Topic 5: Ethical Considerations and Non-Therapy Duties {by 6/27}

Based on the readings due this week consider the following two discussion points: (1) What code of ethics do you think can be/is challenging for counselors to consistently uphold at a high standard (can refer to my textbook chapter [posted no later than 6/24] and/or review the ACA/AMHCA Codes of Ethics)?  (2) What required duties beyond therapy do you find the most frustrating and/or least enjoyable (can refer to my textbook chapter [posted no later than 6/22])?  Your original post should be posted by the beginning of class 6/27.  Post your two replies no later than 6/29.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

21 Comments (+add yours?)

  1. Teresa DiTommaso
    Jun 26, 2019 @ 10:50:55

    1. One of the most challenging code of ethics standards that I see as difficult to uphold in this field, through my observed experience in practicum and internship, is that some counselors use excessive or inappropriate self-disclosure, as explaining in Table 2.2 of Chapter 2. As mentioned in the chapter, most counselors take small steps towards unethical behavior until he or she eventually crosses the line. Although this is just in my personal and limited experience within the field, the counselors that I see disclosing too much information are counselors that have been in the field a long time. I feel as if those individuals may feel as if they are offering life experience and work experience they have gained throughout their years in the field, however, some of their disclosures are in no way helping the client, instead, I feel as if those disclosures are used as a way to validate themselves and the work that they have done throughout the years. The life experience may be appropriate to share at times with client if it going to aid the client in someway, but the majority of times I have seen this type of self-disclosure it is not for that reason, is excessive, and the disclosure is about the counselor, not about the client. Due to the fact that our professional work is personal in nature, it is would be easy to share personal information in order to increase the connection between you and your client, and that is why I believe it is so common within the field, per my limited experience. Therefore, self-disclosure is one aspect of ethics I am very much aware of and I do not disclosure any personal information unless it would be helpful for the client, and even then, I feel as if I hold back things that may be helpful, but in terms of ethical decision-making and my nervousness about making a mistake, I always air on the side of extreme caution.
    2. In terms of the non-therapy duties discussed in Chapter 4, the two that I find most frustrating at times is dealing with MCO and case management. In terms of dealing with MCOs, it is usually not the initial authorization that causes me stress, but the continued stay reviews instead. It is frustrating because for some clients it is so clear to you that they would benefit from continued treatment, but it is difficult for me to make sure that message gets across in a clear and concise way when talking to reviewers. I also still get very nervous when I have to do a continued stay review because I want to sound professional and organized, although it is difficult to do that sometimes when the information you need to express the needs of your client in a way in which will get them more time. The entire process of knowing what information is needed for each MCO is still confusing and those extra 10 or 15 minutes needed for continued reviews adds up, sometimes creating more stress in terms of my completion of other documentation.
    Although I am very aware that case management is a crucial part of being a therapist, I believe we are not taught at all how to handle it within an educational setting. Although there are certain nuances that come from doing it in the field, I feel as if more preparation could be implemented in some way. The biggest frustration I have with case management is the faxing, calling, and re-calling agencies and individuals in order to establish services for a client. The management falls through often, enough services are just not available, and the time it takes cuts into therapeutic duties I would rather be doing. I think it takes practice to determine what services are out there, who to call, and how to get what you want from that agency you are attempting to contact. Case management is still very stressful to me, but I have learned one needs to get creative in terms of finding the most immediate solution for a client.

    Reply

    • Allexys Burbo
      Jun 29, 2019 @ 14:53:03

      Teresa,

      Similar to what you expressed, I too find case management duties particularly stressful. While I understand how essential these tasks are to the therapeutic exchange, I agree that it is often time-consuming and taxing. Navigating the various resources, as you mentioned, may prove especially challenging for the new and unfamiliar counselor. Without proper supervision, guidance and support, this can easily become an overwhelming experience. I, too, wish that on some level this component of field work could be incorporated into our curriculum. Although I recognize the challenges to integrating this into our course work, a brief introduction perhaps to available resources – or maybe how to navigate the case management aspect of the job – might better prepare us for what to anticipate when entering the field.

