a number of materials from Anderson & Anderson, materials that are crucial to the professionalism and structure of the Anderson & Anderson anger management model. Providers, like all professionals who offer counseling or skill-enhancement services, are required to remain current with knowledge and any changes or enhancements that are made for the curriculum. This involves 16 hours of continuing education per year. We will provide specific details for anyone who wants to become certified and listed on our court providers list.

One thing that each provider must keep in mind is that Anderson & Anderson does not guarantee a number of referrals that a provider will receive when listed on the court list. While the courts in L.A. County exclusively refer mandated clients to our list (each mandate will receive a copy of the list), there is no guarantee that a provider will receive phone calls. It is the responsibility of the provider to market his or her services to the general public. We recommend internet marketing as a primary strategy. Anderson & Anderson provides marketing information and advice during our three-day training seminars. In addition, much of this information is included in the Suggested Guide for Anger Management, the facilitator’s guide that is included in both the live trainings and the home study versions. Please call Anderson & Anderson if you have any additional questions.

Rasheed Ahmed
Office Manager
Anderson & Anderson®
The Trusted Name in Anger Management
Ph: 310-207-3591  
Fax: 310-207-6234
http://www.andersonservices.com

•Passive Communication = The passive communicator avoids direct eye contact, fails to  accurately  express his or her feelings, and tends to have low self-esteem. The anger
 is self-directed rather than directed at the source of the anger.

•Passive-Aggressive Communication = The passive-aggressive communicator often
 sounds passive, but is hostile in his/her manner of speaking. He/she uses sarcasm and
 other hostile gestures to get a point across. The listener is left without any indication
 of what the passive-aggressive communicator needs or wants.

•Aggressive Communication = The aggressive communicator invades the space of
 the listener, speaks in a threatening manner, and may throw objects, glare, or attempt
 to intimidate the listener. He or she attempts to blame the listener for whatever
 the source of the disagreement may be.

•Assertive Communication = The assertive communicator speaks in a reasonable
 tone, establishes eye contact with the listener, uses “I” messages, and clearly states
 his or her needs, feelings, and requests. He/she invites the listener to work
 towards a mutually satisfactory resolution of the conflict. This person
 consciously influences the listener by his/her own behavior, and demonstrates skills
 in emotional intelligence.

From these descriptions, you can see which kind of style is crucial for maintaining positive relationships with others. It is important for us to be assertive, especially in circumstances where the listener has done something to incite the anger. The key to getting one’s needs met with resolution is to be the bigger person. Being the bigger person means being Assertive…not aggressive, not passive-aggressive, and definitely not passive.

George Anderson, MSW, BCD, CAMF, CEAP
Diplomate, American Association of Anger Management Providers
Anderson & Anderson®, The Trusted Name in Anger Management
http://www.andersonservices.com/
http://www.aaamp.org
http://www.linkedin.com/in/geoanderson
www.anger-management-resources.org

This is an election year. As a community, we need to be able to trust our leaders and peacekeepers. Can they control their own emotions? Do they have the ability to lead with sound reason? Reason is evaded when problem anger arises.

We cannot underscore the importance of key emotional intelligence skills such as empathy, compassion, awareness, and social conscience when resolving conflict in the face of crisis. A leader’s ability to remain grounded and calm is key to successful conflict and anger management.

Trust and credibility are important in leadership roles. These roles are not limited to the government. Leaders are all kinds of decision-makers - managers, executives, physicians, attorneys, and law enforcement, to name a few. These types of positions often are appointed to individuals who have integrity and the ability to guide. Maintaining these roles to the extent they are intended requires exceptional discipline of one’s emotions, understanding of one’s shortcomings, and having the ability to seek guidance when needed.

By Sonia Brill, LCSW, CAMF
http://www.soniabrillconsulting.com

First, the Anderson and Anderson model recognizes anger as a normal human emotion. Anger is not a mental illness nor is there a diagnosis for anger in the DSM V (Diagnostic and Statistical Manual). As a result, the Anderson and Anderson model utilizes a cognitive-behavioral approach, with structured classes and a client workbook, to address when anger is problematical in a person’s life. Specifically, anger is a problem when it is “too intense, too frequent, too long of duration (including resentments), leads to aggression, and when it destroys personal and professional relationships.” 

