Thursday, December 31, 2009
Change is an interesting thing though. It seems to me that humans think it is easy when it is someone else that is working on change, and we bump up against how difficult it is when it is our own process. Someone announces they want to start exercising and their helpful support system tells them, "Well, just go to the gym." That word just, like it is just about getting in the car and driving to the gym. It seems like it should be, right? That change is about deciding to do something differently and then creating actions to bring about the desired result. If you look around, the evidence is staggering that this is just not that easy!
I love my job because I get to see people change all of the time! I love that sometimes I can see it coming, but that other times, I get to be fascinated by the timing and the circumstances of the shifts when they happen. Sometimes it is about deciding, but time and again the shift seems to come from deeper within and has an emotional component. The thinking part is the last to know but often gets the credit! It often seems to come from accepting (the kind that comes without judgment) where and who one is, warts and all, that allows one to finally shift out of the pattern, the behavior, the perspective, the relationship, the job, the pain.
Change cannot come about without walking through, and with, the fear. No way around that one. If you want the deep, loving relationship you have to confront the fear of loss and abandonment. If you want the new adventure, career, education, you have to confront the fear of failure or, more often, of success. By the way, if you try to "kill" your fear, it will only make it stronger. Countries have played that one out since the beginning of time.
So, as you count down to 2010, reflect on where you are and meet yourself there with compassionate acceptance. From that place, what awaits will unfold.
Blessings to all in the New Year.
Wednesday, December 2, 2009
So what are boundaries? Hard to put into a nutshell. Boundaries are how we define ourselves and they are a way we take care of and protect ourselves. Boundaries can be relational, physical, emotional, spiritual, and intellectual. Too much to go into here (I think I might need Part 2 of Part 2).........
Have you ever asked someone for something and had them say "yes" only to have them later, by their action tell you that their answer was actually "no." Ever done it yourself? The truth is we cannot be honest (a basic requirement for a healthy relationship) and be a people pleaser at the same time! If you "can't say no", you are not living an authentic life and you are not able to live with honesty and integrity. Sorry, it is a brutal truth. Now, I know, many of you have been taught that self-sacrifice is supreme and that you are "selfish" if you say "no." Self-sacrifice is a beautiful thing. But it is only genuine when it flows from one's value system and true calling, when it is about avoiding anxiety and worrying about hurting others feelings it IS self-serving and selfish, just hiding under the facade of "doing for others." The price is exhaustion and resentment. Boundaries are about defining for ourselves what we value and adjusting our priorities accordingly. But, first, if you do not value yourself you will have your priorities off and all will be out of balance. Those who take time to sleep, relax, enjoy a hobby, pray, exercise, maintain friendships, eat healthy, maintain finances, and deal with their emotions as they come up have more to give others (yes, including children), their vocations, their causes, and their faith, not less. Told you that it was counterintuitive!
The previous paragraph was mostly about relational boundaries and how we spend our time, critical aspects of healthy boundaries. I now want to briefly touch on emotional boundaries. Emotions are not good or bad, they just are. Emotional boundaries are about recognizing, honoring, and expressing in a healthy way our emotions and allowing others to do the same. One of the common manifestations of unhealthy emotional boundaries is when somebody feels the feelings of somebody else, for example sadness, because the don't have a strong enough boundary in place. They don't like feeling sad and they often also feel quite anxious because of the powerlessness they feel, so then they result to unhealthy caretaking of that person to fix their sadness, and in turn, their own. It is a great anxiety reducer and becomes addicting (this is when it crosses over to codependency). Lets face it, we keep doing unhealthy behaviors because they often work in the short run. Unfortunately this fixing comes at a very high price and it always destructive to the relationship. The flip side of this coin is feeling numb when someone else is in distress. Sometimes one compensates for a leaky emotional boundary by putting up a wall.
The balance between the two is empathy. Empathy comes from knowing ourselves and spending conscious time in our own emotional worlds and experiencing acceptance of all of the emotions in our emotional range. Then when people in our lives are feeling something, we tap into our own experience and can therefore "get it." We can hold the space for them and allow them to go through it in their own way because we can tolerate our own experience of that emotion. It is very freeing to not have to fix other peoples feelings and personal relationships thrive when caring, healthy boundaries are in place.
