The road to healing can be long and winding with many obstacles. Sometimes we need a bridge…
It was a warm March afternoon as I stood with a father as we watched his children greet the horses in my arena. After a few months of sessions the boys invited him to attend an equine-assisted psychotherapy session with us. The father commented on how helpful our work had been in helping his children find their voice, develop the ability to pause, set respectful boundaries, and find a safe place to share their pain and fears.
I encouraged him to join his sons in the arena as they said hello to the horses. He replied that he was here because the children had asked him to come and he really did not think we could be of much help to him – therapy had not been helpful to him in the past. He went on to share that he had tried everything the VA could offer him since he returned from Vietnam decades earlier. I nodded and invited him to consider that it might be fun to brush a horse with his boys without any expectations or pressure. I encouraged him to simply “be” with his sons and the horses. He stood his ground at the fence.
I stepped into the arena and our session unfolded. Dad was attentive throughout yet did not step in, despite several invitations from his sons. The session ended, we spoke briefly, he was patient and his voice soft as his boys buckled their seatbelts. I did not expect to see him again. His presence told me that something shifted. His breath was deep and slow and eye contact minimal as he left. The wheels in his mind were clearly turning.
The following week I expected the boy’s mother to bring them to their session. Nope, here was Dad again… and again… and again. The next three weeks he shared various unsolicited feeble excuses about why he was bringing them to session instead of Mom. Each week he stood at the gate. Each week we gently invited him in. Each week he stood his ground and did not enter the arena. Until the fifth session. Our biggest horse, standing 17 hands (68”) stared at him from across the arena. As the father stood at the fence, the large paint draft horse approached him. The horse walked across the arena with intent. Suddenly this big man appeared small as he stood face to face with the big horse who stopped just a few feet in front of him. The boys had created an obstacle course and were leading horses around the arena and through the course. Over and over they navigated the course as children will do. The big paint horse remained as still as a statue as did the big man. The boys finished their activity. I signaled to the equine specialist and pointed to the far gate. The equine specialist guided the boys to get a snack, water, and look for the eggs that our hens elusively hide from us on a daily basis. Dad and horse remained still at the gate.
As the boys left the arena, the father’s posture melted. His 6’4 frame draped over the fence as if for the first time in decades he was allowed to relax his body. He hung there for several minutes. The horse remained still. When he stood and looked at me I saw in his eyes the 18 year old boy who was sent to war. His voice sounded very young as he turned and asked “do you think this one would walk the course with me?” I put a halter on the big horse and they walked the course together over and over, just as his children had. The horse matched the rhythm of the man’s footfall. He then asked me to join him. We walked in silence around and around the arena, outside of the course his boys had built. He began telling me a story about the war. Tears fell as we walked and talked. It was a story off loss, regret, fear, shame, and blame. As he finished telling the story he sighed deeply, as did the horse. We walked again in silence for several ‘rounds of the arena. He then took the halter off of the horse and began picking up the obstacle course. This seemed important and I did not stop him to tell him he did not have to clean up. The horse followed him as he stacked cones, rolled barrels, and piled the poles that his boys had used to create the course. When he finished he looked at me and shared that he had never told a single person that story. He had carried the burden all of these years. “Who knew a horse would lighten the load and help me share it with a person?” He then met his children at the minivan and off they went.
We did not speak of this for a while. We closed our work with his children a few months later. At this closing session he asked to again talk with this horse. After spending a few minutes with his horse he shared with me that although he did not understand what had happened, he was grateful for the space and time that we gave him to lean on the fence and be still. He shared that the obstacle course became the theatre for the story in Vietnam and the horse became his higher power – unwavering, omnipresent, and forgiving. He walked the course over and over trying to find a different way than what had transpired. He eventually determined that he had done the best he could in a horrible situation. He shared the story with the horse and then with me. Neither of us left him or judged him. From here he was able to step into therapy with new eyes and begin to truly heal. This was the first step towards true healing.
That was 12 years ago. The boys are grown, the family moved from Arizona to California, and that big horse has passed. I received an “accidental” text a few months ago from his wife. We reconnected to catch up. She shared that she was not sure of the details of that day but she knows that the walk with that big horse set in motion events that changed their lives. Her husband was finally able to heal from the invisible wounds of war and they came to know each other in a way that she never thought possible.
A few years ago you may have read a blog that I wrote about pressure – horses respond and learn by the release, not the application of pressure – so do we. In this case we provided the safe space, removed all pressure and waited.
The welcome that our troops received when returning from Vietnam was far less than welcoming. If you come across a veteran or service member, no matter how old or young, look them in the eyes and take a moment to thank them for their service. It is the least we can do for the freedom we enjoy.
A few months back, I experienced one of my prouder moments as a therapist/mom when sitting in our living room, my then 6-month-old began to cry. My then 2 ½ year old immediately dropped what she was doing and went over to console him, or so I thought. As if the simple act of rushing to her brother’s aid wasn’t already sweet enough, she put her arms around him and said “it’s okay buddy…you can cry if you want.” My heart swelled.
As I thought about this experience later, what came up for me was a reminder as to what messages are truly important for us to be conveying to our children. As a parents, and people, most would attest to the idea that seeing your child or any child for that matter, cry is a difficult thing to witness. We feel helpless and responsible, sad and anxious, guilty and fearful all at once. Add in my therapist mindset, and I also often find myself wondering whether these moments are traumatic, harmful, helpful, or something entirely different that I have yet to identify. Given the answer may even be all of the above, the overwhelm we feel around supporting our children’s emotional health and safety can be weighty.
In these moments, I find myself stepping back and trying to remember the very thing I often share with those I work with. Hurt and pain is a natural part of life. Our job as a parent is not always to prevent these feelings, but to support our children through them in ways where they know they are loved, safe, cared for, and validated. After all, trauma is not necessarily the event itself, it’s what happens when a “bad thing” happens, and needs are not met. Knowing that, as the song goes, we “can cry if we want to” is a need; therefore, it is our responsibility as parents to make sure this message gets reinforced. Next time your child or someone close to you begins to cry, attempt to keep this in mind before jumping in to make their tears go away. Make clear to them that if they need, they can cry as long as they need, and you will be there with them through their process. Let them know their tears make sense and if the feeling comes up, don’t be afraid to cry with them, too. Ultimately, while we can and should take steps towards preventing the unnecessary shedding of tears, the overall goal is not to keep our children from crying all together, but to make sure they know that the choice to cry is theirs if they need it.
There is currently much going on in my life, not more or less than others, but enough to preoccupy me and distract from this writing. This, along with friends who are struggling, led me to contemplate how I have shown up for and in turn how I have felt supported and nurtured by others. So, I am asking the question what are we really meaning when we say, “I support you, I will be thinking of you, I will be praying for you, I will send good energy your way,” etc.? I have said each of these things at some point to various people and heard them shared with me.
Mostly, when I hear these phrases I appreciate the sentiment, say thank you and we both move on. I must admit, however, there are other times, like now, when I have a longing for something more. As I reflect on what this “more” would include, I concluded: asking how I am doing when you have time to listen – asking if I would like a hug and holding on until the tension leaves and/or the tears come (this may take some time with my wife and male friends) – empathizing while challenging me to consider where growth is waiting for me – and the tangibles of “let’s take a walk,” “I would like to come over and bring dinner,” and at times “maybe we should do something different right now like play a game, go watch a movie,” etc.
My wife has always been good about putting her desire to support others into action. As I am writing this, she is writing notes to people in our lives. Even more profound are we willing to do this with those different from us whether the difference is reflected in homelessness, race, or non-normative sexuality or gender? This is my ongoing desire to work with what I would appreciate from others and take action to show up with the time to engage and ask what they need, with the intention of following through. How valued and inspired each of us would feel if we moved beyond loving intentions to loving actions. To all those who have taken time with me, thank you, I am a more fulfilled person for it.
A Look Inside the PCS Intensive Treatment Program and Why We Do What We Do
Welcome to PCS! This issue was born from the realization we perhaps had never provided an overall glimpse into the PCS Intensive Treatment Program (ITP).
The PCS Individual Intensive Program is an intensive, trauma-focused program that concentrates on the client’s individual needs providing 65 hours of engagement. Clients will participate in a rich mixture of individual and group processing from Saturday at noon to the following Saturday at noon.
The hallmark of our program is ITP clients spend over half their time in individual sessions (i.e. 34 hours) typically with a team of 5 to 6 different therapist each bringing their unique personality, style, and skills to the process. This creates an incredible diversity of experiences in a client’s path toward their goals. Additional meetings with a Dietician, our Medical Director, and Psychiatrist create an enlightening and influential treatment system.
The groups are mixed-gender and incorporate individuals and couples presenting with varies issues. You can read a description of each group personally written by its facilitator. Please note we once again welcome non- intensive clients to these in person groups with a therapist referral.
We endeavor from the beginning to the completion of the program to fully engage with clients as they process through their most challenging issues. As always, we welcome questions and feedback as we continue to improve our program.
Pre-screening
We are not for everyone. There is a prescreening process to determine if a client may be right for our program. This includes collecting detailed information from the potential client and phone conversations with one of our therapists between the potential client and primary therapist. We work as a team at PCS and involvement of the primary therapist and sometimes psychiatrist is key to success. Intensive clients must be working with a therapist at home in order to attend.
A PCS Intensive works for those who are:
Highly motivated and want to jump-start their therapeutic process and utilize a program where sessions build off one another, creating a greater possibility of transformational change.
“Stuck” and desire a safe place to face their fear of what change will mean in their life, fear of the unknown.
