borderline
Dr Kate Hudgins
drkatetsi at mac.com
Fri Sep 8 17:41:01 CDT 2006
Ah Adam... you say it all here. You are absolutely right that SSRIs
have been instrumental in decreasing the overarousal associated with
the always turned on amygdala of the severely traumatized people who
of often are called borderline in a very derogatory way. and that
the healing of the therapeutic relationship is crucial.
about the issues of religion and spirituality. Building a
transpersonal strength is core to scene one or stage 1 in TSM
therapy. How we frame that is that this is "something beyond
human". That humans caused the damage in most cases and so you need
to go beyond the human experience. but definition of the DSM
diagnostic criteria, PTSD also is about an abnormal, beyond human
experience. I teach this. And then I suggest many catagories of how
one can go beyond the human dependency which trauma survivors dx with
BPD often, right fully do not trust. Music, nature, poetry, art.
Even dogs or other animals. spiritual practice vs religion.
It is interesting to me as I continue to spend most of my time
working in Asia to learn more about spirituality and religion. The
World Congress on Psychotherapy I just returned from in Malaysia had
a very multicultural, mutiracial, multi religious flavor..with
everyone tolerating and interested in each other. There were many
Muslim women, easily identifed by their head scarves and in the
airport by their burkas. there were Chinese who had long histories
of animism, confucinism, taoism and then no religious beliefs. Some
Christians from the years of being a British colony. Many Catholics
from the Philippines. Yest everyone was respectful of each other.
All TSM groups or sessions start off by people building a Circle of
Safety that consists of personal, interpsonral and transpersonal
strengths. Always someone asks what we mean by transpersonaly and I
provide this broad view. That trauma is most often caused by humans
and there is the need to go beyond the human for full healing and not
just symptom management. People soon embrace the idea and offer many
ways to do that.
Recently, I have asked people in Asia to form small groups and enact
cultural stories, myths and leadership roles that show the values of
their community that go beyond human and have found the learning I
get fascinating. I learn about history. about family systems, about
religious and political leaders. but always we get something beyond
human.
Thanks Adam for all you contribute. Kate
On Sep 6, 2006, at 2:52 PM, Adam Blatner wrote:
> Dear Patti, thanks for your comments.
> My hunch is that Borderline is at times a useful term and
> category, and at times
> may be misleading. First, I think that it is a category that is
> manifested by a complex of
> behaviors, but I'm relatively certain that the syndrome may be
> "caused" by a range of
> elements:
> trauma, acute or chronic
> significant ambivalence in bonding, whether it be from
> neglect or over-enmeshment,
> or mixed, in different roles
> genetic and temperamental hypersensitivity in various ways
> intensified shame-guilt experiences requiring varieties of
> narcissistic dynamics as
> part of syndrome
> various reinforcing experiences (possibly not traumatic,
> but in other ways).
> addiction processes tend to reinforce and also
> express borderline dynamics
> ... and so forth.
>
> For some of these clients, a trial of the new SRI anti-
> depressants can be
> life-changing... and the medicines have no "standard" dose. Some
> folks need less, some
> more, depending on who knows... the right thing is to "titrate" the
> medicine gradually
> upward (over a period of months!) until optimal results with little
> or no side effects.
> Start at low doses, half or a quarter of the standard dose.
> Some folks are pretty
> sensitive. Increase not more often than every week--better, every
> two weeks. Little steps.
> 5, 10, 15, like that. Some people don't feel right or have
> negative side effects at
> modest doses of one type? Taper them off and start them on a
> different type. It might work
> better. Probably should try at least three different kinds before
> giving up, or maybe even
> four, because one just might work fine with no significant side
> effects even if the others
> are more problematical. So there's an art to this, and an
> associated task for many
> therapists is to find a psychiatrist who seems to recognize this art.
> Associated with this is a careful maintenance of the
> relationship with the client
> so that the client is empowered to report back, give feedback,
> refuse to be intimidated.
> The therapist can be a coach and mediator. Finding a doc who will
> respond to calls within
> a few days is good, too, and willing to see more often, or consult
> on the phone a
> little--not for long, drawn-out calls, perhaps, but to adjust the
> meds. Okay, you can
> taper off and we'll try something else; or, Okay, let's go up a
> notch and I'll await how
> it feels.
> These medications should be thought of as somewhat
> elective. It's not as if we
> have to give this antibiotic or the patient will die. Our clients
> have been living with
> these symptoms for years.
