326 THE SEVERE AN D PERSISTENT MENTAL ILLNESS PROGRESS NOT ES PLANNER 5. Inability to Establish and Maintain Relationships (5) A. The client described an inability to establish, nurture, and maintain meaningful, interpersonal relationships. B. The client's difficul ty in relationships is related to his/her failure to listen, support, communicate, or negotiate differences of opinion. C. The client often fails to work through problem situations within his/her relationships, often leading to a lost or diminished relati onship. D. As the client's severe and persistent mental illness symptoms have stabilized, he/she has learned to listen, support, communicate, and negotiate, which has helped him/her to maintain meaningful interpersonal relationships. 6. Estrangement Due to Mental Illness Symptoms (6) A. The client's psychotic symptoms (i. e., hallucinations, delusions, bizarre behavior, manic phases) have had a significant negative effect on his/her social interactions. B. The client tends to be estranged from others due to the negative impact of his/her psychotic symptoms. C. Others often avoid the client due to his/her mental illness symptoms. D. As the client has stabilized his/her mental illness symptoms, his/her social relationships have improved. 7. Loneliness (7 ) A. The client has no close friends or confidants outside of first-degree relatives. B. The client identified ongoing feelings of loneliness. C. The client's social anxiety has prevented him/her from building and maintaining a social network of friends and acquaintances. D. The client has begun to reach out socially and respond favorably to the overtures of others. E. The client reported enjoying contact with friends and sharing personal information with them. 8. Poor Support Network (7) A. The clie nt described a lack of friends to provide support during crises. B. The client sees all of his/her relationships as fair-weather friends. C. The client displayed a pattern of decompensation, which is exacerbated by the lack of a social network to provide support to him/her during these crises. D. As the client has developed better relationships, he/she has found more support and been more stable during crisis times. 9. Lack of Assertiveness (8) A. The client has difficulty saying no to other people whe n he/she is presented with a request for a favor. B. The client attempts to ingratiate himself/herself to others by being eager to meet their needs. C. The client often fails to be assertive in the appropriate situation. D. The client has been taken adv antage of by others because he/she fears rejection if he/she refuses to comply with others' requests. E. The client has begun to set limits in doing things for others and not complying with their requests. 