236 THE SEVERE AND PERSI STENT MENTAL ILLNESS PROGRESS NOTES PLAN NER 11. Provide Empathetic Acceptance (11) A. Empathetic listening was provided to the client, displaying respect for him/her by accepting him/her, despite his/her angry or delusional presentation. B. Acceptance was communicated to the client, despite his/her angry or delusional presentation, but the client's paranoid delusions were not confirmed. C. As the client has been provided with unconditional acceptance, his/her anger, agitation, and paranoia have subsided. 12. Demonstrate Calm Demea nor (12) A. A calm demeanor was demonstrated to the client when he/she disclosed bizarre or antagonistic beliefs. B. As a result of the calm demeanor demonstrated to the client, he/she appears to have decreased his/her fear of rejection. C. The client c ontinues to display fears related to rejection, despite the calm acceptance with which he/she has been provided, and additional feedback was provided to him/her in this area. 13. Reflect Emotions (1 3) A. Indicators of the client's intense emotions (e. g., posture, facial expression, or general presentation) were reflected to him/her. B. Empathy was displayed for the client who was experiencing significant distress related to his/her paranoid delusions. C. The client acknowledged his/her emotions related to paranoid delusions, and these were processed. D. The client tended to deny or minimize emotions related to his/her pattern of delusions, and these were tentatively presented to him/her. 14. Ask Open-Ended Questions (1 4) A. The client was asked open-ended questions about some of his/her delusions or paranoid beliefs. B. The client's paranoid beliefs were accepted as his/her thoughts, although not confirmed. C. Arguing with the client about his/her paranoid beliefs was consistently avoided. D. The cl ient has been more open about his/her delusions or paranoid beliefs and was provided with positive feedback about this openness. 15. Physician Referral ( 15) A. The client was referred to a physician to undergo a thorough examination to rule out any medic al etiologies for his/her paranoia and to receive recommendations for further treatment options. B. The client has followed through on the physician evaluation referral, and specific medical etiologies for his/her experience of paranoia were reviewed. C. The client was supported as he/she is seeking out treatment for the medical concerns that are leading to his/her experience of paranoid thoughts. D. The client has followed through on the physician evaluation referral, but no specific medical etiologies for his/her paranoia have been identified. E. The client declined evaluation by a physician regarding his/her paranoia and was redirected to cooperate with this referral. 