52 THE SEVERE AND PERSI STENT MENTAL ILLNESS PROGRESS NOTES PLAN NER INTERVENTIONS IMPLEM ENTED 1. Assess Behavior, Affect, and Cogn itions (1) * A. The client's experience of distress and disability was assessed to identify targets of therapy. B. The client's pattern of behaviors (e. g., parasuicidal acts, angry outbursts, overattachment) was assessed to help identify targets for thera py. C. The client's affect was assessed, including emotional overractions and painful emptiness, in regard to targets for therapy. D. The client's cognitions were assessed, including biases such as dichotomous thinking, overgeneralization, and catastroph izing, to assist in identifying targets for therapy. E. Specific targets for therapy were identified. 2. Explore Childhood Abuse/Abandonment (2) A. Experiences of childhood physical or emotional abuse, neglect, or abandonment were explored. B. As the c lient identified instances of abuse and neglect, the feelings surrounding these experiences were processed. C. The client's experiences with perceived abandonment were highlighted and related to his/her current fears of this experience occurring in the pr esent. D. As the client's experience of abuse and abandonment in his/her childhood was processed, he/she denied any emotional impact of these experiences on himself/herself. E. The client denied any experience of abuse and abandonment in his/her childhoo d, and he/she was urged to talk about these types of concerns as he/she deems it necessary in the future. 3. Validate Distress and Difficulties (3) A. The client's experience of distress and subsequent difficulties were validated as understandable, given his/her particular circumstances, thoughts, and feelings. B. It was reflected to the client that most people would experience the same distress and difficulties, given the same circumstances, thoughts, and feelings. C. The client was noted to accept the validation about his/her level of distress 4. Orient to Dialectical Behavioral Therapy (DBT) (4) A. The client was oriented to DBT. B. The multiple facets of DBT were highlighted, including support, collaboration, challenge, problem solving, and skill building. C. The biosocial view related to Borderline Personality Disorder was emphasized, including the constitutional and social influences. D. The concept of dialectics was reviewed with the client. E. Information from Cognitive-Behavioral Treatment of Borderline Personality (Linehan) was reviewed with the client. * The numbers in parentheses correlate to the number of the Therapeutic Inte rvenion statement in the companion chapter with the same title in The Severe and Persistent Mental Illness Treatment Planner, 2nd ed. (Berghuis and Jongsma) by John Wiley & Sons, 2008. 