Author Archives: FireSpike

When Social Distancing Becomes Social Isolation: How Online Counseling Helps

Online Appointments With Your Counselor Helps Reduce Feelings of Isolation

We are in unprecedented times with the outbreak of COVID-19, and we are all striving towards best practices around hygiene and social distancing.

This is an incredibly difficult time to be alone for many. If you are working from home and keeping yourself isolated in order to avoid infection, you are doing the right thing. This is actually pro-social behavior in service of our communities right now.

Regular appointments with a counselor online can help with feelings of isolation during social distancing.

However, when these right actions backfire on us—when our minds begin a negative cycle of withdrawing from all life—we may create a downward spiral into negative thinking. Counselors trained in cognitive behavioral therapy (CBT) understand that negative thoughts can lead to negative emotions such as panicfear, and hopelessness. These feelings can lead to further negative actions, and the cycle continues to feed upon itself. This self-destructive cycle can wreak havoc not only on our emotional lives, but on our immune systems as well.


“Living with fear and panic activates our sympathetic nervous system, which releases fight-or-flight stress hormones and can deplete precious resources we need to support a healthy immune system. A robust and strong immune system is an excellent first-line defense against invading viruses and bacteria,” says integrative and functional San Francisco based psychiatrist Karin Hastik, MD.

Furthermore, neuroscience guru Dan Siegel states: “[The mind] occurs throughout the body, in the distributed nervous system, which m

onitors and influences energy and information flowing through our heart and our intestines, and even shapes the activity of our immune system.”

We all need a healthy immune system to protect us right now. Limiting your media intake may be one way to aid your immune system in becoming more resilient. While quarantine is one measure to keep us healthy, it can be difficult to stay out of negative emotions when we isolate in front of the TV and watch fear-inducing news about the coronavirus pandemic.


What else can you do to stop this negative cycle when all the media around you relay such catastrophic information? How can you do more to boost your immune system, which is potentially your primary defense against COVID-19 at this time?

Consider reaching out to an online counselor and connecting via videoconferencing for help.

Christopher Fagundes, an associate professor in the department of psychological sciences who studies the link between mental and immune health says, “There is some evidence that it may be better to video conference versus having a regular phone call to reduce feelings of isolation.”

While it may seem counterintuitive to attempt authentic and meaningful connection through technology, the neurobiology of attachment speaks to the fact that mirror neurons are activated while in attunement within a relationship—even through a screen.

In Praszkier’s 2014 article, Empathy, Mirror Neurons, and SYNC, in which he speaks of our engagement with film, he states, “The mirror neurons embedded in our brain reflect the movement and sounds seen on the screen and beef up the spectator’s empathy. More than that, a body-based, empathy-kindling path (called kinesthetic empathy) induces an inner image of movements seen onscreen. The observer essentially ‘internally simulates’ the observed movements and, without actually moving, feels his own body configuration change in response.” My clinical work as a somatic movement counselor affirms this as well.


Mirror neurons in synchrony, resonating together, create empathy in human relationships as well. “Connections with visceral and emotional circuitry now allow the same systems to support emotional resonance, attunement, and empathy. It is hypothesized that mirror systems and resonance behaviors evolved into our ability to attune to the emotional states of others,” says Louis Cozolino, author of The Neuroscience of Human Relationships. When one attunes to another within a healthy and secure attachment, mirror neurons inside the brain and body rise to the occasion, in effect elevating consciousness and physical well-being during the attunement process.

Siegel speaks about how our very minds are created through the context of shared information with others. “The mind is a relational process. Energy and information flow between and among people, and they are monitored and modified in this shared exchange,” says Seigel.


Linda Graham, author of Bouncing Back: Rewiring Your Brain for Maximum Resilience and Well-Being, says, “If you haven’t yet had the help of enough true others to aid you in claiming the birthright of what I call your inner base of resilience, you can use the new experiences in new relationships to recover it now.” A healthy and secure attachment to a counselor can help you navigate through your anxiety and fear and shed light on how negative beliefs can be undermining your best intentions. Rewiring your brain towards positive thinking can create more buoyant emotions within you, which are protective factors against disease.

We all need as much positivity as we can get right now while this pandemic becomes our new reality. Working with an online counselor can be a great way to make sure you stay healthy, in your mind, body, and spirit while navigating your way through these uncertain times. Please contact me to set up an online appointment during social distancing.

Courtesy of GoodTherapy.

Surviving the Coronavirus: 9 Practical Steps for Couples

Therapy Tips for Couples During COVID-19

Instead of our usual date, we embarked on a nighttime adventure to Costco. It was the last task before my husband, Bob, and I hunkered down in our condo. We are both marriage and relationship therapists and made the decision to do sessions virtually for the next week or two.

COVID-19, the coronavirus or the novel coronavirus, also known as a pandemic, had arrived in the U.S. with a bang.

My thoughts raced: Do we already have it?

We are over 60, so we’re in the high-risk group with elderly people in their 80s and 90s. Wow, I never thought of myself or Bob as that old. We still work full-time, are in pretty good physical shape, and lead a very active life.

My next thought: Will we survive?

As marriage and relationship counselors, we see lots of couples as a team every day in our small, cozy office. Before we packed up to leave, I actually measured the distance between our chairs and the sofa where clients sit. To my dismay, it was only about 5 feet. The experts at the Centers for Disease Control and Prevention say we’re supposed to stay at least 6 feet away from others to minimize the risk of catching the virus.


Next, I wiped down door handles, bathroom fixtures, desks, office equipment, telephones, and anything else I could find that people may have touched. Our suite of five offices had more “surfaces” than I ever imagined. Was I overdoing it? I do have some obsessive tendencies.

I left each of the ten therapists who work in our suite a precious gift, a bottle of hand sanitizer. The bottle I’d placed in our waiting room somehow disappeared. Thank goodness I ordered them before all the stores were sold out.


Therapy tips for couples during the coronavirus.

Back to survival. Bob and I had food, shelter, sanitizer, and so far, no symptoms of the virus. During the first 48 hours home, we immersed ourselves in “breaking news” to make sure we were fully prepared for the coronavirus onslaught. Of course, there was nothing else we could do to prepare. We did get one thing from watching all that news: anxiety and fear that went through the roof.

