214 THE SEVERE AND PERSI STENT MENTAL ILLNESS PROGRESS NOTES PLAN NER 7. Recommend Substance Abuse Evaluation and/or Term ination (7) A. It was recommended to the client that he/she terminate the consumption of substances that could contribute to anxiety. B. The client was referred for a substance abuse evaluation to more completely assess his/her substance abuse concerns a nd how they may trigger anxiety. C. The client was referred for substance abuse treatment to assist him/her in discontinuing his/her consumption of substances. D. As the client has decreased his/her use of trigger substances, he/she has experienced a decrease in anxiety, and this was reviewed. E. The client has declined any evaluation or treatment related to his/her substance use, and was encouraged to seek this out at a later time. 8. Differentiate Anxiety Symptoms (8) A. The client was assisted in di fferentiating anxiety symptoms that are a direct affect of his/her severe and persistent mental illness, as opposed to a separate diagnosis of an anxiety disorder. B. The client was provided with feedback regarding his/her differentiation of symptoms that are related to his/her severe and persistent mental illness, as opposed to a separate diagnosis. C. The client has identified a specific anxiety disorder, which is freestanding from his/her severe and persistent mental illness, and this was reviewed with in the session. D. The client has been unsuccessful in identifying ways in which his/her anxiety symptoms are related to his/her mental illness versus a separate anxiety disorder and was provided with some examples of each area. 9. Acknowledge Anxiety Re lated to Delusional Experiences (9) A. It was acknowledged that both real and delusional experiences could cause anxiety. B. The client was provided with support regarding his/her anxieties and worries, which are related to both the real experiences and delusional experiences. C. The client described a decreased pattern of anxiety due to the support provided to him/her. 10. Identify Diagnostic Classification (10) A. The client was assisted in identifying a specific diagnostic classification for his/her anxiety symptoms. B. Utilizing a description of anxiety symptoms such as that found in Bourne's The Anxiety and Phobia Workbook, the client was taken through a detailed review of his/her anxiety symptoms, diagnosis, and treatment needs. C. The client ha s failed to clearly understand and classify his/her anxiety symptoms and was given additional feedback in this area. 11. Refer to Physician (11) A. A referral to a physician was made for the purpose of evaluating the client for a prescription of psychotro pic medications. B. The client was reinforced for following through on a referral to a physician for an assessment for a prescription of psychotropic medications, but none were prescribed. C. The client has been prescribed psychotropic medications. D. The client declined evaluation by a physician for a prescription of psychotropic medication, and was redirected to cooperate with this referral. 