      Reply

    • Matthew Collin
      Jun 29, 2019 @ 21:12:42

      Teresa,
      I empathize with you when it comes to not enjoying the case management and managed care duties at our internships. Managed care always seemed mundane to me, but it is vital to allow our patience to continue to get care. Case management, however, is very important and far from mundane. For instance, how can our clients participate in therapy if he or she is homeless? If he or she doesn’t have running water or heat? These are the aspects of the job we don’t’ learn in school. I think if we are in the field long enough, we will be able to gather enough resources and contacts in order to have the case management process be less daunting and hopeless.

      Reply

    • Matthew Lubomirski
      Jun 30, 2019 @ 00:06:46

      Hey Teresa,

      I completely agree with your point on case management. It often feels like that is such a crucial part of our job that we are not at all prepared for. Though thinking about I do have a theory on it. I’m sure many of us are aware that the education for a social worker is different from the education we receive. Since social workers can often take the same positions we can I am curious if there presence in those parts of the field further built up the expectation of being able to do case management without the need for much training on the part of the employer. Through stories and conversations I know social workers are often taught a more systemic based method and perspective. Obviously I have no real evidence here but it’s just something to think about.

      Reply

  2. Matthew Collin
    Jun 26, 2019 @ 15:26:22

    1.)I think the one of the most difficult standards to uphold as a therapist is C.2 in the ACA code of ethics which states that counselors should always monitor and take time off for emotional, physical or “mental” problems. The only reason why I think this is hard to 100% uphold is that a therapist can’t call out for every stressful situation he or she may have. For instance, bills I have to pay cause me stress, but is that a good enough excuse to call out? It may or may not affect me during the therapy sessions I have with my client. If it does, I just must learn to be cognizant of it. I just must be hyper focused on how I am feeling is affecting my therapeutic techniques and skills. I also need it to not affect the therapeutic relationship. Sometimes I think any person can be overly consumed by his or her own stressors. Therefore, I think this ethical standard is the hardest to uphold at all times.
    2.)The most unenjoyable part of being a therapist beyond therapy is the paperwork and explanations you need to give to health insurances. The reason why this is the most difficult for me is because I had experiences in my internship where the “reviewers” on the other end had no recollection of what CBT was, or what it entailed. I was using CBT terms that I was taught in our program and they had no idea what the heck I was talking about. They would also give me advice as to what I should do – out of context to my professional orientation (CBT). They also were not concerned about possible future problems my client may have in the future if he or she continued these types of behaviors – they only cared what was wrong with him or her in the moment. Preventative care I think should have a higher focus in the health insurance industry.

    Reply

    • Cassie McGrath
      Jun 27, 2019 @ 16:13:04

      Matt,

      I really like your comment about ethics. I think that it is a good thought regarding the clinician’s health. I do think that you have a good point about the amount of struggle that credits a missed day of work. I would argue it varies from person to person. But I would also say that it requires a lot of self awareness. I also think that in this field some people tend to brush off their own issues in an effort to “help” others. This would be like saying I am having a bad day but my clients are worse so let me go in today and help. But sometimes that is worse to do. I do not think this is an easy one to manage as an individual.

      Reply

    • Allexys Burbo
      Jun 29, 2019 @ 16:03:01

      Matt,

      I think you raise an interesting concern regarding congruence across care. I believe this is an ongoing issue within the field that provokes distress and frustration for many professionals working in our field – particularly on the part of the counselor. For us, the primary goal is to provide optimal care for our clients. For insurance companies, however, the perception is that this is not necessarily the case. Furthermore, incongruent language can make it difficult to portray the needs of the client – our own therapeutic language can get lost in translation. For this reason, it is important that we are clearly and accurately communicating the needs of our client so that all involved parties can work to provide effective care. Your statement regarding the need for preventative care is also one that I relate to. When considering health disparities and the social determinants of health, it is increasingly apparent that incongruent health and social systems leave a number of our clients at a disadvantage when it comes to adequate health care. If our system did a better job at putting more resources toward preventative care, we might see a significant shift in the health outcomes (both physical and psychological) of our clients.

