54 THE SEVERE AND PERSI STENT MENTAL ILLNESS PROGRESS NOTES PLAN NER B. Positive feedback was provided as the client promised to utilize the emergency helpline telephone number rather than engaging in any self-harm behaviors. C. The client has not used the emergency helpline telephone system in place of engaging in s elf-harm behaviors and was reminded about this useful resource. 11. Interpret Self-Mutilating Behavior (11) A. The client's self-mutilation was interpreted as an expression of the rage and helplessness that could not be expressed as a child victim of emot ional abandonment and abuse. B. The client accepted the interpretation of his/her self-mutilation and more directly expressed his/her feelings of hurt and anger associated with childhood abuse experiences. C. The client rejected the interpretation of sel f-mutilating behavior as an expression of rage associated with childhood abandonment or neglect experiences. D. An expectation that the client will be able to control his/her urge for self-mutilation was expressed. 12. Elicit Nonsuicide Contract (12) A. A promise was elicited from the client that he/she will initiate contact with the therapist or an emergency helpline if the suicidal urge becomes strong and before any self-injurious behavior is enacted. B. The client was reinforced as he/she promised to terminate self-mutilation behavior and to contact emergency personnel if urges for such behavior arise. C. The client has followed through on the nonself-harm contract by contacting emergency service personnel rather than enacting any suicidal gestures or self-mutilating behavior; he/she was reinforced for this healthy use of support. D. The client's potential for suicide was consistently assessed despite the suicide prevention contract. 13. Resolve Therapy-Interfering Behaviors (13) A. The client's patt ern of therapy-interfering behavior (e. g., missing appointments, noncompliance, abruptly leaving therapy) was consistently monitored. B. The client was confronted for his/her therapy-interfering behaviors. C. The clinician took appropriate responsibility for the clinician's own therapy-interfering behaviors. D. Therapy-interfering behaviors were problem-solved. 14. Refer for Medication Evaluation (14) A. The client was assessed in regard to the need for psychotropic medication. B. The client was referr ed to a physician to be evaluated for psychotropic medications to stabilize his/her mood. C. The client has cooperated with a referral to a physician and has attended the evaluation for psychotropic medications. D. The client has refused to attend a phys ician evaluation for psychotropic medications and was redirected to do so. 