198 THE SEVERE AND PERSI STENT MENTAL ILLNESS PROGRESS NOTES PLAN NER 29. Increase Sensitivity to Effects of Behavior (2 9) A. Role-playing, role reversal, and behavioral rehearsal were used to increase the client's sensitivity to the negative effect s of his/her impulsive behavior. B. The client was reinforced for his/her increased sensitivity to the negative effects of his/her impulsive behavior on others. C. The client has had significant difficulty identifying negative consequences for his/her impulsive behavior, despite the use of role-playing, role reversal, and behavioral rehearsal. 30. Confront Mania and Enforce Rules ( 30) A. Unhealthy, impulsive, or manic behaviors that occur during contacts with the clinician were identified and confronted. B. Clear rules and roles in the relationship were identified and enforced with immediate, short-term consequences for breaking such boundaries. C. The client's unhealthy, impulsive, or manic behaviors have diminished in response to limit setting within the session. 31. Address Problem Solving (31) A. The client was asked to identify conflicts that can be addressed through problem-solving techniques. B. The family members were asked to give input about conflicts that could be addressed with problem-solving techniques. C. The client and family arrived at a list of conflicts that could be addressed with problem-solving techniques. 32. Teach Problem-Solving Skills (32) A. Behavioral techniques such as education, modeling, role-playing, corrective feedbac k, and positive reinforcement were used to teach the client and family problem-solving skills. B. Specific problem-solving skills were taught to the family, including defining the problem constructively and specifically, brainstorming options, evaluating options, choosing options, implementing a plan, evaluating the results, and reevaluating the plan. C. Family members were asked to use the problem-solving skills on specific situations. D. The family was reinforced for positive use of problem-solving ski lls. E. The family was redirected for failures to properly use problem-solving skills. 33. Assign Problem-Solving Homework (33) A. The client and family were assigned to use newly learned problem-solving skills and record their use. B. The client and fa mily were assigned “Plan Before Acting” in the Adult Psychotherapy Homework Planner, 2nd ed. (Jongsma). C. The results of the family members' use of problem-solving skills were reviewed within the session. 34. Reinforce Control Over Thought Process (3 4) A. The client was reinforced for controlling his/her slower speech. B. The client was reinforced for his/her more deliberate thought process. 