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Are you acting as a caregiver to a loved one? Maybe your elderly parent or a spouse or child that is battling a serious illness? According to womenshealth.gov, 36% of Americans provided unpaid care to another adult with an illness or disability in 2012, and that number has almost certainly climbed as the baby boomer […]
Are you acting as a caregiver to a loved one? Maybe your elderly parent or a spouse or child that is battling a serious illness?
According to womenshealth.gov, 36% of Americans provided unpaid care to another adult with an illness or disability in 2012, and that number has almost certainly climbed as the baby boomer population continues to age.
Acting as a caregiver to another is definitely a labor of love, but it can also take a physical, mental and emotional toll on a person. When you focus all of your energy on the needs of other people, it is entirely too easy to put your own needs on the back burner.
Here are some of the most common signs of caregiver burnout:
With so many people relying on caregivers, it’s important that these people learn to take good care of themselves!
Here are some ways you can begin practicing self-care so you don’t experience burnout:
Get More Sleep
The quantity and quality of sleep you get each night will have a huge impact on how you feel physically, mentally and emotionally. Stress can make it hard for us to get good sleep, so don’t make it any harder.
Avoid caffeinated beverages after 2 pm as well as using any digital screens at night. The blue light emitted from these devices messes with our sleep cycle. You may also want to use room-darkening curtains to make your bedroom dark in the morning so you don’t awaken too early.
Get Plenty of Exercise
All of the stress, tension, and balled-up emotions need to go somewhere, or you’re likely to become sick yourself. Exercise is a great way to work all of this… “stuff” out of you. As a bonus, your body releases endorphins after a good workout, and these chemicals give your mood a nice boost.
Eat Right
Your instinct may be to reach for sugary comfort foods but you need to stay healthy and strong. Opt for protein and healthy fats along with some organic produce.
Ask for Help
While everyone around you may refer to you as “superhuman,” the truth is, you’re just human, and you can’t handle everything by yourself ALL of the time. Ask people to help you provide care once or twice a week so that you may have a little bit of time for yourself.
Talk to Someone
If you are dealing with your own depression and anxiety, it’s important that you speak with someone who can offer coping strategies.
If you or someone you know is a caregiver that could use someone to talk to, please feel free to be in touch. I would be more than happy to discuss how I may be able to help.
References:
Cognitive therapy has been shown over the years to be incredibly effective at helping people recognize and change their behaviors. But, as much potential as therapy has for every individual, some people seem to have success with therapy while others don’t. Some of this stems from what the individuals’ expectations were going into therapy, some […]
Cognitive therapy has been shown over the years to be incredibly effective at helping people recognize and change their behaviors. But, as much potential as therapy has for every individual, some people seem to have success with therapy while others don’t.
Some of this stems from what the individuals’ expectations were going into therapy, some from how much effort they gave, and some from whether or not there was a good personality fit between patient and therapist.
If you’re thinking of exploring therapy and want to ensure your journey is successful, here are some things to keep in mind:
The American Psychological Association defines an evidence-based practitioner as someone who integrates their (1) clinical expertise with (2) available/relevant psychological science and (3a) the client’s values and (3b) cultural context to guide the intervention. This means your therapist should be using proven techniques in a way that jive with your values, preferences, and needs. It’s not about them and what they bring to the table, it’s about what they have to offer and how they can offer it so you might be positively impacted.
It’s important to shop around to find the right therapist for you. Ideally, you want someone who you feel comfortable opening up to and someone you trust to listen and offer guidance. You also want to know your therapist is competent and has your best interests at heart. And finally, you’ll want to have open communication so you can always be sure you are on the same page as far as your “story” and how well the interventions are working.
We live in an instant gratification society. We want what we want and we want it NOW. In many instances, we can get what we want quickly. But this isn’t true for real change.
For therapy to be successful, you MUST be realistic about the process. It is not linear, and it is not quick. This is particularly true if you are dealing with complex, long-term problems. This doesn’t mean you can expect to be in therapy for the rest of your life or even many, many years. It simply means you must appreciate the reality of what you can expect and how quickly.
If you are interested in exploring treatment options, please get in touch with me. I’d be happy to discuss how I may be able to help.