  • What was going to happen?
  • Were we getting the facts?
  • Were my elderly relatives going to die?
  • How would they cope with visitors not being allowed in their retirement community?
  • Should we see our millennial kids, since they might unknowingly carry the virus without symptoms?
  • Would we lose our entire nest egg since the stock market was down and our business might suffer?
  • Was this going to affect the election?

I could have obsessed for hours. I used my relaxation app and finally got to sleep, only to have dreams about other disasters.

This morning when we awoke, Bob and I decided we were going to stop freaking out and do what we tell our clients to do. Here are the nine practical steps we came up with to survive the coronavirus–for ourselves and for you:

1. Limit the amount of time you spend watching news.

We need to stay informed, but overdoing it is not healthy. Bob and I, like many of you, at times become obsessed with the news. We watch it hoping to hear something that will give us a sense of relief. However, that rarely happens. Watching too much news often creates more anxietyfear, and helplessness.

We are choosing to tune in to one or two news shows per day and otherwise listen to music, find some shows to binge watch, or catch up on movies.

Decide how much news you need to watch.

2. Stay present and practice mindfulness.

We all tend to get stuck in our “what ifs,” and linger in the question. When my mind starts fixating on the “what ifs,” I answer the question.

Of course, the worst “what if” is, “What if I or a loved one get the virus and die?” Here is the answer I give myself: “If I die, I will have nothing to worry about,” and “Heaven forbid someone I love dies, I would have to bear the grief, and life would continue.” I don’t mean that to sound cold, but that answer helps me stop obsessing. Then I remind myself that the chances of the worst happening are low, and I bring my mind back to the present to focus on what I can control.

Being mindful means being fully present and aware of what is happening in the moment. Bob and I practice mindfulness and meditation.

3. Focus on gratitude.

When we’re in crisis, we tend to focus on the negative, which can lead to a general feeling of doom and gloom.

When we recognize this happening, we know we can refocus on what we are thankful for: my health today, my family members, my friends, my ability to work from home, having food and sanitizer. The list could go on.

Create your own gratitude list or journal.

4. Focus on what you can control.

When you catch yourself caught in the cycle of fear about what is out of our control, refocus on what you can do.

This morning I super cleaned our condo. I called family and friends. I decided to write this article. I made a decision to use this time to further our business and create some eBooks on relationships. I will practice the piano, one of things I never get to do.

Identify what you have control over. Then immerse yourself in those things.

5. Make a plan.

Bob and I brainstormed ways to use this time productively. We plan to do some projects at home that we never seem to prioritize. In addition, we are going to work on redoing our website and creating some products that couples can use.

Since we don’t want to go to the gym and my exercise classes were cancelled, we committed to doing some type of exercise daily.

We don’t have children at home, but I know many people do. Make a list of ways you can keep your kids productive and entertained. Talk to your partner and friends about ideas. Work with your partner to build in alone time for each of you.

Plan to make the best use of your time.

6. Schedule your activities.

When you create a schedule for yourselves and your kids, there is often a greater sense of organization. We are more likely to be productive when we have a schedule. If your kids are old enough, they can participate in creating this.

We are scheduling wake up time, work time, exercise time, movie time, and bedtime. It’s important to have a routine and stick to it. This is what we have control over, and it will help us stay focused on the present.

Post your daily schedule in the kitchen.

7. Offer to help others.

There is so much need out there. We called some of our neighbors, especially the ones who live alone, and told them to call on us if they need food or other supplies.

Being concerned and compassionate toward others stops the preoccupation with our own anxieties and puts the focus outside yourself. Connecting with others reminds us we are not alone. We are in this together.

Figure out who you can be of service to.

8. Have virtual dates with friends and family.

We thought we would have to cancel the dates we had planned with friends and family. Then I had an idea. We can keep those plans and have “virtual dates.” Using Skype or Zoom, we can actually prepare dinner and then have a meal and talk, “as if” we were out to dinner. Connection decreases feelings of isolation and gives us a greater sense of calm.

Make some virtual dates for yourself.

9. Love each other.

I’m referring to love as a verb. This is a great opportunity to connect with your partner, emotionally and sexually. Giving and receiving love is like food for the soul. And who knows, maybe in nine months we’ll have a generation of post-coronavirus baby boomers.

Let’s hope this pandemic gets under control and subsides sooner rather than later. In the meantime, use these steps and the support of neighbors, friends, family as well as your virtual therapist to get through this storm. The sun will eventually shine.

Set up an online couples therapy appointment to help survive the coronavirus.

Courtesy of GoodTherapy.

University Counseling Can Help When Stressed With Student Loans

Portland State University Students – Don’t Underestimate the Stress of Student Loan Debt!

Higher education can open up a wealth of opportunities. A college degree can make it easier to secure a high-paying job and pave the way toward further education, such as graduate school—a necessary step in becoming a therapist or other health care professional. But the potential rewards of a four-year university degree come at a cost, often a staggering one.

College tuition costs have vastly increased over the past few decades. According to statistics from College Board, a college student in the late 1980s could expect to pay just over $3,000 for 4 years of tuition at a public university. But today, 4 years of tuition at a public university cost around $10,000. Note this figure only includes tuition, not books, board, and other necessary expenses, which may double or even triple your projected expenses.

Private universities, of course, cost far more. And these numbers rise each year, faster than inflation. This means wage increases don’t account for the higher cost of college, and many students are left with more debt than they can easily (or realistically) pay off.

Portland State University Students stress over student loans can be helped with mental health counseling.Student loan debt can certainly impact your financial future, but it can take a toll on your emotional well-being, too.

While many students seek grants and apply for scholarships to attend college, not everyone qualifies for grants or can afford to spend time chasing down multiple scholarships. What’s more, plenty of hopeful students find that the cost of college is still prohibitive, even with these other types of aid. So, lacking the funds to pay for an education, they turn to loans to finance their college years—often without realizing the full cost of these loans.

According to statistics from Pew Research Center, almost half of American adults 30 and younger with a bachelor’s degree or higher have outstanding student loan debt. But even people who don’t complete their education still have to pay back their loans. Among adults under the age of 30, 34 percent have student loan debt, whether they have a degree to show for it or not. Among adults aged 30 to 44, 22 percent still have outstanding student loan debt.

The amount of debt varies widely, especially depending on the type of degree pursued. According to 2016 survey results, a median figure for amount owed, among all borrowers, was $17,000. Among borrowers holding a bachelor’s degree, this figure rose to $25,000, while borrowers with postgraduate degrees reported a median debt of $45,000. About 7 percent of borrowers (or, 1 percent of all American adults) reported owing more than $100,000. Higher debt appears most common among people holding postgraduate degrees.

