56 THE SEVERE AND PERSI STENT MENTAL ILLNESS PROGRESS NOTES PLAN NER E. The client has struggled to understand the behavioral strategies and was provided with remedial information in this area. 19. Conduct Trauma Work (19) A. As the client's adaptive behavior patterns have been evident, work on rememb ering and accepting the facts of previous trauma was initiated. B. The client was assisted in using his/her new adaptive behavior patterns and emotional regulation skills to reduce denial and increase insight into the effects of previous trauma. C. The c lient was helped to reduce maladaptive emotional and/or behavioral responses to trauma-related stimuli through the regular use of adaptive behavioral patterns and emotional skills. D. The client was assisted in tolerating the distress of remembering and a ccepting the facts of previous trauma and in reducing self-blame. E. The client has been noted to be successful in using his/her adaptive behavioral patterns and emotional regulation skills in managing the effects of previous trauma. F. The client has be come more emotionally disregulated due to the trauma work and was redirected to use behavioral and emotional regulation skills. 20. Explore Schema and Self-Talk (20) A. The client was assisted in exploring how his/her schema and self-talk mediate his/her trauma-related and other fears. B. The client's distorted schema and self-talk were reviewed. C. The client was reinforced for his/her insight into his/her self-talk and schema that support his/her trauma-related and other fears. D. The client struggled to develop insight into his/her own self-talk and schema and was provided with tentative examples of these concepts. 21. Assign Exercises on Self-Talk (21) A. The client was assigned homework exercises in which he/she identifies fearful self-talk and creates reality-based alternatives. B. The client was assigned the homework exercise “Journal and Replace Self-Defeating Thoughts” from the Adult Psychotherapy Homework Planner, 2nd ed. (Jongsma). C. The client was directed to complete the “Daily Record of Dysfunctional Thoughts” from Cognitive-Behavioral Therapy of Depression (Beck, Rush, Shaw, and Emery). D. The client's replacement of fearful self-talk with reality-based alternatives was critiqued. E. The client was reinforced for his/her successes at r eplacing fearful self-talk with reality-based alternatives. 22. Reinforce Positive Self-Talk (22) A. The client was reinforced for implementing positive, realistic self-talk that enhances self-confidence and increases adaptive action. B. The client noted several instances from his/her daily life that reflected the implementation of positive self-talk, and these successful experiences were reinforced. 23. Develop Hierarchy of Triggers (23) A. The client was directed to develop a hierarchy of feared and av oided trauma-related stimuli. B. The client was helped to list many of the feared and avoided trauma-related stimuli. 