Topic 7: Experiencing CBT: Self-Practice & Self-Reflection {by 3/27}

Based on the readings due this week consider the following two discussion points: (1) As a therapist in training, what are your general thoughts about practicing CBT skills/techniques on yourself? (2) What technique/exercise provided you the most insight about yourself as a person or therapist (please only share information within your range of comfort; if it helps, focus on process rather than content)? Explain. Your original post should be posted by the beginning of class 3/27.  Post your two replies no later than 3/29.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

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27 Comments (+add yours?)

  1. Sarah
    Mar 26, 2018 @ 21:54:38

    1. Having knowledge of how useful the CBT skills are for overcoming mental health difficulties makes me inclined to use the skills on myself when I am having a mental health crisis. We tell our clients to do homework and use the skills in their lives, and become frustrated when they don’t, so the skills should be things we are willing to use ourselves in order to remain unhypocritical. However, it is much harder than it looks to calm yourself enough to use the skills when you are in the middle of a mental health crisis. Using the CBT skills myself has definitely given me a better perspective on what the experience is like for clients. I am much more patient with clients who do not complete their homework or who are having difficulty engaging in the skills. I like to think I believe you should practice what you preach, so I have some cognitive dissonance about my own minimal usage of CBT skills.

    2. The skill that has helped me the most is using coping cards. I have found them helpful when I am worried about and catastrophizing a future event. For example, I have been experiencing a high level of stress and anxiety centered around finding a job. I am particularly stressed not only about finding a job, but about finding a job that I will love. In order to remind myself to stop catastrophizing, I would write “I will find a job. I have never had trouble finding employment in the past when I was looking, and it is highly unlikely I will now. It is not the end of the world if I do not find the “perfect” job. I am a positive person and have never had a job I highly disliked, so it is unlikely I would dislike the job I choose to accept now. However, if I do not like the job, I can always just keep looking for new employment.” Using the coping cards has made me more aware of how much I catastrophize things that I am worried about. It has helped me to be more aware of the unnecessary stress those thoughts make me experience.

    Reply

    • Alec Twigden
      Mar 27, 2018 @ 11:37:22

      Sarah,
      I agree that it is important for us as therapist to have a sense of the effort required in the techniques and exercises that we prescribe. I also agree that the skills are much harder to employ than we sometimes let on. By practicing the skills that we teach, we gain perspective that enables us to be patient and empathic with our clients. I also see your cognitive dissonance about practicing what you preach as a healthy sign that you want to believe in what you do.

      Reply

    • Ana
      Mar 27, 2018 @ 12:28:22

      I agree that practicing the CBT skills can really benefit us on a more personal level in terms of promoting mental health. If we have a strong understanding of the skills we are more likely to naturally use it in our real lives. It is basically practicing what we preach which can benefit the therapeutic relationship as the clients see that we aren’t just “telling them” what to do but we believe in these concepts. The belief we project can become motivating to clients who may be hesitant to buy into the model.

      Reply

    • Rachael Hickey
      Mar 29, 2018 @ 17:16:53

      Sarah
      I could not agree more that we are being hypocritical if we tell our clients to do things that we wouldn’t do ourselves, and it gives us an appreciation for the challenge it can be to implement these skills in the moment. I also feel conflicted about my sometimes minimal effort in engaging in skills in the moment. Like my clients tell me, it’s easier said than done! I, too, am one to catastrophize situation and checking the facts and looking at the likelihood of certain outcomes helps me as well. Reflecting on past experiences is helpful when you realize that what you’re worried about has never actually happened.

      Reply

  2. Cora Spillman
    Mar 27, 2018 @ 09:39:51

    As a therapist in training, I think it is important to use/practice CBT skills/techniques on myself. Since I know the rationale and benefits of CBT skills/techniques, I think it would only prove to be beneficial if I used them when I am experiencing distress. Although I think it would be beneficial, I think there is only a certain range of distress that could be reduced through self-practice. At some level of distress, it would be important to seek out support from someone else, rather than trying to conduct self-therapy. Since beginning this program, I have attempted to use several CBT skills/techniques on myself. The biggest challenge has been challenging myself to view something from a different perspective. It would be helpful to have another person challenging me, as I would probably be more likely to listen to someone else (rather than myself).