If this blog resonates with you, try something this week:
Whenever you feel distressed (anxious, hurt, angry, resentful) take a minute to have a conversation with yourself. Ask yourself, "What about this situation is creating this distress in me?, Am I feeling any other feelings? What in this situation, if it changed, would eliminate or reduce my distress? If I were feeling courageous, what action could I take to bring that about? Just observe, just listen. The first step to working on boundaries is becoming conscious.
Here is an inspiring quote for the road:
Wednesday, November 18, 2009
One thing to consider as you enter into holiday season is how much of your experience seems dictated by obligation and trying to meet the expressed or unexpressed expectations of others. One way of knowing this is to take an internal measurement of resentment. Resentment is wonderful at telling us that we need a different boundary and that we have often stepped out of healthy self care. Resentment is often created by saying "yes" when what we needed to say was "no." Take some time to check in with yourself. Are you doing something because you believe someone will be mad or hurt if you don't? You have probably already crossed over into trying to meet the expectations of others that conflicts with your own self care or the care of your family.
Focus on two things and I can safely say you will enjoy your holidays more!
First off, listen to your intuition, thoughts,and feelings around what your value system is as it relates to the holidays and give yourself permission to follow it. This value system will dictate how you spend your time and money and why. Is this a time for friends and family? Is this a time of relaxation and renewal? Is this about simplicity for you and a focus on the spiritual? Is it a time for gift giving and providing joy for others? Take some time to sit with this and let the answers come to you. This is not about selfishness. If you do this you will spend some time doing things you don't want to do but the difference is that you will feel good about it. For example, you may not feel ready to visit your grandmother at the nursing home but you will be loving yourself and her by visiting and you will feel positive later when you think about your visit. When we don't follow our own value system, we do things we don't want to do and feel resentment about it later.
The second piece is taking steps to create your holiday time by chosing what you want to do and start saying NO or limiting time spent on the rest. Identify the aspects of the holiday that bring you joy and that flow from your value system and decide to do them this year. Schedule them or begin planning them if they are events. Listen to your self about what is important to you. Sit down with your family and talk about it. Truthfully, kids don't enjoy spending time with their stressed out, frazzled parents who are too busy trying to create the perfect Christmas for them! Do you enjoy hours in the mall, shopping and looking at decorations? Great. If not, find a less stressful alternative for yourself. Are you crafty and enjoy putting extra time into wrapping gifts? Great. If not, throw them in a gift bag and move along. Love holiday parties? Great. Make them a priority and spend less time decorating your front yard. Find the parties torture? Great. Say no to the invite and sit home in front of your tree with some eggnog. Know that you can't or don't want to go to multiple family gatherings. Say no. Your anxiety will spike and then you will realize that everybody survived. If a family member stays upset, all that does is reveal what is already there (an unhealthy relationship) and you can then address that later if you chose to. You know that you are out of your value system if you are losing sleep, are irritable to those around you, spending money you don't have, or dreading too many hours in the week.
You are in an ongoing creative process, chose to create what you want for yourself and for your family. Don't agonize what to say "no" to, decide what you are going to say "yes" to and let that set the stage for your holiday season!
Wednesday, November 11, 2009
As you may or may not know, that is not necessarily the experience of all. In fact the statistics of those who come back from combat with PTSD are sobering, at least to me. Approximately 20% of the veterans of our current war have PTSD, and with each deployment the chances for PTSD go up. For those that are deployed for a third time, their chance are between 30-50% that they will return with PTSD.
Let me say a little bit about what PTSD is.......PTSD is a cluster of symptoms that fall under three categories, re-experiencing, avoidance, and hyperarousal. Those with PTSD may have flashbacks, where they are literally re-experiencing the traumatic event. It is not that they are thinking about the event, their brain has taken them back there. Nightmares would fall under this category. One might also get triggered by something in their environment and their brain associates it with the trauma, they then may experience severe anxiety or distressing feelings. For example, the sound a chopper blades can be a trigger for many Vietnam vets. Dust blowing in one's face can take a Desert Storm vet right back to Kuwait. These flashbacks, nightmares, and associated anxiety are not voluntary and often very difficult to intervene on. The brain has been changed by the horrors experienced and it is very difficult treatment wise to get it back in balance. The avoidance symptoms are in place because the mind and the psyche will do what it takes to not trigger the systems of the brain in charge of re-experiencing so one's life may become paralyzed by the desperate attempt to "not go there." The hyperarousal is based on the fact that sometimes the fight or flight system can't be turned off, or it gets turned on way too often. These symptoms are going to involve insomnia, inability to concentrate on daily life as one is in "survival mode), irritability, constant anxiety or the feeling of being "amped up."
