316 THE SEVERE AND PERSI STENT MENTAL ILLNESS PROGRESS NOTES PLAN NER 5. Fear of Social Mistakes (5) A. The client reported resisting involvement in social situations because of a fear of saying or doing something foolish or embarrassing in front of others. B. The client has been reluctant to involve himself/herself in social situations because he/she is fearful of his/her social anxiety becoming apparent to others. C. The clie nt has become more confident of his/her social skills and has begun to interact with more comfort. D. The client reported being able to interact socially without showing signs of social anxiety that would embarrass him/her. 6. Performance Anxiety (6) A. The client reported experiencing debilitating performance anxiety when expected to participate in required social performance demands. B. The client described himself/herself as unable to function when expected to complete typical social performance dema nds. C. The client avoids required social performance demands. D. As treatment has progressed, the client has become more at ease with typical social performance demands. E. The client reports no struggles with performance anxiety. 7. Physiological Anx iety Symptoms (7) A. The client has an increased heart rate and experiences sweating, dry mouth, muscle tension, and shakiness in most social situations. B. As the client has learned new social skills and developed more confidence in himself/herself, the intensity and frequency of physiological anxiety symptoms has diminished. C. The client reported engaging in social activities without experiencing any physiological anxiety symptoms. INTERVENTIONS IMPLEM ENTED 1. Build Rapport (1) * A. Consistent eye co ntact, active listening, unconditional positive regard, and warm acceptance were used to build rapport with the client. B. The client began to express feelings more freely as rapport and trust levels increased. C. The client has continued to experience d ifficulty being open and direct in his/her expression of painful feelings; he/she was encouraged to be more open as he/she feels safer. 2. Assess Nature of Social Discomfort Symptoms (2) A. The client was asked about the frequency, intensity, duration, a nd history of his/her social discomfort symptoms, fear, and avoidance. * The numbers in parentheses correlate to the number of the Therapeutic Intervention 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. 