Making some progress in weekly or bi-weekly therapy, but not the broader changes they are looking for.
Busy with work and home and find it difficult to keep consistent weekly or bi-weekly appointments and would prefer a shorter, but more intensive span of time to create movement.
Experiencing an intense current crisis and struggle to manage daily living, needing a space to stabilize and strengthen in grounding and coping skills.
Making some gains in recovery, but still experience relapses due to their need to process the deeper causal roots to their problematic or addictive behaviors.
A PCS Intensive does NOT work for those who are:
Signing up because someone else in their life is making them do it, and they otherwise would stay home.
Pointing the finger in defensiveness and blame, struggling to face what makes them difficult to those around them.
Using the intensive as a checklist, and uninterested in making genuine changes.
Resist transparency and are not ready to tell the truth.
Experiencing severe mental illness, including auditory hallucinations, extreme paranoia or delusional thoughts.
Actively suicidal or homicidal.
Continuing to act out or use substances.
Assessment
Intensive clients are provided with a battery of online assessments several weeks prior to beginning their program. Because the client is completing these on their own schedule and before they arrive, it offers more therapy time upon arrival. It is also more comfortable for the client to complete these at home.
We offer assessments specifically designed for each client’s program and treatment plan. All of this information is provided to the client’s primary therapist in a report sent after the client has returned home.
When the client arrives they will also meet with a dietitian to discuss a variety of nutritionally related topics. Physical health and well being is very important to mental health as well.
The sessions with our medical director and psychiatrist generally take place early in the program so that the information can be shared with his or her team. This information is also included in our final report to the referring therapist.
Workshop
The PCS Intensive is a weekly offering built around “The Murray Method,” developed by Marilyn Murray in the early 1980’s. Clients begin the process on a Saturday, with Marilyn’s workshop and explore “The Scindo (Latin for “split”) Syndrome,” looking at how adverse childhood events cause “survivor” parts to develop, who try to cope and manage their powerless and painful circumstances, the Circles of Intimacy, helping to organize a hierarchy of healthy intimate connections, and lastly, the Trauma Egg, a document the client creates that chronicles difficult traumatic life events, so the client can understand patterns in negative internalized messages and coping styles.
The concluding workshop provides an opportunity for each person to review and share insights and their commitment to personal health. Clients state these two “book-end” sessions offer a special opportunity for initiation and closure with their group.
Everything you ever wanted to know about PCS Group Therapy
Emotional Regulation
When we experience trauma, addiction or attachment issues, we often struggle with emotional regulation, tolerance and resiliency. We are taught (and sometimes not) about emotion from our caregivers. How was emotion modeled in your family? Was it over the top? Was it dismissed? Was there room for you to have an emotional experience? Did someone else take up too much emotional space? We are social animals with nervous systems designed to co-regulate with those around us. What did your nervous system “learn” about trust and safety?
“Psychodrama —meaning “psyche in action”—is an experiential group that helps us explore our inner and outer worlds through action vs talking. Through enactment, participants explore issues and concerns in a safe environment with the help of the group. The goal of psychodrama helps participants discover their inner truth, express emotions freely and establish authentic interactions with others.” (paraphrased from Karen Carnabucci’s Practical Psychodrama).
Equine-Assisted Therapy
Our Equine-Assisted Psychotherapy (EAP) group meets offsite for 2 hours. In our fast paced world it can be difficult to slow down and be present. Due to their size, the horses will organically help you to slow down, be mindful, and present. The activities will engage you intellectually, emotionally, socially and physically. The horses become a canvas onto which you project your reality. By becoming aware of both your non-interpretive observation and the story that follows, you become better informed about yourself and how you move through your world. Through this organic process you will begin, or deepen, your journey of self-discovery and awareness. You will be invited to consider new ways of being in, and engaging with, the world.
Communication is at the core of our daily living, and the higher the stakes in terms of relationship, the greater the chance we can inadvertently dance into the “Demon Dialogues”. Whether we are talking about a significant other, close family member or close friend, the tendency can be to either go into a fight response (“Attack-Attack/Find the Bad Guy”), a fight/flight response (“The Protest Polka”) or a freeze response (“Freeze/Flee”). We end up “amygdala-hijacked”, deep into our “reptilian brain”, and find it difficult to get grounded and engage in a “Wise-Minded” exchange.
Using the Awareness Wheel and Listening Cycle, this group assists in helping clients get out the “Demon Dialogue Dance” through the encouragement of vulnerability, assertiveness, curiosity, validation and empathy.
Offense Cycle
This group focuses on the offense cycle (also called an intimacy-blocking cycle) and the clarification process. We all engage in some form of maladaptive behavior that contributes to a lack of intimacy with self and others. This group is designed to help identify our offensive behaviors in order to break the cycle and set the stage for healthy intervention. Participants will be encouraged to recognize what is under the surface and how their behaviors impact others.
Borders and Boundaries
This group is designed to educate, encourage, and empower you to establish and maintain healthy boundaries. It will support you in exploring the ways you treat yourself, they ways you treat others, and the ways you allow others to treat you. Setting boundaries is an important part of establishing our identity, engaging in healthy relationships, and is a crucial aspect of mental health and well being. In setting boundaries, we are prioritizing ourselves and what we need.
Mindfulness
Mindfulness and meditation are vital components within recovery and healing. We are not only our thinking, we are the awareness behind the thinking and experience of our life. Deepening one’s relationship with this awareness and self is vastly improved when engaging in daily mindfulness or meditation. Mindfulness group will address how and why meditation and mindfulness are necessary aspects integrating one’s healing experience.
Compulsivity
Each of us experiences some form of out-of-control behavior, even if it is reflected in our over-control. In this mixed gender group space is created to share your story of addictive, compulsive, and/or out of control behavior. Each participant is encouraged to openly discuss those things hidden from others. The process of directly confronting our secrets often provides opportunity for reducing shame.
Spirituality
This group gives us the opportunity to share diverse experiences of faith and unfaith in an experiential or discussion format that maximizes the integration of spirituality and therapy. It allows everyone to share lifestyle choices, inspirations and values in a welcoming setting to provide strength or renewed strength to all.
Courageous Living
Courageous living is dedicated to increasing your ability to live your life as a healthy adult. This group works on reducing shame and finding the courage it takes to be accepting and loving of ourselves. In so doing, we will also be able to accept and love the important people in our lives and build emotionally intimate relationships.
Anger & Forgiveness
The Anger/Forgiveness group focuses on three inter-related topics; anger, apology and forgiveness. Through videos, discussion, experiential exercises/interactions and group handouts, participants learn more about the important role that anger plays in our lives (protection) and how to manage this powerful emotion.
A mixed gender group focusing less on claiming the label of codependency, but more on recognizing our learned behavior of ignoring or minimizing our own needs to focus on others. Emphasis is placed on affirming self and identifying self-care. The group provides each member an opportunity to check in and provide feedback to one another in an open forum.
Healthy Balance
In this group, we explore more in-depth Marilyn Murray’s model for how we respond to challenging events in our lives, as well as how we can design our lives as a Healthy Balanced Person. As children, we develop different “parts” of ourselves as we learn to adapt to our world. By noticing and nurturing these “parts,” we can help ourselves meet our needs today in healthy ways as mature adults. We also explore unhealthy strategies and ways of coping with our unmet needs that are often destructive, both to others and ourselves. Lastly, this group reviews homework assignments that are due for the Concluding Workshop at the end of the intensive therapy program.
Power of Positivity and Play
The “P3” (the power of positivity and play) group is based on principles of positive psychology including the importance of recognizing and integrating core gifts/strengths and values in to one’s day to day life and relationships. The importance of positivity and play as sources of fulfillment, well-being and overall balance in life are emphasized. Group members engage in interactions in which they share and celebrate “their awesomeness” (successes, traits, talents/skills, etc.).
Relationship Enhancement Group is a psychoeducational group aiming to provide an introduction to attachment theory, the basis for Emotionally Focused Therapy (EFT). With this information, group members should be able to identify their attachment styles and give thought to ways in which their attachment styles work together with their partner’s to create their negative cycle of interaction.
Wrap Up Group
This group offers an experiential activity for Intensive Program participants to express gratitude to their fellow group members and reflect on their own progress. This group also includes a review of financial packets and program information, follow-up sessions, and other pertinent matters. Clients are provided an opportunity to share in depth feedback about their intensive experience.
Follow Up
Each intensive client has a follow up video session scheduled with their case manager (and often their referring therapist) to discuss the client’s continued progress. This session also allows the client to let his therapy team know about any issues since arriving home.
Have you ever wondered about the best path to help a young adult through therapy? Our young adult program is offered twice a year and is specifically designed for single persons age 18-25. Our next young adult week is December 18-23, 2022. This program fills quickly and often has a wait list.
We also offer family intensive programs. Families of 6 or more may attend our intensive program together. The week will be reserved for you and your family members offering individual, couples and group therapy as needed by each family member.
How Instant Gratification Influences the Brain & Deteriorates Recovery
The saying, “good things come to those who wait” has become harder to employ.
Patience was long considered a virtue, but it seems more like an anachronism today.
In today’s world we have access to fast everything—information, food, technology, entertainment, comfort, prescriptions, sex, etc.
Don’t know the spelling of a word? Use Siri or Google it. Feeling hungry but are too tired to cook dinner? Postmates it. Feeling lonely? Launch Tinder and start swiping right. Forgot it is your friend’s birthday tomorrow? Get a gift delivered that day with Amazon.