Can you imagine living with these symptoms and trying to pursue a career? Parent a child? Have a fulfilling relationship? Enjoy hobbies? It can be a devastating syndrome. It leads one to pursue any means to alleviate the tormenting symptoms so drug and alcohol abuse are common, as is depression.
There are new treatments for PTSD that have proven to be helpful (EMDR, Somatic Experiencing therapies, group therapy, and medications) but we haven't figured out a way to cure this.
So, on this day when many honor the heroes and the mind of the country goes to the men who stormed Omaha beach, to the Pat Tillmans of the world, to those who provide the blanket of protection, please allow it to extend to those who continue to struggle with the impact of their sacrifice. He may be the homeless man in the downtown of a urban area, he may be the alcoholic in a local AA meeting, those whose "weakness" is often viewed with disdain by the same who originally honored their intention. Honor the living vet that have given his life, have a voice for him or her when they may not be able to have a voice for themselves, know that many die for this country but that it just may happen years after their combat experience is over.
Tuesday, November 3, 2009
I think it is important to start off looking at how our perceptions of what we need and want may be way off from what actually impacts our life experience. Daniel Gilbert, PhD (I suspect will soon be called "Uncle Dan" by me, as he is a major contributor in my field) is one of the happiness gurus and is a professor and researcher at Harvard. He has discovered a fascinating fact about humans and happiness, that is, that we largely fail to anticipate what will actually make us happy! The research is staggering and humbling. Social psychologists can largely predict what poor decision most of us will make in given situations! (Check out Daniel Gilbert's Ted Talk on mistaken expectations). How happy are you right now? This is how happy you will be a short time after you win $250 million in the Powerball! Yes, there will be a spike of jubilation and incredulity, and then you will return to your basic state. How happy are you right now? This is how happy you will be shortly after the wedding you have been anticipating would finally bring you the happiness you seek. There is a fascinating study done prior to a recent election where people anticipated their disappointment vs. happiness based on the outcome. Even with as fear based as political opinions have gotten, people's happiness was largely not impacted by the election results. Those who were unhappy prior to the election, even if they received the outcome they had hoped for, the research shows are most likely still feeling that way. What is interesting about this has nothing to do with politics, it is the struggle for us to accurately predict what will bring us to the emotional, psychological, and physical state we prefer. If we can't predict it accurately, how can we create it? Well........read on.
So what does make us happy?? There is some interesting information out there about this and it would take me multiple blogs, but I will touch on some highlights.
Well, for starters, it isn't money or financial security. Even though this is counter-intuitive, I promise you the evidence is overwhelming. I am not minimizing the loss of a job or the importance of financial self-care. I am telling you that, once you have paid your bills, the amount of money you have in the bank is unrelated to how happy you are. In fact, in the pursuit of the ever elusive financial security or the quest for material possessions, largely takes away from the time and energy it takes to invest in those things that make us happy. Though, if we use our money to create experiences vs. purchasing things, the evidence is that this does increase our feelings of positive well-being.
One key component to happiness is connectedness to other people. Having quality relationships and community, according to research, is a common experience of those who report experiencing a general contentment with life. Cultures that emphasize the community over the individual have less depression and furthermore, seem to have some biological protection. The culture in the United States largely favors individualistic values which affords us some wonderful benefits as a nation. They key is to keep a balance between the "me" and the "we." If I may add my own observation, simply having people around you does not cut it. Seek out your kindred spirits! Seek out those that can "hold the space" when you are having a difficult time with life. Seek out those who also place a high value on connectedness with themselves, others, and their world......those relationships feed the soul.
Another tidbit of advise from the happiness experts? Turn off your TV. A recent study out of the University of Maryland found that happy people report spending more than 30% less time watching television. They are likely to be developing closer relationships, pursuing a hobby, exercising, listening to music, attending church or a spiritual meeting of some sort, creating, playing, being absorbed in a challenging task, meditating, spending time outside or other endeavors that lead to more enjoyment or meaning. Turn on the TV for a favorite show or sporting event and then let it slip back into playing a secondary role in your life. If you are watching TV with your children or your spouse, you are not actually spending much meaningful time with them. TV viewing is a solitary event. Food for thought..........