No one ever wants to be on the receiving end of romantic betrayal. The emotional pain of discovering that someone you love and trust has been cheating and lying to you can be overwhelming. When you are the victim of massive deception and betrayal, it can leave you feeling sadness, confusion, resentment, and anger. Many […]
No one ever wants to be on the receiving end of romantic betrayal. The emotional pain of discovering that someone you love and trust has been cheating and lying to you can be overwhelming.
When you are the victim of massive deception and betrayal, it can leave you feeling sadness, confusion, resentment, and anger. Many victims also feel an increase in their anxiety and a decrease in their self-esteem. But infidelity doesn’t just affect our emotional health, it also affects our mental health.
In fact, many victims of infidelity experience the same symptoms that are linked to Post-Traumatic Stress Disorder (PTSD), becoming totally disoriented and confused as to what has happened to them.
Some of the classic symptoms of PTSD often experienced by those whose partners have cheated on them are:
If you have been the victim of infidelity, then know that you, like a soldier returning from war, have been psychologically injured and you require tender care to set you on the path back to you.
As devastating as it can be to learn that your significant other has betrayed you in such an intimate way, there is a light at the end of the tunnel. You can pick up the pieces of your life and find joy and comfort once again.
Here are some ways you can begin to heal after infidelity:
Don’t fall into the “I should have known…” trap. This is not your fault. Now is the time to be on your own side.
Your emotions will be overwhelming for a little while. You will feel lost, anxious and panicky. When these feelings start to rise, STOP, take a slow deep breath and let it out. Take another one and another one. It is amazing how deep breathing can completely calm us almost instantly. Your breath will become your new best friend.
Remember, you’re not just healing from infidelity, you are healing from the PTSD that the infidelity caused. You will need some professional guidance to help you cope with the symptoms you are currently experiencing.
If you would like to explore treatment options, please be in touch with me. I would be happy to help you on your journey to becoming whole and happy once again.
Resilience With the pandemic continuing into 2021, stress levels are at an all time high. Most people have been challenged in unimaginable ways. Whether it be isolation and loneliness from sheltering in place, loss of income, or even loss of a loved one due to Covid 19, we ,as a nation, have been pushed to […]
Resilience
With the pandemic continuing into 2021, stress levels are at an all time high. Most people have been challenged in unimaginable ways. Whether it be isolation and loneliness from sheltering in place, loss of income, or even loss of a loved one due to Covid 19, we ,as a nation, have been pushed to the limits.
However in times of stress, one’s resilience comes to the forefront. In focusing on self care and self exploration , it is the rule rather than exception, that struggles, anxiety, grief, and trauma can provide an opportunity for growth. To be clear, this is not to dismiss pain,anguish, and struggle. Rather, we can use these difficulties as a springboard for growth.
What is Resilience?
Resilience is defined as the capacity to respond to pressures and tragedies quickly, adaptively and effectively(Graham,2013). It is our ability to both “go with the flow” and learn from our difficult experience, resulting, in time, a better understanding of self, increased confidence, and functioning. But it begs the question, why are some folks more resilient than others, and can resilience be taught?
The truth is some folks are more resilient than others. Some of this stems from a having a strong support system and a healthy development prior to the difficult event. That being said, even the most resilient person will struggle with traumatic event, like a pandemic. So if even the most resilient struggles, is it possible to learn to be more resilient? The answer is yes.
Neurons that Fire Together, Wire Together
Neuroplasticity is the brain’s ability to form new pathways and grow. Studies on neuroplasticity(Siegel,2007)repeatedly show the brain’s ability to re-wire, grow and change in response to new experiences, both joyful and traumatic. This means that when we are faced with a new challenge, our brains are primed to learn new ways to cope. Similarly, when we try new healthful ways of coping in the face of struggle, our brains are ready to develop new pathways, becoming stronger and more resilient. Further, the window of opportunity for increasing resilience does not have an expiration date. The brain continues to create neural pathways throughout our lives.
Ways to Increase Emotional Resilience
Practice daily self care: good nutrition, sleep, and exercise increases our general sense of well being and provides a sense of stability in the face of negative events.
Journaling: Writing about your struggles allows increased self reflection and emotional attunement. This creates new understandings of our inner voice and increases resilience. Focus on what things are particularly challenging as well as the ways you cope. Thinking about what lessons may be learned, and how you would like to be different, stimulates the brain.
Mindfulness: Become aware and curious about your thoughts and feelings in response to challenge. Focus simply on noticing rather than judging. This is a powerful data collector for our brains, providing new material to link/ wire for growth.
