212 THE SEVERE AND PERSI STENT MENTAL ILLNESS PROGRESS NOTES PLAN NER F. The client's anxiety over some dreaded event has diminished significantly, and his/he r compulsive rituals have also decreased in frequency. G. The client has not engaged in any ritualistic behaviors designed to prevent some dreaded situation. 5. Compulsions Seen as Unreasonable (5) A. The client acknowledged that his/her repetitive and compulsive behaviors are excessive and unreasonable. B. The client's recognition of his/her compulsive behaviors as excessive and unreasonable has provided good motivation for cooperation with treatment and follow-through on attempt to change. INTERVENTIO NS IMPLEMENTED 1. Develop Trust (1) * A. Today's clinical contact focused on building the level of trust with the client through consistent eye contact, active listening, unconditional positive regard, and warm acceptance. B. Empathy and support were pro vided for the client's expression of thoughts and feelings during today's clinical contact. C. The client was provided with support and feedback as he/she described his/her maladaptive pattern of anxiety. D. As the client has remained mistrustful and rel uctant to share his/her underlying thoughts and feelings, he/she was provided with additional reassurance. E. The client verbally recognized that he/she has difficulty establishing trust because he/she has often felt let down by others in the past, and he /she was accepted for this insight. 2. Assess OCD History (2) A. Active listening was used as the client described the nature, history, and severity of his/her obsessive thoughts and compulsive behaviors. B. Through a clinical interview, the client desc ribed a severe degree of interference in his/her daily routine and ability to perform a task efficiently because of the significant problem with obsessive thoughts and compulsive behaviors. C. The Anxiety Disorder's Interview Schedule for DSM-IV (Di Nardo, Brown, and Barlow) was used to assess the client's frequency, intensity, duration, and history of obsessions and compulsions. D. The client was noted to have made many attempts to ignore or control the compulsive behaviors and obsessive thoughts, but wit hout any consistent success. E. It was noted that the client gave evidence of compulsive behaviors within the interview. * The numbers in parentheses correlate to the num ber of the Therapeutic Intervention statement in the companion chapter with the same title in The Severe and Persistent Mental Illness Treatment Planner, 2nd ed. (Berghuis and Jongsma) by John Wiley & Sons, 2008. 