>
> Another theme Patti touched on is also addressed in Linehan's
> DBT, and must be dealt
> with gingerly: spirituality and religion. While I don't think these
> domains are in
> themselves curative, they can provide a powerful map of the larger
> process, and also a
> symbol set for grounding. But many patients have really been turned
> off by religion, or
> found themselves in a tight conundrum because of old or rigid dogma
> that many modern
> pastoral counselors would themselves criticize. So negotiating the
> broader philosophy of
> life (with or without spiritual or religious elements) need not
> become an excessively
> intellectualized endeavor, and can be a useful adjunct to the
> overall enterprise.
>
> The other problem with diagnostic categories is that I think
> they are often
> misleading in that they miss other elements. As I describe on my
> webpage about the real
> diagnostic categories, the therapy process proceeds very
> differently depending on degrees
> and types of treatment alliance, psychological mindedness, ego
> strength, and socioeconomic
> resources. Someone "high" in these will offer an entirely different
> clinical course than
> someone "low" in these factors, and indeed the therapy often must
> spend a good deal of
> attention developing these role elements. Sometimes addressing the
> "borderline" pathology
> can hardly proceed until first one develops a grounding of
> strengths-- and we're not
> talking about warming-up in one session, we're talking about months
> or years of work.
> One of my maxims is, "Don't put a client in touch with his
> negative voices until
> you've first put him in touch with his positive voices." Or some
> variation of this.
> Another maxim is "a good diagnosis," and by that I don't
> mean finding the "right"
> label so much as investigating and understanding not only the four
> diagnostic variables
> mentioned, but the actual story, the existential challenges, faced
> by a client. For
> example, not a few of our clients are trapped in a marriage or
> family or job or social
> system that has a significant degree of toxicity. That the client
> may feed into the
> relationship dysfunctions doesn't diminish the actual reinforcing
> stresses. Well,
> enough. For the most part I agree with Patti's reflections on the
> professional dimensions
> of her work. Warmly, Adam
> ----- Original Message -----
> From: "PATRICIA DESERT" <honeybwomn at msn.com>
> To: <list at grouptalkweb.org>
> Sent: Wednesday, September 06, 2006 9:28 AM
> Subject: Re: client or trainee
>
>
>> Dear Ann--this sounds like Marsha Linehan's DBT therapy where each
>> client
>> works with both a primary therapist in individual therapy and w/a
>> "trainer"
>> in a skills training group. No therapy or processing of any kind
>> around
>> issues is done in the group--clients are role trained to take this
>> kind of
>> material back to their therapist. With a few exceptions the group
>> trainer
>> focuses only on behavioral skills related to stress tolerance,
>> emotional
>> regulation, interpersonal relating, etc. and cts thoroughly learn
>> about
>> their diagnosis. And of course clients have to be motivated to do
>> this
>> work. DBT is a wonderful model with lots of room for action
>> methods. I'm
>> looking into seeing if any groups like this exisit in Baltimore.
>> And thanks
>> for the journal info. I'll look it up. Best regards, Patti
>>
>>> From: "Ann Hale" <annehale at swva.net>
>>> Reply-To: list at grouptalkweb.org
>>> To: <list at grouptalkweb.org>
>>> Subject: Re: client or trainee
>>> Date: Mon, 4 Sep 2006 20:15:44 -0400
>>>
>>> Patti, Stephen Sidorsky presented on, and wrote for the Journal an
>>> excellent article on the Psychodramatic Treatment of Borderline
>>> Personality, vol 37, no 3 (Fall, 1984) pp. 117-125. There has
>>> also been
>>> some succcess in treating a group of about six-8 who are entirely
>>> borderline. They spend time in group getting to know their diagnosis
>>> backwards and forwards, and prt of the sessions is identifying
>>> aspects of
>>> it when it is occuring. The therapists (four) work in tandam of
>>> twos, and
>>> the facilitators trade off, in sequence. And, each person sees
>>> their own
>>> therapist. It is an interesting approach. The purpose of the
>>> group is to
>>> dilute dependency on the primary therapist.