Secondly, the Anderson and Anderson model also recognizes anger as a “secondary emotion.” Anger arises from a hidden (or denied) primary emotion and the client’s unique and learned belief system. The Anderson and Anderson model sharpens the focus and the folly of a client’s anger to identify the primary emotion and the client’s underlying belief system through practical writing exercises, DVDs, class interaction, and role-playing.

The primary efficacy of the Anderson and Anderson model is found in its direct approach to changing behaviors – immediately! The Anderson and Anderson model is a skills building curriculum that addresses the “what” of angry behavior rather than addressing the psychotherapeutic reasons, or the “why” a client is angry! The success of realizing the capacity, ability, and self-confidence resulting from changing one’s behavior has enormous traction and inertia or “legs” for changing other maladaptive behaviors as discovered by those treatment centers using the Anderson and Anderson model of anger management!

Tom Wentz, Ph.D., C.A.M.F.
Anger Management Facilitator
Anderson & Anderson, A.P.C.

Our Belief System

A personal conflict belief system is formed from messages we receive throughout our lives from parents, family of origin, religion, culture, friends, teachers, the media and individual experiences. The beliefs affect how we respond to tension, conflict or anger.

Reaction to Conflict

Our reaction to a particular conflict is based on our beliefs about conflict itself. If we believe that conflict is basically negative, we usually react in a negative fashion, for example, by complaining, fighting or person directed aggression. If we believe that conflict is neutral and happens every day, we will react calmly and logically. Most important we react to a conflict has consequences for everyone involved.

Some Consequences of Our Reaction

The consequences of our reaction will also be negative or positive. If our reaction is to respond aggressively or passively, the consequence may be hurt feelings and the problem may get worse. If, instead, we agree to talk about the problem, calmly and assertively, there will likely be positive consequences such a good feeling about ourselves and about the other person. A positive/emotionally intelligent reaction may even help us solve t he problem causing the conflict.

Enhancement skills in managing anger, stress, communication and increasing emotional intelligence can be acquired by attending executive coaching or anger management classes.

George Anderson, MSW, BCD, CAMF, CEAP
Diplomate, American Association of Anger Management Providers
Anderson & Anderson®, The Trusted Name in Anger Management
http://www.andersonservices.com/
http://www.aaamp.org
http://www.linkedin.com/in/geoanderson
www.anger-management-resources.org

Anger, stress, tension and conflict in the workplace, which may have been addressed earlier at lesser cost to all involved, must be approached in a crisis mode. Providers of anger management, executive coaching, conflict management, stress management and Employee Assistance are suddenly being inundated with referrals from H.R. Managers nationwide. It is incumbent on the part of all Anderson & Anderson anger management providers nationwide to make the public aware of services that address workplace anger and stress. Ads should be placed on some or all of the follow sites: www.andersonservices.com, www.aaamp.org, www.anger-management-resources.org, Google, Yahoo and MSN.

George Anderson, MSW, BCD, CAMF, CEAP
Diplomate, American Association of Anger Management Providers
Anderson & Anderson®, The Trusted Name in Anger Management
http://www.andersonservices.com/
http://www.aaamp.org
http://www.linkedin.com/in/geoanderson
www.anger-management-resources.org

After that, we went to USC so I could go on the Cinema School tour. I think it was worthwhile just for some of the anecdotes, like the fact that Spielberg built a sound facility at USC because he lost a bet with Lucas over whether or not the first Indiana Jones would do well or not (Lucas would have built one at his alma mater if it hadn't).

I really screwed up the back of my feet with the shoes I was wearing, so we went to the Grove to watch Prince Caspian. It could have been worse... but it could have been a whole lot better. They definitely focused too much on the battles to the detriment of the character development. And I really hate how all of those novels/movies beat the God into you... I know that was C.S. Lewis' goal, but really. "Why didn't I see Aslan?" "Maybe you didn't want to see him." "Why hasn't Aslan come to help us?" "Maybe he wants us to help ourselves." UGH.

The Grove Theater and the shops around it were beautiful, though.

