86 THE SEVERE AND PERSI STENT MENTAL ILLNESS PROGRESS NOTES PLAN NER 34. Reinforce Physical Exercise (34) A. A plan for routine physical exercise was developed with the client, and a rational for including this in his/her daily routine was made. B. The client and therapist agreed to make a commitment toward implementing daily exercise as a depression reduction technique. C. The client has performed routine daily exercise, and he/she reports that it has been ben eficial; these benefits were reinforced. D. The client has not followed through on maintaining a routine of physical exercise and was redirected to do so. 35. Recommend Exercising Your Way to Better Mental Health (35) A. The client was encouraged to read Exercising Your Way to Better Mental Health (Leith) to introduce him/her to the concept of combating stress, depression, and anxiety with exercise. B. The client has followed through with reading the recommended book on exercise and mental health and rep orted that it was beneficial; key points were reviewed. C. The client has implemented a regular exercise regimen as a depression reduction technique and reported successful results; he/she was verbally reinforced for this progress. D. The client has not followed through with reading the recommended material on the effect of exercise on mental health and was encouraged to do so. 36. Build Relapse Prevention Skills (36) A. The client was assisted in building relapse prevention skills through the identifica tion of early warning signs of relapse. B. The client was directed to consistently review skills learned during therapy. C. The client was assisted in developing an ongoing plan for managing his/her routine challenges. 37. Connect Repressed Emotions wit h Depression (37) A. The client was taught about the possible connection between previously unexpressed feelings and his/her current state of depression. B. As the client has been assisted in gaining insight into his/her suppressed feelings from the past, his/her current feelings of depression have diminished. C. The client verbalized an understanding of the relationship between his/her current depressed mood and the repression of anger, hurt, and sadness, and this was processed. D. The client was unabl e to connect his/her repressed feelings and his/her current state of depression and was provided with additional feedback in this area. 38. Teach Expression of Repressed Emotions ( 38) A. The client was taught about healthy ways in which he/she can expres s his/her repressed emotions. B. To help the client express repressed emotions, specific techniques were modeled. C. Physical techniques for expressing emotions (e. g., beating a pillow) were reviewed. D. Verbal and written expressions of emotions (e. g., writing a letter) were reviewed. E. Specific rituals for expressing repressed emotions were reviewed (e. g., writing the emotion down, then tearing it up, and tossing it into the wind). 