174 THE SEVERE AND PERSI STENT MENTAL ILLNESS PROGRESS NOTES PLAN NER 27. Explore Substance Abuse ( 27) A. The role of substance abuse was explored regarding its contribution to conflict within the relationship, as well as contributing to the client's severe and persistent mental illness symptoms. B. Substance abuse by one of the partners was acknowledged as a strong contributing factor to escalating conflict between them. C. Although substance abuse appears to be a critical component of relationship conflict, neither partner was willing t o acknowledge the fact of substance abuse being a factor. D. The client was confronted with his/her need for substance abuse treatment in addition to continued treatment for his/her severe and persistent mental illness. 28. Integrate Substance Abuse and Mental Health Treatment ( 28) A. The client's mental health and substance abuse treatment were coordinated so they can be provided in an integrated manner. B. Clinicians focusing primarily on the client's severe and persistent mental health treatment were urged to integrate his/her substance abuse treatment as well. C. Treatment staff, focusing on the client's substance abuse treatment, were alerted to the need to also treat his/her severe and persistent mental illness. 29. Discuss Closeness versus Distan ce (29) A. A discussion was facilitated between the client and his/her partner regarding the factors that contribute to a desire for closeness versus those that promote distance/safety. B. The client and his/her partner were provided with assistance in i dentifying factors that contribute to a closeness or for distance/safety. C. The need for a waiting period for the client's partner to regain trust was acknowledged as a normal expectation. D. The client and his/her partner were provided with feedback re garding the partner's caution about resuming normal levels of trust, interaction, sexual activity, and so forth, subsequent to the client's symptoms abating. E. The client was praised for his/her acceptance of his/her partner's need for caution prior to resuming normal closeness. F. The client and his/her partner have argued over the level of closeness expected after the client's symptoms have abated and were provided with additional feedback in this area. 30. Emphasize the Sexual Relationship as a Mirro r (30) A. Emphasis was placed on the concept of the sexual relationship being a mirror of the rest of the relationship. B. The need for positive emotional interaction prior to sexual involvement was emphasized. C. The client was provided with positive r einforcement for his/her focus on positive emotional interaction with his/her intimate partner. D. The client's partner reported that the client does not focus on positive emotional interaction, and the client was provided with additional education in thi s area. 31. Physician Evaluation Referral (3 1) A. The couple was referred to a physician who specializes in sexual dysfunction to obtain an evaluation of any organic causes for their sexual problems. 