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At The Center for Stress and Anxiety Management, our psychologists have years of experience. Unlike many other providers, our clinicians truly specialize in the diagnosis and treatment of anxiety and related problems. Our mission is to apply only the most effective short-term psychological treatments supported by extensive scientific research. We are located in Rancho Bernardo, Carlsbad, and Mission Valley.

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Read our award-winning blogs for useful information and tips about anxiety, stress, and related disorders.

 

Filtering by Tag: anxiety San Diego

How Do I Know If I Need Therapy?

Jill Stoddard

By Annabelle Parr

Each May we celebrate Mental Health Awareness Month to draw attention to and reduce stigma around mental health issues. According to the National Alliance on Mental Illness, or NAMI, 1 in 5 people will be affected by mental illness in their lifetime. And as we discussed last May during #CureStigma, “while 1 in 5 Americans are affected by a mental health condition, 5 in 5 Americans know what it is to feel pain. The frequency, intensity, and duration can vary, but pain itself is a function of being human. When culture stigmatizes the 1 in 5 and simultaneously dichotomizes illness and wellness, the resulting message is that it is shameful to struggle and to feel pain. In essence, stigma says that it is shameful to admit our own humanity.”

Do I need therapy?

Given that all of us will at some point encounter painful experiences and emotions, this year we are discussing how to know when it might be helpful to seek therapy. Though it may be clear that those affected by a previously diagnosed mental health condition could benefit from therapy, for those who are either undiagnosed or are struggling with anxiety, stress, grief, sadness, etc. but do not meet diagnostic criteria for a mental health disorder, it may be harder to discern whether therapy is warranted.

How am I functioning in the important areas of my life?

For nearly every condition in the Diagnostic and Statistical Manual (DSM-V; APA, 2013), clinically significant impairment in an important area of functioning is a required criterion to receive a diagnosis. In other words, the presenting symptoms must be making it very difficult to function at work or school, in relationships, or in another important life domain (e.g., a person is feeling so anxious that she is not able to make important presentations at work, or so stressed that he is finding it difficult to connect with his loved ones).  When life has begun to feel unmanageable in some capacity, or if something that was once easy or mildly distressing has become so distressing it feels impossible, it may be worth considering therapy.

Could things be better?

It’s also important to note that you do not have to feel as though things are falling apart before you seek professional counseling. Therapy can be helpful in a wide range of situations. It can help you not only navigate major challenges or emotionally painful periods, but also can enhance your overall wellbeing by helping you to identify your values and lean into them. Maybe things are going fine, but could be better. A therapist can help you identify what could be going better and can help you learn to fine tune the necessary skills.

I want to try therapy, but where do I start?

Whether things feel totally unmanageable or it just feels like they could be better, it’s important to find a therapist with expertise relevant to what you would like assistance with. Working with children requires different expertise to working with adults, just as working with couples and families requires additional expertise to working with individuals. Different conditions also correspond with particular evidence based practices. For stress and anxiety disorders – including social anxiety, generalized anxiety, panic disorder or panic attacks, and phobias – evidence based practices include Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT). The gold standard of treatment for obsessive compulsive disorder (OCD) is Exposure and Response Prevention (ERP), and evidence based treatments for PTSD include Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT) (all of these—ERP, PE, and CPT --fall under the CBT umbrella). So no matter what you are seeking treatment for, ensuring that the therapist you choose has expertise that aligns with the types of concerns you are struggling with is critical. For some more tips on finding and choosing a therapist, click here and here. For more information on the different kinds of licenses a therapist may have, click here.  

Though there is no right or wrong answer as to whether or not you need therapy, if you are unable to behave in ways that make life manageable and/or fulfilling because of difficult thoughts or feelings, you may find therapy beneficial.

CSAM IS HERE TO HELP

If you or someone you love might benefit from cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT) for anxiety, panic, phobias, stress, PTSD, OCD, or insomnia, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at info@csamsandiego.com

5 Myths About Anxiety

Jill Stoddard

By Trevor McDonald
edited by Annabelle Parr

People are talking about mental illnesses, like anxiety disorders, more often and more openly. Social media and access to digital content has helped facilitate the conversation. However, there is still a stigma surrounding mental illness, and while easy access to content can help reduce shame, stigma and misunderstandings about mental illness, it can also spread mistruths and foster outdated myths. This hurts those who suffer from mental illnesses as well as those trying to understand and support them. So let’s clarify some things about anxiety.