    From the modules we had assigned, I really enjoyed module 3 – using behavioral activation to change patterns of behavior. Although I have previously completed an activity log for another class, I like how this module broke down how mood may vary depending on the time of day, or depending which day of the week it is. Being able to reflect on the days/times that increase my anxiety or negative emotions was helpful in understanding the connection between the activity, time of day, or day of the week and how it influenced my mood. I also enjoyed creating the hierarchy of pleasurable and necessary activities. Although I am decently good at completing necessary tasks throughout the week, I found it helpful to see how I could balance the most difficult tasks with pleasurable tasks, so it doesn’t seem as overwhelming.

    Reply

    • Alec Twigden
      Mar 27, 2018 @ 11:48:04

      Cora,
      You raise an important point that speaks to limitations of a book, experiencing therapy as a client. The readings help us see therapy and homework from a client’s perspective but in way that we are still conducting the therapy. I think there may be more insights to be had by attempting therapy ourselves as there is value in hearing alternative perspectives and also just the process of explaining situations to other people helps to clarify them and helps to surface assumptions that we maybe didn’t know we were making.

      Reply

    • Ana
      Mar 27, 2018 @ 13:04:04

      I also have completed behavioral activation skills. I did enjoy the way the SP/SR broke it down into sections that were easy to build on one another. I really enjoyed the process of identifying pleasurable, necessary activities and creating the hierarchy of activities. This helped me be more insightful and reflective of my schedule and activities. I really enjoyed keeping track of one emotion across the activity, which helped keep me focused. Like you mentioned, the activity helps identify the balance I have across the week. Identifying this helps me create balance of tasks/obligations and self-care.

      Reply

    • Sarah
      Mar 27, 2018 @ 13:36:09

      Cora,

      I love how you talked about the potential weaknesses of self use of the CBT skills. You’re right that when you’re stuck in a way of thinking, it can be difficult to challenge your own thinking in order to form new beliefs. You’re right that seeking outside help when you get stuck like that is super beneficial. I also like how you talked about the behavioral log. It seems like it really helps you. From having done them in the past, I think of them as a bit too time consuming, so I tend to only use them in more extreme circumstances. They are incredibly helpful, but I find myself less likely to do them because of how much time they take, so I can definitely understand clients not wanting to complete them. Knowing this, I will be much more patient with clients and will take a more hands on approach in guiding them through completing the task.

      Reply

  3. Alec Twigden
    Mar 27, 2018 @ 11:26:07

    (1) Practicing CBT skills and techniques on myself seems to be an effective way of getting in touch with the reality of being a client. Although there is are many skills and techniques that are helpful, questions about the helpfulness of a technique versus the time and effort it takes are worth exploring. For me, practicing these skills help me weigh the two sides in order to highlight areas that are worth my time and exercises that I would not complete as a client. Although practicing these techniques on myself are most informative about personal preferences, they speak to the amount of effort that they require but also the ways that they provide benefit. Referring back to the propositional and implicational systems introduced in the ICS model, practicing these skills helps me as a therapist to develop my empathy toward work that my clients do in a way that is felt in the broader implicational system and hopefully influences the therapy I provide such that I do not have to weigh the helpfulness of a technique versus the effort it requires in such a conscious/effortful way.

    (2) Developing a problem-based formulation, with a problem statement, and strength-based formulation, followed by goal setting, resonated well with me because it set a clear and defined foundation for steps that followed. Personally, this step seemed more helpful than most other processes for change because although this requires a lot of effort, if I were to take one written step, it would be this one as it provides some degree of guidance and insight on its own. I also like that it emphasizes both the problem (the purpose of therapy) but also strengths that help to de-pathologize the problem and enlighted a pathway to change by activating the implicational system toward a new way of being. In this way it could be a way of making therapy at least somewhat exciting, even before changes are made. By engaging in some of our own therapeutic techniques, I am better able to understand some of the ways that therapy can be valuable to my clients.

    Reply

    • Jeremy Pierce
      Mar 28, 2018 @ 15:18:15

      Alec I like your point of doing the exercises as a way to help you feel like if they were worth your time, as a way to gauge whether certain things make sense for certain clients. I think all of us are different and may enjoy or get something out of certain things whereas others may not. On the flip side, someone may still benefit from an exercise even if we our self did not enjoy it or benefit from it. I’d say just keep this in mind in the event you might not think something is important or helpful, but it could be for another person. I think having a feel for what clients may be more open to things helps but again everyone is so different it can be hard to gauge!