>>> ----- Original Message -----
>>> From: PATRICIA DESERT
>>> To: list at grouptalkweb.org
>>> Sent: Monday, September 04, 2006 2:24 PM
>>> Subject: Re: client or trainee
>>>
>>>
>>> Hello Everyone--Adam hit on an area that deeply resonates for
>>> me at this
>>> time--that is, characterological disorders. I am in the midst of
>>> working
>>> with two clients exhibiting classical symptoms of Borderline
>>> Personality
>>> Disorder. It continually manifests in rage at me for not fixing
>>> them, for
>>> caring more for my other clients, for holding to time boundaries of
>>> sessions when they are late, for not giving them 2 hr sessions
>>> whenever
>>> they want them, for long phone message between sessions
>>> criticizing all
>>> that I haven't done, for not remembering exactly what was said
>>> last summer,
>>> last month, last week, etc., etc. These criticisms are relentless.
>>>
>>> I have had 18 years of enormously rewarding work with clients,
>>> mostly
>>> Axis I disorders and some with mild to moderate Axis II. Until
>>> this year,
>>> after working with these two for over a year, I have never felt
>>> this sense
>>> of frustration, anger, or at times inadequacy. And for the first
>>> time in
>>> my 18 years as a therapist I acted out my anger at one client and
>>> told her
>>> with no compassion or empathy that her behavior was both rude and
>>> disrespectful to me and to the other client whose session she
>>> attempted to
>>> interrupt.
>>>
>>> Obviously my stuff got triggered big time and I recognize that
>>> I need
>>> supervision around this and am getting it. However, I'm curious
>>> to hear
>>> from anyone else who has had their own similar responses to these
>>> kinds of
>>> clients and some action methods that were helpful, besides the TSM
>>> Containing Double and mindful breathing, both which are definitely
>>> powerfully helpful at times. Private practice is sometimes a
>>> lonely
>>> place, with little peer connection, and hearing from you all
>>> about your
>>> experiences is helpful. Thanks. Patti
>>>
>>> ----- Original Message -----
>>> From: Adam Blatner
>>> To: list at grouptalkweb.org
>>> Sent: Tuesday, August 29, 2006 2:11 PM
>>> Subject: client or trainee
>>>
>>>
>>> Hello All, Responding to an excellent professional question:
>>> Can a
>>> group member join a training group: And responding further to Bud's
>>> response (attached after this below):
>>>
>>> Bud's attitude is understandable and somewhat compatible with
>>> many
>>> directors and perhaps even Moreno's generous spirit, but it is
>>> also I think
>>> mistaken for the following reasons. Part of this emerged with the
>>> difficulties emerging with the encounter group fad of the 1970s:
>>> There are many people who are clearly mentally ill and
>>> just want
>>> to get better, have no aspirations to being a therapists.
>>> Some people, on the other hand, are vibrantly healthy and
>>> self-sufficient, and while they have some mild issues that need
>>> to be
>>> worked on, they basically have the character to train and be
>>> therapeutic
>>> for others, should they be interested in taking on that task.
>>> A significant number fall between the two, and their
>>> problems
>>> are associated more with their interpersonal style. In the APA's
>>> Diagnostic
>>> and Statistical Manual, the problems they encounter are noted in the
>>> category called personality disorders, also known as "Axis 2"
>>> disorders.
>>> Many people who have depression, anxiety, and other
>>> Axis I
>>> diagnoses are also co-morbid, meaning they have more than one
>>> problem--not
>>> just their anxiety, but also character or personality tendencies
>>> that set
>>> them up for the defeats that then eventuate in depression and/or
>>> anxiety,
>>> or other symptoms. (Another example of co-morbidity is the way
>>> people with
>>> mild PTSD--perhaps not fulfilling all the criteria for full
>>> diagnoses--
>>> and/or addiction problems may also come crashing into more
>>> clearly Axis I
>>> types of symptom clusters.)
>>> The second and most important thing that wasn't much
>>> recognized before the mid-1960s is the pervasiveness of varying
>>> degrees of
>>> Axis II tendencies, which can be mild, moderate, or severe, and
>>> more, the
>>> key here is that these folks don't have primary anxiety--i.e.,
>>> feeling
>>> ego-alien or uncomfortable with their own symptoms; rather they are
>>> ego-syntonic with their life style, whether it be passive-
>>> aggressive,
>>> obsessive-compulsive, hypomanic, hystrionic, borderline,
>>> narcissistic, etc.
