274 THE SEVERE AND PERSI STENT MENTAL ILLNESS PROGRESS NOTES PLAN NER 23. Educate the Family about Symptoms of Mental Illness ( 23) A. The client's family, friends, and caregivers were educated about the symptoms of mental illness, with specific emph asis on the nonvolitional aspects of some symptoms. B. The client's family members, friends, and caregivers were supported for their increased understanding about the symptoms of mental illness and the nonvolitional aspects of some symptoms. C. The clien t's family members, friends, and caregivers rejected the information regarding his/her symptoms of mental illness and the nonvolitional aspects of some symptoms and were given additional feedback in this area. 24. Role-Play Response to Anger Outbursts ( 24) A. Specific responses to the client's anger outbursts were role-played with his/her family members. B. The client's family, friends, and caregivers were advised to focus on providing short, specific directions and to avoid arguing about reality. C. The client's family, friends, and caregivers were reinforced for their understanding of assertive, safe, direct responses to his/her anger outbursts. D. The client's family, friends, and caregivers remain confused about how to respond directly to his/her an ger outbursts in an assertive, safe manner; further direction was provided to them. 25. Refer to Family Psychoeducational Program (25) A. The family was referred to a psychoeducational program to help demonstrate techniques to cope with the client's psych otic behaviors. B. The client was referred to a multigroup family psychoeducational program to help learn and share about techniques to cope with the client's psychotic behaviors. C. The family was engaged in the psychoeducational program and has identif ied ways in which they have learned to cope with the client's psychotic behaviors. D. The client's family has not engaged in the psychoeducational program and was redirected to do so. 26. Identify Psychosis Triggers ( 26) A. The client was requested to i dentify specific behaviors, situations, and feelings that occurred prior to decompensation or psychotic episodes. B. The client identified specific behaviors, situations, and feelings that occurred prior to his/her decompensation, and these triggers were processed. C. The client was unable to identify specific behaviors, situations, and feelings that have occurred prior to decompensation and was given suggestions in these areas. 27. Identify Symptoms Maintenance Cycles (27) A. The client was assisted in identifying emotional reactions that tend to maintain his/her symptoms. B. The client was assisted in identifying how the effects of his/her psychotic symptoms may exacerbate those symptoms. C. Examples were used to identify the self-reinforcing nature o f some psychotic symptoms (e. g., withdrawal leading to isolation and loneliness; paranoid accusations leading to negative actions of others that falsely support the delusion). 