      Reply

    • Cora Spillman
      Mar 30, 2018 @ 13:13:06

      Alec, I enjoyed reading your response to part 1 of the blog post. I think it is interesting to hear how you conceptualized the techniques in regards to how a client may feel when completing them. I hadn’t entirely thought about it in that way, as I was more so focused on how the skills would benefit my own well-being. I definitely think it is important to consider how we feel about completing the exercises, and then consider how the client would feel completing the exercises. If it is a technique that takes a lot of time and practice, and I don’t personally feel it to be time-effective, it is quite possible my client would feel the same way.

      Reply

  4. Andrew Lampi
    Mar 27, 2018 @ 11:55:47

    1. As a therapist in training, I think it is incredibly important and useful to utilize the same techniques we teach our clients in an effort to help ourselves. I think this for two main reasons: the first is that I think this gives us a perspective that if we lacked would threaten to damage the therapeutic relationship. I am a firm believer in practicing what you preach, and I feel as though I could not legitimately offer suggestions or interventions to clients without having a working understanding of how they play into one’s life, and I cannot think of a better way to do this than by implementing these strategies ourselves. Secondly, this also has the potential to serve our own mental health and well-being in a self-care capacity that allows us to be better, more effective clinicians for our clients. Just as taking time for hobbies, friends, and family (among other strategies) are all essential to our self-care, ensuring that our day-to-day functioning is occurring at its highest level continues to help us be effective. While I think it would be impractical to use all of the CBT strategies in our repertoire in our daily lives, giving them a go at different times, especially when they may be most beneficial can give us insight and benefit our well-being in ways that help us be more effective and have greater empathy for our clients.

    2. There have been several techniques that I have used that have provided me insight about myself, but one example comes quickly to mind. I have a tough time dealing with blood, be it giving blood, getting it drawn, or even seeing/hearing about others engaging in these activities. Through the training from this program and learning about the techniques used to help people with BII phobia, I’ve tried using several different interventions to help me get through times when I have to be in situations like these (i.e. doctor’s visits, etc.). I’ve been relatively successful in reducing some of my anxiety when faced or engaging in these situations through some cognitive restructuring and trying to refrain from avoiding the situation, even if not fully engaging in exposure/response prevention. This experience has taught me that I’m capable of handling more than I thought I’d be able to, at least initially. On a personal level, that feels pretty good and pretty gratifying. On a professional level, it’s given me the experience I think would help me increase my skills and knowledge as a therapist. Understanding how these interventions might work with clients has given me extra (albeit anecdotal) confidence in their efficacy, and it’s also helped me be a better, more effective therapist when dealing with clients whose stories deal with these situations, requiring their discussion.

    Reply

    • Brenden Knight
      Mar 27, 2018 @ 16:06:23

      Andrew,
      I understand your increased confidence in CBT interventions, having tested them on yourself in specific situations. I agree that seeing the efficacy firsthand (albeit anecdotal as you say) cultivates stronger commitment to the CBT approach. Moreover, seeing promising results in my own life as a result of these techniques also makes me a better therapist. Beyond personal benefits, testing these techniques also makes us better teachers. That is, we can plan for obstacles and explain homework assignments more efficiently for our clients, having practiced them ourselves and learning the “tips and tricks.”

      Reply

  5. Ana
    Mar 27, 2018 @ 12:17:41

    1. As a therapist in training, I think it is really important to practice CBT skills in order to have a better understanding of how to use them (gain some competency). It is also important to practice the techniques in order for us to be genuine with clients about their experience in the process of change. If we have gone through the process ourselves, we will be better able to validate and support our clients. Also having the experience can enlighten us to the barriers clients will face when trying to practice the skills. This foresight can be beneficial in problem solving and creating alternative methods to engage the client in the change process. We can also have a better understanding of how involved the techniques can be (time, effort, focus, etc.) which can help us choose more appropriate skills to practice with the client based on their presentation.
    2. The downward arrow technique is definitely one in which I feel provides me with the most insight. It forces me to be more introspective and analyze where these things are coming from and why they are so impactful in my life. I think that this skill is very useful to get at schemas and core beliefs which I find to be one of the more challenging aspects of CBT in practice. It can be a challenge to implement as many clients have difficulty being introspective and get stuck with the “I don’t know.” It is important to learn how to coach a client through this technique when they keep getting stuck.