      Reply

  3. Matthew Lubomirski
    Jun 27, 2019 @ 15:31:16

    (1)Look over the code of ethics for counseling can feel overwhelming. It seems like there is a crazy number of rules we have to follow. But most of the time those rules don’t even apply to our day to day. There are a select few that really stand out. The basics like don’t get to personal with your clients, and remember to follow confidentiality. I think one of the ethic rules that can feel hard to up hold consistently is possibly one of the most important. The simple rule of do no harm. First hearing it, it almost sounds laughable that, that is the one that could be so challenging. After all how hard is it to not harm your clients right? But when you really stop to think about it the answer doesn’t seem so clear. I’m sure we have all heard the stories. The therapist does something they think is right and it ends up awful for the client. Harm was done, even though not intended. In some cases this gets taken to court. The therapist loses their license or because of proper documentation they get off with nothing but are still left feeling guilty. Do no harm at a base level is easy. But to a high standard it can seem impossible. After all that’s when we start hitting the subject. Did you use the right words? Implement the right intervention? I think on a micro level plenty of therapists, even the ones that aren’t fruit loops, harm their clients all the time. But at the end of the day positive change is made. So the small mistakes go unnoticed. This is especially true for us who are just starting out. We may make mistakes that turn a client off to the idea of therapy. But we may never know it becuase to us they will just be another no show. It’s much easier to avoid catastrophic harm. But I think it’s impossible to avoid minor harm.
    (2) In terms of required duties beyond therapy I am sure we can all agree that we hate paperwork. Even for those who are good at it don’t necessarily like it. It takes a special kind of individual to enjoy such a task and if they do, they are probably in another field that makes more money for the unique interest. But for me right up there with paperwork is mandatory trainings. If you dislike long boring meetings and power points as much as I do then I am sure you are also not thrilled about the idea of having to go to a training. My reasons go on and on. You ever want to do something like clean your room? Then someone tells you to do it and you just don’t want to anymore because now you have too. That’s how I feel about trainings. I’d rather taking an online course or read a book. For many of the training I have taken I rarely feel like I left with lasting knowledge. Sadly trainings are an important part of our career development and maintaining our licenses. So despite my dislike for them, I know ill be sitting through a lot of them in my future.

    Reply

    • Louis D’Angelo
      Jun 28, 2019 @ 14:10:39

      Hi Matt,

      You bring up a great point about the “do no harm” principal. This being, where does one draw the line of harmful practice? Of course we could say that a therapist who tells the client that they are to blame for all their problems and endorse shame and hopelessness would be doing harm. But how about unintentional harm such as an ineffective safety plan that was never revised, where do we call this harm and where do we call this malpractice? For me it is a scary idea of actually doing unintentional harm. This is why consultation with a supervisor and immediacy work with the relationship with the client and the measurements of effectiveness of the interventions are key.

      Reply

  4. Cassie McGrath
    Jun 27, 2019 @ 16:05:07

    1) Ethics. I have a lot of thoughts about ethics. Some of the code of ethics I find easy to follow and a no brainer, such as intimate relationships with clients (obviously do not engage). One aspect of ethics I find interesting is that of diagnosing a client. The code of ethics encourages clinicians to appropriately treat clients for their diagnosis. I think that my biggest concern with this is the push to diagnose so quickly. I guess this goes beyond ethics and concerns me related to my thoughts with Managed Care. The push to diagnosis so that reimbursement occurs seems to go against the ethical duty to do no harm. Now I am not saying that every diagnosis is doing a dis-service to a client. But I do think that the push to diagnose can lead to improper diagnoses. I dont think this will be something that I will ignore in practice but it does make me worry about the push from agencies and supervisors to appropriately diagnose, or to diagnose to bill. One other ethical consideration that I find interesting, is the idea of accepting gifts. This is something that i have heard really mixed reviews about and one that I am not sure I have set my standard on yet. I do think that you as a clinician have to have a view that you want to stick with all of your clients. I have heard that some clinicians are okay with accepting minor gifts from clients, I have heard from others that they accept none. I have very mixed feelings about all of this and in some ways I think it is easier to accept nothing because that way you never question it.

    2) I may be strange in this way but I do not mind the aspects that fall outside of therapy. I guess for me, I like the other stuff because I can see how systemically it is so important. I dont know if it is my experience with the system that has made me appreciate these other aspects but they are so important and I would argue relate to the actual therapy that is being done. So many things that we have to do guide are therapy sessions and allow for the most tracking and progress. These other aspects such as progress notes, assessments, and case formulations are a large part of the therapy that we do. I am not saying that I love doing paperwork but I guess I can see the importance of it, and there have been times that I have really relied on my paperwork being done to help me with other things. As an example, if you are doing any referrals for a client for additional services, there are some that require certain documentation. Having it done when it is supposed to makes the rest easier, you can put in those referrals right away and provide the client with services they need sooner rather than later.

