194 THE SEVERE AND PERSI STENT MENTAL ILLNESS PROGRESS NOTES PLAN NER 9. Monitor Medication Rea ction (9) A. The client's reaction to the medication in terms of side effects and effectiveness were monitored. B. The client reported that the medication has been effective at reducing energy levels, flight of ideas, and the decreased need for sleep; he /she was urged to continue this medication regimen. C. The client has been reluctant to take the prescribed medication for his/her manic state, but was urged to follow through on the prescription. D. As the client has taken his/her medication, which has been successful in reducing the intensity of the mania, he/she has begun to feel that it is no longer necessary and has indicated a desire to stop taking it; he/she was urged to continue the medication as prescribed. 10. Monitor Ability to Participate in P sychotherapy (10) A. The client's pattern of symptom improvement was monitored, with a focus on how stable he/she is in regard to participation in psychotherapy. B. The client was judged to be significantly improved and capable of participating in psycho therapy. C. The client was judged to still be too manic to allow helpful participation in psychotherapy. 11. Conduct Family-Focused Treatment (11) A. The client and significant others were included in the treatment model. B. Family-focused treatment was used with the client and significant others as indicated in Bipolar Disorder: A Family-Focused Approach (Miklowitz and Goldstein). C. As family members were not available to participate in therapy, the family-focused treatment model was adapted to indivi dual therapy. 12. Assess Family Communication Patterns (12) A. Objective instruments were used to assess the family communication patterns. B. The level of expressed emotions within the family was specifically assessed. C. The Perceived Criticism Scale (Hooley and Teasdale) was used to assess family communication problems. D. The family was provided with feedback about their pattern of communication. E. The family has not been involved in the assessment of communication patterns, and the focus of treat ment was diverted to this resistance. 13. Educate about Mood Episodes (13) A. A variety of modalities were used to teach the family about signs and symptoms of the client's mood episodes. B. The phasic relapsing nature of the client's mood episodes was e mphasized. C. The client's mood episode concerns were normalized. D. The client's mood episodes were destigmatized. 14. Teach Stress Diathesis Model (14) A. The client was taught a stress diathesis model of Bipolar Disorder B. The biological predisposi tion to mood episodes was emphasized. C. The client was taught about how stress can make him/her more vulnerable to mood episodes. D. The manageability of mood episodes was emphasized. 