Employee Assistance Professionals Are Not Trained in Anger Management

Many companies and governmental agencies throughout the nation claim to offer anger management assessments, referrals and counseling as an employee benefit through their employee assistance programs. Unfortunately, most employee assistance professionals have no training or experience in anger management assessment or intervention.

Recently, a key member of the Employee Assistance Program Staff of the United States House of Representatives completed certification from Anderson & Anderson in anger management facilitation. This EAP manager explained that she is professionally trained at the Masters level in Clinical Social Work and substance abuse counseling. She acknowledged that she had no training in anger management and was not sure what anger management really is. Furthermore, she was unaware of appropriate referral resources for clients in need of anger management in her local area. She and her staff were routinely referring clients to mental health providers with disastrous results.

The highest level of professional certification in the employee assistance profession is the Certified Employee Assistance Professional, CEAP. I am a CEAP with over thirty years of experience. I can say with certainty that there is neither a requirement nor any mention of anger on the CEAP certification exan relative to anger or anger management. In spite of this, business, industry and governmental agencies are relying on Employee Assistance Providers to offer assistance in anger management as an employee benefit.

The information below is taken directly from the website of Employee Assistance Professional Association: http://www.eapassn.org/public/pages/index.cfm?pageid=507.

What is employee assistance?

Employee Assistance is the work organization’s resource that utilizes specific core technologies to enhance employee and workplace effectiveness through prevention, identification, and resolution of personal and productivity issues.

What is an employee assistance program (EAP)?

An employee assistance program (EAP) is a worksite-based program designed to assist (1) work organizations in addressing productivity issues and (2) “employee clients” in identifying and resolving personal concerns, including, but not limited to, health, marital, family, financial, alcohol, drug, legal, emotional, stress, or other personal issues that may affect job performance.

EAP Core Technology

The employee assistance program Core Technology (EAP Core Technology) represents the essential components of the employee assistance profession. These components combine to create a unique approach to addressing work organization productivity issues and “employee client” personal concerns affecting job performance and ability to perform on the job. The EAP Core Technology consists of the following:

(1) Consultation with, training of, and assistance to work organization leadership (managers, supervisors, and union stewards) seeking to manage the troubled employee, enhance the work environment, and improve employee job performance, and outreach to and education of employees and their family members about availability of EAP services;

(2) Confidential and timely problem identification/assessment services for employee clients with personal concerns that may affect job performance;

(3) Use of constructive confrontation, motivation, and short-term intervention with employee clients to address problems that affect job performance;

(4) Referral of employee clients for diagnosis, treatment, and assistance, plus case monitoring and follow-up services;

(5) Consultation to work organizations in establishing and maintaining effective relations with treatment and other service providers and in managing provider contracts;

(6) Consultation to work organizations to encourage availability of, and employee access to, health benefits covering medical and behavioral problems, including but not limited to alcoholism, drug abuse, and mental and emotional disorders; and

(7) Identification of the effects of EA services on the work organization and individual job performance.

A careful reading of the core technology and description of an Employee Assistance Program above clearly shows that anger or anger management is never mentioned. Yet anger management “counseling and referrals” are offered daily throughout the nation by EAPs. At the very least, this appears unethical, unprofessional or even fraudulent.

There is nothing in the core technology to assure that EAP professionals have any exposure whatsoever to anger management. Anger is not a mental health issue as determined by the American Psychiatric Association. Specifically, the APA maintains that anger is not a pathological condition and is therefore not listed in the Diagnostic And Statistical Manual of Nervous and Mental Disorders (DSMIV). Given this information, it is clear that mental health professionals, including Employee Assistance Professionals, have no expertise in anger management.

Anger management referrals are on the rise

Bullying workers may say they don’t push other people around, but ComPsych Corp., an employment assistance program, says it has had an uptick in anger management referrals due to bullying or intimidating behavior.

The Chicago firm polled 1,000 employees from US firms around the country between March and April. Of those, only 3 percent described themselves as intimidators. But the company said that when it reviewed its caseload, it found that 90 percent of the anger management cases it receives yearly stemmed from clients’ concerns about bullying behavior.

The company, which examined how employees resolve conflicts in the workplace, said 10 percent of the respondents fell into the following groups: negotiators who use bargaining tactics to ease tensions and find common ground; communicators who rely on their persuasive abilities; avoiders who shy away from conflict; or procrastinators who tend to wait before diving in and resolving a problem with a co-worker. According to the company, people who bully colleagues or subordinates are more likely to demonstrate poor restraint, including angry outbursts or abusive language at work. In fact, these are the co-workers who get their way by forcing their peers to submit.