    Reply

    • Louis D’Angelo
      Jun 28, 2019 @ 14:17:01

      Hi Cassie,

      I completely agree with your point that much of the documentation and collateral communication tasks we are expected to complete are so important to the work. When I had started, documentation had worried me. Specifically time commitments and thoroughness of the progress. It was intimidating to me but I kept on top of it and saw it head on. Now I am consistently completing notes after sessions and collaterals. These are the documentation of the work that we do and they are often reviewed by other agencies, insurances, and event accreditation boards. They are an incredibly necessary part of our job and are actually not as difficult as I had thought it would be.

      Reply

    • Teresa DiTommaso
      Jun 28, 2019 @ 21:39:44

      Cassie,

      First off, your “do not engage” comment made me laugh out loud. Second, I really like your point of how diagnosis enters the realm of ethics. Although it is not something that comes up in all settings or in every-day practice in some settings, the pressure to diagnose correctly and for reimbursement can be at odds in many different circumstances. In my personal experience, companies will not treat individuals with certain diagnoses because they cannot get reimbursed for it. Now, it is understandable that we all need to get paid in order to do our job, but where does this line of thinking move towards the ethical code of “do no harm” ? Although I am sure there is no black and white statement that can be made about when one ethical concern turns into another, keeping in mind the role of diagnosis is very important. Regardless of how many times I hear professionals say we treat the symptoms and not the diagnosis, which I believe is true, the diagnosis biases us in conscious or unconscious ways, not to mention the lasting stigma effects it has on the client that is receiving that diagnosis, especially when it comes to personality disorder diagnoses. Again Cassie you always bring up things I do not consider, so thanks!

      Reply

  5. Stephanie Mourad
    Jun 27, 2019 @ 16:25:10

    1) One of the codes that I found that might be challenging is confidentiality. Obviously we’re not telling other people about who are clients are and what their issues are but during my time in internship, I found myself slipping a few times. That is, when I would speak to my classmates in the hallways at school about a client, I had to remind myself that I’m in a public space where anyone could hear me. Although I’m not saying my client’s name, I still need to be cautious as to what I reveal. We want to seek advice about clients and what interventions we should use and what steps to take but we also have to keep confidentiality. We have to reveal as little information as possible. I’ve heard stories where counselors have revealed too much information in public and have actually gotten in trouble by the board. So it’s important to always discuss these things in private and realize that anyone could be listening. What I also found is email addresses and making sure our email addresses are signed out. I’ve had an experience at my internship where I’ve logged into a computer and one of my co-intern’s emails is signed in. There was an open window with her email exchanges with a client’s parent. We need to remember to always sign out. If it had been someone else that logged into that computer, lets say a client or someone unauthorized logged in then that person could have gotten in trouble and client information would have been revealed.

    2) Paperwork. I struggled with this a lot during my internship because everything had a due date. I guess it’s good that I had a due date because it helped motivate me more to finish my paperwork but its just so tedious. It’s not challenging to write the paperwork and assessments but rather when you have a large caseload, you’ll probably end up staying after hours just to finish the paperwork. I remember during my first few months of internship, I was given about four to five new clients in a week. So basically all my paperwork was due around the same week. I actually came into internship on the days that I wasn’t scheduled just so that I could finish it all and not have to worry about it. The more I waited to finish my assessments, the more paperwork piled up. Because not only do you need to type up your assessments, but you have to write progress notes for each session, and then eventually your case formulation and treatment plans are due. It just piles up and its even more difficult when you have back to back sessions. I guess just juggling all of that is frustrating and finding time to complete that and also making sure you’re not burnt out.

    Reply

    • Teresa DiTommaso
      Jun 28, 2019 @ 21:43:54

      Steph,

      I can definitely relate to your discussion on confidentiality and how we must always be aware of what we are saying, how we are saying it, and where we are saying it. I related most to your example of talking with classmates about our internship and practicum experience and wanting to share with them the experiences you have had with a client or pick their brain about potential interventions to use with your client. IT was most difficult for me to contain that sensitive information when discussing it with my peers in this program, because you all are the people that not only understand it but would be able to help me if and when I feel stuck or troubled by a particular case. Therefore, I complete agree with your statement that no matter where we are, even if we are talking with colleagues, we want to make sure we are taking the utmost care to preserve patient confidentiality.