Practice Self-compassion: cut yourself a break when shame/guilt/self deprecating thoughts come up. This practice is a very powerful fuel for resilience.
Psychotherapy: Psychotherapy can be a powerful catalyst for resilience. New insights, coping techniques, and emotional attunement help fuel resilience. In some instances of trauma or enduring depression/anxiety, working with a trained psychotherapist is needed to create new coping skills and insights. Having a mental health professional serve as shepherd, witness, and support while working through intense trauma and emotional strife is a powerful tool for change.
Resilience is a constant and enduring quality that we all can cultivate. Here’s to finding our strongest inner selves.
Be well,
Dr. Marsh
Pamela Warner Marsh, Psy.D., is a licensed clinical psychologist at Marsh Psychology Group. Contact her at 248-860-2024 or pmarsh@marshpsychologygroup.com
Resources and Citations:
https://www.apa.org/topics/resilience
https://www.mayoclinic.org/tests-procedures/resilience-training/in-depth/resilience/art-20046311
Graham, Linda. Bouncing Back: Rewiring Your Brain for Maximum Resilience and Well-Being. New World Library, 2013.
Siegel, Daniel (2007). The Mindful Brain: Reflection and Attunement in the Cultivation of Well-Being (Illustrated ed.). W. W. Norton & Company.
Psychotherapy: what to expect in your first session
What to Expect in Your First Psychotherapy Session
Although seeking help for mental health struggles is becoming more accepted and de-stigmatised, even the most accepting people may wonder what exactly to expect in the first meeting with a therapist. In general, here are 3 things every first psychotherapy session should include:
I hope this helps demystify the first session. Here are some links to further explore starting psychotherapy and different types of treatment :
https://www.npr.org/2019/12/11/787058888/how-to-start-therapy
https://www.apa.org/topics/psychotherapy/approaches
https://www.goodtherapy.org/learn-about-therapy/types
Be well,
Dr. Marsh
Pamela Warner Marsh, Psy.D. is a fully licensed clinical psychologist and Director of Marsh Psychology Group. She can be reached at pmarsh@marshpsychologygroup.com or 248-860-2024
Not many of us will get through life without facing our own share of challenges. But some people experience not just stress and strife, but actual trauma. Trauma may come in the form of a physically or emotionally abusive relationship, a physical accident such as a car accident, rape, the sudden loss of a loved […]
Not many of us will get through life without facing our own share of challenges. But some people experience not just stress and strife, but actual trauma. Trauma may come in the form of a physically or emotionally abusive relationship, a physical accident such as a car accident, rape, the sudden loss of a loved one, or war.
When a person experiences trauma, their entire world changes almost instantly. Many trauma survivors have a hard time feeling safe and secure. They begin to feel anxiety and depression, have trouble sleeping, and may experience other behavioral changes that are frightening to them and their loved ones.
When you have experienced trauma and begin to see some of the symptoms of post-traumatic stress disorder (PTSD), it’s time to explore treatment so you can begin healing. The idea of therapy can feel scary and overwhelming to people with PTSD, mainly because they need to have a sense of total control to feel safe.
But trauma therapy is really something that can empower an individual with PTSD. With the help of a caring and qualified mental health professional, the person can begin to process past events, stripping that traumatic event of its power.
Trauma therapy is a form of cognitive-behavioral therapy (CBT) and has the potential to actually change the way your brain works through what is called neuroplasticity. Neuroplasticity simply means our brains and neural pathways (how we think and feel) are malleable. Through specific mental health tools and strategies, we can retrain our brains to let go of the fear and begin to heal.
Some of the goals of trauma therapy are:
If you or a loved one are living with PTSD, it’s important that you recognize the symptoms and seek help. Life does not have to continue to be scary or overwhelming. There are strategies that can help you process your pain so that you may continue to live your life full of joy and peace.
If you would like to explore treatment options, please get in touch with me. I would be very happy to help you leave the past in the past and move on to brighter tomorrows.
SOURCES:
Not many of us remember our teenage years as walks in the park. That’s because this time in our life is punctuated by uncertainties, social pressure, and a surge of hormones. Because of this perfect storm, many teens act out, which can cause a lot of chaos and disruption in the home and family. Here […]
Not many of us remember our teenage years as walks in the park. That’s because this time in our life is punctuated by uncertainties, social pressure, and a surge of hormones. Because of this perfect storm, many teens act out, which can cause a lot of chaos and disruption in the home and family.
