Contributed by Shana Boger, Therapy Intern
The holidays are upon us, and so is Christmas cheer. Or at least it should be, right? The commercialism of the holiday season (not to mention the growing list of Hallmark Christmas movies that are on all month) make us excited for Christmas, but they also create an expectation in our minds. Expectations of the experience and, more importantly, expectations of ourselves. That said, the holidays can also be stressful. How many of us are hosting a holiday party and meal? How long are our holiday shopping lists? Who will all be at the family Christmas party, and how do we ensure that everyone gets along? Hoping for that holiday bonus so you can afford everything on your shopping list? The stress of the holidays can often fog our minds to an extent that we don’t even allow ourselves to enjoy the holidays.
I’m noticing this in myself more and more as I grow older, but I most clearly see it in my own mother. My mother is a busy, dedicated woman, and has always been the one to make the holiday meal (which begins months in advance by making a list of all the foods she needs to make, followed by a shopping list, etc.) When the holiday arrives, everything is wonderful. The food is delicious, the tree is lit up beautifully, the stockings are hung just right, and the gifts are wrapped and meticulously placed under the tree. But where is my mother while we’re eating the delicious food? In the kitchen, cleaning up the counters and helping others make their plates. Where is she when we’re opening gifts? Picking up all the wrapping paper we’ve thrown to the side in excitement. She is always thinking about what task needs to be done next in order for things to go smoothly. I know my mother enjoys her role on the holidays, but I also know that stress often overshadows our own excitement of the holidays and, the more I grow into adulthood, the more I feel myself becoming stressed about the holiday season.
This holiday season, I want to offer a different way of approaching the holidays. And so I’ve thought to myself – how do we reduce the stress of the holidays? It all comes back to self-care. Here are some simple, yet effective forms of self-care and stress reduction:
Beyond the few tips that I’ve mentioned here, I also want us to think about the small things that we truly enjoy about the holidays and allow ourselves those things! For me personally, it’s grabbing a Christmas cookie and a cup of hot chocolate, snuggling in with my dog under a cozy blanket on the couch, and watching the Grinch. It is different for all of us. So grab that fa-la-latte from Caribou Coffee. Sit and admire your hard work of decorating the Christmas tree. Go outside and get that fresh air and moment away from your not-so-favorite uncle. Hum or sing your favorite Christmas carol. Whatever it is that makes the holidays less stressful and more enjoyable, do it! After all, the holidays only come around once a year.
A a clinician: Starting with a timeline of events can help you determine where the client has been and what negative beliefs are impeding their happiness and fullness of life.
We want to find what is a maladaptive response to things that happen in life and help them become more adaptive. This is what helps people to function well. Sort of 'updating the circuits' if you will. EMDR can help you update them after you find them.
The following is based on my experiences as a clinician.
Start with a question like: "What is the earliest memory you have?" An example may be something like: "I went to the hospital because I fell off the bed. I had a broken clavicle. It happened when I was 3 years old. I remember my mom being upset and it hurt a lot and I had to have my arm strapped down. I hated it. I wanted them to let my arm out but they wouldn't. My parents fought about it and it got pretty nasty. They were both mad all the time."
This type of answer will tell you as the clinician to look for the 'I'm not safe' 'I am trapped' and/or 'I am vulnerable' negative belief, there may be other beliefs like 'I'm not important,' 'I am invisible', or 'I am not worthy', because of the fighting going on that as a 3 year old the person believes is about him/her.
This client could have problems with relationships, hospitals/doctors, having someone grab their arm or feeling trapped when in certain physical positions, they may have dreams about falling off of things and have general feelings of low self worth.
Continue to get event after event and you will begin to see themes for them. You may find several times when they tried to do something and it wasn't well received or they had a couple of bad job experiences. Cluster those events as negative belief systems.
Our worth is dictated to us by how our first relationships treat us. At 3 years old, it is a time when we are learning our separateness from our parents and our ability to do things. It is Erikson's 3rd stage, called Initiative vs. Guilt. We are drawn in this stage to look for things we can do on our own, start something (and finishing with help) and feel good about it. When we are told no repeatedly for trying to do things, or unable to do so, we often feel bad about ourselves.