>>> What this means is that they become upset when people get tired
>>> of their
>>> behaviors, abandon them, divorce them, fire them from their jobs,
>>> but they
>>> don't see what they did that got people so riled up! Folks with
>>> character
>>> problems tend to deny it, minimize it, and so forth. Now we're
>>> getting
>>> closer to the games people play in wanting to become "therapists."
>>> It doesn't matter if you buy the diagnostic categories
>>> I've
>>> mentioned--they're just tools, and I'm not all that attached to
>>> them in
>>> their specifics. What we're talking about is, in Eric Berne's
>>> Transactional
>>> Analysis language, the "games people play."
>>> I will confess that I have some mild characterological
>>> tendencies, and I haven't met anyone yet who doesn't have a bit,
>>> so we're
>>> talking about how much, and whether a person is really committed to
>>> cleaning up his or her act. Lots of folks don't really get down.
>>>
>>> Perhaps another factor here is whether much significant
>>> therapy
>>> can happen in a group--especially a training group. The problem
>>> is that
>>> there is a dual relationship: On one hand, there is the deal with my
>>> problems goal; on the other hand, there's a bit of do you respect
>>> me as a
>>> therapist, can you? I confess, there are people with patterns of
>>> behavior
>>> that are intense enough, and lack of insight deep enough, and a
>>> kind of
>>> resistance to really looking just thick enough, or lack of mental
>>> agility,
>>> so that while I might find them okay to work with as clients, I
>>> would never
>>> ever consider them capable of actually helping others. We have to
>>> really
>>> get clear about this.
>>> I am afraid that there is a kind of humanistic
>>> egalitarianism--
>>> in California it used to be called "woo woo," that is post-Hippie
>>> "whatever" "it's all good" blind to the actual range of issues in
>>> people.
>>> It would be nice to assume that all can be wonderful, but there is
>>> absolutely no evidence that supports this assumption.
>>>
>>> So back to the problem: I've been in groups, sometimes
>>> with people
>>> who were in counseling programs, and it was clear to me that they
>>> were not
>>> only miles from being ready to help others, or even begin to; but
>>> were
>>> fairly blind to the deficits in their personalities that would be
>>> problematical: Some were painfully inhibited, passive, reticent,
>>> highly
>>> defended; others were "drama queens," seeking emotional catharses
>>> and
>>> tending to dominate and exhaust the group. And so forth.
>>> Experienced group
>>> leaders could make a list of their most trying group members.
>>>
>>> We must also remember that the desire to graduate, to be
>>> seen as
>>> being good as the group leader, to be a trainer, is a common
>>> desire of
>>> people whether or not they have the talent, ability, experience,
>>> maturity,
>>> or other role requirements for the job. To accede to such desires
>>> is only
>>> one step away from letting any teenager do brain surgery without
>>> having to
>>> go to medical school, much less residency.
>>>
>>> So, yes, trainees who have more than the mildest of
>>> problems
>>> should indeed have as their primary therapist someone who is out
>>> of the
>>> stream of their own vocational guidance, someone who can confront
>>> their
>>> manipulations, and someone to whom they don't have to hide those
>>> manipulations. They also need someone outside the group to whom
>>> they can
>>> complain about the group leader. (This observation is a variation
>>> on the
>>> saying, "No man is a hero to his wife's psychotherapist.")
>>>
>>> So it's not the "rules," that are the problem, but
>>> the actual
>>> principles that acknowledge the reality that transferential
>>> problems will
>>> emerge, they are common, and they are made almost impossible to
>>> address if
>>> the group has any other agenda than the commitment to explore the
>>> interactions themselves, with a view to clearing up blocks and
>>> blind spots.
>>> A secondary hope to be appreciated, admired, respected, to prove
>>> competence, to gain final approval for vocational advancement, is a
>>> significant dual relationship. Add the financial element: What is
>>> the group
>>> member paying for, therapy or training? This further muddies the
>>> water.
>>>
>>> Well, sorry, but I want to indicate to the group members
>>> that the
>>> more conservative practitioners aren't just defending their guild
>>> status,
>>> but trying to address actual complexities in dual
>>> relationships. I'm
>>> open to your thoughts. Warmly, Adam Blatner
>>>
>>>
>>> ----- Original Message -----
>>> From: BARNETT WEISS
>>> To: connie at souldrama.com ; list at grouptalkweb.org
>>> Sent: Tuesday, August 29, 2006 11:52 AM
>>> Subject: Re: Question
>>>
>>>
>>> Of course, I am not a TEP so I can only answer from my
>>> perspective
>>> having trained many persons in the past in some of the work in
>>> many venues.