The last tidbit out of the happiness research to ponder comes out of the work of Mihaly Csikszentmihalfi's, a Czech psychologist, on "flow." Flow is the experience of being immersed, totally focused, and energized by a task. When one is in flow, time flies and the creative juices are, well, flowing! This task can be mental, spiritual, relational, or physical (athletes call it "being in the zone"). The key is to follow your bliss, your curiosity, your passion!
There is so much out there on this topic. I tried to pick the aspects of happiness that seem the most timely or impactful. I welcome your comments. In the meantime.......Carpe diem!
Monday, October 26, 2009
As someone who has been in some form of the mental health profession for 17 years, I frequently get comments and questions about my job. One of the most frequent comments I receive is in the vein of "I couldn't listen to people's problems/complaining all day." For me, I don't see myself as listening to problems all day and it is very rare that I have clients that incessantly complain. Truly. I am someone who, along with many others in mine and related fields, treats mental health disorders, which includes mild, moderate, and severe depression. Before you feel exempt, know that you have probably qualified to seek the services of a mental health professional at some point in your life. Anxiety and depression especially are VERY common in the good 'ol USA. I thought with this little blog, I would give out some general info on mental disorders, and specifically, depression. The following excerpt was taken directly from the National Institute of Mental Health (NIMH) website:
"Mental Disorders in America
Mental disorders are common in the United States and internationally. An estimated 26.2 percent of Americans ages 18 and older — about one in four adults — suffer from a diagnosable mental disorder in a given year.1 When applied to the 2004 U.S. Census residential population estimate for ages 18 and older, this figure translates to 57.7 million people.2Even though mental disorders are widespread in the population, the main burden of illness is concentrated in a much smaller proportion — about 6 percent, or 1 in 17 — who suffer from a serious mental illness.1 In addition, mental disorders are the leading cause of disability in the U.S. and Canada for ages 15-44.3 Many people suffer from more than one mental disorder at a given time. Nearly half (45 percent) of those with any mental disorder meet criteria for 2 or more disorders, with severity strongly related to comorbidity.1
In the U.S., mental disorders are diagnosed based on the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV).4
- Approximately 20.9 million American adults, or about 9.5 percent of the U.S. population age 18 and older in a given year, have a mood disorder.1
- The median age of onset for mood disorders is 30 years.5
- Depressive disorders often co-occur with anxiety disorders and substance abuse."
There is so much to depression, whether it is the varied types of treatment, research on its causes, the public response to depression or those that are depressed, etc. I figured I would just start the ball rolling with some general info and will follow up with more on depression. Stay tuned.
Monday, October 19, 2009
Uncle Sigmund's Gift #1: Identifying the unconscious
Now, many have talked about the idea that we aren't aware of most of the activity and potential of our brains. Uncle Sigmund really expanded this idea and highlighted how much of our psyche is operating without our consent or direction! Enough said. Well, at least for now.
Uncle Sigmund's Gift #2: Defense Mechanisms
Defense mechanisms are securely built on the foundation of Gift #1, many of the defense mechanisms that he observed come from the unconscious. Usually fueled by anxiety, we have very creative ways of making sure that uncomfortable material doesn't cause psychological distress. While you may think defense mechanisms are negative, I think they deserve our respect. Thank God they are in place or many would not be able to function in their daily lives. Our psyche knows what we can or can't handle. Now, when there is material festering down in the depths that is being diverted through defense mechanisms, it causes problems, that is for sure. There does comes a time to release the defense mechanism, face the pain and anxiety, and heal the past, but that timing is different for everybody. One of the most interesting defense mechanism to me is projection. Projection is when we unconsciously cast our undesirable or unwanted thoughts, emotions, attributes, cravings or desires onto another person, religion, country, group, political party, etc. Of course it is a bit tricky. How can you tell the difference amongst your value system, your preferences or your projections? The best way is to follow the charge-the anger or the fear. When it is projection we feel a lot of energy and the situation looks very black or white to us! Do you get confused when a political candidate campaigns passionately against some issue and then turns out to have the same skeleton is his or her closet? Projection. Isn't fascinating when everybody can see it clearly but them. We all do it! We would have healthier people, families and nations though if we all took time to examine our projections. Shadow work is always transformative.