According to the National Institute of Mental Health (NIMH), anxiety disorders are the most common American mental illness, affecting 40 million adults – 18% of the population. Despite this substantial figure, the Anxiety and Depression Association of America (ADAA) estimates that only 33 percent of those suffering will receive treatment.

Anxiety is a blanket term. We all know what it feels like to feel anxious. But when we talk about anxiety as a mental illness, we may be referring to any number of disorders, from generalized anxiety disorder to social anxiety disorder to panic disorder to a specific phobia. Though all of these things fall under “anxiety,” each manifestation looks and feels a bit different.

Fortunately, anxiety disorders can be treated. Having a supportive network that includes mental health professionals and ideally, understanding loved ones, is critical. The first step toward encouraging and facilitating treatment is dispelling myths and providing education for both those struggling with anxiety and the people around them. Here are five of the biggest myths about anxiety disorders:

1. “You don’t really have anxiety. Everyone gets anxious/nervous!” Of course, everyone feels anxious or stressed sometimes. But according to the DSM V, when someone has an anxiety disorder, they feel excessively anxious about a number of things more often than not, and it significantly impairs their ability to function in a major area of their life. We must understand that there is a big difference between feeling anxious about a particular event or challenge, and feeling the chronic anxiety that comes with an anxiety disorder. Furthermore, it’s important not to toss around statements such as “I’m so OCD” when all we mean is that we like our desk organized. Minimizing an anxiety disorder in these ways undermines the challenge that something like generalized anxiety disorder or OCD can pose to people who are struggling with them.

2.  “You can get over anxiety with yoga, taking a walk, or meditation.” While taking a holistic approach to wellness is smart, and such activities can help with the symptoms of anxiety, taking a yoga class won’t “cure” an anxiety disorder any more than it will spina bifida. Though it can be tempting to offer advice to try to help those struggling with anxiety, it’s important not to minimize their experience or assume that you have a solution to offer them. Only a mental health professional should be offering any kind of “prescription” or suggestion for treatment.

3. “Anxiety means a person is weak, or they must have had a really bad childhood.” The former is never true; the latter could be part of the foundation for an anxiety disorder, though this is certainly not always the case. Trauma can kick start an anxiety disorder, but it’s not the only source. A big reason people with mental illnesses don’t talk about their condition is because they don’t want to be seen as weak or feeble, even though they’re not. It takes tremendous strength to live with any disorder. Invisible disabilities can be especially trying because people can’t “see” the disorder a person is battling.

4. “Anxiety isn’t that big of a deal.” Everything is relative. Anxiety disorders exist on a spectrum. If you know someone with anxiety, you can’t gauge how severe their disorder is. But unless you are a therapist, psychiatrist, or doctor, it’s not your job to gauge the severity of someone else’s anxiety. What you need to know is that anxiety is a big deal to the person suffering from it, no matter where they fall on the spectrum. Further, unlike a broken leg, anxiety can’t be seen on the outside.  So someone may appear perfectly put together on the outside, but is suffering in silence on the inside.

5. “I won’t be able to relate to someone with anxiety.” This myth is usually based on a person’s fear that they won’t know what to say when someone is struggling with anxiety. It’s human nature to want to “fix” things, but anxiety can’t be fixed that easily, especially by a non-professional. Remember that it’s not your job to “fix” someone’s anxiety or make it go away. All they really need from you is empathy. And listening well is far more important than knowing what to say. So when talking to someone with anxiety, let them lead the conversation, don’t judge them, and don’t try to fix it. Let them know that you want to understand and that you hear that they are struggling.  You might also offer to help them connect with professional help.

We’ve come a long way in our understanding of anxiety disorders. Psychological research has given us a solid understanding of anxiety and how to treat it effectively. Of course, there is always more to learn, but now the bulk of our work lies in sharing our understanding with the community and eliminating the damaging and unnecessary stigma that still surrounds mental illness. Working to un-learn false claims and myths of the past is a big step in the right direction. Doing your part to educate yourself and others will make a big difference in the lives of everyone with an anxiety disorder.