So, this seemingly small incident can make us download one or more negative belief into our neuro-pathways. All negative beliefs make us desperately want find reasons they are not true. However, our brains see more of when that negative belief IS true. Things we see validates that negative belief, over and over again through our life. It makes it difficult to rid ourselves of that negative belief and we respond to it maladaptively over and over again. A reaction if you will to keep ourselves safe. Our brains don't know the difference between a physical danger and an emotional danger.
So, when that same person has an argument with someone they love, the old networks fire off and we have the same reactivity as when we were young. They may have a shut down, fighting or avoidance response related to all this old content that comes rushing back to them when 'triggered' to remember these things.
This is a simplistic view, but from the age of 3 to 30, one can have several of these types of reactions and 'triggers' which makes it more and more likely that the next thing that happens to them will have the same response. These responses are maladaptive now, but they were adaptive when the person was 3 years old. It is like, the brain finds what works and sort of etches it in and uses the same response over and over again because it worked once. It is like gambling... that rush with the win prompts the next bet.
Our job as the clinician is to find the negative belief that hurts their ability to respond adaptively and help them update that neuropathway.
Positives experiences are things the brain doesn't spend as much time on cataloging because we are wired for health and safety, so we find the negatives first!
Getting a second positive timeline of events can help to build resiliency and show the person they have good things in their lives. When you do both at the same time, you can reduce the activation of negative emotion substantially and not let the person leave your office with too much emotion. Keeping them in the window of tolerance.
Have them tell you about happy events that give them positive memories and feelings. Have them bring up the positive emotion, find it in their body and assign a positive belief to that specific memory or event. Then have them tap in (tapping their heels or hands on knees, alternatingly for a count of 6 or so, don't actually count) or meditate with breathing on the positives that those memories give them. This can substantially help them to function better during your treatment and help them feel more in control of their emotions during treatment.
There is much more to this, but these are two basic things you can use to help guide your therapy, (making a plan) and prepare them for therapy.
Hope to see you in Consultation!
In Every stable relationship the following pillars are present
1) An Openness that allows each person to Validate the other's experiences and feelings.
2) Show Empathy in their understanding of how difficult some things are for the other person.
3) Feeling safe to be Vulnerable in the presence of their partner will help the couple to,
4) Trust their partner and see they both want a good outcome.
5) Bring these all together to form an increased Intimacy that allows a couple to move forward in healing their hurts and forgive the other.
6) A new Respect in the relationship will occur as a result of the all of this work so far.
7) Communication, behaviors and beliefs in the 'space between' will be positive and collaborative Problem Solving will happen easier in the relationship, securing a positive future.
Some couples have never been truly intimate with each other. They need to know they have the capacity to be vulnerable enough with each other and they have experienced this ability in the past.
Most people have negative beliefs that keep them from having empathy for themselves and others. Some have a negative belief of self that they are somehow unworthy. This belief hurts their ability to see the worth in others and believe that their partners can find worth in them. Helping them to find some empathy for self, will help them find empathy in their partner.
Empathy comes with validation of each other's perspectives. The therapist must model this, validate, validate, validate! Then help them see the child inside. Tying the past to the present, through the AIP lens is imperative in helping the client their current responses to things are very much rooted in the past. This will help them connect to themselves, so they can connect to their partners. Extra benefit... the partner sees this happening and is often able to see that child inside and give them empathy. This starts the healing in a real way. It provides a little distance to the emotional cycle and helps them to see their responses and their partner's responses as being the child's hurt feelings that are still present.
To be continued...
EMDR Resourcing for Couples - Early Stages of Therapy
This is only a small part of the process but the technique can be used as a stand alone resource intervention, integrated into your normal practice.
Many couples come in very angry at each other and unable to communicate in a constructive way. Both feeling misunderstood, needing a validated connection with their partner. These are symptoms of attachment deficits. Our goal is to help heal these deficits.
You may notice that one part of the couple will avoid, while the other will pursue, or conversely they may both pursue or both avoid each other and the issues that cause the wounds. These dynamics must be taken into consideration. This is a re-enactment of their own attachment cycles.
I have found in my work with couples, there are several things that need to happen for them to be on the same page, for both to want to engage in a way that will be more conducive to healing their wounds. Although this is an intensely personal process for the individual, there is another level of vulnerability when they are together. I attempt to help them find that safe space, the in between, where they can see the other with deeper connection. Our client is the relationship. To get to the heart of the connection, each person must identify their own vulnerabilities, empathize with the other and a desire to forgive.