This survey also found that almost a third of American adults between the ages of 25 and 40 believe the benefits of their college degree(s) are not worth the lifetime expense of paying it off.

A better understanding of debt’s heavy impact can provide clarity on just why so many students believe the value of their degree doesn’t measure up to the costs incurred.

Not everyone worries about loans coming due while still attending college. More often, these approaching payments seem like a distant concern, one dwarfed by the immediate reality of exams, group projects, and part-time jobs. Many students also don’t fully comprehend the total amount of the monthly payments they’ll eventually need to make, or the number of years required to completely pay off their loans.

Students with greater awareness of the looming burden of debt may feel intense pressure to study as much as possible and earn good grades. They may hope doing well and graduating with honors will help them find a good job right away and stay on top of loan payments. While this goal may have merit, it can nonetheless leave them with little time for self-care, rest, and forming relationships and friendships. Some students may even burn themselves out with volunteer work or participation in activities they hope will appeal to potential employers.

Many students may prefer to avoid thinking about the debt they’ll face. But avoidance doesn’t always help, and it might eventually come out in the form of anxiety and other distress.

It’s also fairly common for students under pressure to neglect their health:

Students who have to work while attending college often have less time for restful sleep.
Busy students may end up snacking or choosing fast-food or convenience store meals because they don’t have time to prepare more nutritious, balanced meals.
Spending the majority of their time studying and working leaves students with little time for physical activity, socializing, or relaxation, important factors in physical and emotional wellness.
These challenges can trigger even more serious concerns. Students under a lot of pressure, especially those who already struggle to adequately meet their physical or emotional needs, may have a higher risk of depression, anxiety, and other mental health conditions.

The significance of the debt burden tends to hit, for many borrowers, once they’ve graduated from college and made it through the 6-month grace period. Some students manage to secure a good job, perhaps one that pays well and offers benefits like health insurance. This can help relieve some debt-related anxieties.

In a best-case scenario, someone finds a position in their ideal field, earns promotions, and eventually sees their salary increase over time. The ability to make monthly student loan payments and still have enough money left to live a comfortable life is ideal, but it’s not a common scenario.

Research from the Centre for Global Higher Education suggests student loan debt can have a negative impact on life after graduation in the following ways:

Student loan debt can limit career choices by making it necessary to accept any available job in order to make loan payments. This can decrease workplace satisfaction, which can contribute to depression over time.
Debt, particularly higher amounts of debt, can lead many women to delay getting married, having children, or both.
Many people with student loan debt also delay buying homes. They may also have little or no savings and also lack money for retirement.
Not only does student loan debt make it harder to take care of daily financial needs, like rent, groceries, and clothing, it can make it almost impossible to budget for needed extras, like medical emergencies, car trouble, and so on. For some people, unnecessary expenses—vacations, trips to visit family members, or the occasional dinner out—might be completely out of the question.
Worries over debt often present physically, with symptoms like loss of sleep, muscle and head pain, or gastrointestinal distress.
Overall, people with student loan debt report higher levels of anxiety and financial distress, according to a 2013 article published in the American Psychological Association’s gradPSYCH Magazine. The article cites research that suggests people having trouble paying off student loans have almost twice the risk for mental health concerns, including anxiety and depression.

Complicating the issue is the fact that many people avoid talking about debt and other financial worries due to stigma, or fear of stigma. People with high levels of student debt may feel anxious about pursuing relationships, due to concerns about their future financial situation or worries about what their future partners may say about their debt.

It’s not uncommon for people with a lot of student loan debt to have a hard time talking about their financial worries. Many people simply struggle to open up about financial issues in general. But others might associate debt with a sense of failure or shame. This can make it difficult to reach out for professional support from therapists or financial counselors.

Avoidance of the problem doesn’t lead to improvement. It often makes the problem worse. Borrowers struggling to pay off student loan debt may come to believe they’ll never get ahead and feel hopeless about their financial future. For many, a bleak financial outlook translates to a bleak outlook overall.

Student Loan Planner, a financial coaching website, surveyed 829 members of their mailing list in 2019. According to their results, one out of every 15 people paying off student loan debt had considered suicide as a result of their debt. The results also suggested student loan debt plays some part in around 9 percent of deaths among young professionals who die by suicide.

The survey also found evidence to suggest borrowers with higher levels of debt are more likely to consider suicide: Just over 11 percent of borrowers who owe between $80,000 and $150,000 report contemplating suicide.

A final finding: Nearly 6 percent of those who replied to the survey knew someone whose student loan debt factored into their death by suicide.

Student loan debt is a serious concern among American adults. If you’re feeling overwhelmed or distressed by your debt, consider reaching out to a therapist for support. A therapist can’t help you resolve your debt. But they can offer compassion without judgment and help you address related mental health symptoms, enabling you to feel more capable of tackling debt in a productive way.

If you or someone you know is showing stress and wants to know how counseling can help – contact my Portland office for more information.

Courtesy of Good Therapy.


Cilluffo, A. (2019, August 13). 5 facts about student loans. Pew Research Center. Retrieved from
Dickler, J. (2017, October 17). Student loans take a mental toll on young people. CNBC. Retrieved from
Lockert, M. (2019, September 4). Mental health survey: 1 in 15 high student debt borrowers considered suicide. Student Loan Planner. Retrieved from
Maldonaldo, C. (2018, July 24). Price of college increasing almost 8 times faster than wages. Forbes. Retrieved from
Novotney, A. (2013). Facing up to debt. gradPSYCh Magazine, 1. Retrieved from
Student loan debt has negative consequences in later life, review by IOE researchers suggests. (2018, June 11). UCL Institute of Education. Retrieved from
Trends in college pricing 2019. (2019). College Board. Retrieved from
Walsemann, K. M., Gee, G. C., & Gentile, D. (2015). Sick of our loans: Student borrowing and the mental health of young adults in the United States. Social Science & Medicine, 124, 85-93. Retrieved from

With Life Coaching Many Youth Want to Discuss Spirituality

Study Finds Spirituality Is An Important Aspect of Life Coaching Treatment

Spirituality important aspect to life coaching treatment.Regular attendance of religious services has declined with time, according to data from Gallup. Yet many Americans still say spirituality is an important part of their life. Over half (51%) of Americans say religion is “very important” to them, and 89% believe in God.