>>> I really don't see what the problem is in welcoming a person
>>> from one of
>>> your groups into a training program. If there is to be a
>>> distinction drawn
>>> about this, I am not at all clear as to why there should be.
>>>
>>> Psychoanalysis to begin with and many other psychotherapeutic
>>> approaches have implicit rules about the relationship of the
>>> therapist to
>>> the client that exclude such conversions and even those are
>>> somewhat murky
>>> decisions. In most of the training programs, you have to go
>>> through the
>>> therapy yourself to be more completely aware of what your clients
>>> are going
>>> to be experiencing when you work. So the trainee has to find
>>> someone else
>>> to do the therapy with them.
>>>
>>> In the training groups that I have lead, I was doing the
>>> therapy for
>>> everyone at first and then working with the more advanced students
>>> co-directing the psychodrama's of other members of the group as
>>> we went
>>> along with greater and greater hands off as they built their
>>> skills and
>>> confidence. I really don't quite see the distinction here. I also
>>> made
>>> myself vulnerable at times and became a protagonist briefly
>>> choosing my
>>> director and working with it.
>>>
>>> I remember a time at Beacon when Zerka asked me to direct
>>> her in her
>>> own psychodrama as she needed to get some clarity about some
>>> things. I was
>>> happy to do so while others in the group were quite fearful and
>>> actually
>>> reacted very intensely when Zerka was working as it brought up a
>>> great deal
>>> for them. While dealing with the group became quite a challenge,
>>> I was
>>> quite confident in working with this protagonist since I knew
>>> that I had
>>> one of the best co-directors ever...Zerka!!
>>>
>>> In fact, I see everyone's psychodrama as being co-directed
>>> by the so
>>> called designated Director and the protagonist themselves. If you
>>> are not
>>> following the direction of the protagonist, in my estimation, you
>>> are
>>> moving in the wrong direction. Words similar to those from Zerka are
>>> emblazoned in my memory.
>>>
>>> So again, I don't get why a client couldn't become a
>>> trainee at any
>>> time.
>>>
>>> Blessings, all, Bud
>>>
>>> Connie Miller <connie at souldrama.com> wrote:
>>> Dear Adam:
>>>
>>> Muddy?? This is a swamp!
>>>
>>> Ultimately it is the decsion of the trainer. My groups
>>> are for
>>> "Training in Aciton Methods" and they also comprise those wanting
>>> psychodrama certification. This in fact stimulates those in
>>> training to
>>> want to get certification later in psychodrama. Otherwise I feel
>>> like we
>>> will never have those certified to do psychodrama increase and
>>> psychodramatists will then become a special and exclusive group
>>> and will
>>> die. Also this is why I agree with you about teaching different
>>> parts of
>>> psychodrama separately to help spread psychodrama. And of course
>>> I would
>>> never allow anyone in the group who was not using the group
>>> methods in
>>> thier own work but only wanted to use the group for therapy.
>>>
>>> I however am studying for the written part of the tep
>>> exam where
>>> it asks under the ethics part,,, what do you do if someone in
>>> your therapy
>>> group wants to join your training group? Technically I guess the
>>> right
>>> anser is not allowing duel relationships but is this what the all
>>> the
>>> traianers are actually doing?? Right now, I have only met one.
>>> this is why
>>> I am looking for group feedback.
>>>
>>> Thanks Connie
>>>
>>>
>>> -----Original Message-----
>>> From: Adam Blatner [mailto:adam at blatner.com]
>>> Sent: Monday, August 28, 2006 08:39 AM
>>> To: list at grouptalkweb.org
>>> Subject: Re: Question
>>>
>>>
>>> Dear Peter, Connie, and group.
>>> Peter, your open-hearted attitude is commendable,
>>> but I
>>> wonder if you have considered the potential for less-than-worthy
>>> motivations. There are people who want the status of
>>> professionalism, but
>>> are yet unwilling to take on the full responsibility for self-
>>> management
>>> that this implies. What I'm referring to is the role of "patient" or
>>> "client," in which the therapist has a more non-judgmental
>>> attitude of
>>> "I'll try to help you at the level that you are functioning."