Instant gratification refers to the experience of satisfaction or receipt of reward as soon as a response is made. Simply stated, instant gratification is the act of receiving a reward and/or pleasure without having to wait.
At the heart of instant gratification is one of the most basic drives inherent in humans—the tendency to see pleasure and avoid pain. Having our desires quickly met is not necessarily a bad thing.
So what’s so bad about instant gratification?
For starters, having an over-reliance on certain instant gratification-fueled impulsive behaviors can create changes in our brains. The repeated exposure to instant gratification disrupts the balance of benefits versus risks in delay of receiving an available reward.
A study at Harvard observed two groups of participants consuming chocolate. Group A indulged in the chocolate while Group B had no access to the chocolate. After the study, both groups were given chocolate and Group B reported higher happiness, savored the taste more, and was in a better mood afterwards. This study shows what people think will make them happy isn’t always what will and that you can have too much of a good thing.
If we experience more pleasure and happiness through delayed gratification, why is it so difficult to choose delayed over instant?
Our brains are constantly changing in response to our actions and behaviors. For instance, if the desire is to lose weight we may impulsively purchase the newest trending diet pill that advertises “Lose 20 pounds in 2 weeks!” rather than going for a walk every morning. Each time this compulsion for instant gratification is acted on, our brain pathways for those actions are reinforced and strengthened, making it easier to fall into the same patterns the next time around and harder to break the cycle.
The start of the cycle may look like having a drink one night after a long day at work to then finding any minor inconvenience the next day in order to justify drinking again the next night.
Getting caught up in the instant gratification cycle can make you susceptible to addictions, jealousy, anger, and impulsive behavior. It also often leads to increased stress, anxiety, and feeling overwhelmed.
As it pertains to instant gratification harming our recovery, research has found that individuals with mental health issues are less likely to wait for things they find pleasurable. For example, if symptoms of depression are present, there is an impact on how the brain processes things – particularly our prefrontal cortex which deals with decision making, problem solving, and memory.
As the struggling person goes straight to self-soothing behaviors to give themselves a quick boost, they may neglect their basic needs as a result, harming their recovery.
Looking at Maslow’s hierarchy of needs, we see how vital meeting our physiological needs (like food, sleep, and shelter) is. These needs sit at the bottom of the pyramid, and if the physiological isn’t addressed first, safety, belonging, esteem, and self-actualization fall by the wayside.
In addition, researchers have found that the ability to delay gratification is not just an important part of goal achievement, it might also have a major impact on long-term life success and overall well-being.
So, next time you notice yourself falling into the compulsion cycle for instant gratification, pause and assess your needs rather than act. Rather than rushing to a psychiatrist to get a prescription for ADHD medication, ask yourself: “Am I getting enough sleep?” Instead of going straight to the fridge to pop open wine after work, ask yourself: “Would going for a walk or taking some deep breaths help me destress?”
Emotions can be interesting… Fleeting yet intense, confusing yet our best teachers. When we are in tune with them they can be helpful, and when we are not we might miss something important or feel out of control. If you know me, I could get an award for compartmentalizing and avoiding emotions and, quite frankly, I’ve prided myself on this. I historically have a habit of treating feelings like something on my to-do list. My thought process is often, “I don’t have time right now to feel that” and I often do not come back to it. I have been challenging myself on this recently and that is partly why I write this to hold myself more accountable. What I have found as the antidote to my compartmentalization and avoidance is the simple concept of slowing down. It’s so important yet our daily lives seem to move so fast around us that it is easy to get caught up and run from what our emotions are trying to tell us. As we slow down and give ourselves the chance to sit with and truly be with our emotions, we can, with time learn to not fear and run from them. Once I slowed down enough recently to recognize it, I learned my anxiety has been begging me to slow down and I have even gotten some relief now that I have listened. Funny how that works, right? While I know this is easier said than done and all our stories are complex and dynamic, I invite you to join me in slowing down today. Maybe we can slow down enough together that we will not miss what our best teachers are trying to tell us.
Epistemic trust is a term with which many may be unfamiliar. It began as a term used in sociology before being adopted into the vernacular of psychologists in more recent years. The most basic definition is “one’s trust in communicated knowledge.” However, it can be more specifically described as “the capacity of the individual to consider the knowledge that is conveyed by others as significant, relevant to the self, and generalizable to other contexts” (Campbell, 2021). This communication can be in many forms, such as spoken words, non-verbal communication cues like body language, or reinforced messages communicated across a lifetime. The development of epistemic trust begins early in life as we interact and learn from those around us and is continually refined throughout our lives to adapt to our social environments.
Most of the psychological research studies on epistemic trust focus on personality disorders, specifically borderline personality disorder (Fonagy et al., 2015). However, more recent studies are considering epistemic trust as it relates to other kinds of psychopathology, and its implications for belief in conspiracy theories has even been considered (Tanzer et al., 2021). Unfortunately, due to the novelty of this concept in psychological studies, there is a shortage of available research to explore this topic further, especially in trauma-related areas. However, the recent development and validation of a questionnaire to measure an individual’s level of epistemic trust, mistrust, and credulity can aid in this area. This questionnaire allows for a closer and more standardized look at individuals’ epistemic trust and can be incorporated easily into future research (Campbell et al., 2021).
Considering epistemic trust and how it pertains to clients can also be useful in the treatment planning process. For example, one study highlighted that individuals diagnosed with personality disorders who had an elevated level of epistemic mistrust had poorer outcomes from their therapy experiences (Knapen et al., 2020). This may be the case for many that enter therapy with complex trauma backgrounds or other conditions that have reinforced a distrust in communication from others. This opinion can be supported by the argument that “epistemic trust may be the final common pathway through which aversive relational experiences in the past result in interpersonal dysfunctioning, which in turn result in dysfunctional therapeutic relationships, rendering it difficult for patients to trust whatever is offered to learn in therapy” (Knapen et al., 2022).
Little research has been done on achieving the restoration of epistemic trust, but it is believed that therapeutic interventions may be the most beneficial (Kamphuis & Finn, 2019). To date, there has been no known study that aims to investigate the relationship between trauma-focused therapy and restoration of epistemic trust. Such a study may prove to be a critical piece to understanding how epistemic trust impacts this population of therapy clients and whether trauma-focused therapy is an effective tool in the restoration of epistemic trust. As this concept continues to gain interest, we can expect a wealth of exciting developments in this area that will ultimately lead to improved therapeutic outcomes for clients everywhere.
References
Campbell, C., Tanzer, M., Saunders, R., Booker, T., Allison, E., Li, E., O’Dowda, C., Luyten, P., & Fonagy, P. (2021). Development and validation of a self-report measure of epistemic trust. PLOS ONE, 16(4), e0250264. https://doi.org/10.1371/journal.pone.0250264
Fonagy, P., Luyten, P., & Allison, E. (2015). Epistemic Petrification and the Restoration of Epistemic Trust: A New Conceptualization of Borderline Personality Disorder and Its Psychosocial Treatment. Journal of Personality Disorders, 29(5), 575–609. https://doi.org/10.1521/pedi.2015.29.5.575
Kamphuis, J. H., & Finn, S. E. (2019). Therapeutic Assessment in Personality Disorders: Toward the Restoration of Epistemic Trust. Journal of Personality Assessment, 101(6), 662–674. https://doi.org/10.1080/00223891.2018.1476360
Knapen, S., Hutsebaut, J., van Diemen, R., & Beekman, A. (2020). Epistemic Trust as a Psycho-marker for Outcome in Psychosocial Interventions. Journal of Infant, Child, and Adolescent Psychotherapy, 19(4), 417–426. https://doi.org/10.1080/15289168.2020.1812322
Knapen, S., van Diemen, R., Hutsebaut, J., Fonagy, P., & Beekman, A. (2022). Defining the Concept and Clinical Features of Epistemic Trust: A Delphi study. Journal of Nervous & Mental Disease, 210(4), 312–314. https://doi.org/10.1097/NMD.0000000000001446
Tanzer, M., Campbell, C., Saunders, R., Luyten, P., Booker, T., & Fonagy, P. (2021). Acquiring knowledge: Epistemic trust in the age of fake news [Preprint]. PsyArXiv. https://doi.org/10.31234/osf.io/g2b6k
I have been at Psychological Counseling Services (PCS) since 2012. One of the most difficult parts of being a therapist is meeting a client in their current crisis and as you join and get to know them better, you realize there is a treasure-trove of historical harms that desperately need attention and may even be exacerbating the issue at hand. In a weekly or bi-weekly therapy model, however, there may be little time to excavate and address the root of the matter.
I’ll give you an example: A client enters therapy for their significant other’s betrayal, and they struggle to find strength and obtain positive traction. Underneath this recent trauma lies the fact they lost a parent in a car accident when they were twelve and maybe they were also severely bullied in high school, or their parents fought constantly and eventually divorced.
It’s not that they cannot heal in weekly therapy, they can; it will just take much longer. Not only because there may be a complex history of trauma, but also because “real life” just has the advantage. We are all familiar with the scientific word “homeostasis”, or as my beloved colleague, Marilyn Murray (PCS Trauma Consultant and author of “The Murray Method”) would say, “the baseline for normal”. It means we have formed a certain muscle memory around how things tend to be, and we become comfortable in that space and often resist change or the unknown. Therefore, it is common for a client to grab important insights within the confines of the one to two hours a week in a therapy office, but then outside the office the pull towards the “old baseline” wins out. They want to make changes but need a space and time to build traction and momentum in a different direction. It is then that intensive therapy becomes an appealing suggestion and opportunity.