Before I begin, I discuss their intentions individually to make sure they both have the goal of staying in the relationship and will do the work it takes to be successful. I theneducate them on how the wounds in their relationship are symptoms of old trauma or bad experiences from both partners that has been brought into the relationship, into the 'space between'. I help them understand how trauma affects the brain and how their neuropathways are 'frozen' by repeated 'validation of the negative belief' throughout life experiences. I discuss how that effects their behaviors and emotions in and about the relationship. I explain to them how EMDR can help to reduce the interpersonal negative effects of those events.
I also teach them the technicalities of EMDR work and how to 'walk it through' or 'tap it in'. I show them the feet as I walk through as I sit. I also demonstrate tapping on my knees and say "just tap like this, not too fast, between 6 and 12 times, not too many, but don't count". I find it helps them to be able to have dual attention for the resource. I also work with them on their own individual calm place, conflict free place in nature. It is imperative that the individual have skills to self calm and regulate.
Couples must BOTH want to save their relationship and be committed to each other to work it out. Identify the commitment to the process. That is the beginning of the healing. Then you work on their ability to be INTIMATE with each other in a sense of human connection.
Validation, Empathy, Vulnerability all work toward an Intimate, connected relationship.
Here is one thing you can do to help the enhance the positives of the shared space, between them.
Teaching how to formulate a SHARED Conflict Free Image of Togetherness is one step to help remind them they are on the same page.
The following is written from the therapist perspective, with narrator comments in parentheses.
Therapist: Have you ever been on a trip or had a shared experience where you experienced a really good connection? Have them explain this experience.
(I often get answers like, honeymoon, trip without the kids, camping, road trip. All places where freedom is the feeling, reduced responsibilities etc. Their perceptions are their own, it doesn't matter if they have the same part of that memory or one of them have a different one. They just have to use that experience to help them realize their closeness.)
Therapist: Bring up that experience, what is the temperature, what sounds are associated with the experience, smells, how are you holding yourself? Where are you in proximity to your spouse, remember those good feelings you shared at that time. Bring this up and amplify the picture, make it brighter and more intense, when you get a good sense of that closeness tap it in. (Have them tap it in or walk it through, you can have them to this together or tap for each other if appropriate).
Debriefing the experience:
Therapist: What came up for you as you were re-experiencing that time together? Share what was the best part for you (each client shares). Remember that it doesn't matter if you have different 'best parts', both of your perceptions are valid and cause good feelings toward the relationship.
Give them this as homework on a daily basis, spending time remembering the positives of how they felt with each other.
If you'd like to learn more, I will be presenting a full day on October 2, 2017 in Sioux City. Go to www.EMDRandBeyond.com to get more information or to have me come see you!
I have studied many different approaches to working with couples/families. All of my comments come from studies and experience working with couples/families. Some of the more current studies for couples was in Emotion Focused Therapy. Many of the EMDR references come from my original EMDR relationship focused training by Laurel Parnell and subsequent belief focused EMDR training by Roy Kiessling. As most therapists accumulate knowledge and don't remember where it was learned, so do I. This is an attempt to give credit to those who came before me and have shown how well they do their work.
It's hard to remember to be grateful all the time. But when we can, it is a very satisfying feeling.
True gratitude doesn't come from saying 'thank you' rotely, or saying we appreciate something.
But, being grateful for something is an action. An acknowledgement of what you are happy that you have.
The dictionary says that 'Grateful' is a feeling or showing an appreciation of kindness; thankfulness.
What are you grateful for?
Sometimes it is difficult to articulate, or show our feelings of thankfulness and appreciation. Sometimes it is easy. If you know the person. But how often do we express gratitude or thankfulness to others that you don't really know. Those that have an impact on your life even if just a small one. The person who goes out of their way to make sure your coffee is just right. The person who complimented you on something of small importance. That random person who opens the door for you or the greeter at the grocery store? These people make a difference if you stop to think about it. Problematically, they become part of the wallpaper of life. We don't notice these things because we are busy, rushed or just simply not focused on being where we are in the moment.
What would it take to be here, in the moment... from moment to moment and show simple gratitude?
Do you notice gratitude when you feel it?