Uncle Sigmund's Gift #3: Defining dreams as the language of the unconscious
I love me a good dream! There is no way to prove to the skeptic that dreams are really more than just your brain taking out the garbage at the end of the day. I get that. Certainly very difficult to research. I am a convert though, thanks to Uncle Carl. I believe that they are always telling us what is going on in the depths of our psyche. More on dreams later.
"Psych 101" will be another blog series of mine. Now that I have a venue, I don't think I can pass up the opportunity to write and dialogue about some of the fundamentals the study of human behavior and the human psyche.
"Knowing your own darkness is the best method for dealing with the darkness of other people."-Carl Jung
Monday, October 12, 2009
I had the wonderful opportunity last week to hear a leading researcher in the impact and treatment of trauma (this includes, but is not limited to, physical, sexual, and emotional abuse as a child or adult, combat, significant stress like a death or huge financial loss, etc), Bessel van der Kolk. Dr. van der Kolk spent 28 years at Harvard and now has his own institute in the Boston area. I will try to highlight some of the really important stuff.......
When we are born, our brain has a lot of development still left to do, a lot of the old brain (what we share with the animals) is in there and ready to fire and our frontal lobe, well, its under construction. Our frontal lobe is new brain, its the part of our brain that is huge in defining our personalities. Its what makes me "Sarah." One of the system that is relatively intact when we are born is our fight or flight system, this is what gets kicked into high gear when we perceive a threat (it is important for compassion and education purposes to know that most of the perceiving of such things is done unconsciously, or in other words, by old brain, NOT by the frontal lobes). We develop a second system as little people that allows us to self regulate, basically to calm down. This system is developed through interaction with the environment and primarily through interaction with the primary caregivers. If the environment is chaotic, abusive or neglectful that system is underdeveloped, so that creates an internally anxious, hypervigilant, stressed out person. Most, about 80%, of this systems nerves are efferent, meaning they go from the body to the brain! This is why telling people to think differently and "move on" is useless, and often cruel. The conscious, thinking part of their brain didn't cause this and therefore can't fix it. Someone in this position isn't remembering what happened, they are reliving it. It is important to note that negligence can be very distructive, for it is often viewed as less detrimental. For example, there are many children of alcoholics that had a "happy" drunk or a "calm drunk" for a parent, as opposed to a violent one. It appears as though their systems are also significantly impacted, most likely because an impaired parent is often not present emotionally, intellectually, and on many subtle levels, interacts with their children very differently. Adult children raised in these environments often see the world as negative, they often feel very anxious, they find that they are often controlling and judgmental, in other words, the world and its inhabitants are continued to be interpreted (by their survival focused brain) as lacking. When this system is working, the frontal lobes stay online during stress. The person is able to stay in the present, to know that they are safe and to address their environment appropriately. If you can do this, be grateful.
So, what happens if this system is faulty? Well, if one cannot internally physiologically and emotionally self-regulate they seek out external means of doing so. Substance abuse and addictions of various sorts, food, smoking, compulsive relationships, perfectionism (big in US culture), all work to physiologically alter one's internal experience. Down the healthier avenue, one may seek out exercise, body movement meditations such as yoga and tai chi, mediation and prayer, etc.
One is more likely to be retraumatized as an adult if this system did not fully develop. The foundation is not there and so the stress response takes over. For example, those who survived 9/11 but came from troubled childhoods were more likely to develop PTSD (Post Traumatic Stress Disorder-a severe, pervasive, anxiety condition) than those who weren't. They simply have different brains.
We can treat this! There are techniques and evidenced-based approaches that are making an impact. For example, EMDR (Eye Movement Desensitization and Reprocessing), somatic experiencing, other therapies that focus on the physiology are showing wonderful results. Stay tuned. I am passionate about the treatment of trauma and will have more to say!