The PCS Intensive Program
The PCS Intensive is a weekly offering built around “The Murray Method,” developed by Marilyn Murray in the early 1980’s. Clients begin the process on a Saturday, with Marilyn’s workshop and explore “The Scindo (Latin for “split”) Syndrome,” looking at how adverse childhood events cause “survivor” parts to develop, who try to cope and manage their powerless and painful circumstances, the Circles of Intimacy, helping to organize a hierarchy of healthy intimate connections, and lastly, the Trauma Egg, a document the client creates that chronicles difficult traumatic life events, so the client can understand patterns in negative internalized messages and coping styles.
From there, the client begins the weekly process of over 30 individual therapy hours, which include Family Systems, CBT, DBT, Emotionally-Focused Therapy, Art Therapy, EMDR, and other experiential therapies. Additionally, there are 25 group hours, that includes Equine Therapy, Psychodrama, Anger and Forgiveness, Compulsivity, Codependency, Emotional Regulation, Communication, Mindfulness, Boundaries, Courageous Living, and the Power of Positivity and Play.
The days are roughly 7AM to 7:30PM with a few short breaks in the middle, and the individual work ends Friday at 5PM. The intensive then concludes with a follow-up to Marilyn’s Workshop on Saturday morning (9AM to 12PM).
The groups are mixed-gender and incorporate individual and couple’s clients who are dealing with a broad scope of issues, including substance and process addictions, complex trauma, relational trauma and issues, betrayal, divorce, blended family concerns, grief, career concerns, and severe life crises.
No matter what modality is used, all the therapists speak the same language in terms of helping clients grieve what they needed and deserved, but did not receive. Clients are helped to grow a wise-minded, healthy, balanced Adult Self who can “parent” the parts of self that get activated in grief/sadness, over-functioning or over-caretaking, defensiveness, anger, rebellion, or deception.
A PCS Intensive works for those who are:
Highly motivated and want to jump-start their therapeutic process and utilize a program where sessions build off one another, creating a greater possibility of transformational change.
“Stuck” and desire a safe place to face their fear of what change will mean in their life, fear of the unknown.
Making some progress in weekly or bi-weekly therapy, but not the broader changes they are looking for.
Busy with work and home and find it difficult to keep consistent weekly or bi-weekly appointments and would prefer a shorter, but more intensive span of time to create movement.
Experiencing an intense current crisis and struggle to manage daily living, needing a space to stabilize and strengthen in grounding and coping skills.
Making some gains in recovery, but still experience relapses due to their need to process the deeper causal roots to their problematic or addictive behaviors.
A PCS Intensive does NOT work for those who are:
Signing up because someone else in their life is making them do it, and they otherwise would stay home.
Pointing the finger in defensiveness and blame, struggling to face what makes them difficult to those around them.
Using the intensive as a checklist, and uninterested in making genuine changes.
Resist transparency and are not ready to tell the truth.
Experiencing severe mental illness, including auditory hallucinations, extreme paranoia or delusional thoughts.
Actively suicidal or homicidal.
Continuing to act out or use substances.
The Process
The work I get to do with intensive clients is a unique and fulfilling aspect to my job, because I typically get to help heal deep, difficult life experiences and I get to do that work as part of a therapeutic team. Each intensive has a Case Manager and a team of 4-5 additional therapist who are assigned different areas of focus, such as a genogram, a trauma egg, setting up targets and processing with EMDR (Eye Movement Desensitization and Reprocessing), somatic experiencing, experiential work, addiction and relapse prevention work, relational processing, understanding offensive behaviors and patterns, healthy intimacy, boundary-work, and health and wellness work.
Typically, clients arrive guarded, unsure and at times, overwhelmed. Still, the process begins very quickly by excavating their history and significant life experiences, in order to understand patterns and themes that have impacted their lives. As clients gradually begin to open-up, they start to positively affect each other and instigate change. The bonding begins early with Equine Therapy on Sunday evening and intensifies as they experience their first Psychodrama Group process, where they help a volunteer from the group put a piece of their story in action with the goal of experiencing catharsis and resolution. By Tuesday morning, they typically are ready to share in a meaningful way in their first processing group. The more clients talk about what is uncomfortable to share, the more they inspire others in the group to do the same. The sharing is spiritually powerful and moving, because clients are allowing themselves to be vulnerable and experience real connection; a connection they are encouraged to replicate with the important and healthy people in their lives.
Many clients will express how much they “get it” in an intellectual way. However, what frustrates them is how much they do not feel it. The most satisfying aspect of my job typically happens closer to the end of the week when I witness a client fundamentally shift what was once intellectual, into a “felt” experience; they no longer know they are lovable, deserving, worthy, good-enough, empowered or trust-worthy, they feel it.
At the end of my first week at PCS, I saw a client from the East Coast who completed a 2-week process, smiling, whistling and practically skipping to his car. He jumped in and was headed to the airport – back home, back to his family. I don’t think his journey ended that day, in fact, he was really at the end of the beginning, but it was awesome to see how good he felt!
Please excuse me, I am asking for a moment of your time. This seems presumptuous for someone who has spent most of his adult life “never” having enough time. I know it seems overstated but trust me I never have enough time. It seems a chronic condition – no matter how far ahead, in short order falling behind circles back. Certainly, a tendency to say yes (do not want to disappoint anyone) and an ongoing difficulty to pronounce the word “no” (do not want to hurt another’s feelings) contribute to my ailment. Additionally, there is the ongoing distortion if I get this or that completed the illusive experience of calm and peace are waiting for me.
It seems I may fear peace and calm. Perhaps these fears partly explain working the ridiculous hours I have – maybe I could “buy” more time. Truth be told it has more likely served to shorten my time on this earth. Sure, there are moments of boredom and perhaps even periods of depression where life moves more slowly and yet I always return to the belief I am running out of time. One contribution to this chronic stressor is the belief I can do just one more thing. Of course, this has served to frustrate those around me as I have developed a consistent arriving 5 to 15 minutes late, because there was one more thing I knew I could squeeze in before leaving – “to save the time of doing it later.” This is the dilemma of never having enough time, if you avoid doing it now, you have to make time for it later.
This at times leads to never getting around to something, “there is not enough time,” which provides the wonderful excuse – “I did not have enough time.” There is a certain level of anxiety and stress this game with time creates. Yet it is this very experience of stress which drives me. I live life with intensity, rushing to accomplish, and yet looking as calm as a cucumber (although I have no earthly idea if cucumbers are emotionally calm and cool). I certainly would have written about this chronic condition earlier if I had enough time… As it turns out moving into my 60’s, there is a certain truth to this statement, “at 61 I am running out of time.”
Age has also promoted greater reflection, something you typically do not take time for when you are constantly “short on time.” I believe the truth is there has always been enough time, I just did not believe there was enough time for me (i.e., childhood belief). It must be time then to let go and grieve this relationship I have developed with time and move toward acceptance there has always been enough time. Acceptance in the reality I am not what I accomplish, rather I am an individual deserving of time to slow and just be. I could write more, but…well, you guessed it, I am out of time.
Like many of you, I traveled to work today using the Interstate system, bright and early, my coffee in hand. As I entered onto the I-10, I sighed at the usual sight of bumper-to-bumper traffic. The much-dreaded rush hour greeted us all with open arms, as if it had jokes and all the time in the world. On the radio came the old Bangles song, “Manic Monday” (written by Prince if you did not know).
As I listened to the song, I decided to practice some mindfulness and be aware of my experience as it was happening. After all, I preach mindfulness to my clients. It is important to the process that I practice what I preach. Mindfulness means to be present in the moment, to be aware of feelings and sensations you are experiencing in the moment without judgment. “This is frustration,” I thought as I looked at the hundreds of cars slowly moving before and behind me. “This is what frustration feels like. This is what feeling trapped feels like.” Memories of convoys during military deployments came to mind. “Thinking,” I pointed out to myself. “Now, you are thinking again.” I gently and kindly brought myself back to the present moment. I noticed the tension in my back. My hands feeling the steering wheel, I began to pay attention to the different sounds I was hearing. The Bangles song came alive. The different instruments came to the forefront of my hearing, some playing continuously throughout the song while others made small contributions here and there. Some of the instruments provided the rhythm while others provided the melody. Some were higher notes and others were lower. All of it blended together to make an upbeat song that, if you were around in the 80s, you loved to sing along with as it spoke to the common blues we each often feel saying goodbye to the short weekend and hello Monday work. Some of the instruments caused me to feel happy as I felt the melody lift my spirits. “This is happy,” I thought without judgment. “This is what happiness feels like.” I sang a few lines, feeling my voice vibrate through my vocal cords and just noticing what that felt like.
Then, clarity: You know the moments I am speaking of when something shifts and you see things in a completely different, fuller light, or when you can see random pieces of your experience suddenly become linked in a profound way. In that moment, I realized all of these instruments playing in the song, each so different from one another in their roles, the diversity, it was all of us. The instruments, the song: it contained each of us. Some of us were playing continually, others only now and then, and it was all okay because it created an experience for the listener. Some of us are high notes; others are low. Some of us are the rhythm; others are the melody. However, it is each instrument playing in balance and in sync together that creates a song that can inspire, motivate, entertain, and/or heal. If we could only give one another the space and trust to play their part. If we could only give ourselves the space and trust to play our part. Each of us showing up authentically, adding to the song in our own unique way that can create a remarkable, even spiritual journey for both the players and the listeners. Life can be a struggle, yes. It can also be a really good song.