After the movie we went to Canter's Deli for dinner. Roozbeh certainly knows all the diners in town, since he's so used to being on shoots at all hours =)

Watch and listen to Dr. Wentz’s analysis, economically responsible approach, and message of hope for San Francisco’s students.

You can see Dr. Wentz’s panel presentation by following these instructions:

• Click on http://sanfrancisco.granicus.com/MediaPlayer.php?publish_id=285

• Then Click Video on Demand

• Then Click Additional Programs

• Then scroll down to Public Defender's Juvenile Justice Summit 2008 and click the link

If you have any questions, you may call Anderson & Anderson at 310-207-3591.

George Anderson, MSW, BCD, CAMF, CEAP
Diplomate, American Association of Anger Management Providers
Anderson & Anderson®, The Trusted Name in Anger Management
http://www.andersonservices.com/
http://www.aaamp.org
http://www.linkedin.com/in/geoanderson
www.anger-management-resources.org

The new July 2008 Anderson & Anderson® Anger Management Providers List will be aggressively used as a marketing tool for all anger management providers that utilize our model in Los Angeles County. We update the list every six months by making requested changes (for the providers currently on the list) and adding new providers who have met all of the standards that are necessary for correctly providing and teaching the skills of the curriculum. Anderson & Anderson® will make all necessary changes for the upcoming list by June 16th; then, the process for getting the list distributed to all of the courts by July 1st will commence. Anderson & Anderson® will mail ten copies of this list via priority mail to all criminal courts that handle misdemeanor cases. In addition, Family Law Courts, as well as the Children’s Courts and the Department of Children & Family Services, will be included in this mailing. Each provider on the list will also receive a copy of the list via e-mail.

We request that all providers on this list actively participate in this marketing campaign by doing the following:

• Place a copy of this list on your website

• Include a copy of this list in your marketing to Police Departments, Human Resource
   Managers, Attorneys, Probation Departments, Parole and other organizations

• Include a statement on your business cards as well as brochures and flyers referencing your inclusion on 
   this exclusive list.

• Place a simple ad on Google, Yahoo, MSN, Craigslist.com, and topix.net. This will market your website. 
   your website. Also, you would be wise to advertise your site on www.aaamp.com and 
    www.anger-management-resources.org

• Make references to your status as an approved Anderson & Anderson provider.

• Finally, place links from your website to every other provider’s site who is on the list. This gives your
   list. This gives your organization and all other providers on the Los Angeles List. This gives your
   organization and all other providers on the Los Angeles List credibility. It increases the ranking of the 
   increases the ranking of the entire group.

Please contact George Anderson or Rasheed Ahmed in our office for more information or assistance.

George Anderson, MSW, BCD, CAMF, CEAP
Diplomate, American Association of Anger Management Providers
Anderson & Anderson®, The Trusted Name in Anger Management
http://www.andersonservices.com/
http://www.aaamp.org
http://www.linkedin.com/in/geoanderson
www.anger-management-resources.org

What I do recommend is making this delicious and easy grapefruit and orange salad. Served chilled with mint, it's indescribably refreshing.

If that doesn't give you enough relief from the heat, here's another suggestion: slice up some lemons, then toss them in a pitcher of ice water with some mint sprigs. A confession: I've unabashedly stolen this idea from the lovely folks at Culver City's Café Surfas — you know what they say about imitation and flattery.

Stay cool...

Citrus Salad with Mint Sugar, from Bon Appétit
Makes six portions.

2 white grapefruits
2 pink grapefruits
6 large navel oranges
½ cup fresh mint leaves
¼ cup sugar
Seeds from 1 pomegranate or ¼ cup dried cranberries (I skipped this step; pomegranate season is October through January, and the idea of dried cranberries in this salad didn't appeal to me. That said, I realize it's not quite citrus season, either. It's a heck of a lot closer though.)

1. Cut peel and white pith from grapefruits and oranges. Cut between membranes to release segments. Combine fruit in large shallow bowl. (Fruit can be segmented one day ahead. Cover and refrigerate.)
2. Place mint and sugar in processor. Pulse on and off; blend until mint is finely chopped, occasionally scraping down sides of bowl. Sprinkle mint sugar and pomegranate seeds over fruit; serve.

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