230 THE SEVERE AND PERSI STENT MENTAL ILLNESS PROGRESS NOTES PLAN NER D. The client was redirected about ways to incorporate his/her new strategies into his/her routine and life. 38. Develop a Coping Card (38) A. The client was provided with a coping card on which specific coping strategies wer e listed. B. The client was assisted in developing his/her coping card in order to list his/her helpful coping strategies. C. The client was encouraged to use his/her coping card when struggling with anxiety-producing situations. 39. Explore Secondary Ga in (39) A. Secondary gain was identified for the client's panic symptoms because of his/her tendency to escape or avoid certain situations. B. The client denied any role for secondary gain that results from his/her modification of life to accommodate pan ic; he/she was provided with tentative examples. C. The client was reinforced for accepting the role of secondary gain in promoting and maintaining the panic symptoms and encouraged to overcome this gain through living a more normal life. 40. Differentiat e Current Fear from Past Pain (40) A. The client was taught to verbalize the separate realities of the current fear and the emotionally painful experience from the past that has been evoked by the phobic stimulus. B. The client was reinforced when he/she expressed insight into the unresolved fear from the past that is linked to his/her current phobic fear. C. The irrational nature of the client's current phobic fear was emphasized and clarified. D. The client's unresolved emotional issue from the past w as clarified. 41. Encourage Sharing of Feelings (41) A. The client was encouraged to share the emotionally painful experience from the past that has been evoked by the phobic stimulus. B. The client was taught to separate the realities of the irrationall y feared object or situation and the painful experience from his/her past. 42. Support Activity Rather than Escape (42) A. The client was urged to engage in activities rather than escape into a pattern of avoidance. B. The client was reinforced as he/she reviewed his/her pattern of engagement rather than escape. C. The client continues to focus on escape and was urged to increase his/her engagement in small steps. 43. Enlist Support System (43) A. The client's support system was enlisted in the implemen tation of specific stress reduction techniques. B. The client's support system was enthusiastic and supportive of the client's stress reduction techniques, and the client was encouraged to utilize this support on a regular basis. C. The client's suppor t system has declined significant involvement in helping the client to implement specific stress reduction techniques, so alternative means of development support for stress reduction were developed. 