The road to healing can be long and winding with many obstacles. Sometimes we need a bridge…
It was a warm March afternoon as I stood with a father as we watched his children greet the horses in my arena. After a few months of sessions the boys invited him to attend an equine-assisted psychotherapy session with us. The father commented on how helpful our work had been in helping his children find their voice, develop the ability to pause, set respectful boundaries, and find a safe place to share their pain and fears.
I encouraged him to join his sons in the arena as they said hello to the horses. He replied that he was here because the children had asked him to come and he really did not think we could be of much help to him – therapy had not been helpful to him in the past. He went on to share that he had tried everything the VA could offer him since he returned from Vietnam decades earlier. I nodded and invited him to consider that it might be fun to brush a horse with his boys without any expectations or pressure. I encouraged him to simply “be” with his sons and the horses. He stood his ground at the fence.
I stepped into the arena and our session unfolded. Dad was attentive throughout yet did not step in, despite several invitations from his sons. The session ended, we spoke briefly, he was patient and his voice soft as his boys buckled their seatbelts. I did not expect to see him again. His presence told me that something shifted. His breath was deep and slow and eye contact minimal as he left. The wheels in his mind were clearly turning.
The following week I expected the boy’s mother to bring them to their session. Nope, here was Dad again… and again… and again. The next three weeks he shared various unsolicited feeble excuses about why he was bringing them to session instead of Mom. Each week he stood at the gate. Each week we gently invited him in. Each week he stood his ground and did not enter the arena. Until the fifth session. Our biggest horse, standing 17 hands (68”) stared at him from across the arena. As the father stood at the fence, the large paint draft horse approached him. The horse walked across the arena with intent. Suddenly this big man appeared small as he stood face to face with the big horse who stopped just a few feet in front of him. The boys had created an obstacle course and were leading horses around the arena and through the course. Over and over they navigated the course as children will do. The big paint horse remained as still as a statue as did the big man. The boys finished their activity. I signaled to the equine specialist and pointed to the far gate. The equine specialist guided the boys to get a snack, water, and look for the eggs that our hens elusively hide from us on a daily basis. Dad and horse remained still at the gate.
As the boys left the arena, the father’s posture melted. His 6’4 frame draped over the fence as if for the first time in decades he was allowed to relax his body. He hung there for several minutes. The horse remained still. When he stood and looked at me I saw in his eyes the 18 year old boy who was sent to war. His voice sounded very young as he turned and asked “do you think this one would walk the course with me?” I put a halter on the big horse and they walked the course together over and over, just as his children had. The horse matched the rhythm of the man’s footfall. He then asked me to join him. We walked in silence around and around the arena, outside of the course his boys had built. He began telling me a story about the war. Tears fell as we walked and talked. It was a story off loss, regret, fear, shame, and blame. As he finished telling the story he sighed deeply, as did the horse. We walked again in silence for several ‘rounds of the arena. He then took the halter off of the horse and began picking up the obstacle course. This seemed important and I did not stop him to tell him he did not have to clean up. The horse followed him as he stacked cones, rolled barrels, and piled the poles that his boys had used to create the course. When he finished he looked at me and shared that he had never told a single person that story. He had carried the burden all of these years. “Who knew a horse would lighten the load and help me share it with a person?” He then met his children at the minivan and off they went.
We did not speak of this for a while. We closed our work with his children a few months later. At this closing session he asked to again talk with this horse. After spending a few minutes with his horse he shared with me that although he did not understand what had happened, he was grateful for the space and time that we gave him to lean on the fence and be still. He shared that the obstacle course became the theatre for the story in Vietnam and the horse became his higher power – unwavering, omnipresent, and forgiving. He walked the course over and over trying to find a different way than what had transpired. He eventually determined that he had done the best he could in a horrible situation. He shared the story with the horse and then with me. Neither of us left him or judged him. From here he was able to step into therapy with new eyes and begin to truly heal. This was the first step towards true healing.
That was 12 years ago. The boys are grown, the family moved from Arizona to California, and that big horse has passed. I received an “accidental” text a few months ago from his wife. We reconnected to catch up. She shared that she was not sure of the details of that day but she knows that the walk with that big horse set in motion events that changed their lives. Her husband was finally able to heal from the invisible wounds of war and they came to know each other in a way that she never thought possible.
A few years ago you may have read a blog that I wrote about pressure – horses respond and learn by the release, not the application of pressure – so do we. In this case we provided the safe space, removed all pressure and waited.
The welcome that our troops received when returning from Vietnam was far less than welcoming. If you come across a veteran or service member, no matter how old or young, look them in the eyes and take a moment to thank them for their service. It is the least we can do for the freedom we enjoy.
A few months back, I experienced one of my prouder moments as a therapist/mom when sitting in our living room, my then 6-month-old began to cry. My then 2 ½ year old immediately dropped what she was doing and went over to console him, or so I thought. As if the simple act of rushing to her brother’s aid wasn’t already sweet enough, she put her arms around him and said “it’s okay buddy…you can cry if you want.” My heart swelled.
As I thought about this experience later, what came up for me was a reminder as to what messages are truly important for us to be conveying to our children. As a parents, and people, most would attest to the idea that seeing your child or any child for that matter, cry is a difficult thing to witness. We feel helpless and responsible, sad and anxious, guilty and fearful all at once. Add in my therapist mindset, and I also often find myself wondering whether these moments are traumatic, harmful, helpful, or something entirely different that I have yet to identify. Given the answer may even be all of the above, the overwhelm we feel around supporting our children’s emotional health and safety can be weighty.
In these moments, I find myself stepping back and trying to remember the very thing I often share with those I work with. Hurt and pain is a natural part of life. Our job as a parent is not always to prevent these feelings, but to support our children through them in ways where they know they are loved, safe, cared for, and validated. After all, trauma is not necessarily the event itself, it’s what happens when a “bad thing” happens, and needs are not met. Knowing that, as the song goes, we “can cry if we want to” is a need; therefore, it is our responsibility as parents to make sure this message gets reinforced. Next time your child or someone close to you begins to cry, attempt to keep this in mind before jumping in to make their tears go away. Make clear to them that if they need, they can cry as long as they need, and you will be there with them through their process. Let them know their tears make sense and if the feeling comes up, don’t be afraid to cry with them, too. Ultimately, while we can and should take steps towards preventing the unnecessary shedding of tears, the overall goal is not to keep our children from crying all together, but to make sure they know that the choice to cry is theirs if they need it.
There is currently much going on in my life, not more or less than others, but enough to preoccupy me and distract from this writing. This, along with friends who are struggling, led me to contemplate how I have shown up for and in turn how I have felt supported and nurtured by others. So, I am asking the question what are we really meaning when we say, “I support you, I will be thinking of you, I will be praying for you, I will send good energy your way,” etc.? I have said each of these things at some point to various people and heard them shared with me.
Mostly, when I hear these phrases I appreciate the sentiment, say thank you and we both move on. I must admit, however, there are other times, like now, when I have a longing for something more. As I reflect on what this “more” would include, I concluded: asking how I am doing when you have time to listen – asking if I would like a hug and holding on until the tension leaves and/or the tears come (this may take some time with my wife and male friends) – empathizing while challenging me to consider where growth is waiting for me – and the tangibles of “let’s take a walk,” “I would like to come over and bring dinner,” and at times “maybe we should do something different right now like play a game, go watch a movie,” etc.
My wife has always been good about putting her desire to support others into action. As I am writing this, she is writing notes to people in our lives. Even more profound are we willing to do this with those different from us whether the difference is reflected in homelessness, race, or non-normative sexuality or gender? This is my ongoing desire to work with what I would appreciate from others and take action to show up with the time to engage and ask what they need, with the intention of following through. How valued and inspired each of us would feel if we moved beyond loving intentions to loving actions. To all those who have taken time with me, thank you, I am a more fulfilled person for it.
A Look Inside the PCS Intensive Treatment Program and Why We Do What We Do
Welcome to PCS! This issue was born from the realization we perhaps had never provided an overall glimpse into the PCS Intensive Treatment Program (ITP).
The PCS Individual Intensive Program is an intensive, trauma-focused program that concentrates on the client’s individual needs providing 65 hours of engagement. Clients will participate in a rich mixture of individual and group processing from Saturday at noon to the following Saturday at noon.
The hallmark of our program is ITP clients spend over half their time in individual sessions (i.e. 34 hours) typically with a team of 5 to 6 different therapist each bringing their unique personality, style, and skills to the process. This creates an incredible diversity of experiences in a client’s path toward their goals. Additional meetings with a Dietician, our Medical Director, and Psychiatrist create an enlightening and influential treatment system.
The groups are mixed-gender and incorporate individuals and couples presenting with varies issues. You can read a description of each group personally written by its facilitator. Please note we once again welcome non- intensive clients to these in person groups with a therapist referral.
We endeavor from the beginning to the completion of the program to fully engage with clients as they process through their most challenging issues. As always, we welcome questions and feedback as we continue to improve our program.
Pre-screening
We are not for everyone. There is a prescreening process to determine if a client may be right for our program. This includes collecting detailed information from the potential client and phone conversations with one of our therapists between the potential client and primary therapist. We work as a team at PCS and involvement of the primary therapist and sometimes psychiatrist is key to success. Intensive clients must be working with a therapist at home in order to attend.
A PCS Intensive works for those who are:
Highly motivated and want to jump-start their therapeutic process and utilize a program where sessions build off one another, creating a greater possibility of transformational change.
“Stuck” and desire a safe place to face their fear of what change will mean in their life, fear of the unknown.