>>> Some of these
>>> levels can be quite immature, entitled, un-self-modulated,
>>> dependent,
>>> passive-aggressive, and so forth. Many people are not willing to
>>> live up to
>>> the simplest requirements of being responsible enough to pay
>>> regularly and
>>> in good faith, to show up regularly and on time, of refusing to
>>> be civil
>>> under the excuse of victimhood or the right to emotional
>>> expressiveness,
>>> and so forth.
>>> To move to a training group is a kind of
>>> graduation into a
>>> recognition by peers and group leader that one has moved into a full
>>> process of taking charge of one's life. Not all issues are
>>> resolved--I
>>> quite agree with Peter about this-- but there has been a
>>> graduation of
>>> sorts that is the equivalent of finishing therapy in the sick or
>>> dysfunctional role.
>>>
>>> The problem is tricky, and it is a dual role--
>>> clients wish
>>> for unconditional regard, but this term is misleading. It
>>> confuses the
>>> archetypal maternal unconditionality--I'll draw you forth however
>>> you may
>>> be, age 1, age 3, age 8, age 80...
>>> and the archetypal paternal conditionality: You
>>> are
>>> recognized as being qualified to swim, do brain surgery, take 2nd
>>> level
>>> geometry, only when you have clearly demonstrated your mastery of
>>> the first
>>> level or other realistic requirements.
>>>
>>> Alas, the actual requirements for training as a
>>> counselor have
>>> become hopelessly muddy, and it is quite possible to be excessively
>>> immature and still get into a training program somewhere, and even
>>> graduate. This is because there are significant financial
>>> incentives to
>>> accept all comers, to keep people in rather than wash them out,
>>> to blur and
>>> overlook deficiencies. Arguments that the number of training
>>> programs and
>>> trainers should be limited evokes counter-accusations of being
>>> elitist and
>>> guild-like. Arguments that call on the belief in the innate
>>> goodness of
>>> people confuse the reality of people being a nexus of hundreds of
>>> roles and
>>> role components, some of which are more talented, and the ways
>>> strengths
>>> often compensate for, and not infrequently disguise weaknesses. So
>>> significant discrimination is needed.
>>>
>>> In some universities, this graduation - acceptance
>>> into a
>>> graduate school - problem of transference, dependence, and
>>> approval is
>>> circumvented by a general policy that there be a period in which
>>> graduates
>>> must travel elsewhere and perform for supervisors who have not
>>> been in the
>>> nurturing role, the object of parental transference. Perhaps
>>> later, having
>>> demonstrated clear competence and maturity, they may be re-
>>> considered for a
>>> position in the upper graduate or even lower faculty level. It's an
>>> interesting challenge--perhaps one that requires a hard look at
>>> the limits
>>> of good feeling, tele, etc.
>>>
>>> I hope I haven't muddied the issues too much.
>>> Warmly, Adam
>>> ----- Original Message -----
>>> From: Peter Howie
>>> To: connie at souldrama.com ; list at grouptalkweb.org
>>> Sent: Sunday, August 27, 2006 10:49 PM
>>> Subject: Re: Question
>>>
>>>
>>> Hi Connie,
>>>
>>> It is often a natural step. The psychodrama groups are
>>> developmental. The training is developmental. Not all work can be
>>> done in a
>>> training groups and hence experiential groups are required as
>>> well for
>>> trainees. Not all development can be done in experiential groups
>>> and hence
>>> training is available. What does the training do? It expands a
>>> persons
>>> functioning, their capacity for warming themselves in a spontaneous
>>> fashion, their capacity to role reverse with others and creates
>>> mental
>>> models for the process of doing so. While I run the groups
>>> differently the
>>> larger purpose is the same - a more spontaneous world.
>>>
>>> Cheers
>>>
>>> Peter Howie
>>> Brisbane, Australia
>>>
>>>
>>>
>>>
>>> At 12:19 PM 24/08/2006, you wrote:
>>>
>>> I was wondering what other trainers do when a group
>>> member
>>> wants to join the psychodrama training group. what are your
>>> feelings on
>>> them being in both?
>>> Connie
>>> Grouptalk mailing list
>>> List at grouptalkweb.org
>>> http://grouptalkweb.org/mailman/listinfo/list_grouptalkweb.org
>>>
>>>
>>>
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Kate Hudgins, Ph.D., TEP
Clinical Psychologist
Director of Training
Therapeutic Spiral International, LLC
ww.therapeuticspiral.org
drkatetsi at mac.com
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