    Reply

    • Sarah
      Mar 27, 2018 @ 13:28:27

      Ana,

      I love how you talked about practicing the skills to increase competency. I hadn’t thought about that before you mentioned it, but you’re right. The practice can help us to help our clients with the skills. You have to be competent at something in order to teach it. I also like how you brought up that engaging in the skills ourselves can shed light on the barriers our clients face when attempting to use the skills. I also love that bring up the importance of coaching clients through the skills when they become stuck. You raised some really good points.

      Reply

    • Andrew Lampi
      Mar 28, 2018 @ 20:39:49

      Ana,
      I think your point about being able to predict potential roadblocks and understand the commitment these techniques involve is great. I agree that going through the process this way would offer us the chance to get a real-life look at what exactly these techniques require and what it is we’re asking of our clients when we suggest them. I think it’s also important to consider how we adapt these techniques from their textbook explanations in order to make them fit within the context of our own lives. Understanding that our clients will need to do the same and being there to support them in that process is also important for us to do. I think this also plays into your description of the use of the downward arrow technique. Having a personal idea of how clients might respond to this, and how frustrating it can be could offer some great insight into how to help our clients ultimately succeed in its use. Knowing what roadblocks might lie in the way and how we can avoid them is a great skill clinicians can use with their clients.

      Reply

    • Matt Miracle
      Mar 30, 2018 @ 01:11:22

      Ana,

      It’s nice to hear the downward arrow technique is useful for you; when I use it with clients I typically just get the response of “I don’t know,” like you mentioned. Anyway, I agree, practicing CBT skills can be useful. I think it’s often easy for us as therapists to forget how hard change can be. Simply finding the motivation to exercise and eat healthy can be tough, yet we’re sometimes trying to sell people on changing their entire lifestyle. By practicing CBT ourselves, it can also act as a way to remind ourselves how difficult it is to experience change.

      Reply

  6. Rachael Hickey
    Mar 27, 2018 @ 13:36:51

    1. As a therapist in training, I think it is critical to practice CBT skills on myself. I think it would be hypocritical to suggest something to a client that you wouldn’t/haven’t tried yourself. Furthermore, by practicing CBT skills yourself, it allows you to better understand what is involved in the skill, any potential barriers that may pop up in trying to implement the skills, and this makes you better able to explain it. Clients often feel misunderstood and singled out when they have to do things those around them do not, and being able to personally vouche for the skill can help minimize the stigma and may increase motivation in the client to actually try the skill and practice it regularly. Practicing this skill with them in session will reinforce the skill through social learning theory and to effectively model this skill, you will need to have practiced the skill yourself.

    2. I sometimes have difficulty with anxiety and there are several CBT tools I find useful. A tool I use a lot with my clients and myself is cognitive restructuring and checking the facts and evidence for anxiety provoking thoughts. This helps to be more objective about the situation and reduce stress. I also find Judith Beck’s technique of identifying the worst-case scenario, best-case scenario, and most likely scenario helpful. Similar to checking the facts, this allows me to look at all possible outcomes, not just the most catastrophic possibility, and then further provides the opportunity to look at problem and/or emotion-focused coping skills I can use for these scenarios. I can appreciate the difficulty in what we set our clients out to do, as I sometimes find that while I can cognitively understand the skills and their utility, I have a hard time actually implementing them or finding an alternative thought that I feel connected with.

    Reply

    • Brenden Knight
      Mar 27, 2018 @ 15:36:08

      You bring up a good point about not being a “hypocrite” by suggesting something to a client (e.g., a behavioral experiment) that you yourself have not tried or would not be willing to try. I have found myself on multiple occasions asking myself if I would engage in an exposure that my client agrees to. Ignoring this topic only serves to promote the myth that therapists are invulnerable and above our own practices. Just sifting through modules 3-5 in the book reminded me of how difficult it can be to personally incorporate “homework” throughout the week because of the time commitment alone. Perhaps the nature of meeting with clients for an hour each week reinforces the idea that our clients have all the time in the world to complete assignments. The reality is that we may meet client who have busy lifestyles themselves. Therefore it is important to recognize the effort required to carry through with assignments (and positively reinforce completions!)