Making some progress in weekly or bi-weekly therapy, but not the broader changes they are looking for.
Busy with work and home and find it difficult to keep consistent weekly or bi-weekly appointments and would prefer a shorter, but more intensive span of time to create movement.
Experiencing an intense current crisis and struggle to manage daily living, needing a space to stabilize and strengthen in grounding and coping skills.
Making some gains in recovery, but still experience relapses due to their need to process the deeper causal roots to their problematic or addictive behaviors.
A PCS Intensive does NOT work for those who are:
Signing up because someone else in their life is making them do it, and they otherwise would stay home.
Pointing the finger in defensiveness and blame, struggling to face what makes them difficult to those around them.
Using the intensive as a checklist, and uninterested in making genuine changes.
Resist transparency and are not ready to tell the truth.
Experiencing severe mental illness, including auditory hallucinations, extreme paranoia or delusional thoughts.
Actively suicidal or homicidal.
Continuing to act out or use substances.
Assessment
Intensive clients are provided with a battery of online assessments several weeks prior to beginning their program. Because the client is completing these on their own schedule and before they arrive, it offers more therapy time upon arrival. It is also more comfortable for the client to complete these at home.
We offer assessments specifically designed for each client’s program and treatment plan. All of this information is provided to the client’s primary therapist in a report sent after the client has returned home.
When the client arrives they will also meet with a dietitian to discuss a variety of nutritionally related topics. Physical health and well being is very important to mental health as well.
The sessions with our medical director and psychiatrist generally take place early in the program so that the information can be shared with his or her team. This information is also included in our final report to the referring therapist.
Workshop
The PCS Intensive is a weekly offering built around “The Murray Method,” developed by Marilyn Murray in the early 1980’s. Clients begin the process on a Saturday, with Marilyn’s workshop and explore “The Scindo (Latin for “split”) Syndrome,” looking at how adverse childhood events cause “survivor” parts to develop, who try to cope and manage their powerless and painful circumstances, the Circles of Intimacy, helping to organize a hierarchy of healthy intimate connections, and lastly, the Trauma Egg, a document the client creates that chronicles difficult traumatic life events, so the client can understand patterns in negative internalized messages and coping styles.
The concluding workshop provides an opportunity for each person to review and share insights and their commitment to personal health. Clients state these two “book-end” sessions offer a special opportunity for initiation and closure with their group.
Everything you ever wanted to know about PCS Group Therapy
Emotional Regulation
When we experience trauma, addiction or attachment issues, we often struggle with emotional regulation, tolerance and resiliency. We are taught (and sometimes not) about emotion from our caregivers. How was emotion modeled in your family? Was it over the top? Was it dismissed? Was there room for you to have an emotional experience? Did someone else take up too much emotional space? We are social animals with nervous systems designed to co-regulate with those around us. What did your nervous system “learn” about trust and safety?
“Psychodrama —meaning “psyche in action”—is an experiential group that helps us explore our inner and outer worlds through action vs talking. Through enactment, participants explore issues and concerns in a safe environment with the help of the group. The goal of psychodrama helps participants discover their inner truth, express emotions freely and establish authentic interactions with others.” (paraphrased from Karen Carnabucci’s Practical Psychodrama).
Equine-Assisted Therapy
Our Equine-Assisted Psychotherapy (EAP) group meets offsite for 2 hours. In our fast paced world it can be difficult to slow down and be present. Due to their size, the horses will organically help you to slow down, be mindful, and present. The activities will engage you intellectually, emotionally, socially and physically. The horses become a canvas onto which you project your reality. By becoming aware of both your non-interpretive observation and the story that follows, you become better informed about yourself and how you move through your world. Through this organic process you will begin, or deepen, your journey of self-discovery and awareness. You will be invited to consider new ways of being in, and engaging with, the world.
Communication is at the core of our daily living, and the higher the stakes in terms of relationship, the greater the chance we can inadvertently dance into the “Demon Dialogues”. Whether we are talking about a significant other, close family member or close friend, the tendency can be to either go into a fight response (“Attack-Attack/Find the Bad Guy”), a fight/flight response (“The Protest Polka”) or a freeze response (“Freeze/Flee”). We end up “amygdala-hijacked”, deep into our “reptilian brain”, and find it difficult to get grounded and engage in a “Wise-Minded” exchange.
Using the Awareness Wheel and Listening Cycle, this group assists in helping clients get out the “Demon Dialogue Dance” through the encouragement of vulnerability, assertiveness, curiosity, validation and empathy.
Offense Cycle
This group focuses on the offense cycle (also called an intimacy-blocking cycle) and the clarification process. We all engage in some form of maladaptive behavior that contributes to a lack of intimacy with self and others. This group is designed to help identify our offensive behaviors in order to break the cycle and set the stage for healthy intervention. Participants will be encouraged to recognize what is under the surface and how their behaviors impact others.
Borders and Boundaries
This group is designed to educate, encourage, and empower you to establish and maintain healthy boundaries. It will support you in exploring the ways you treat yourself, they ways you treat others, and the ways you allow others to treat you. Setting boundaries is an important part of establishing our identity, engaging in healthy relationships, and is a crucial aspect of mental health and well being. In setting boundaries, we are prioritizing ourselves and what we need.
Mindfulness
Mindfulness and meditation are vital components within recovery and healing. We are not only our thinking, we are the awareness behind the thinking and experience of our life. Deepening one’s relationship with this awareness and self is vastly improved when engaging in daily mindfulness or meditation. Mindfulness group will address how and why meditation and mindfulness are necessary aspects integrating one’s healing experience.
Compulsivity
Each of us experiences some form of out-of-control behavior, even if it is reflected in our over-control. In this mixed gender group space is created to share your story of addictive, compulsive, and/or out of control behavior. Each participant is encouraged to openly discuss those things hidden from others. The process of directly confronting our secrets often provides opportunity for reducing shame.
Spirituality
This group gives us the opportunity to share diverse experiences of faith and unfaith in an experiential or discussion format that maximizes the integration of spirituality and therapy. It allows everyone to share lifestyle choices, inspirations and values in a welcoming setting to provide strength or renewed strength to all.
Courageous Living
Courageous living is dedicated to increasing your ability to live your life as a healthy adult. This group works on reducing shame and finding the courage it takes to be accepting and loving of ourselves. In so doing, we will also be able to accept and love the important people in our lives and build emotionally intimate relationships.
Anger & Forgiveness
The Anger/Forgiveness group focuses on three inter-related topics; anger, apology and forgiveness. Through videos, discussion, experiential exercises/interactions and group handouts, participants learn more about the important role that anger plays in our lives (protection) and how to manage this powerful emotion.
A mixed gender group focusing less on claiming the label of codependency, but more on recognizing our learned behavior of ignoring or minimizing our own needs to focus on others. Emphasis is placed on affirming self and identifying self-care. The group provides each member an opportunity to check in and provide feedback to one another in an open forum.
Healthy Balance
In this group, we explore more in-depth Marilyn Murray’s model for how we respond to challenging events in our lives, as well as how we can design our lives as a Healthy Balanced Person. As children, we develop different “parts” of ourselves as we learn to adapt to our world. By noticing and nurturing these “parts,” we can help ourselves meet our needs today in healthy ways as mature adults. We also explore unhealthy strategies and ways of coping with our unmet needs that are often destructive, both to others and ourselves. Lastly, this group reviews homework assignments that are due for the Concluding Workshop at the end of the intensive therapy program.
Power of Positivity and Play
The “P3” (the power of positivity and play) group is based on principles of positive psychology including the importance of recognizing and integrating core gifts/strengths and values in to one’s day to day life and relationships. The importance of positivity and play as sources of fulfillment, well-being and overall balance in life are emphasized. Group members engage in interactions in which they share and celebrate “their awesomeness” (successes, traits, talents/skills, etc.).
Relationship Enhancement Group is a psychoeducational group aiming to provide an introduction to attachment theory, the basis for Emotionally Focused Therapy (EFT). With this information, group members should be able to identify their attachment styles and give thought to ways in which their attachment styles work together with their partner’s to create their negative cycle of interaction.
Wrap Up Group
This group offers an experiential activity for Intensive Program participants to express gratitude to their fellow group members and reflect on their own progress. This group also includes a review of financial packets and program information, follow-up sessions, and other pertinent matters. Clients are provided an opportunity to share in depth feedback about their intensive experience.
Follow Up
Each intensive client has a follow up video session scheduled with their case manager (and often their referring therapist) to discuss the client’s continued progress. This session also allows the client to let his therapy team know about any issues since arriving home.
Have you ever wondered about the best path to help a young adult through therapy? Our young adult program is offered twice a year and is specifically designed for single persons age 18-25. Our next young adult week is December 18-23, 2022. This program fills quickly and often has a wait list.
We also offer family intensive programs. Families of 6 or more may attend our intensive program together. The week will be reserved for you and your family members offering individual, couples and group therapy as needed by each family member.
How Instant Gratification Influences the Brain & Deteriorates Recovery
The saying, “good things come to those who wait” has become harder to employ.
Patience was long considered a virtue, but it seems more like an anachronism today.
In today’s world we have access to fast everything—information, food, technology, entertainment, comfort, prescriptions, sex, etc.
Don’t know the spelling of a word? Use Siri or Google it. Feeling hungry but are too tired to cook dinner? Postmates it. Feeling lonely? Launch Tinder and start swiping right. Forgot it is your friend’s birthday tomorrow? Get a gift delivered that day with Amazon.