Spiritual beliefs (religion-specific or personal) can affect mental health. A new study published in Spirituality in Clinical Practice suggests spirituality may be an important aspect of quality treatment. According to the study, most young adults seeking treatment for serious mental health issues think spirituality is relevant to their well-being.

The relationship between mental health and spirituality is complex. It is neither consistently negative nor consistently positive. Clinicians who want to explore spirituality must be prepared to discuss a wide range of experiences and perspectives.

The study used qualitative interviews to gather data on 55 young people aged 18 to 25 years old. Participants had been diagnosed with serious mental health issues such as schizophrenia and bipolar. They had all sought emergency mental health care. Researchers assessed how young adults seeking psychiatric care talked about religion and spirituality.

Thirty-four participants (61.8%) brought up spiritual topics in their interviews with little to no prompting. Many emphasized the important role spirituality played in their mental health. Some recurring themes included:

Positive and negative effects of spirituality on mental health.
Relationship with God.
The role of religion in support systems and emotional wellness.
Many participants emphasized the complex role of spirituality in their lives. Thus, culturally sensitive counseling may be critical to helping youth explore the connection between spirituality and mental health. Some youth may be eager to discuss spiritual concerns, but uncertain about how to begin the conversation. Others may fear they will be judged for their religious conflicts.

Research has long suggested that spiritual beliefs can serve as a protective mechanism. Religious people might even live longer. A 2017 study found people who regularly attended religious services were 55% less likely to die during the 18-year study period (compared to secular peers). A 2016 study of women found similar results. Women who attended services more than once a week were 33% less likely to die during a 16-year period.

This apparent connection between spirituality and longevity may be because religion offers a sense of community and purpose. A 2014 review suggests religion and spirituality can bolster mental health by:

Offering positive coping skills (such as prayer and meditation).
Providing access to a supportive community.
Encouraging positive beliefs, such as the idea that continued self-improvement offers a chance at a better life.
The effect of spirituality on mental health is not universally positive, however. The same study says religion and spirituality may damage mental health by:

Encouraging unhealthy coping tools (such as excessive self-criticism).
Leading to poor communication.
Promoting harmful beliefs, such as the notion that mental health issues are a punishment from God.
Abusive or discriminatory religious beliefs can lead to harmful practices in therapy. Conversion therapy—a discredited form of therapy designed to alter a person’s sexual orientation—often draws on religious beliefs.

Spiritual issues can also play a role in mental health issues. For instance, a person who feels abandoned by God may be more vulnerable to depression. A crisis of faith can be a source of immense anxiety and guilt.

Even people of the same faith may have vastly different views on spirituality and religious experience. Some strategies that can help therapists respectfully and effectively discuss religion include:

Understanding the role that religion and spirituality play in their own life. This can help therapists avoid projecting their own beliefs onto clients.
Treating spirituality as one aspect of a person’s belief system, similar to their views on marriage or politics.
Allowing the client to discuss their values, then working with them to set and achieve goals consistent with those values.
Being cautious about integrating spirituality into treatment. Research is still in its infancy, so clinicians should avoid over-reliance on religious models and lean heavily on research-supported practices.
It is possible to incorporate spirituality into therapy without endorsing a specific religion. Many clinicians use therapeutic techniques with roots in spiritual practice, such as mindfulness and meditation. These strategies can offer people immense comfort.

Religion and spirituality can be very personal, emotional issues. If you are a person seeking therapy (or already in therapy), you may benefit from bringing these topics up in treatment. A skilled therapist can help you address your spirituality without offering judgment.

If you or someone you love is interested in learning more about life coaching, contact my Portland office.

Courtesy of Good Therapy.


Discuss religion, spirituality when treating young adults with severe mental illness. (2018, July 30). EurekAlert. Retrieved from
Ducharme, J. (2018, February 15). You asked: Do religious people live longer? Time. Retrieved from
Newport, F. (2016, June 29). Most Americans still believe in God. Retrieved from
Oxhandler, H. K., Narendorf, S. C., & Moffatt, K. M. (2018). Religion and spirituality among young adults with severe mental illness. Spirituality in Clinical Practice. Retrieved from
Religion. (n.d.). Gallup. Retrieved from
Weber, S. R., & Pargament, K. I. (2014). The role of religion and spirituality in mental health. Current Opinion in Psychiatry, 27(5), 358-363. Retrieved from

I Love You, I Hate You: Surviving Relationship Churn with Couples Counseling

Couples Counseling May Help Your On-Again, Off-Again Relationship

Businesses have long used the term churn to denote the loss of customers and clients. More recently, psychologists have introduced the concept of relationship churn. In this context, relationship churn refers to unstable on-again, off-again relationships. When couples break up and then reconcile—sometimes many times in a row—this is churn.

Although more prevalent among adolescents and young adults, people of all ages can experience relationship churn. Churning relationships often inspire intense emotions. A person may cycle through intense love, anger, jealousy, grief, and anxiety over the state of the relationship in just a few days.

Relationship churn is a new concept that remains poorly studied, so it is unclear how common these tumultuous relationships are. Most research into the topic has examined relationships among people in their teens, twenties, and thirties, so most data on the topic apply to adolescents and emerging adults. A 2012 study of adolescents and young adults found 44% of participants who had a romantic relationship during the two years prior to the study had at least one breakup followed by a reconciliation. A 2013 study found that more than a third of couples who break up will reunite. The same study found that a fifth of married people experience relationship churn.

Defining relationship churn can prove challenging. One partner might think the couple has reconciled after they have sex, even when the other thinks they are still fighting. Likewise, breakups are not always certain. One partner might think the couple is merely taking time apart even as the other believes the relationship to be permanently over.

The media is filled with depictions of on-again, off-again relationships. Penny and Leonard on The Big Bang Theory broke up only to later reunite and marry. Ross and Rachel on Friends spent much of the series pining away for one another. They remained broken up even after having a child and finally reconciled in the season finale.

Permanently breaking up with a partner can be very difficult. Even when a relationship is irretrievably broken (or even abusive), partners may love one another or experience intense infatuation and attraction.