I have this overwhelming feeling of gratitude when I look outside and see a beautiful landscape or sunset. Cliche maybe. But it is true. It fills my heart with wonder and thankfulness that I have the opportunity to see such beauty. I have had many experiences like that in my life. I try to take pictures of those things, but they never seem to do those views justice.
I have also had the opportunity of spending special time with family and friends. I have such a great warmth when I look out at the scene of those that I love and can't help but feel gratitude for the time we are spending together in that moment.
When I go back to my life, I begin to loose my focus on gratitude that shortly before filled me up. I wonder why that happens?
I would love to hold on to that feeling all the time. I will look to see what it will take to do so in my future.
What will you do to hold onto that wonderful feeling of deep gratitude that has the power to fill your heart?
M.S., LMHC, IADC, CAMS I
“The richest and fullest lives attempt to achieve an inner balance between three realms: work, love, and play.” ~Erik Erikson
Balance. It’s a word we hear often. It’s an idea or a concept that we strive for daily; consistently and relentlessly trying to achieve that magical level that keeps us in mental stability. We try to find a working balance between our jobs, our families, and our need to relax and enjoy our lives. And often times, we find that our lives are out of balance because life is a constant moving object, constant waves hitting the beach and then receding back again. Life does not stay stagnant or frozen in time, it is forever moving. So how do we maintain balance in a life that is ever changing?
We adapt. We learn, we grow, we change with the changing tide. We decide what is important to us and we focus our attention to make that matter. We learn to put our emotional needs ahead of working impossible hours to get the next promotion, or put our children’s needs ahead of our desire to skydive off a cliff. We seek to understand ourselves better, to find a sense of self that is strong, so that we can head off a crashing tumble in the ocean of our lives, to keep riding the wave of change as it comes in again.
As a therapist, I have struggled with finding a sense of balance that is harmonized with what I do. I learned early in my career that I could not live for just my career, that I needed to have more focus in other areas of my life as well. I, on occasion, must be willing to put my needs ahead of my work, to focus on being a partner, a friend, a sister, a daughter, an aunt, a living breathing human being. This is not an easy emotional feat when your career is based on helping others find their path and themselves. It feels selfish and as if I’m letting others down. But it is essential to maintain my internal harmony.
It is hard to find that perfect balance between work, love, and play. And when you do find it, it changes almost as quickly as it came to be. Perhaps the concept of “balance” isn’t something you “find”, but rather something you simply “are”. I am a balanced person today.
Contributed by Renae Jones MS, LMHC
The Power of Validation
Have you ever felt understood? As in someone really understands you – they get you – and
they get it! It’s one of the best feelings to experience.
In my own parenting journey I have had the experience of watching my child, who I love more
than words can say, have a major melt down and present behaviors that are more than words
can describe! My reaction – Stop – Stop – Stop! I quickly think to myself I HAVE to make them
STOP. They get escalated and I get escalated. This is great. Now the both of us are flying off the
handle. Didn’t I just mention I love this child more than words can say? So why am I losing it?
Why am I raising my voice – ok – admit it – yelling? And I have to ask myself – don’t you think if
he/she could stop he/she would stop? This is likely about as much fun for them as it is for you
right now – how are you feeling?
Yes – go with that - how are you feeling? Horrible, my heart is racing, my face is red, my voice is
raised (OK - I’m yelling), perhaps I’ve even pounded my fist on the table or kicked the couch. I
feel awful and it gets even worse when I consider that I’m doing this in response to my four
year old child. Nice – I hope this picture goes into their short term memory with a caption “OK,
not Mom’s finest hour but I love her just the same.” So that’s how you’re feeling. Now, more
importantly and very key in breaking this cycle – how are they feeling?
Now go with that – how are they feeling? Well, from the looks of things they are not feeling well at all. Laying on the floor screaming and thrashing about is not the international sign of “I’m having a great day”. So they’re feeling – what – did they say? Did anything come out in which they identified a feeling, any “I hate you”, “I can’t stand this”, “I hate school”, “I’m scared” – anything. Because if anything did you have the start of your validation and perhaps the start of de-escalating this child who you really do love more than words can say. If they identified a feeling, you can validate it simply by repeating what they just said.
They say, “I’m scared.” Your response, “You’re scared.” Yep, it’s that easy.
They say, “I’m mad.” Your response, “You’re mad.” See - easy.