All Employee Assistance Professionals should be trained and certified as anger management facilitators. This will assure that they are capable of assessing the needs of employees in need of assistance in managing anger, stress, improving communication and increasing emotional intelligence. Human Resource Managers and Risk Management Consultants should have a minimum of two or four hour introduction to anger management assessment and referrals.

Health and mental health professionals should be offered elective courses in anger management from competent, experience facilitators of anger management.

There should and will be a coordinated national campaign initiated by the American Association of Anger Management Providers to inform the public of the importance and scope of anger management practice nationwide.

George Anderson, MSW, BCD, CAMF, CEAP
Diplomate, American Association of Anger Management Providers
Anderson & Anderson®, The Trusted Name in Anger Management

On-line Anger Management Schools a Consumer Disaster

Anger Management as a discipline is an emerging area of specialization that lacks state or local regulations. In spite of its popularity, few Judges and Prosecuting Attorneys really understand what a legitimate anger management program should include. Anger management is a course that is designed to teach enhancement skills in recognizing and managing anger and stress, increasing assertive communication and emotional intelligence. Anger management is not counseling nor psychotherapy, and is therefore not designed to treat emotional or nervous disorders. All anger management programs should contain the following:

  • Trained Facilitators with a minimum of 40 hours in the assessment and intervention of adolescents and adults   referred to anger management programs.
  • A specific  anger management curriculum that includes Pre and Post Test tools.
  • Language and culture specific client workbooks designed to teach the skills in anger management, stress  management, communication and emotional intelligence.
  • Ancillary training material including posters, DVDs, videos and other instructional guides.
  • After-care/follow-up of clients who have completed the course in order to reduce the potential for recidivism.

Currently, on-line anger management providers are equivalent to on-line traffic schools. Anyone with computer skills can open his or her program without any standards whatsoever. Therefore, it is the consumer who is the ultimate loser. Ideally, all providers should be members of the American Association of Anger Management Providers and listed on their provider list at www.aaamp.org.

George Anderson, MSW, BCD, CAMF, CEAP
Diplomate, American Association of Anger Management Providers
Anderson & Anderson®, The Trusted Name in Anger Management

Latest Trends in The Emerging Specialization of Anger Management Services

Hospitals and Health Care

The Joint Commission on the Accreditation of Health Care Organizations, JCAHO, is requiring new standards for “disruptive behavior” among professional healthcare staff. Disruptive physician behavior has been determined to increase medical errors and risk patient safety. These new requirements have created a Cottage Industry for specialized anger management facilitators nationwide. Resources designed to address this issue are now available on-site as well as locations in a number of major cities.

The dramatic rise in the incidence in “traumatic stress disorder” among returning Iraq veterans has increased the need for Clinical Social Workers, Psychologists and Psychiatrists to seek certification training in anger management since person directed aggression is a chronic problem for veterans with this diagnosis. As experts in the treatment of post- traumatic stress disorder, VA Hospitals and Veterans Resource Centers are aware of the need for specialized intervention for PTSD and are moving to seek anger management facilitator certification for its treatment staff.

Criminal Justice System

The state of New York joins California and Texas in offering anger management in jails and prisons for inmates whose original offense included person or property directed violence. Research conducted by the Bureau of Prisons in Canada and Australia have demonstrated the value of anger management in the reduction of recidivism in violent prison inmates. California now requires anger management for inmates as well as parolees prior to completion of their parole status.

Business And Industry

The average cost of litigation in alleged cases of a “hostile work environment” is $720,000 per case. Businesses small and large have quickly discovered that offering anger management for interpersonal conflicts at work is a saving rather than a cost.

Organizational anger management can be offered by Certified Anger Management Facilitators to small groups of 10 to twenty participants. These courses are between two and four hours. They are proactive and are designed for prevention. Prevention is far less costly than crises intervention following a violent incident at work.

For many years, “going postal” was used to describe employees whose workplace violence led to injury or death. Eight years ago, the U.S. Postal Service began offering anger management on the clock, without cost to any postal employee. In addition, employees who appeared to be experiencing stress or anger at work were mandated to take anger management classes. This approach was so successful, one rarely hears of violence in the U.S. Postal Service.