A 2017 study identified numerous reasons for the cycle of breaking up and getting back together, including:

Believing that problems in the relationship will improve or that the breakup may change a partner’s behavior.
A strong sense of investment in the relationship.
Relationship ambivalence. For example, a person might dislike relationship conflict but feel intense love or trust for their partner.
Uncertainty about the future, which may motivate couples both to break up and to later get back together.
A sense of familial duty. Even if a relationship is unhappy, partners may reunite because of family obligations.
Fear of being alone. Singlehood can be difficult, especially for someone who is accustomed to being in a relationship. For some people, such as those with separation anxiety or anxious attachment styles, being single can be scary. Even if a relationship is unhappy, loneliness can trigger a reconciliation.
Everyone brings their life experiences to their relationships. These experiences color their expectations, their perceptions of what is normal, and their hopes and fears about the relationship. A reunion following a breakup is no different. However, it can be difficult for couples to separate the baggage from their prior relationship from the new relationship.

Research published in 2013 found that ongoing relationship churn makes it progressively more difficult to end the relationship. Couples trapped in a cycle of breaking up and making up report lower relationship satisfaction and greater uncertainty about the future of the relationship. Another 2013 study found that high-churn relationships had higher conflict than stable relationships, including relationships in which couples remained stably broken up.

This doesn’t mean that it is impossible for a relationship to succeed following a breakup. Some people even successfully remarry after an acrimonious divorce and are able to enjoy many years of happy marriage.

To increase the odds of success a second—or third—time around, it’s important to identify what went wrong in the earlier relationship. A therapist may be able to help couples sort through old issues. Treating the new relationship as a fresh start may also help. Bringing up long-resolved emotional wounds, especially as a weapon in fights, can make it difficult to move forward.

Relationships in which there is abuse—including verbal, sexual, physical, or financial abuse—are not safe for either partner. Reuniting without addressing the abuse is a recipe for further abuse, and it may give the abusive partner greater control. Likewise, when a partner is abusive to children, reuniting can be traumatic to the kids and harmful to the entire family. Before considering a reunion, each partner must weigh the effects of the relationship on their physical and emotional wellbeing.

Abuse isn’t the only reason to break up for good. Some signs that a relationship is doomed include:

Continually repeating old patterns. Every couple has a few fights that repeat themselves. But if a couple continues to fight about the same things that caused the earlier break-up, this may indicate the relationship is beyond repair.
Getting back together without discussing relationship problems. Couples who reunite without committing to sustained change tend to repeat the same patterns as before.
Reuniting solely because of loneliness or jealousy. Getting back together without a commitment to ongoing communication and relationship improvements can make the next breakup even more painful.
A couples counselor may be able to help couples assess whether their relationship can be saved and what must happen to save it. Therapy can even ease the breakup process by offering support to each partner and helping couples transition to a different type of relationship. For parents of young children who must continue to co-parent, therapy can be particularly helpful.

Both partners do not have to go to therapy to see improvements. It takes two people to create relationship conflict. Individual therapy can help a person identify their role in the conflict. It may also help a person understand why they keep returning to the relationship. If the relationship ends, the right therapist can help ease feelings of grief, jealousy, or low self-esteem.

Courtesy of GoodTherapy.

If you or someone you love is in a relationship churn, consider couples or individual counseling at my Portland, Oregon office.

How a Counselor Can Help With Loneliness

Negative Self-Talk Is a Sign to Contact a Counselor

Dear GoodTherapy,

My life is a sad state of affairs. I have no real friends to speak of, just my cat Lula. Even she doesn’t like me very much. I can’t work because of a disability. I basically sit at home all day eating myself a little closer to irreversible depression and eventual death.

This is no way to live, but it’s all I’ve got. I used to rationalize that being alone was okay because I’m an introvert, but that’s dumb. Introverts need love and socializing too. I have nothing! I feel so lonely.

I don’t think it’s realistic to expect me to go out and make a bunch of friends. I’m ugly, not very interesting, and I’m not easy to get close to. I don’t let people in. Not sure why, I just never have. So then the question becomes, how do I accept my life for what it is? Is it as simple as no longer judging it as meaningless and empty? Please help me stop feeling so alone.

—Only the Lonely

Dear Lonely,

I hear your very real sadness coming through. Thank you for reaching out. I am actually hearing two different questions in your message—how do I accept my life as it is, and how do I change it to be less lonely?

I recommend you start by finding a therapist in your area. I hear a lot of negative self-talk and negative self-concept in your message. Finding a way to appreciate what you have to offer yourself and the world around you will be an important first step. Your comment about not letting people in—and that you never have—lets me know the work really begins there in understanding what about connecting with others is scary for you.

You also mention not wanting to judge your life as “meaningless and empty.” I agree this is an important goal! Feeling a sense of purpose is essential to long-term well-being. That purpose can be localized or it can be on a broader scale, but feeling that we matter, that we have an impact, that we have a reason for being here is important. You are not alone in struggling to find purpose. Again, working with someone to explore what is meaningful to you will be important.

You are right: introverts need connection too. It is up to you, though, what connection looks like. I have known people who had many friends and were very social and still felt extremely lonely. Meaningful connection with self, with others, and with the world around us can help reduce feelings of loneliness. I encourage you to start that journey by finding someone who can help you work on a meaningful connection to yourself, one in which you feel more accepting of who you are. From there, you can explore how to connect with others.

Best of luck,

Erika Myers, MS, MEd, LPC, NCC

Courtesy of GoodTherapy.

If you or someone you love is having problems with loneliness, please contact my Portland, Oregon office for an appointment.

Coaching Helps Develop Healthy Relationships with Dependent Personalities

Dependent Personality Disorder Can Have Healthy Relationships with Coaching

Dependency on others is the hallmark characteristic of dependent personality disorder (DPD). This can create problems within relationships, since nearly all adult relationships need a degree of interdependence to be considered healthy. Interdependence, simply put, means the people in the relationship maintain their sense of self while working together to meet each other’s needs as well as their own.

If you live with DPD, you may have an intense and overwhelming need for others to take care of you, so much so that you fear being abandoned or left alone. To avoid the possibility of abandonment, you might find yourself going out of your way to make certain you have the continued support of your romantic partner, family members, or friends. This might cause you to go to great lengths to please them, often by doing things you’d prefer not to do.

This behavior may seem to help you get your needs met, but it often leads to unhealthy or imbalanced relationships. You might end up staying with a partner who isn’t right for you, or even one who’s toxic or takes advantage of you, simply because you don’t want to be alone.

Relationship coaching for Dependent Personality.But it is possible to build healthy relationships when you have DPD. Awareness of the condition, and how it affects your interactions with others, is a good first step.