      Reply

    • Cora Spillman
      Mar 30, 2018 @ 13:16:34

      Rachael, I completely agree with your responses to both parts one and two of this week’s blog post. I think practicing CBT techniques ourselves, will only give us a better understanding of our clients, and we will likely gain more empathy for them. Some of the CBT techniques we ask our client to complete, can be challenging for myself, even when not under distress. I can only imagine what it might feel like for someone experiencing high levels of distress and attempting to complete the exercise. This is definitely something to keep in mind when assigning clients new homework or activities.

      Reply

  7. Brenden Knight
    Mar 27, 2018 @ 14:42:46

    1) As a novice therapist I find great value in testing my own theoretical orientation on myself from time to time. In all areas of life, I value “practicing what one preaches,” especially in a profession that demands strong command, understanding, and expertise with specific interventions and techniques. Moreover, experiencing the process of “self-therapy” makes me more appreciative and committed to the cognitive-behavioral approach. Of course, practicing CBT skills on myself does not necessarily mean that it is always a pleasant or enjoyable experience. I often find myself making self-defeating statements when I uncover one of my own negative automatic thoughts or engaging in an avoidance behavior (e.g., “I shouldn’t do that, I should be better than this. After all, I’m supposed to help other people with this stuff!”). Yet, I believe that self-examination (i.e., SP/SR) is an essential tool for any aspiring cognitive behavioral therapist. Moreover, SP/SR is not a one-time deal. I believe that practice over the lifetime produces the best results and the most effective clinicians. The day that we become “better” than our own professional practices is the day that we stop growing as professionals altogether. Moreover, my times of self-practice are often rewarding and insightful (because I love this stuff).

    2) As the book recommends, beginning therapists should focus on SP/SR that applies to one’s experiences as a therapist. However, the authors also note that readers often find the greatest benefits from practicing these techniques in their personal lives as well. I have found benefits to both approaches. Moreover, the technique that I have found most helpful applies to both my professional and work life. Learning to step outside of my habitual day-to-day automatized activity and self-monitoring my underlying intentions has revealed a stark amount of my own avoidance and safety behaviors. Prior to my training as a cognitive-behavioral therapist, I lacked the motivation of asking myself in any given situation, “Why am I behaving in this particular way?” Monitoring my actions (or inaction) on a periodic basis has revealed that I too “fall victim” to the maintaining cycles of anxiety at times. Having this insight alone has helped me to challenge my own dysfunctional patterns of behavior and reappraise my distorted thoughts associated with these behaviors. For example, I noticed early on at my internship that I felt immensely more comfortable (and “safe”) when I carried my clipboard to the waiting room when greeting a new client for intake. Underlying this behavior was the thought that carrying a clipboard conveyed a sense of professionalism and competence. Moreover, I thought that the consequence of not engaging in this behavior would be a negative perception from others about my clinical abilities as “just an intern.” Simply identifying this safety behavior created necessary change as I learned to challenge my underlying dysfunctional thoughts with contradictory behavior (i.e., greeting clients empty-handed).

    Reply

    • Matt Miracle
      Mar 30, 2018 @ 01:30:24

      Brenden,

      That clipboard story is pretty funny, but a good example nonetheless. You make a good point about self-monitoring and self-reflection. I think these are practices that have also helped me grow the most throughout my internship. On a similar note, when I started my internship, I was not very aware of the scenarios that would cause me to experience countertransference in therapy nor did I even think it was a possibility. However, I feel like I’ve since learned a lot of patience, how to monitor myself, reflect, and keep in mind that the therapy session isn’t about my opinions/judgements. These skills and experiences are important, I think, for personal and professional growth.

      Reply

  8. Jeremy Pierce
    Mar 27, 2018 @ 15:59:03

    (1) As a therapist in training, what are your general thoughts about practicing CBT skills/techniques on yourself?
    I think its a great idea to be able to practice what we preach and use CBT techniques on ourselves. I think being able to use what we have learned on ourselves is a great way to be able to further conceptualize certain methods, for instance examining our automatic thought as in given situation. I have practiced this for a long time and it helps me understand the value of getting our clients to try it. I think its good to look at a variety of components of CBT, including but not limited to rec. det., coping strategies, and self-efficacy because they are great ways to further understand ourselves as well, which is a very important piece to life in my opinion. Again, the more we practice these skills on our self, the easier I think it will be to work on them with clients because we will be that much more sure and confident that what we are saying is helpful because we experience the benefits our self.