They say, “I hate you.” – Your response, “You hate me.” OK, that one’s not so easy. However,
the thing to remember is you are validating a feeling they are having right in that time they’re
having it. So try to keep in mind this is what they’re feeling right now, not forever. And truly, although hearing this is not easy, there’s a big difference between saying and doing. It is, after all, our actions and behaviors that get us in trouble and not our feelings. And if a child can express a feeling safely and be heard they are less likely to act on feelings that are bottled up and eating away at them later on in life. So hear them, and more so, understand them. That’s the power of validation of feeling.
So what about the child who lays on the floor screaming and thrashing about with no
identifiable words coming out. They don’t or can’t (pre-verbal) give you any words to describe
what they’re feeling. Well, again, look at the presentation and give a guess. “It looks like you’re
mad.” “You seem frustrated.” “You’re sad – am I right?”
This may seem patronizing or condescending to some people but it’s an act of enormous love to
try and understand each other. Understanding and accepting is a big part of love. It is not loving
to fix each other or stop each other, although that is usually our intent when we try to fix our kids or stop a meltdown. We want them to be the best they can be and we don’t like seeing them in pain. However, there is an implied message with fixing and stopping that can be perceived as - I’m loved – but not when I do this or I’m a great kid - if I just got rid of this part. As parents, of course we love our kids entirely and absolutely. And so we must love them through thick and thin, when they have halos over their heads and when they have horns growing out of them.
There lies the power of validation of feeling. So, when they are up there having an episode and it is EPIC – try it. They may not hear it because their brain is in survival mode at that point. Imagine the brain of a rabbit being chased by a fox – that’s where they’re at. But give it a try and when they’ve calmed down a bit, do it again. Rather than you going to that place with them and both of you losing your cool, stay calm and say something like - “It looks like you’re mad and I love you more than words can say.”
Contributed By Diana Bonus, LMHCP
It’s November. Fall is in full swing, leaves are blowing, pumpkin spice is in the air, and temperatures are becoming cooler. Fall, specifically November, is also the time when we honor the tradition of giving thanks. Many of us will gather with friends and family, roast a turkey, watch some football, and share a couple of reasons we are thankful. While all of these customs are important and meaningful, I wonder, when was the last time that you examined the meaning of giving thanks?
Giving thanks. Look at the word “giving.” Our holiday is not Thanks-having, it’s Thanks-giving. Thanks is not something you have, it’s something you give. Thanks-giving is action. It’s synonymous with the discipline of practicing gratitude. Gratitude is not an emotion, not something you feel, it’s something you do. When you flex your gratitude muscle, it might feel sore and tired, but what is that age old saying? Ah, yes, “No pain, no gain.” Flexing your gratitude muscle can be as simple as saying “thank you” to the bank teller or the grocery store clerk before they say it to you. You may even be surprised at the balance between giving thanks and the size of your gratitude muscle.
Often we find ourselves spending time looking for someone or something to blame for our circumstances. Here is a Thanks-giving challenge: instead of grumbling about your car, speak gratitude that you have transportation. Instead of looking at the mess your children have created, tell your children what you appreciate about them. Find something every day to be grateful for, and watch how sleek and toned that muscle becomes. Today I am grateful for warm chocolate chip cookies!
What are you grateful for?
Contributed by Tammera Bibbins LISW
Self - Care IS Self - Preservation
Self-care… We are beginning to hear that phrase more often. There is finally an understanding about how absolutely important self-care is for those who are in the helping profession. We, in the helping profession, spend much of our time and attention devoted to the care of others. And what about those not in the helping profession? Let’s look at our social context. We live in a capitalistic society that praises the movers and the shakers, the over achievers, and the Type A personalities. Our society emphasizes producing and doing. We have almost become a culture of Human Doings instead of Human Beings. So it’s no wonder that we continue to struggle with finding that just right balance. When we think of self-care, images of getting a massage, getting out with friends, and (at least for women) getting manicures and pedicures often come to mind. And now that we understand the importance, we are now being reminded how important it is that we take care of ourselves, manage our stress, and live as healthily as possible.
But are we really seeing the whole picture? Sure, massages and pedicures feel great to the body. Laughing and having a good time with friends is restorative, but there is a bigger picture that we often do not think about.