If you live with DPD, you may have an intense and overwhelming need for others to take care of you, so much so that you fear being abandoned or left alone.

In basic terms, dependent personality means you rely on other people to take care of you. You might experience serious distress at the thought of having to do things on your own, because you don’t think you can care for yourself. You might feel helpless or unable to make decisions for yourself—both significant decisions, like the career you choose, and minor decisions, like what you’ll make for dinner.

You might lack well-developed self-esteem and have little confidence in your own abilities. This can contribute to beliefs like, “I can’t do anything myself,” “Someone else can do a better job,” or “If I upset them, they’ll leave me.” Because you need continued support from loved ones, you may withhold normal, healthy responses, like anger, frustration, or disagreement, even if they do something problematic or upsetting.

This condition is diagnosed in adulthood, and only in people who do have the ability to make decisions on their own without excessively depending on others. People sometimes experience dependency as a result of a health condition or other mental health condition, and this isn’t quite the same as DPD. It’s also important to note that people in abusive relationships may display traits that seem similar to those associated with DPD, such as extreme submissiveness or fear of disagreeing with the abuser. If these behaviors only happen in the abusive situation, DPD wouldn’t be diagnosed.

It’s important to understand these characteristics aren’t your fault. Personality disorders are complicated issues that develop from a multitude of factors, and it’s not always easy to recognize there’s something problematic about your behavior. These traits are ingrained—a part of your personality—and they can be difficult to change. But change is possible.

There’s nothing wrong with consulting your romantic partner about decisions you make, especially those affecting you both. In fact, this is pretty normal (and beneficial) in a healthy relationship. What sets this type of dependency apart from DPD? In a healthy relationship, you don’t wholly depend on your partner. You ask their advice, consider it, then make a decision that works for both of you.

If you have DPD, it may seem natural to turn to your partner for help with decisions, since you may feel incapable of doing anything alone. You might ask them to choose what stores you shop at, what kind of clothing you buy, what you do with your free time, and whether you should go for a promotion. You might harbor your own opinions about these choices, your partner’s behavior, or other issues that pop up in daily life. But because you worry expressing your true feelings will lead to disapproval and withdrawn support from the people who take care of you, you don’t say what you truly feel. This can eventually diminish your sense of self.

If these behaviors resonate with you, it can help to practice making your own decisions in your relationship. A caring partner can support you by:

Stepping back to let you make your own decisions
Encouraging you to take responsibility for household matters
Encouraging you to express your true opinions
Many people with DPD end up in relationships with people who take advantage of them. A few signs of abuse include:

Threatening to withdraw emotional or financial support
Belittling or attempting to control you
Insisting on sexual acts you aren’t comfortable with as a condition of support
A therapist can offer guidance and support if your relationship is abusive.

Having dependent personality means you may not trust yourself to make your own decisions. You believe you can’t function without the help of others. This can contribute to the distorted view that your child is more capable of making decisions for you.

Accordingly, parents living with DPD may overly rely on children to handle tasks or decisions children aren’t emotionally capable of making. This may be more common in situations where you’re a single parent living with DPD and don’t have another person to rely on.

It’s normal for children to have opinions on things like meal planning, where to purchase their clothing, or how to spend free evenings. And children, especially older children, should also contribute around the house and help manage their own schedules and responsibilities. But it’s not healthy for parents to ask children to take care of all household tasks and responsibilities or make decisions about adult responsibilities or social situations.

As a parent, you may have interest in what your child thinks of your romantic partner. But there’s a difference between asking, “What do you think about (Partner’s name)?” and “Should I keep dating (Name) or should we break up?”

DPD can make workplace interactions challenging, if you struggle to get necessary tasks done on your own. Your coworkers may notice your difficulty with self-starting, and some might consider your continued need for prompting and encouragement troublesome.

Presenting yourself as incapable or needing regular support and assistance to do your work can create challenges, even conflict, in the workplace. If you’re left to work alone, you might believe you can’t complete the task or project successfully and end up not doing it at all. However, you might do fairly well when you have supervision or support from someone else.

If you have DPD, you may notice your friendships follow a pattern similar to your romantic relationships. Your fear of being left alone can play out in ways that make you seem clingy and needy. You may worry disagreeing with friends will result in them no longer caring for you and avoid expressing personal opinions and desires to ensure their continued support.

You might also readily volunteer to help friends out, even when you’d rather not do something (like help them move or clean their house). Because you want them to continue to be there for you, you sacrifice your time, but less-than-ethical friends may take advantage of this trait.

Good friends should be there for each other and support each other in times of need, but true friends should also encourage you and support you in doing things for yourself.

It’s very difficult to address personality disorders without help from a therapist trained to recognize symptoms and help you work through them effectively. But therapy can always have benefit. Personality disorders can’t be cured, but therapy can help you address behaviors causing problems in your life and learn new ways of relating to others.

Dependent personality treatment can be incredibly beneficial, since it can lead to more fulfilling, healthy relationships. A trained therapist can support you as you work to realize your own capabilities, both when it comes to making decisions and taking care of yourself. Since people with DPD can sometimes transfer feelings of dependency to their therapist, it’s important to work with a therapist experienced in helping people with DPD.

In therapy, you might:

Practice self-sufficiency and assertiveness skills
Learn to cope with fears of being alone
Practice decision-making
Become comfortable spending time on your own
Learn to express disagreement in productive ways
DPD can often occur with other conditions. Childhood illness, attachment issues, or separation anxiety sometimes play a part in its development. But DPD can also factor into the development of concerns like social anxiety or depression. Therapy can help you address symptoms of these conditions, as well.

Healthy relationships should be fairly balanced. Some of the time, you might need more support from your partner than usual, and at other times, they may need more from you. But typically, it’s unhealthy for one person to rely solely on another.

If you or someone you love has questions about dependent personality disorder, contact my Portland area office to learn more about relationship coaching.

Courtesy of Good Therapy.