Instant gratification refers to the experience of satisfaction or receipt of reward as soon as a response is made. Simply stated, instant gratification is the act of receiving a reward and/or pleasure without having to wait.
At the heart of instant gratification is one of the most basic drives inherent in humans—the tendency to see pleasure and avoid pain. Having our desires quickly met is not necessarily a bad thing.
So what’s so bad about instant gratification?
For starters, having an over-reliance on certain instant gratification-fueled impulsive behaviors can create changes in our brains. The repeated exposure to instant gratification disrupts the balance of benefits versus risks in delay of receiving an available reward.
A study at Harvard observed two groups of participants consuming chocolate. Group A indulged in the chocolate while Group B had no access to the chocolate. After the study, both groups were given chocolate and Group B reported higher happiness, savored the taste more, and was in a better mood afterwards. This study shows what people think will make them happy isn’t always what will and that you can have too much of a good thing.
If we experience more pleasure and happiness through delayed gratification, why is it so difficult to choose delayed over instant?
Our brains are constantly changing in response to our actions and behaviors. For instance, if the desire is to lose weight we may impulsively purchase the newest trending diet pill that advertises “Lose 20 pounds in 2 weeks!” rather than going for a walk every morning. Each time this compulsion for instant gratification is acted on, our brain pathways for those actions are reinforced and strengthened, making it easier to fall into the same patterns the next time around and harder to break the cycle.
The start of the cycle may look like having a drink one night after a long day at work to then finding any minor inconvenience the next day in order to justify drinking again the next night.
Getting caught up in the instant gratification cycle can make you susceptible to addictions, jealousy, anger, and impulsive behavior. It also often leads to increased stress, anxiety, and feeling overwhelmed.
As it pertains to instant gratification harming our recovery, research has found that individuals with mental health issues are less likely to wait for things they find pleasurable. For example, if symptoms of depression are present, there is an impact on how the brain processes things – particularly our prefrontal cortex which deals with decision making, problem solving, and memory.
As the struggling person goes straight to self-soothing behaviors to give themselves a quick boost, they may neglect their basic needs as a result, harming their recovery.
Looking at Maslow’s hierarchy of needs, we see how vital meeting our physiological needs (like food, sleep, and shelter) is. These needs sit at the bottom of the pyramid, and if the physiological isn’t addressed first, safety, belonging, esteem, and self-actualization fall by the wayside.
In addition, researchers have found that the ability to delay gratification is not just an important part of goal achievement, it might also have a major impact on long-term life success and overall well-being.
So, next time you notice yourself falling into the compulsion cycle for instant gratification, pause and assess your needs rather than act. Rather than rushing to a psychiatrist to get a prescription for ADHD medication, ask yourself: “Am I getting enough sleep?” Instead of going straight to the fridge to pop open wine after work, ask yourself: “Would going for a walk or taking some deep breaths help me destress?”
Emotions can be interesting… Fleeting yet intense, confusing yet our best teachers. When we are in tune with them they can be helpful, and when we are not we might miss something important or feel out of control. If you know me, I could get an award for compartmentalizing and avoiding emotions and, quite frankly, I’ve prided myself on this. I historically have a habit of treating feelings like something on my to-do list. My thought process is often, “I don’t have time right now to feel that” and I often do not come back to it. I have been challenging myself on this recently and that is partly why I write this to hold myself more accountable. What I have found as the antidote to my compartmentalization and avoidance is the simple concept of slowing down. It’s so important yet our daily lives seem to move so fast around us that it is easy to get caught up and run from what our emotions are trying to tell us. As we slow down and give ourselves the chance to sit with and truly be with our emotions, we can, with time learn to not fear and run from them. Once I slowed down enough recently to recognize it, I learned my anxiety has been begging me to slow down and I have even gotten some relief now that I have listened. Funny how that works, right? While I know this is easier said than done and all our stories are complex and dynamic, I invite you to join me in slowing down today. Maybe we can slow down enough together that we will not miss what our best teachers are trying to tell us.
Epistemic trust is a term with which many may be unfamiliar. It began as a term used in sociology before being adopted into the vernacular of psychologists in more recent years. The most basic definition is “one’s trust in communicated knowledge.” However, it can be more specifically described as “the capacity of the individual to consider the knowledge that is conveyed by others as significant, relevant to the self, and generalizable to other contexts” (Campbell, 2021). This communication can be in many forms, such as spoken words, non-verbal communication cues like body language, or reinforced messages communicated across a lifetime. The development of epistemic trust begins early in life as we interact and learn from those around us and is continually refined throughout our lives to adapt to our social environments.
Most of the psychological research studies on epistemic trust focus on personality disorders, specifically borderline personality disorder (Fonagy et al., 2015). However, more recent studies are considering epistemic trust as it relates to other kinds of psychopathology, and its implications for belief in conspiracy theories has even been considered (Tanzer et al., 2021). Unfortunately, due to the novelty of this concept in psychological studies, there is a shortage of available research to explore this topic further, especially in trauma-related areas. However, the recent development and validation of a questionnaire to measure an individual’s level of epistemic trust, mistrust, and credulity can aid in this area. This questionnaire allows for a closer and more standardized look at individuals’ epistemic trust and can be incorporated easily into future research (Campbell et al., 2021).
Considering epistemic trust and how it pertains to clients can also be useful in the treatment planning process. For example, one study highlighted that individuals diagnosed with personality disorders who had an elevated level of epistemic mistrust had poorer outcomes from their therapy experiences (Knapen et al., 2020). This may be the case for many that enter therapy with complex trauma backgrounds or other conditions that have reinforced a distrust in communication from others. This opinion can be supported by the argument that “epistemic trust may be the final common pathway through which aversive relational experiences in the past result in interpersonal dysfunctioning, which in turn result in dysfunctional therapeutic relationships, rendering it difficult for patients to trust whatever is offered to learn in therapy” (Knapen et al., 2022).
Little research has been done on achieving the restoration of epistemic trust, but it is believed that therapeutic interventions may be the most beneficial (Kamphuis & Finn, 2019). To date, there has been no known study that aims to investigate the relationship between trauma-focused therapy and restoration of epistemic trust. Such a study may prove to be a critical piece to understanding how epistemic trust impacts this population of therapy clients and whether trauma-focused therapy is an effective tool in the restoration of epistemic trust. As this concept continues to gain interest, we can expect a wealth of exciting developments in this area that will ultimately lead to improved therapeutic outcomes for clients everywhere.
References
Campbell, C., Tanzer, M., Saunders, R., Booker, T., Allison, E., Li, E., O’Dowda, C., Luyten, P., & Fonagy, P. (2021). Development and validation of a self-report measure of epistemic trust. PLOS ONE, 16(4), e0250264. https://doi.org/10.1371/journal.pone.0250264
Fonagy, P., Luyten, P., & Allison, E. (2015). Epistemic Petrification and the Restoration of Epistemic Trust: A New Conceptualization of Borderline Personality Disorder and Its Psychosocial Treatment. Journal of Personality Disorders, 29(5), 575–609. https://doi.org/10.1521/pedi.2015.29.5.575
Kamphuis, J. H., & Finn, S. E. (2019). Therapeutic Assessment in Personality Disorders: Toward the Restoration of Epistemic Trust. Journal of Personality Assessment, 101(6), 662–674. https://doi.org/10.1080/00223891.2018.1476360
Knapen, S., Hutsebaut, J., van Diemen, R., & Beekman, A. (2020). Epistemic Trust as a Psycho-marker for Outcome in Psychosocial Interventions. Journal of Infant, Child, and Adolescent Psychotherapy, 19(4), 417–426. https://doi.org/10.1080/15289168.2020.1812322
Knapen, S., van Diemen, R., Hutsebaut, J., Fonagy, P., & Beekman, A. (2022). Defining the Concept and Clinical Features of Epistemic Trust: A Delphi study. Journal of Nervous & Mental Disease, 210(4), 312–314. https://doi.org/10.1097/NMD.0000000000001446
Tanzer, M., Campbell, C., Saunders, R., Luyten, P., Booker, T., & Fonagy, P. (2021). Acquiring knowledge: Epistemic trust in the age of fake news [Preprint]. PsyArXiv. https://doi.org/10.31234/osf.io/g2b6k
I have been at Psychological Counseling Services (PCS) since 2012. One of the most difficult parts of being a therapist is meeting a client in their current crisis and as you join and get to know them better, you realize there is a treasure-trove of historical harms that desperately need attention and may even be exacerbating the issue at hand. In a weekly or bi-weekly therapy model, however, there may be little time to excavate and address the root of the matter.
I’ll give you an example: A client enters therapy for their significant other’s betrayal, and they struggle to find strength and obtain positive traction. Underneath this recent trauma lies the fact they lost a parent in a car accident when they were twelve and maybe they were also severely bullied in high school, or their parents fought constantly and eventually divorced.
It’s not that they cannot heal in weekly therapy, they can; it will just take much longer. Not only because there may be a complex history of trauma, but also because “real life” just has the advantage. We are all familiar with the scientific word “homeostasis”, or as my beloved colleague, Marilyn Murray (PCS Trauma Consultant and author of “The Murray Method”) would say, “the baseline for normal”. It means we have formed a certain muscle memory around how things tend to be, and we become comfortable in that space and often resist change or the unknown. Therefore, it is common for a client to grab important insights within the confines of the one to two hours a week in a therapy office, but then outside the office the pull towards the “old baseline” wins out. They want to make changes but need a space and time to build traction and momentum in a different direction. It is then that intensive therapy becomes an appealing suggestion and opportunity.
