260 THE SEVERE AND PERSI STENT MENTAL ILLNESS PROGRESS NOTES PLANNER D. Upon the review of the stimuli, thoughts and situations that precipitated the client's fears and avoidance, he/she has been able to decrease his/her level of fear and avoidance. 5. Differentiate Anxiety Symptoms (5) A. The client was assisted in differentiating anxiety symptoms that are a direct affect of his/her severe and persistent mental illness, as opposed to a separate diagnosis of an anxiety disorder. B. The client was provided with feedback regarding his/her differentiation of symptoms that are related to his/her severe and persistent mental illness, as opposed to a separate diagnosis. C. The client has identified a specific anxiety disorder, which is freestanding from his/her severe and persistent mental illness, and this was reviewed within the session. D. The client has been unsuccessful in identifying ways in which his/her anxiety symptoms are related to his/her mental illness o r a separate anxiety disorder. 6. Acknowledge Anxiety Related to Delusional Experiences (6) A. It was acknowledged that both real and delusional experiences could cause anxiety. B. The client was provided with support regarding his/her anxieties and wor ries, which are related to both the real experiences and delusional experiences. C. The client described a decreased pattern of anxiety due to the support provided to him/her. 7. Identify with Recovery from Trauma (7) A. The client was provided with a d escription of Posttraumatic Stress Disorder. B. Information from Overcoming Posttraumatic Stress Disorder (Smyth) was used to help describe symptoms. C. The client was assisted in identify how he/she may recover from trauma. 8. Explore Facts of Traumati c Event (8) A. The client was gently encouraged to tell the entire story of the traumatic event. B. The client was given the opportunity to share what he/she recalls about the traumatic event. C. Today's therapy session explored the sequence of events b efore, during, and after the traumatic event. 9. Assess Depression (9) A. The depth of the client's depression and his/her suicide potential were assessed. B. Since the client has significant depression and verbalizes suicidal urges, steps were taken to provide more intense treatment and constant supervision. C. The client's depression was not noted to be particularly serious, and he/she has denied any current suicidal ideation. 10. Assess Chemical Dependence (10) A. The client was asked to describe hi s/her use of alcohol and/or drugs as a means of escape from negative emotions. B. The client was supported as he/she acknowledged that he/she has abused alcohol and/or drugs as a means of coping with the negative consequences associated with the traumatic event. C. The client was quite defensive about giving information regarding his/her substance abuse history and minimized any such behavior; this was reflected to him/her and he/she was urged to be more open. 