Pre-employment anger assessments are excellent in weeding out potentially aggressive employees. Pre and Post Tests are routinely used for employees mandated by their HR Managers for aggressive/inappropriate behavior at work.

Transportation Organizations

Bus and rail transportation is stressful for both passengers and staff. Given the rapidly deteriorating condition of America’s inferstructure, rapid transit authorities are finally recognizing the need for anger management, stress management, communication and emotional intelligence.

A number of transit authorities have contracted for organizational anger management training including pre and posttests for new employees.

In Summary

Anger management is one of the most rapidly growing interventions in human services. Anger management is a course offered in an individual coaching format for physicians and executives or in small groups for referrals from a wide range of organizations including Health Care, Criminal Justice and Business. All anger management courses must begin with a non-psychiatric evaluation that is designed to determine the clients’ level of functioning in recognizing anger, stress, assertive communication and emotional intelligence. Physicians and executives undergo a more comprehensive series of assessments which include “burnout”, “leadership”, “decision making” and “time management” scales.

For anger management resources, visit the website of The American Association of Anger Management Providers at http://www.aaamp.org.

George Anderson, MSW, BCD, CAMF, CEAP
Diplomate, American Association of Anger Management Providers
Anderson & Anderson®, The Trusted Name in Anger Management

An Open Letter to Physician Well-Being Committee Chairs, Hospital H.R. Managers/Administrators

As the Nation’s largest provider of Executive Coaching/Anger Management for Physicians, Anderson & Anderson is committed to advocating best practices in providing mandated or volunteer services for “disruptive physicians”. With this goal in mind, we would like to bring to your attention an evasive tactic currently being used by some physicians to avoid enrollment in Coaching Programs designed exclusively for “disruptive physicians”.

Some physicians are enrolling in on-line or home study anger management classes, which are presented in a self-help format for criminal court referrals unrelated to medical professionals or health care organizations. These classes are in no way consistent with JCAHO standards and should not be accepted.

The three legitimate providers of intervention for “disruptive physicians” are: the PACE Program at the University of San Diego School of Medicine, the Distressed Physicians Program at Vanderbilt University and Anderson & Anderson Executive Coaching/Anger Management Program, which unlike the others, offers classes 7 days a week to accommodate the busy and generally, hectic schedules of a physician’s practice and commitments.

The Anderson & Anderson Program is available at our Brentwood/Los Angeles office or on-site anywhere in the United States. This program is consistent with the new Joint Commission requirements for “disruptive physicians”. The Anderson & Anderson Anger Management/Executive Coaching program is listed in the Directory of Physician Assessment And Remedial Education Programs, Federation of State Medical Boards. Currently, it is the industry leader in intervention for disruptive physicians.

Your hospital’s reputation is too valuable to risk the consequences that may arise from the abusive behavior of a “disruptive physician”. There are numerous cases recently cited where physicians have acted in a disruptive manner that may cost their respective institutions unnecessary dollars in litigation and other related costs. The average cost of litigation for these types of cases averages $720,000 per case.

For more information, visit our website at http://www.andersonservices.com or contact our offices at (310) 207-3591. Please see are partial list of clients who you may recognize as leaders in their field.

George Anderson, MSW, BCD, CAMF, CEAP
Diplomat, American Association of Anger Management Providers
Anderson & Anderson, The Trusted Name in Anger Management

Stopping disruptive physician behavior

By Eric Berkman

Imagine a nurse being so intimidated by a condescending and abusive doctor that she decides not to contact him for an emergency while he’s on call.

Or perhaps a patient suffering from internal bleeding but refusing treatment when he sees his doctor screaming at the nurses. Or a doctor loudly refusing to listen to his nurses, undoing a course of treatment and causing the death of a patient.

While these scenarios may sound like a bad ER script, they’ve actually happened, according to anonymous comments submitted by nurses, technicians and physicians who responded to a national survey on disruptive physician behavior and the risks it creates in the clinical setting.

As a result of these risks, the Joint Commission announced a new standard in July addressing “behaviors that undermine a culture of safety.”

The standard requires accredited hospitals and health organizations to maintain a code of conduct that defines “acceptable and disruptive and inappropriate behaviors” and requires organizational leaders to create and implement a process for managing disruptive and inappropriate behaviors.

Doctors and health care lawyers welcomed the new standard, saying the failure of many hospitals to police the issue on their own has put patients in harm’s way and heightened the risk of liability due to bad medical outcomes or hostile work environments.