CSAM IS HERE TO HELP

If you or someone you love might benefit from acceptance and commitment therapy (ACT), cognitive behavioral therapy (CBT), or biofeedback for anxiety, depression, stress, or PTSD, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at csamsandiego@gmail.com.

An Acceptance and Commitment Therapy Approach to New Year's Resolutions

Jill Stoddard

by Annabelle Parr

As we enter another new year, many of us have set our 2017 resolutions. Maybe you make resolutions, maybe not, but either way this is generally a time of reflection. In what ways do we hope this year will be different from last? What are we hoping to change in our lives? What goals do we have going forward?

 The new year always seems to be a good time to think about making some changes because it gives us the chance to start fresh in some ways. But in other ways it is simply just another day. Nothing changed automatically on January first. What can change is our perspective, and it is our job to ensure that our actions follow. This is the tough part. Do you find yourself already struggling to maintain your resolution? Do you wonder why we have such a hard time keeping our resolutions for more than a few weeks? How do we make our resolutions stick?

The truth is, change is often slow. Occasionally we are able to make huge changes immediately, but more often than not change takes time. New year's resolutions often fail to take into account that it may actually take you all year to create the change you were hoping to see on January second. When we fail to recognize all the small steps on the road toward change, we set ourselves up for disappointment and failure. A new year's resolution sounds like an easy solution: set a major goal for the new year ahead. But our resolutions are empty unless they are backed by action, and creating a resolution doesn't necessarily help us to make an action plan.

Acceptance and Commitment Therapy (ACT) offers some ideas and tools that can be very helpful in guiding us along the process of change. Whether you come in to see a therapist for Acceptance and Commitment Therapy, or whether you apply the wisdom it can offer to your life on your own, this model can help us to keep our resolutions all year long.

ACT aims to increase psychological flexibility, which means that you are able to connect to the present moment consciously and choose to behave in a manner as consistent with your values as the situation allows. Part of the purpose behind ACT is to get in touch with your personal values (not those determined for you by society, family, friends, or any other external source), and then use these values to guide your actions and formulate specific goals. This is usually what we are aiming for with our new year's resolutions.

For example, if my resolution is that I want to eat healthier, a good place to start is to examine my values. Do I feel like I "should" eat healthier because I feel pressured by our health conscious culture or by my friends, family or partner? Or do I want to eat healthier because I value my physical health, deep in my heart? Or perhaps I value my role as a model to my children, and want to eat healthier for this reason. Once I determine my values and make sure that my resolution is driven by my own intrinsic motivation, then I can create a concrete plan of action to move forward.

The Choice Point Model, another helpful ACT tool, offers us a framework to use when we face a decision. A choice point is a moment in time where we can choose to act in a manner that is either consistent or inconsistent with our values. The Choice Point is about identifying the hundreds of moments in a day where we can be on autopilot and be driven by thoughts and feelings, or we can make a conscious, deliberate choice that is in the service of our values. When in this moment, we can use the acronym STOP:

S: Slow down. Take 3 mindful breaths.

T: Take notice. What are you thinking and feeling?

O: Open up. Make room for those thoughts and feelings instead of trying to avoid the discomfort.

P: Pursue values. Do what matters to you.

Sometimes, in a Choice Point, we will choose to avoid or procrastinate acting in a values consistent manner, and that is okay. Give yourself grace when this happens. But remember that though avoidance may provide relief for the moment, in the long run it will make us feel worse. So if we can STOP and choose to act in accordance with our values as frequently as possible, it will serve us.

As you approach this new year and begin thinking about your potential resolutions, remember that big change happens slowly, choice point by choice point. Remember to consider your values, and to STOP when you hit a choice point. If you feel you need some extra support along the road to change or healing...

CSAM IS HERE TO HELP

If you or someone you love might benefit from acceptance and commitment therapy (ACT), cognitive behavioral therapy (CBT), or biofeedback for anxiety, depression, stress, or PTSD, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at csamsandiego@gmail.com.