      Reply

  6. Aleksa Golloshi
    Jun 27, 2019 @ 16:50:39

    1. Most of the standards in the ACA Code of Ethics are agreeable and seem relatively easy to follow. The one section that stands out to me falls under Section A, which discusses the counseling relationship. A.8. states that when a counselor agrees to provide services to two or more people who have a relationship, the counselor needs to clarify from the beginning which persons are the clients and the nature of the relationships the counselor will have with each involved person. The section continues to discuss that if the counselor performs conflicting roles they may need to adjust, clarify, or withdraw from certain roles. This section made me think of having a couple as my clients and siding more with one client over the other. I’m aware that I have certain biases and I worry that these biases may skew how authentic I’ll appear in session. If I were working with a couple where one of the spouses was unfaithful I believe I would side with the faithful partner, and this may influence how I’d act towards the unfaithful partner. Having these two clients and treating one of them unfairly because of my personal beliefs would be considered unethical, I believe. By siding with one partner I wouldn’t be clearly identifying my relationship with that client and therefore I’d act unethically. This is a worry that I have based on my beliefs, but I assume I wouldn’t agree to seeing a couple with an unfaithful partner in the first place. The issue however, is that I most likely wouldn’t know that one of the partners is unfaithful until after a few sessions. Realistically, this may be an irrational thought of mine. I worry about always providing the best counseling that I can, and it’s ethical standards like this that make me wonder if I’m reading too much into something, or if I truly would be acting unethically.

    2. Managed care organizations is the one topic mentioned in chapter 4 that I find the most frustrating. There had been times during my internship that clients couldn’t see me because they changed their insurance, or authorizations were not approved. I completely understand that insurances and people need to get paid, but I don’t get how people can’t be seen because they don’t have an active insurance. It was painful to me to tell clients I couldn’t see them until they updated their insurance, or whatever the case was involving their insurance, especially if this client was visibly in distress. I believe it’s extremely unjust to push someone’s mental health aside because they can’t pay for a session, or because their insurance can’t pay. I get that I need to get paid, and the organization that I work for needs to get paid, but I think it’ll be more decent to see a client and then bill for the session when their insurance is updated. The other topics mentioned in the chapter, such as progress notes and paper work, are necessary and therefore they don’t really frustrate me.

    Reply

    • Stephanie Mourad
      Jun 29, 2019 @ 13:07:39

      Aleksa,
      I agree with you with having trouble siding with one partner when conducting couple’s therapy. I conducted couple’s therapy once during my internship and I did find myself siding with one person. I think its important to be aware of our biases and seek advice from our supervisor or colleagues on how to solve this problem. Although one partner may have been unfaithful, we need to hear the side of the other person and not assume things based off our own feelings about infidelity. I also think that in moments like that, we need to be more mindful and prepare ourselves for therapy with couple’s by leaving all our biases out the door and just focus on our clients.

      Reply

  7. Louis D’Angelo
    Jun 27, 2019 @ 17:15:06

    1. I believe certain expectations of confidentiality as defined by the ACA code of ethics can be difficult in certain situations. Of course these situations do not include disclosing names of clients on your caseloads but more so situations in which the client we see is not the identified client such as working in a juvenile correction facility or DYS. In some cases the client does not have full control over the information that is disclosed to collateral contacts. In instances where client information must be disclosed to insurance agencies probation officers or caregivers against the desire of the client built rapport with that client may be broken and require much time in repair. Further, this also includes when those instances where information is given to a collateral contact with a release of information is appropriate and is ethical. Of course considering reports of harm and duty to warn are understood, yet again, instances where the client we are seeing is not our identified client, there is a lot of gray area of what should be disclosed to a probation officer for example. In my experience, this required consultation with my supervisor before sharing information with a collateral contact.
    2. Just recently I had sat for a phone screening for a home based therapy position. They had told me that the job required on call shifts from 6am-6pm for 8 weeks and the shifts of 6pm-6am. This was not only shocking, but also difficult to manage. This expected duty on top of a high case load seems extremely tolling. Especially with the separation of work and personal life, this seeming very unmanageable and if a factor that I could see would quickly lead to burn out of their in home clinicians.