    (2) What technique/exercise provided you the most insight about yourself as a person or therapist (please only share information within your range of comfort; if it helps, focus on process rather than content)? Explain.
    I think some of the exercises that help the most are behavior activation logs. I find these helpful to show how active I am and if there are times or areas of my weekly routine that I could be doing more or less of something. Honestly I think they mostly help me plan, and I love having a steady structure to my schedule or I feel all over the place with uncertainty of what I could or should be doing. For instance, sometimes I am able to recognize that instead of going home to relax, I could go to the gym or see some of my friends to be more productive with my time. Also, it helps me to be able to see if I might need to adjust a really busy day to spread out a workload instead of cramming a ton into one day. At my internship there are some days where I see a lot of clients in a given day so recently I am try to make sure I get a head start on progress notes, even just by making bullet points on my notes during a session.

    Reply

    • Andrew Lampi
      Mar 28, 2018 @ 20:40:27

      Jeremy,
      I agree that seeing the benefit of CBT techniques firsthand helps give us confidence in recommending them to our clients. Even understanding the empirical support for these methods, having a more nuanced understanding of their implementation and a personal report of their success can even help us communicate the efficacy of these interventions at an even greater level. I also think it’s interesting to see how many clinicians like us use strategies similar to behavior logs on a daily basis. Even if we don’t use them for the purpose of tracking our physical activation day-to-day, planning ahead and making the most use of our time, especially when at the office, is something that would likely benefit us all.

      Reply

    • Rachael Hickey
      Mar 29, 2018 @ 17:21:29

      Jeremy
      You make a great point that by practicing the skills ourselves, we are better able to conceptualize them for our clients and help them better tailor the skills to certain situation. Clients sometimes feel like what we suggest for them to try will not work, so having that direct evidence from ourselves that we could provide to them (given an appropriate circumstance for self-disclosure) can be a powerful statement and may help motivate them to try to the skills. Behavioral scheduling/activation is something I would really benefit from, but am admittedly not very good at. I try to plan and schedule things, but usually end up with many things to do on one or two days that I have put off from previously scheduled times. I find it stress-relieving to write out what needs to be done and it’s very satisfying to cross them off the list when done.

      Reply

  9. Matt Miracle
    Mar 27, 2018 @ 16:35:51

    1. When I’m stressed or having problems, I don’t really ever consciously stop and think to practice CBT techniques on myself. Rather, I think I tend to naturally be a logical/analytical thinker (sometimes to my detriment) and this is what drew me into CBT in the first place. Often times, I’ll weigh the evidence for and against something or look for cognitive distortions in my own thinking. Although I do think this helps me live life relatively free of most unproductive worry and anxiety, I have found in therapy I often have difficulties dealing with strong emotions because I’ll only want to problem-solve or work towards a client’s established goals. As I’ve mentioned in previous blog posts, I’ve also found that I do a lot of “activity scheduling” naturally as well. Just like I schedule work and school activities, I tend to schedule my hobbies as well. I think this is a good practice not only for one’s own mental health, but also because it shows that one can practice what they preach.
    2. Before going into a situation, I often like to identify the worst-case scenario, best-case scenario, and most likely scenario and prepare for all three. For me, if I’m feeling anxious, it helps to be able to roleplay the scenarios out in my head and be prepared for the worst. I’ll often use this with my social anxiety clients to help prepare them for an exposure exercise. This can be helpful in identifying possible obstacles that were unknown before so that one can prepare for them ahead of time.

    Reply

    • Jeremy Pierce
      Mar 28, 2018 @ 15:22:24

      Matt I like how you recognize scheduling helps you even though it doesn’t sound like its something you only do because its a CBT method. Having that as your own solid skill could help you be able to be an expert in that area and allow you to teach clients about it, as it is an area of strength for you. I also like your approach before sessions thinking about best/worst case scenarios. I always try to stay open-minded as to what could happen, like if a clients is happy or mad to be there, so I can adjust to that but I think it could help me to use a similar approach going forward!

      Reply

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Adam M. Volungis, PhD, LMHC

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