122 THE SEVERE AND PERSI STENT MENTAL ILLNESS PROGRESS NOTES PLAN NER C. As the client has stabilized, he/she has regained some abilities, status, and competence and reports less of a sense of loss. D. The client has become more at ease with the incapacitating effects of his/her severe mental illness symptoms. 10. Low Self-Esteem (7) A. The client stated that he/she has a very negative perception of himself/herself. B. The client's low self-esteem was evident within the session as he/she made many self-disparaging remarks and maintained very little eye contact. C. The client related his/her low self-esteem to his/her history of losses. D. The client's self-esteem has increased as he/she is beginning to find reasons to affirm his/her self-worth. E. The client verbalized positive feelings tow ard himself/herself. 11. Childhood Trauma (8) A. The client reported that he/she had a history of childhood traumas that includes abuse. B. The client reported that painful memories of his/her abusive childhood experiences are intrusive and unsettling. C. The client reported that nightmares and other disturbing thoughts related to childhood abuse have interfered with his/her sleep. D. The client reported that his/her emotional reactions associated with the childhood abusive experiences have been resolv ed. E. The client was able to discuss his/her childhood abusive experience without being overwhelmed with negative emotions. 12. Abusive Parent Figures (8) A. The client described his/her parents as rigid, perfectionist, and hypercritical, resulting in consistent feelings of inadequacy. B. The client reported that his/her parents were threatening and demeaning, resulting in feelings of low self-esteem. C. The client reported that his/her parents were hyperreligious, resulting in rigid, high expectation s of behavior and harsh discipline. D. The client described an emotionally repressive atmosphere at home during his/her childhood as a result of his/her parents' lack of nurturance, encouragement, and positive reinforcement. E. The client is able to affi rm himself/herself now, in spite of a history of parental rejection. 13. Dissociative Phenomena (9) A. The client described a pattern of dissociative experiences. B. The client displayed periods of lost time, depersonalization, and other dissociative ph enomena. C. The client's dissociative experiences have diminished in frequency and intensity. D. The client no longer experiences dissociative phenomena. 14. Paranoia (9) A. The client's speech and thought patterns displayed paranoid ideation. B. The client is distrustful and reactive subsequent to his/her experience of significant losses. 