    Reply

    • Matthew Lubomirski
      Jun 29, 2019 @ 23:58:13

      He Louie,

      Your point here on the challenges of confidentiality is great. Much like with my idea of do no harm I really liked how you took an ethical code that most would think is the easiest to follow and presented it in a way where it actually is pretty difficult to figure out. It sometimes feels like navigating the web of confidentiality can be a huge mess. Of course one could always take the safe route and say nothing ever but that doesn’t seem realistic.I think there is an even deeper layer to your point when we start to think about all the paperwork and release forms that exist. In some cases sharing confidential information is fine if the right releases are signed and navigating that can seem like a real pain.

      Reply

  8. Allexys Burbo
    Jun 27, 2019 @ 17:44:45

    While generally, the code of professional ethics is one that is easily maintained, one component of the code stands out for me when considering the challenges to adherence at a high standard. Although it is quite obvious that we as professionals only perform and integrate practices/interventions that are within our realm of competence, I imagine that this might present as a challenge when working with specific clients. While the ultimate goal is to meet the needs of our clients, this could be particularly challenging when the perception of what is best for the client exceeds the limits of our knowledge in a specific domain. In this instance, the drive to fulfill the therapeutic needs of the client outweighs awareness of the ethical dangers of engaging in a practice that is beyond our scope of expertise which might unintentionally provoke harm. It is important, for this reason that counselors continuously work to expand their skills and consume literature that will contribute to their knowledge. Additionally, it is integral to connect with other professionals who may provide adequate treatment. Consulting with professionals who have specialized knowledge and skill-base is imperative to maintaining ethical standards. In the position of the professional, it is our ethical duty to reduce risk and harm. For this reason it would be considered unethical to engage in an intervention or strategy that was implemented with limited knowledge or training. My thought is that this would be particularly challenging for beginning professionals – those entering the field brand new, bright-eyed, bushy-tailed and filled with endless creative energy – who are especially interested in engaging in challenging work. In this instance, limited training in a specialized area might escape their judgment which could leave them at risk for addressing issues that are beyond their scope of knowledge and skill.

    At this point in the semester, it is probably glaringly apparent that my least enjoyable duty outside of conducting therapy is the never-ending load of documentation that is required (but really, are we shocked?). While I understand the both the legal and practical need for adhering to requirements of documenting contact with clients, it is still my greatest area of frustration – primarily because time-management is terrible. Although the pressure of meeting deadlines provokes some level of anxiety, I wonder if the other point of contempt is that I struggle with permanently documenting the intimate challenges my clients face. Assigning diagnoses (which might not fully encompass or adequately depict the experience of the client) to meet the requirements outlined by managed care, for instance, seems – on some level – unfair to the very personal experiences of the client. Some of these documents, while protected by confidentiality and other ethical requirements, contain the labels that leave our clients feeling worried about the weight they might carry. While this is generally has little to do with my lack of effective time management, it is something that I have reflected on.

    Reply

    • Stephanie Mourad
      Jun 29, 2019 @ 13:13:54

      Allexys,
      I agree with you about making sure we update our knowledge in specific areas that we lack. It is our duty to cause no harm to our clients and if we engage in an intervention or skill that is not appropriate to help their problems then we could be putting our clients at risk. I think it is also important to seek out help and supervision with learning new methods. We have to be honest with ourselves and with our clients. If we are not confident in our knowledge in a specific area then we have to acknowledge that and seek help. Thinking down the road, if we get a client that we are not experienced in helping then we have to recommend additional help like another counselor or therapist. For example, I have no knowledge on eating disorders or how to treat it. I don’t think it would be appropriate for me to take on that case.

      Reply

    • Cassie McGrath
      Jun 29, 2019 @ 15:42:32

      Allexys,

      I really like your discussion on ethics and the impact of ethical considerations. I think you bring up some good points about meeting a clients needs. I think this is something that comes up when working with clients who may have a different perception of what they would like out of therapy than what we have to offer. I feel as though this is where we may see a need for something to Change for a client but the client being unwilling to work on that change at the time, I think it gets grey here in regards to what we are working on with our clients and how we are most helpful. In regards to your point about documentation, you got this.

      Reply

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Adam M. Volungis, PhD, LMHC

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