The PCS Intensive Program
The PCS Intensive is a weekly offering built around “The Murray Method,” developed by Marilyn Murray in the early 1980’s. Clients begin the process on a Saturday, with Marilyn’s workshop and explore “The Scindo (Latin for “split”) Syndrome,” looking at how adverse childhood events cause “survivor” parts to develop, who try to cope and manage their powerless and painful circumstances, the Circles of Intimacy, helping to organize a hierarchy of healthy intimate connections, and lastly, the Trauma Egg, a document the client creates that chronicles difficult traumatic life events, so the client can understand patterns in negative internalized messages and coping styles.
From there, the client begins the weekly process of over 30 individual therapy hours, which include Family Systems, CBT, DBT, Emotionally-Focused Therapy, Art Therapy, EMDR, and other experiential therapies. Additionally, there are 25 group hours, that includes Equine Therapy, Psychodrama, Anger and Forgiveness, Compulsivity, Codependency, Emotional Regulation, Communication, Mindfulness, Boundaries, Courageous Living, and the Power of Positivity and Play.
The days are roughly 7AM to 7:30PM with a few short breaks in the middle, and the individual work ends Friday at 5PM. The intensive then concludes with a follow-up to Marilyn’s Workshop on Saturday morning (9AM to 12PM).
The groups are mixed-gender and incorporate individual and couple’s clients who are dealing with a broad scope of issues, including substance and process addictions, complex trauma, relational trauma and issues, betrayal, divorce, blended family concerns, grief, career concerns, and severe life crises.
No matter what modality is used, all the therapists speak the same language in terms of helping clients grieve what they needed and deserved, but did not receive. Clients are helped to grow a wise-minded, healthy, balanced Adult Self who can “parent” the parts of self that get activated in grief/sadness, over-functioning or over-caretaking, defensiveness, anger, rebellion, or deception.
A PCS Intensive works for those who are:
Highly motivated and want to jump-start their therapeutic process and utilize a program where sessions build off one another, creating a greater possibility of transformational change.
“Stuck” and desire a safe place to face their fear of what change will mean in their life, fear of the unknown.
Making some progress in weekly or bi-weekly therapy, but not the broader changes they are looking for.
Busy with work and home and find it difficult to keep consistent weekly or bi-weekly appointments and would prefer a shorter, but more intensive span of time to create movement.
Experiencing an intense current crisis and struggle to manage daily living, needing a space to stabilize and strengthen in grounding and coping skills.
Making some gains in recovery, but still experience relapses due to their need to process the deeper causal roots to their problematic or addictive behaviors.
A PCS Intensive does NOT work for those who are:
Signing up because someone else in their life is making them do it, and they otherwise would stay home.
Pointing the finger in defensiveness and blame, struggling to face what makes them difficult to those around them.
Using the intensive as a checklist, and uninterested in making genuine changes.
Resist transparency and are not ready to tell the truth.
Experiencing severe mental illness, including auditory hallucinations, extreme paranoia or delusional thoughts.
Actively suicidal or homicidal.
Continuing to act out or use substances.
The Process
The work I get to do with intensive clients is a unique and fulfilling aspect to my job, because I typically get to help heal deep, difficult life experiences and I get to do that work as part of a therapeutic team. Each intensive has a Case Manager and a team of 4-5 additional therapist who are assigned different areas of focus, such as a genogram, a trauma egg, setting up targets and processing with EMDR (Eye Movement Desensitization and Reprocessing), somatic experiencing, experiential work, addiction and relapse prevention work, relational processing, understanding offensive behaviors and patterns, healthy intimacy, boundary-work, and health and wellness work.
Typically, clients arrive guarded, unsure and at times, overwhelmed. Still, the process begins very quickly by excavating their history and significant life experiences, in order to understand patterns and themes that have impacted their lives. As clients gradually begin to open-up, they start to positively affect each other and instigate change. The bonding begins early with Equine Therapy on Sunday evening and intensifies as they experience their first Psychodrama Group process, where they help a volunteer from the group put a piece of their story in action with the goal of experiencing catharsis and resolution. By Tuesday morning, they typically are ready to share in a meaningful way in their first processing group. The more clients talk about what is uncomfortable to share, the more they inspire others in the group to do the same. The sharing is spiritually powerful and moving, because clients are allowing themselves to be vulnerable and experience real connection; a connection they are encouraged to replicate with the important and healthy people in their lives.
Many clients will express how much they “get it” in an intellectual way. However, what frustrates them is how much they do not feel it. The most satisfying aspect of my job typically happens closer to the end of the week when I witness a client fundamentally shift what was once intellectual, into a “felt” experience; they no longer know they are lovable, deserving, worthy, good-enough, empowered or trust-worthy, they feel it.
At the end of my first week at PCS, I saw a client from the East Coast who completed a 2-week process, smiling, whistling and practically skipping to his car. He jumped in and was headed to the airport – back home, back to his family. I don’t think his journey ended that day, in fact, he was really at the end of the beginning, but it was awesome to see how good he felt!
Please excuse me, I am asking for a moment of your time. This seems presumptuous for someone who has spent most of his adult life “never” having enough time. I know it seems overstated but trust me I never have enough time. It seems a chronic condition – no matter how far ahead, in short order falling behind circles back. Certainly, a tendency to say yes (do not want to disappoint anyone) and an ongoing difficulty to pronounce the word “no” (do not want to hurt another’s feelings) contribute to my ailment. Additionally, there is the ongoing distortion if I get this or that completed the illusive experience of calm and peace are waiting for me.
It seems I may fear peace and calm. Perhaps these fears partly explain working the ridiculous hours I have – maybe I could “buy” more time. Truth be told it has more likely served to shorten my time on this earth. Sure, there are moments of boredom and perhaps even periods of depression where life moves more slowly and yet I always return to the belief I am running out of time. One contribution to this chronic stressor is the belief I can do just one more thing. Of course, this has served to frustrate those around me as I have developed a consistent arriving 5 to 15 minutes late, because there was one more thing I knew I could squeeze in before leaving – “to save the time of doing it later.” This is the dilemma of never having enough time, if you avoid doing it now, you have to make time for it later.
This at times leads to never getting around to something, “there is not enough time,” which provides the wonderful excuse – “I did not have enough time.” There is a certain level of anxiety and stress this game with time creates. Yet it is this very experience of stress which drives me. I live life with intensity, rushing to accomplish, and yet looking as calm as a cucumber (although I have no earthly idea if cucumbers are emotionally calm and cool). I certainly would have written about this chronic condition earlier if I had enough time… As it turns out moving into my 60’s, there is a certain truth to this statement, “at 61 I am running out of time.”
Age has also promoted greater reflection, something you typically do not take time for when you are constantly “short on time.” I believe the truth is there has always been enough time, I just did not believe there was enough time for me (i.e., childhood belief). It must be time then to let go and grieve this relationship I have developed with time and move toward acceptance there has always been enough time. Acceptance in the reality I am not what I accomplish, rather I am an individual deserving of time to slow and just be. I could write more, but…well, you guessed it, I am out of time.
Like many of you, I traveled to work today using the Interstate system, bright and early, my coffee in hand. As I entered onto the I-10, I sighed at the usual sight of bumper-to-bumper traffic. The much-dreaded rush hour greeted us all with open arms, as if it had jokes and all the time in the world. On the radio came the old Bangles song, “Manic Monday” (written by Prince if you did not know).
As I listened to the song, I decided to practice some mindfulness and be aware of my experience as it was happening. After all, I preach mindfulness to my clients. It is important to the process that I practice what I preach. Mindfulness means to be present in the moment, to be aware of feelings and sensations you are experiencing in the moment without judgment. “This is frustration,” I thought as I looked at the hundreds of cars slowly moving before and behind me. “This is what frustration feels like. This is what feeling trapped feels like.” Memories of convoys during military deployments came to mind. “Thinking,” I pointed out to myself. “Now, you are thinking again.” I gently and kindly brought myself back to the present moment. I noticed the tension in my back. My hands feeling the steering wheel, I began to pay attention to the different sounds I was hearing. The Bangles song came alive. The different instruments came to the forefront of my hearing, some playing continuously throughout the song while others made small contributions here and there. Some of the instruments provided the rhythm while others provided the melody. Some were higher notes and others were lower. All of it blended together to make an upbeat song that, if you were around in the 80s, you loved to sing along with as it spoke to the common blues we each often feel saying goodbye to the short weekend and hello Monday work. Some of the instruments caused me to feel happy as I felt the melody lift my spirits. “This is happy,” I thought without judgment. “This is what happiness feels like.” I sang a few lines, feeling my voice vibrate through my vocal cords and just noticing what that felt like.
Then, clarity: You know the moments I am speaking of when something shifts and you see things in a completely different, fuller light, or when you can see random pieces of your experience suddenly become linked in a profound way. In that moment, I realized all of these instruments playing in the song, each so different from one another in their roles, the diversity, it was all of us. The instruments, the song: it contained each of us. Some of us were playing continually, others only now and then, and it was all okay because it created an experience for the listener. Some of us are high notes; others are low. Some of us are the rhythm; others are the melody. However, it is each instrument playing in balance and in sync together that creates a song that can inspire, motivate, entertain, and/or heal. If we could only give one another the space and trust to play their part. If we could only give ourselves the space and trust to play our part. Each of us showing up authentically, adding to the song in our own unique way that can create a remarkable, even spiritual journey for both the players and the listeners. Life can be a struggle, yes. It can also be a really good song.
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info@pcsintensive.com
