30 THE SEVERE AND PERSI STENT MENTAL ILLNESS PROGRESS NOTES PLAN NER B. Empathy and support were provided 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 anger expression. D. As the client has remained mistrustful and reluctant 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 was accepted for this insight. 2. Assess Anger Dynamics (2) A. The client was assessed for various stimuli that have triggered his/her anger. B. The client was helped to identify situations, people, and thoughts that have triggered his/her anger. C. The client was assisted in identifying the thoughts, feelings, and actions that have characterized his/her anger responses. 3. Arrange More Restrictive Setting (3) A. The client was judged to be at imminent risk o f harm to himself/herself or others, and an admission to a more restrictive treatment setting was coordinated. B. The client declined voluntary admission to a more restrictive treatment setting and was petitioned to be involuntarily admitted. C. The clie nt has decreased his/her pattern of angry outbursts as a result of treatment in a more structured setting. D. The client reacted to the threat of an impending psychiatric hospitalization with a decrease in his/her anger outbursts. 4. Remove Anger-Provoki ng Stimuli (4) A. The client's environment was reviewed for possible anger-provoking stimuli. B. Specific anger-provoking stimuli were removed from the client's environment. 5. Physician Referral (5) A. The client was referred to a physician to undergo a thorough examination to rule out any organic contributors for anger outbursts and to receive recommendations for further treatment options. B. The client has followed through on the physician evaluation referral, and specific medical etiologies for ang er outbursts were reviewed. C. The client was supported as he/she is seeking out medical treatment that may decrease his/her anger outbursts. D. The client has followed through on the physician evaluation referral, but no specific medical etiologies for anger outbursts have been identified. E. The client declined evaluation by a physician for a prescription of psychotropic medications and was redirected to cooperate with this referral. 6. Review Substance Abuse (6) A. The client's use of street drugs o r alcohol as a contributing factor to anger control problems was reviewed. 