American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, fifth edition. Arlington, VA: American Psychiatric Association.
Blair, O. (2018, October 23). Dating someone with dependent personality disorder: Balancing support and self-care. Retrieved from
Dependent personality disorder. (2007). Harvard Mental Health Letter. Retrieved from
Dependent personality disorder. (2017, March 30). Cleveland Clinic. Retrieved from
Maccafferi, G. E., Dunker-Scheuiner, D., De Roten, Y., Despland, J. N., Sachse, R., & Kramer, U. (2019, October 15). Psychotherapy of dependent personality disorder: The relationship of patient-therapist interactions to outcome. Psychiatry. doi: 10.1080/00332747.2019.1675376

LGBT Counseling Can Help Men With Loneliness

Why Do So Many Men Feel Lonely? Counseling Can Help

Most people crave social connection. While social media, endless apps, and new technology promises to connect more people, many people feel lonelier than ever. While isolation can be a trigger for loneliness, loneliness and isolation are not identical. A person can feel lonely even when surrounded by others, especially if they don’t have deep connections that feel meaningful to them.

Loneliness doesn’t just feel bad. It can have profound implications for health. Some research even suggests that chronic loneliness can be as harmful to a person’s health as smoking 15 cigarettes per day.Why men are so lonely and how LGBT counseling can help.

Research on gender differences in loneliness is mixed. Some studies show that women are lonelier than men; others show the reverse. Most researchers, however, agree that single men tend to be especially lonely, and that certain social norms governing masculinity may increase the risk of loneliness in men. Some early research on loneliness also suggests men may be less likely than women to admit to feelings of loneliness.

Studies consistently find that women are more likely to have dense social networks than men. From childhood, women are socialized to value friendship, confide in their friends, and to foster deep intimacy with close friends. Even when men have many friends, they may feel uncomfortable sharing emotions or airing feelings of vulnerability.

A 2018 analysis of people living in rural regions found that 63 percent of men felt comfortable opening up to friends, compared to 74 percent of women. Women were also more likely to participate in activities, such as church gatherings, that foster friendship and a sense of community.

Although social isolation is a serious concern among single men, research suggests that emotional feelings of loneliness are even more important. A 2011 study tied social isolation to reduced life satisfaction, but the link was even stronger for emotional loneliness. Researchers also found that male university students were significantly more likely to report emotional feelings of loneliness than female students.

Masculine social norms teach men that vulnerability is weakness. Homophobia is also prevalent. Straight cisgender men may fear being labeled “gay.” These two forces can make it very difficult for men to reach out to others in friendship. Even when men have friends, they may fear judgment if they display weakness or ask for help.

Heterosexual male friendships often feature a boastful sort of masculinity, in which men brag about their sexual prowess, their financial success, or their independence. This culture can make it hard for men struggling in their relationships to share their challenges. It also shows men that the ideal man is one who uses others—not one who invests deeply in interdependent relationships.

This isolation can be a self-replicating intergenerational cycle. Men may discourage sons from showing weakness or emotion. Boys also witness their fathers modeling stoic behavior and may mimic it. In this way, the stigma of emotionally connecting to other men passes from one generation to the next.

Men in most studies are more likely than women to have long-term partners. These partners can ease some loneliness. Indeed, many men rely on their partners as a primary or sole source of emotional support. This increases men’s vulnerability to loneliness when relationships end or partners die. A 2017 survey found women are more comfortable being single than men. Sixty-one percent of single women in the UK reported being happy, compared to just 49% of single men.

In addition to supporting their male partners, women in long-term heterosexual relationships may help them socialize by building and fostering social networks. Emotional labor like remembering birthdays, sending holiday cards, planning family get-togethers, and scheduling outings with friends has traditionally fallen to women. When a man loses his partner, he may lose an important social lubricant. That may mean losing friends and social opportunities.

Building friendships with other men can be challenging, especially when a man is no longer in school. A few strategies may help:

Join communities and organizations that foster intimacy. Churches, volunteer organizations, and support groups may offer groups specifically for men looking for closer relationships.
Seek friendships with men who value alternative forms of masculinity and who are willing to talk about the need for human connection.
Consider working to turn acquaintances into friends. Invite a social media friend who speaks out against toxic masculinity or male loneliness to an outing.
Take a more active role in family efforts to grow relationships. Don’t rely on women to plan all social outings or reach out to others.
Try starting a new group or organization. Ask other dads to meet up once a month or invite acquaintances from church to start a group for men who want to grow meaningful relationships.
Identify any harmful beliefs you have about friendship or masculinity. Do you believe that crying indicates weakness or that real men don’t need others? Work to understand where these beliefs come from and actively correct them.
Practice conversations with other men ahead of time. Think about questions to ask them about their lives or opinions. Consider what you hope to share about yourself.
Don’t rely on social media as a sole or primary source of socialization. While social media can bring people together, it also relies heavily on brief interactions rather than the sustained, meaningful connection that grows lasting friendship.
Model vulnerability to other men and boys. Men who see that strong men can be vulnerable may feel more comfortable being vulnerable themselves. Sons who see their fathers invest in friendships may be less reticent to do so themselves.
Counseling can help many men practice and master new social skills. Men may also benefit from counseling when social anxiety impedes relationships or when loneliness is so severe that it leads to depression.

If you or someone you love is having difficulty with loneliness, contact my Irvington office to make a counseling appointment.

Courtesy of Good Therapy.


Henning-Smith, C., Ecklund, A., Moscovice, I., & Kozhimannil, K. (2018). Gender differences in social isolation and social support among rural residents [Ebook]. University of Minnesota Rural Health Research Center. Retrieved from
Neville, S., Adams, J., Montayre, J., Larmer, P., Garrett, N., Stephens, C., & Alpass, F. (2018). Loneliness in men 60 years and over: the association with purpose in life. American Journal of Men’s Health, 12(4), 730-739. Retrieved from
Salimi, A. (2011). Social-emotional loneliness and life satisfaction. Procedia – Social and Behavioral Sciences, 29, 292-295. Retrieved from
Sex differences in loneliness: the role of masculinity and femininity. (1998). Sex Roles, 38(7-8). Retrieved from
Yarrow, A. (2017). All the single ladies: 61% of women in the UK are happy to be single, compared to 49% of men. Retrieved from

Relationships Help Mental Health In Couples Counseling

Can Romantic Relationships Improve Mental Health in LGBTQ+ Youth?

Romantic relationships can have a big impact on LGBTQ+ youth. In a study published in Abnormal Psychology, relationships protected homosexual youth from the emotional distress of bullying and stigma. Bonds with parents and peers didn’t have the same protective effect. This suggests closeted homosexual youth may not be getting the full emotional support they need.

Romantic Relationships Help Mental HealthMeanwhile, romantic relationships were associated with higher stress levels in bisexual youth. This trend may have been due to unique stressors in the bisexual population.