“With the improvement of health care in general and the demand that patients be provided good care, this has been recognized as an area that hasn’t really been addressed,” says Luis Sanchez, director of Physician Health Services, a subsidiary of the Massachusetts Medical Society that provides consultation and support to doctors struggling with mental health, behavioral and substance abuse issues. “Enforcing [rules] against bad behavior is no fun, but it must be done to promote good behavior.”

Experts suggest that organizations take steps to ensure that their conduct codes are effective by:

–Training medical staff on behavior in the health care workplace;

–Instituting an effective reporting procedure;

–Intervening in a supportive, non-punitive way; and

–Not using the code to discipline physicians for freely debating ideas about patient care.

The study

In the 2006 study of disruptive physician behavior, Alan Rosenstein – vice president and medical director of VHA West Coast, an affiliation of 1600 nonprofit hospitals nationwide – and co-author Michelle O’Daniel surveyed more than 5,000 anonymous respondents at more than 150 hospitals.

They discovered that 75 percent of respondents had witnessed disruptive behavior in physicians, 38 percent were aware of adverse events that could have occurred as a result of such behavior and 14 percent witnessed adverse events that were the direct result of such behavior.

“Though we found that only 3 to 5 percent of medical staff engage in disruptive behavior, this small percentage has an enormous impact on the entire organization,” says Rosenstein, a practicing internist who’s observed such conduct in the workplace.

Meanwhile, a 2003 study conducted by the Institute for Safe Medication Practices revealed that 40 percent of clinicians have remained silent while witnessing such behavior rather than question an intimidating colleague.

Both sets of findings indicate that disruptive and intimidating physician behavior poses far greater risk to clinical collaboration and patient safety than most people realized, leading to the new standard.

The scope of the problem

A “Sentinel Event Alert” that accompanied the standard defines disruptive behavior to include verbal outbursts, physical threats, refusal to perform assigned tasks or respond to pages and phone calls, use of condescending language and impatience with questions.

Physicians agree that the number one cause of this behavior among their ranks is stress. The typical doctor has too much to do with too little time and overly high expectations to meet. Plus, many are dealing with life-or-death situations. Meanwhile, tensions are exacerbated by nursing shortages and grueling productivity requirements in the managed-care environment.

These tensions can make physicians angry, leading to disruptive behavior – and potentially negative consequences.

For example, a hospital could find itself mired in harassment, discrimination or hostile-work-environment litigation if it were to consistently allow physicians’ abusive or demeaning behavior toward colleagues or subordinates to go unaddressed, says health care attorney Jim Hilliard of Connor & Hilliard in Walpole.

Disruptive behavior gets particularly serious when it occurs in patients’ presence, says Hilliard.

It can raise the anxiety level of patients who are already on edge. When it happens in psychiatric settings, where patients may be dealing with post-traumatic stress, it can cause them to experience the same sensations that drove them into the hospital in the first place.

“When it becomes an issue between clinical staff, patients feel like, ‘My God, I’m a third wheel here,’” he says.

Dealing with the problem

Norwood attorney Scott Liebert recalls an incident 15 years ago where a surgeon called in an anesthesiologist who was at home to perform a surgery that the anesthesiologist felt could wait until the morning.

They verbally sparred in the patient’s presence as the operating room was being set up, and once the patient was under anesthesia, the two started physically fighting.

“They were rolling on the floor in the OR,” says Liebert. “Cooler heads in the room prevailed and they completed the case. The patient was never aware. But still the hospital took formal action and reported it to the Board of Registration in Medicine.”

The fact is, as Rosenstein points out, hospitals have historically been reluctant to confront such situations head-on for a variety of reasons, perhaps most significantly the hierarchical nature of the hospital.

It’s natural that a hospital administrator will be hesitant to confront a prominent surgeon who produces a huge amount of revenue for the hospital about his abusive or intimidating demeanor, but it may need to be done for the sake of patient safety.

The inability of hospitals to police themselves is exactly what spurred the Joint Commission to act. But experts stress that the standard is very open-ended and any behavior policy will have little impact without certain steps being taken.

Mary Anne Badaracco, chief of psychiatry and chair of the medical executive committee at Beth Israel-Deaconess Medical Center in Boston, says medical staff at her hospital undergo constant training in acceptable professional behavior.

“All our departments are expected to have as part of their regular education meetings guidelines about physician behavior and health and how to approach a physician who we think is having difficulty,” she says.