Anxiety in the Courtroom

Jill Stoddard

Witness Preparation Services

by Annabelle Parr

Have you ever felt especially nervous before a big presentation? Do you find your heart racing and palms sweating when you have to speak in front of a large group of people? You’re not alone. On average, people rate their fear of public speaking higher than their fear of death. Potentially one of the highest pressure, highest stakes public speaking situations is on the witness stand in a courtroom or during a deposition. Even the most experienced witnesses can feel anxiety, which left unaddressed can hinder their testimony. Anxiety is the number one communication obstacle in legal proceedings (Pitera, 2013).

Source URL: http://www.utahcriminallaw.net/what-happens-if-a-witness-lies-in-court/

Source URL: http://www.utahcriminallaw.net/what-happens-if-a-witness-lies-in-court/

Witnesses typically have very specific fears related to testifying. Some common witness fears include, but are not limited to, a fear of letting people down, losing their job, making a mistake, looking incompetent, being embarrassed, judged or blamed, or having to reveal private, personal information. Witnesses also tend to take on more responsibility for the outcome of the case than is necessary or realistic (Pitera, 2013).

Though the source of a witness’s anxiety may be completely unrelated to their credibility or honesty, jurors tend to judge witnesses more on the basis of behavior than testimonial content (Afremow, 2011). Therefore, a testimony could be flawless and completely true, but if it is delivered poorly the concrete verbal content may not matter.

Typical anxious behaviors that jurors tend to interpret as signs of unreliability include non-verbal cues such as poor eye contact, fidgeting, appearing tense, and inconsistency of demeanor or tone (Afremow, 2011). Helping witnesses to become conscious of these subtle reactions as well as the sources of their anxiety before testifying can help them to manage the visible cues thus increasing their perceived credibility.

Meeting with a licensed psychologist who specializes in anxiety management is a great way to help prepare witnesses and allow them to address their anxiety before taking the stand. Using cutting edge, evidence-based, cognitive-behavioral techniques, the therapist can help witnesses modify their anxiety, bringing it into an optimal range for peak performance.

Source URL: http://www.everydayhealth.com/smoking-cessation/living/coping-with-the-urge-behaviorally-and-mentally.aspx

Source URL: http://www.everydayhealth.com/smoking-cessation/living/coping-with-the-urge-behaviorally-and-mentally.aspx

Therapeutic techniques that can help prepare witnesses include:

  • cognitive reappraisal, which involves changing catastrophic cognitions that fuel anxiety and lead to poor performance
  • grounding, mindfulness, and relaxation
  • reduction of safety seeking, avoidance, or anxiety driven behaviors such as lack of eye contact, speaking too softly, fidgeting, talking too much or too little, or looking to the attorney for reassurance
  • video-taped feedback, which can help reduce anxiety by showing the witness that they don’t look as anxious as they feel, as well as helping them to notice and address visible safety behaviors

A therapeutic setting offers a safe space to practice testifying and receive non-judgmental, constructive feedback and tools that the witness can apply in court and during depositions. If you or your client are preparing to stand as a witness, know that feeling anxiety is normal, but that it doesn’t have to determine the tone of the testimony.

CSAM IS HERE TO HELP

If you or someone you know might benefit from witness preparation services for anxiety or stress, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at csamsandiego@gmail.com.

References:

Afremow, J. (2011). Witness this: Behavioral science in the courtroom. Psychology Today. Retrieved from https://www.psychologytoday.com/blog/trust-the-talent/201110/witness

Pitera, M. J. (2013). Witness tip: Anxiety is the #1 barrier affecting communication. Litigation Insights. Retrieved from http://www.litigationinsights.com/witness-preparation-2/witness-tip-anxiety-is-the-1-barrier-affecting-communication/

DEALING WITH BACK-TO-SCHOOL ANXIETY IN YOUNG CHILDREN

Jill Stoddard

a guest blog post originally posted on SitterCity.com

As parents prepare their children for the school year to begin, it’s easy to get swept up in all the details: Are the school medical forms filled out? What’s left on the school supplies list? Have you found an after-school sitter yet?

Ticking off all the items on your family’s back-to-school checklist is important, but it’s equally important to pay attention to your child’s behavior during the weeks leading up to school. Anxiety about advancing to a new grade or starting a new school is normal; after all, people of all ages need time to adjust to a new situation. Here are a few ways you can turn those back-to-school jitters into excitement.