The study recruited participants from Project Q2, the longest ever longitudinal study of LGBTQ+ youth. The project involves a racially diverse group of 248 Chicago youth between the ages of 16-20. Most participants identified as lesbian, gay, bisexual, or transgender.

In the study, gay and lesbian youth displayed less distress when they were in a relationship. Romantic relationships also buffered the stress of victimization and bullying. Bonds with friends and family did not provide the same benefits.

The study’s authors suggest these young people may rely on their partners for support they often cannot find elsewhere. A 2014 study in the Journal of Adolescence reached a similar conclusion. In that study, youth attracted to individuals of the same gender experienced stress from anticipating societal rejection. Romantic relationships helped improve their emotional well-being.

The study’s authors say their research points to the value of helping young people find romantic relationships. Outreach programs such as “queer proms” may offer more than a fun evening. They can also help young people develop dating skills and find partners. The resulting romance could lead to improvements in mental health by helping offset the effects of discrimination.

One exception to these findings was in regard to bisexual youth. Bisexual people in relationships were 19% more distressed than their single peers. This may be due to unique stereotypes bisexual individuals face. The study’s authors mention previous research in which romantic partners “expected” bisexual women to engage in threesomes (likely due to the myth that bisexual people are inherently polyamorous.).

There is also the matter of bisexual erasure. Bisexual individuals are often told their sexuality is “just a phase.” When a bisexual person enters a relationship, others may claim the person was really straight or gay all along, depending on their partner’s gender. This invalidation can have serious effects on a bisexual person’s emotional health.

(Note: These results are not meant to imply that romantic relationships are bad for bisexual individuals. They merely show how bisexual people are more likely to experience distress in relationships due to stigma.)

Baams, L., Bos, H. M., & Jonas, K. J. (2014). How a romantic relationship can protect same-sex attracted youth and young adults from the impact of expected rejection. Journal of Adolescence, 37(8), 1293-1302. doi:10.1016/j.adolescence.2014.09.006
Celebrate bisexuality! GLAAD dispels common myths and stereotypes. (2011, September 23). GLAAD.
Romantic relationships buffer gay and lesbian youth from emotional distress. (2018, February 16). EurekAlert.

Courtesy of Good Therapy.

The Role Joy Plays In Our Emotional & Mental Health

Counseling Flow of Joy

Since it’s the season to bring “joy to the world,” I thought this might be an appropriate occasion to ask you to consider what brings joy to you. Somebody asked me this question recently, and I had to think for a few minutes.

I’d somehow forgotten that joy is something that’s not only important in terms of how we experience life, but it’s also a vital quality in terms of how we measure healthy emotional and mental well-being. I’m a therapist and I’d somehow forgotten that…hmm. I guess I’ve been too busy focusing on other people’s lives and haven’t stopped long enough to consider this important aspect of my life.

Counseling flow to increase joy.And so, do I actually experience joy in my life? Not the kind like “Hey, this is a great dinner,” but instead the kind where I can look back on special times and smile at the memories? The answer is “Yes,” and typically children and animals are part of my personal joy “quotient,” since both cause me to laugh and be silly in ways that I’m normally not during the everyday logistics of my life.

They also require that I stay in the present whereas, under other circumstances, I can sometimes get lost in the fog of the future, where life usually seems more complicated, and even more fearful, than it usually ever is. Children and animals teach me the importance of remaining “in the now,” and if they happen to not be available, then meditation almost always helps in that regard, albeit not in the same light-hearted, comedic, and spontaneous way, at least so far!

During moments of joy, I can almost feel the positive neurotransmitters, like serotonin, racing through my brain as they uplift me and allow me to escape from any stress or pressure that I might otherwise be feeling. But I realize there’s always room for more joy, so my task is to discover how I can create it for myself.

My job as a psychotherapist often involves helping clients discover ways of creating the lives they want for themselves, and I’ve often suggested that they identify activities that involve something we, as therapists, refer to as “flow.” The idea of “flow” is that we become so engaged in the activity that we have no connection to the temporal aspect of our day; in fact, time literally seems to stop when we’re engaged in this activity we love so much. It’s when life can be bustling all around us, yet we aren’t in the least connected to it, because we’re off in the space of “flow.”

It’s like taking a mental “time-out,” and the kind that pays untold dividends for us, but also for those who are closely involved in our lives. And, by the way, I’m not referring to an addiction to technology or any other such activity that has a negative impact on our lives, either personally or relationally.

Rather, it’s an involvement with something we feel is expanding us while at the same time, it increases feelings of satisfaction and personal reward within the depth of us. It results in a completely positive, and even joyful, experience.

Why is “flow” so important? Or joy? Well, because these experiences allow us to separate from the more stressful or frustrating aspects of daily life, no matter what phase of life you might be in. In fact, it’s during the most stressful and frustrating times of life when you’ll need to identify ways to offer yourself experiences of “flow” or joy that you’re lacking so much.

But typically, these are the times we’re somehow wired to suffer through whatever’s going on until it’s over before we begin to take care of ourselves in ways that will actually do the trick. By then, however, it may take considerably longer to recover from the impacts the stress has had on our lives because we weren’t paying enough attention to the inevitable internal scream for a “time-out.” Consequently, we usually discover that the damage of not listening to that scream resulted in even more stress. And so the cycle continues.

I’m not a believer in New Year’s resolutions – at all. In fact, I’m convinced that making them is more often than not a recipe for feeling terrible about oneself, mainly because we usually lack the commitment to maintain them for any serious length of time. Instead, I’d encourage you to begin thinking about the different ways that you might bring flow – or even more flow if you’re already engaged in an activity that results in it – into your life.

Flow often begets joy – in fact, it’s often through our experiences of flow that we ultimately discover joy. So, I’d like you to consider the importance of this for you, for your relationships, and ultimately for your emotional and mental health.

And rather than viewing this “search” for flow as optional, begin seeing it as something that’s as vital as the food, the rest, and the exercise you offer your body so it can operate at a much higher emotional and spiritual level than it has previously.

Make this a commitment to yourself, and not a resolution. Both are very different from one another; one is a form of self-love, and the other is a form of self-hate, or at the very least an obligation to attend to…until we decide we won’t, a decision that’s usually made by mid-February.

I wish you well in your (re)search, and take a moment to share with me what you discover. I’d love to hear about the path you’re paving towards your own experience of joy.

Courtesy of Therapy Tribe.