However, a behavior code is useless if people don’t know to whom to report an incident or, worse yet, fear retaliation or feel doing so will be futile, says Rosenstein.

“We recommend a consistent process of handling every single complaint, and maybe even a multidisciplinary group to review every complaint,” he says.

At the same time, he adds, “people need to change the attitude of, ‘I can’t do this to this physician.’ The CEO instead needs to say, ‘I can’t tolerate this.’”

Supportive manner

Liebert says interventions need to be handled in a supportive manner rather than a punitive one.

If all a hospital does is punish, it creates an environment where people may be even more afraid to come forward with a complaint out of fear of getting someone powerful in trouble.

Instead, he suggests carefully investigating the situation. Perhaps a doctor is acting out because of an anxiety disorder that’s inadequately diagnosed, or a substance abuse problem.

“In a lot of situations, intervention early on can be in everybody’s best interest,” Liebert says, adding that referring a troubled physician to PHS, Sanchez’s organization, for assistance is often an excellent first step.

Finally, hospitals must ensure that their code is used appropriately to protect patient and staff safety.

“When evaluating disruptive behaviors we would hope that the process is done fairly and conclusions are based on a thorough, unbiased review of the situation with resulting actions based on the merits of the situation and not the individual involved,” Rosenstein says.

Questions or comments should be directed to the editor at: reni.gertner@mamedicallaw.com

Health care organizations nationwide are moving quickly to refer “disruptive physicians” to intervention programs consistent with JCAHO guidelines

Two of the major intervention organizations for “disruptive physicians” have long waiting lists of physician clients. The fact that Hospitals are moving to address this important issue is an indication of the risks that are apparent in the failure to act. The risks are increased legal liability, hostile work environments and patient safety.

The average cost of a “disruptive physician” lawsuit is $720,000 per case. Regardless of the outcome, the cost of litigation is indefensible for Hospitals and healthcare organizations. Therefore, patient safety and employee morale are taking precedence over the tendency to deny or avoid addressing the bad behavior of a small number of physicians.

The Distressed Physician Program at the Vanderbilt University School of Medicine has a waiting list through July of 2009. The PACE Program at the University of California at San Diego only accepts 8 new participants 4 times each year. Therefore, the chances of enrollment are indeed difficult at best.

Traditional counseling and psychotherapy are not really appropriate or useful for skill enhancement in managing anger, stress or enhancing communication and emotional intelligence. In addition, physicians are being advised by their legal counselors to avoid interventions that imply the presence of psychiatric impairment. Anger is not a mental or nervous disorder and, therefore, is not in itself an indication of mental illness.

Anderson & Anderson, based in Los Angeles, in collaboration with major hospital chains has been proactive in anticipating the need for flexible programs for busy physicians nationwide. The Anderson & Anderson model is available on-site seven days a week in a sensitive, executive coaching format which protects the confidentiality of each physician client.

George Anderson, MSW, BCD, CAMF, CEAP
Diplomate, American Association of Anger Management Providers
Anderson & Anderson®, The Trusted Name in Anger Management

The American Association of Anger Management Providers


George Anderson, BCD, LCSW, CAMF

Anger Management Certification Training

8:30 AM – 4:30 PM

Location: The Best Western Gateway Hotel, Santa Monica
1920 Santa Monica Blvd.
Santa Monica, CA 90404-1909

The Anderson & Anderson model of anger management is the most effective and widely recognized curriculum in the world. This model, which has been featured in Los Angeles Times Magazine, focuses on enhancing emotional intelligence and assertive communication while introducing behavior strategies for identifying and managing anger and stress.

On this day, Adult Anger Management will be examined. A demonstration of the Conover Assessment will be conducted with a discussion of its usefulness. “Gaining Control of Ourselves,” in conjunction with experiential exercises and videos, will be used to initiate the participants to this intervention. Most major corporations have accepted this model for use by H.R. and EAP Managers.

Cost: $500.00 includes client workbook, facilitator guide, and certification.

Approved for 8 CEU’s by CAADAC (#2n96-341-0805), BBS (#PCE60),
CAADE (#CP40-793-C-1009), TCBAP, and the CA. Board of Corrections

*Free One-Year general membership in the American Association of Anger Management Providers

**This training is also available on interactive CD’s. Please visit http://www.AndersonServices.com for more information.

For more information, please call 310-207-3591, or visit http://www.andersonservices.com/certificationseminars.html