(Please note: If you suspect that something more than garden-variety jitters is going on, call your pediatrician who can refer you to a child psychologist for a consultation.)

Get some sleep.

A well-rested kid is a happy kid. While it’s fun to stay up late and sleep in during the summer, it’s important to get bedtime on track at least a week before school starts. Kids can feel grouchy, upset or fearful when they’re sleep deprived. Start practicing normal school day wakeups a week or two in advance so they get used to their new schedule.

Attend the open house. 

Schools often host an open house a couple weeks before classes begin. Be sure to clear your schedule for it — it’s an invaluable chance for your child to meet their new teacher and start feeling comfortable with them, as well as a chance to check out their new classroom.

Plan play dates. 

If you’re new to a school, open houses are also a chance for kids to mingle with their new classmates a little with the safety of you still being around, so they’re not making as many introductions on the first day of school. As you chat with the other parents, see if any of them are open to the idea of a play date, even if it’s just meeting up informally at the playground so your kids can continue to get to know each other.

Do a practice run. 

If your child is starting at a new school, take the time to do a dry run of the morning commute. On one of the mornings they’re waking up early, be sure to get them dressed and out the door on time, too. Practice walking or driving to school — whatever your normal commute will entail. If your child is taking a bus to school for the first time, drive along the bus’s route and answer any questions they might have about what school buses are like.

Eat at a cafeteria. 

Is this the first time your child will be eating a hot lunch at school? Go to a cafeteria-style restaurant to help them practice holding a tray, waiting in line, selecting from multiple options and sitting at a bench-style table. Even if you’re planning to pack a bag lunch, it’s doesn’t hurt to get your child used to a cafeteria-like environment.

Visit the library.

It’s time to do a little back-to-school reading! There are plenty of great children’s stories that address back-to-school anxiety. A few worth checking out are First Day Jitters by Julie Dannenberg; The Night Before Kindergarten and The Night Before First Grade, both by Natasha Wing; The Kissing Hand, by Audrey Penn; and Miss Bindergarten Gets Ready for Kindergarten, by Joseph Slate. Talk to your librarian to see if they have any other recommendations as well.

Take care of the details.

Pay attention to little things that will help make the first week of school smooth sailing. Have them pick out some new clothes and a new backpack for the first few days of school so there are no morning wardrobe meltdowns. If they’re bringing their lunch, plan out a few of their favorite meals ahead of time. Create a morning “launch pad” for backpacks and coats. These may seem like little things, but they can add up to a lot of stress for a child, and they’re easy to prepare for in advance.

Listen to them.

Keep those lines of communication open! Ask you’re child if they’re excited for school, what subject they’re looking forward to most and what friends they’re excited to see. If they’re experiencing social anxiety this is a good time to start talking it out and reassuring them. Being understanding and supportive is the most important thing you can do to ensure your little one has a great back-to-school experience.

The Importance of Boundaries

Jill Stoddard

by Annabelle Parr

Do you ever feel like you can’t say no?  Do you believe that you are responsible for the emotions of others?  Do you take others’ opinions and needs into account before your own?  Do you find yourself unsure of what you want or need (Eddins, 2015)?  If so, you are certainly not alone.  However, your feelings, thoughts, and needs matter.  By setting some boundaries in your life, you can begin to treat your needs as important.

Boundaries and Anxiety

Image source: https://blogs.goarch.org/blog/-/blogs/boundaries-healthy-limits-or-barriers-to-relationships-

Image source: https://blogs.goarch.org/blog/-/blogs/boundaries-healthy-limits-or-barriers-to-relationships-

For people who struggle with anxiety, learning how to create healthy boundaries can be a helpful tool.  Though sometimes people cope with anxiety by creating unnecessary boundaries or avoiding situations that serve as triggers, other times anxiety is experienced as a result of unclear lines between self and other.  When you don’t protect your sense of self, it is easy to feel overwhelmed and take on responsibility for everything and everyone (Eddins, 2015).  This can lead to feelings of guilt and anxiety.  It is not hard for a vicious cycle to ensue, where a lack of boundaries leads to anxiety, and where anxiety leads to a feeling that you cannot set clear and effective limits.