Self-care isn’t something you tick off your To-Do list once you’ve gone to a yoga class or had a massage. Self-care is a constant repetition of many tiny habits, which together soothe you and make sure you’re at your optimum—emotionally, physically, and mentally. We often don’t look at the emotional or mental side of self-care.
Here are some examples from each category:
These are but a few ideas and I’m sure this list could be much longer. So as we move forward in our quest for Self-Care, let’s not to forget to see the whole picture.
What is Self-Care to you? Turning off the phone, computer and television after a certain hour. Using music to soothe instead of stimulate. Just listening to the sounds around you. Playing, reading a good book and using quiet time thinking positive thoughts. Often times our stress comes from within. The part of us that is unhappy and gets caught up in Shoulding all over ourselves. If we can be quiet and experience joy in those moments on a consistent basis, our selves are preserved much better.
Domestic violence is defined as a behavior or behaviors used by one person in a relationship to control others. I have to admit that before I started working with clients who have experienced this themselves and have suffered significant trauma from being in these types of relationships, I used to think that domestic violence only included physical abuse against others. Now that I have been exposed to this from working with families in their homes and currently as a new Mental Health Clinician, I realize that Domestic Violence is much more than physical and has many different levels.
Commonly we assume that the perpetrator in domestically violent relationships is male, but the reality is that men can also be victims of domestic violence, we just rarely hear about it as they are less likely to report it is happening. Types of domestic violence can include name calling, using intimidation to get the results you want, actual threats of physical harm, sexual assault, and several others. The victims of domestic violence are not the only individuals affected by the abuse, it also affects children and any other individuals in the home or out of the home indirectly. It is so important to think about the indirect effects. Children who have been exposed to domestic violence can be affected behaviorally and emotionally. Even in infancy. Trauma effects children no matter what age. Being non verbal doesn't mean there are no effects.
Because often times a victim of Domestic Violence aligns with their abuser, they may have difficulty leaving the situation. They may feel love for the other person and be confused between the positive feelings and negative feelings they have for that person, believing that the good can overcome. They may feel no support due to the controlling factor in these relationships and isolation that occurs for many reasons. There may be children involved, and they may resist going to a shelter that is too hard to get into anyway and feel there is no other option than to stay or be financially insecure.
There are cycles to domestic violence which begin with the tension that builds right before the abusive incident, the blow up happens where immediately after the offender is calmer, realizes what has been done, may begin to blame the victim and feels sorry. Then the making-up stage begins where apologies and promises are made, then the calm begins which is where the nice things in the relationship happen that is difficult to walk away from. This is the stage I like to refer to as the honeymoon stage where the offender continues to make promises and might even go as far as buying the victim gifts, then something happens and the tension begins to build. The cycle begins again.
Some of the psychological effects domestic violence can have included guilt, shame, humiliation, anxiety, depression and withdraw. These same psychological effects are present in men and women victims of domestic violence. If you are a victim of domestic violence or if you are a provider and a client reports past or present domestic violence there are some short-term and long term interventions that can be used to help them.
Short-term interventions include making a crisis plan intervention, making a plan for safety. If you are a provider, following your agencies policy for reporting, complete a crisis intervention plan with the client, provide them with resources/psychoeducation about domestic violence, and also giving them resources on domestic violence shelters and hotlines they can utilize until they see you again. Other interventions may be planning for departure, making a plan for your children to be safe, contact the authorities and obtain a protection order to ensure safety. As a provider, it is important to attempt following up with the client in between sessions if able.
Short-term interventions can also be offered to the batterer through therapeutic interventions for them to deal with their own traumatic content that prompts them to offend. Referrals to education and emotional management programs or other appropriate interventions. This may help them develop appropriate ways to express their emotions other than doing things they probably don't want to do anyway. Along with these immediate or short-term interventions, you can also utilize EMDR interventions to process the trauma.
EMDR is a very effective way to reduce the maladaptive behaviors at the source. It helps to resolve painful experiences for the victim and the offender of domestic violence!
I feel as someone who is recently graduated from a Masters Level Mental Health program, it has is important for me to continue educating myself as a new Mental Health Clinician to make sure I continue educating myself about new interventions that can be used to process trauma so I can be effective in meeting my clients where they are in their process. A good rapport between the clinician and the client is so important for the victim to feel like they have a safe place to share their experiences. But most important it is important to take care of yourself!
Contributed by Nicole Reedy, MA