Monday, October 5, 2009
One thing that my job has taught me is that the truth really does set you free and its close cousin, you are only as sick as your secrets. This may be a bit dramatic but I think this is the key to higher levels of mental and emotional health. The road to honesty is extremely difficult and there are many obstacles to overcome. For starters, one needs to be honest with themselves and that takes time for self-reflection, courage to face the truth, and usually some type of consequence which inspires one to do it differently. Emotionally, shame is the biggest hindrance to this endeavor, followed closely by fear........(they often work together). Let me expand on the shame thing.....because its role is paramount. Many hide their secrets from themselves or others because of the shame it triggers. Shame is that feeling, that state of being, that is about feeling less than, unworthy, unlovable, inadequate, invisible, alone in the world and we have all sorts of defenses to prevent that from coming up into our consciousness. One has to confront their shame and it defenses in order to find the freedom that comes from being who they actually are, demons and all. "Being who you actually are" sounds great when its all the good stuff about us, but what about when we have to say that who we actually are is also an addict, or someone who is cheating on their spouse, or someone who as been abused or has abused, or someone who's family was less than perfect, etc, that's when we tend to put up the walls. We use all of Uncle Sigmund's (the grandpappy of psychology, Sigmund Frued, will always be referred to by me as, "Uncle Sigmund") identified defense mechanisms to then create the story we want to believe and the story we present to the world. We have all done this, we will all do this.
So, what is the benefit of living in your truth and revealing your secrets? The irony is the one often feels a significant reduction in shame after going through the gate of honesty and self revelation. The build up of shame, the depression and anxiety caused by the pent up emotions, the fallout experienced in once's close relationships, the addiction that is fed by the secrets, the energy it takes to maintain the facade, all take a toll. Don't get me wrong, the gate of honesty is very difficult to walk through, especially when another is involved. This is where the fear comes in, usually at the foundation one must confront their fear of abandonment and their fear of rejection.
I have observed, both in my life and the life of my clients, the greatest beneficiary of truth telling is in one's relationships. Your relationship with others, your Higher Power, and yourself. Secrets block intimacy. For example, you cannot lie to your spouse (and yes, minimizations and omissions count) about an extramarital affair and have a close emotional connection with them. The lie prevents healing. Unconsciously and consciously, you will protect the secret and many other aspects of you get shoved down as well. Most spouses and 99.9% of the children know something is going on so this further increases the wedge. In the example of addiction, one has to reveal the full extent of their addiction and places it has taken them in order to experience the fullness of grace given to them at that level of sobriety. Or, on a smaller scale, one gets to be, and therefore attract, people that live genuinely, demons and all. Food for thought.........
"Knowing your own darkness is the best method for dealing with the darkness of other people"-Carl Jung
Thursday, October 1, 2009
We live in a culture that seems to hold tightly to the idea that we can change if we decide to and that much of our poor behavior is due to poor cognitive decisions, a lack of knowledge, or even low intelligence. In my practice and when I hear people's stories, I find that this is often not the case. While I am a proponent of personal responsibility and empowerment, I have also observed that human behavior is often counterintuitive and its causes are much more complex. The field of psychology has discovered some fascinating things about human behavior. I hope to add information and encourage exploration of this with this blog. For example, we can try to chalk up the continued use of an individual's alcohol and drugs to bad decision making, when the complexity of the underlying causes of addiction can fill volumes. Or many in our culture are surprised when a beautiful person with money turns out to be troubled........we are confused, "They have so much going for them." In actuality, there is very little evidence to support the idea that money or beauty will insulate you from the pain of life or protect you from depression.
The field of psychology has discovered some fascinating things about human behavior. I hope to add information and encourage exploration of these things...........stay tuned!
Wednesday, September 30, 2009
Some of my posts will be directly research based, commenting on recent research or established principles in the fields of human behavior. Others posts will be observing the more ambiguous aspects of psychology and the practice of counseling, for example, look for my blog series, "Things My Job Has Taught Me." To learn more about my counseling practice, visit my website at www.matheson-counseling.com.
I would love to share a little bit about what the field of psychology, and the practice of psychotherapy, has discovered, and create a platform for dialogue and exploration. Please join me!
Disclaimer: No matter what I write about, it's not specifically about you. I have literally worked with hundreds of clients and many have similar circumstances or struggles, so there may be a familiar ring to my stories or illustrations. Also, I may take poetic license with stories, weaving in my own experience with those of my colleagues, so each story may be a composite of different people, situations, and outcomes. No matter what I write about, it is not psychological or counseling advice directed at you. Please consult with a professional personally if you are needing psychological, emotional, or relational treatment.