What Are Boundaries

So what exactly are boundaries?  Boundaries help us to define who we are.  They orient us in our relationships, and signify to us and to others where “I end and you begin” (Eddins, 2015).  Boundaries can apply to any area of our lives, and can range from material boundaries to physical, mental, or emotional boundaries to sexual or spiritual boundaries (Lancer, 2015).  Boundaries are very personal, and there is not a right or wrong answer regarding to how to set ones that work for you.  They are based on your beliefs, values, opinions, and needs (“12 Signs,” 2015).

Boundaries as an Act of Love

A common misconception for people who struggle in this area is that setting boundaries is selfish.  However, self-care is not selfish.  Have you ever flown on an airplane, and heard the stewardess tell the passengers in case of an emergency to put their own oxygen mask on before helping others with theirs?  This “oxygen-mask” rule is a profound metaphor for the idea that we cannot take care of others if we have neglected to take care of ourselves first. 

Image source:  http://www.thedynamicturnaround.com/healthyboundaries.htm

Image source:  http://www.thedynamicturnaround.com/healthyboundaries.htm

Setting boundaries for ourselves and giving ourselves permission to articulate our needs is an act of self-love (Strgar, 2010).  And in the wise words of Brené Brown, “we can only love others as much as we love ourselves” (2010).  Furthermore, when we set clear limits in our lives, we are better able to be compassionate towards others.  Brown (2010) states that “the heart of compassion is really acceptance,” and when we lack boundaries, we are not accepting our own needs and we may have a difficult time accepting others if we feel they are taking advantage of us. 

So contrary to this idea that boundaries are selfish, they actually help us love ourselves and others better.

How Therapy Can Help

You are the only one who has the ability to set boundaries in your life.  However, therapy can be helpful in navigating this challenging task.  Therapy offers a place where you can explore your values, your feelings, and your relationships.  Your therapist can help support you in the process of determining where you need to establish stronger boundaries or areas in which you might benefit from more flexibility.

Therapy can also be a good place to experience a relationship with very clear boundaries.  Dr. Irvin D. Yalom (2002) describes “therapy as a dress rehearsal for life,” meaning that it is a safe place to encounter challenging aspects of life and relationships before you face them outside of the therapy room.  An important goal of therapy is to take what you have learned and apply it to the rest of your life, but it can be helpful to practice new skills in a safe space first.

Don’t Forget to Be Kind To Yourself

One final thing to note is that boundaries are learned (Lancer, 2015).  If you are not used to setting clear limits in your life, know that it is a skill that takes practice.  The best way to start learning this skill is to cultivate self-awareness and practice asserting yourself (Lancer, 2015).  Remember, it is important to give yourself grace and to seek support throughout this process.  If you feel like you could benefit from some professional support in developing boundaries in your life…

CSAM IS HERE TO HELP

If you or someone you love might benefit from acceptance and commitment therapy (ACT), cognitive behavioral therapy (CBT), or biofeedback for anxiety, depression, stress, or PTSD, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at csamsandiego@gmail.com.

References:

12 Signs you lack healthy boundaries (and why you need them). (2015).  Harley Therapy Counselling Blog. Retrieved from http://www.harleytherapy.co.uk/counselling/healthy-boundaries.htm

Brown, B. (2010). The gifts of imperfection: Let go of who you think you’re supposed to be and embrace who you are.  Center City, MN: Hazelden Publishing.

Eddins, R. (2015). Keeping Good Boundaries & Getting Your Needs Met. Psych Central. Retrieved from http://psychcentral.com/lib/keeping-good-boundaries-getting-your-needs-met/

Lancer, D. (2015). What are personal boundaries? How do I get some?. Psych Central. Retrieved from http://psychcentral.com/lib/what-are-personal-boundaries-how-do-i-get-some/

Stgar, W. (2010). The importance of boundaries. The Huffington Post. Retrieved from http://www.huffingtonpost.com/wendy-strgar/working-boundaries_b_717339.html

Yalom, I. D. (2002).  The gift of therapy: An open letter to a new generation of therapists and their patients. New York, NY: HarperCollins Publishers.