Here are 3 reasons why teens can benefit from therapy:
Most teens have a certain level of self-worth issues growing through this awkward phase. But there are those teens that really suffer from low self-esteem. Therapy can help adolescence build their self-esteem.
Dealing with school, friendships, work, choosing a college… are all major stressors in a young person’s life. And many teens find it hard to speak with their parents. Therapy offers teens a way to communicate and let go of some steam and pressure that is building up.
There should be a rule that no young person should suffer the loss of a close friend or family member. Sadly, many teens do experience loss and the grief that accompanies it. This can be incredibly difficult for the teen and their parents to navigate. A therapist has been trained to know exactly how to guide a young person through the stages of grief.
It’s perfectly normal for teens to feel worried and anxious at times. But some teens experience such severe anxiety, it negatively impacts their life, schoolwork and relationships. Therapy can help teens learn to manage their symptoms.
Unfortunately, many teens learn to cope with the intensity of life by using drugs and alcohol. A therapist can assess a teen’s substance use and determine the best course of action.
These are just some of the benefits teens can gain from working with a therapist. If you or a loved one would like to explore treatment options, please get in touch with me.
SOURCES:
Tips for Parents/Guardians: Dealing with a “Difficult” Teenager Many parents/guardians of a teenage child find this complex period of development confusing, highly stressful, and even exhausting. Due to your teenage child’s significant changes in brain structure, hormonal regulation, and increased exposure to peer influence and media suggestion, this period is often extremely difficult to navigate […]
Tips for Parents/Guardians: Dealing with a “Difficult” Teenager
Many parents/guardians of a teenage child find this complex period of development confusing, highly stressful, and even exhausting. Due to your teenage child’s significant changes in brain structure, hormonal regulation, and increased exposure to peer influence and media suggestion, this period is often extremely difficult to navigate for both the parent(s)/guardian(s) and the teenage child experiencing these changes.
Below are some tips that may assist you in guiding your teenager through this often-difficult developmental period, while minimizing your personal stress in the process:
1. Don’t take it personally. Autonomy-seeking is a normal and necessary part of brain development during adolescence; therefore, resistance to structure and rules is a normal and overwhelmingly common behavior in adolescence. It is also important to remember that your teenage child does not yet have the vocabulary or emotional regulatory skills to appropriately communicate their feelings. For example, a frustrated adolescent may yell, “You’re the worst parent ever!” to simply convey feelings of annoyance or frustration. With this in mind, it can be easier to remain objective and not allow your own negative emotions to control your reaction when addressing problematic behaviors from your teenage child.
2. Be willing to compromise. Many parents/guardians have difficulty with this due to fear of losing control within the parent-child dynamic and/or “giving in” to the child. If you find yourself resisting compromise with your teenager, I invite you to ask yourself this question: “Do I want to be right and spend six hours arguing with an angry 14-year-old, or do I want to compromise and have a calmer and more relaxing evening?” If you choose the latter, brainstorm options either alone or with your partner (if applicable) and present them to your teenage child. This allows your teenage child to exercise autonomy while you as the parent/guardian maintain overall authority within the parent-child dynamic. For example, “You cannot stay out past your curfew on a school night to go to out with friends; so, you can either extend your curfew by half-an-hour this Saturday, or I will pick you up this evening instead of you being driven home by friends so you are home by your curfew.”
3. Validate your teen’s feelings and experiences. “Teenage drama” may seem extremely minor and/or silly to you, but peer-related events that happen during this critical developmental period are extremely important to your teenage child. Your child’s ability to navigate these situations in a healthy way is critical to their psychological development. Validating your teenager’s feelings and providing authentic support and guidance through difficult situations they will face is extremely beneficial to their overall emotional wellbeing.
4. Monitor your own behaviors. Unfortunately, “Do as I say and not as I do” is not an effective strategy at promoting positive behavioral changes. As humans, our primary
learning strategy is through mimicking the behaviors we are most frequently exposed to, and, in most cases, this is through a child’s parent(s)/guardian(s). It is therefore critical for you to examine your own behaviors if they are similar to ones you wish for your child to change. For example, if you swear often but wish for your child to stop this behavior, the most effective strategy is to attempt to control this behavior in front of your child (as opposed to continuing to swear in front of your child but then disciplining the child for mimicking this behavior).
5. Create clear structure and boundaries for your teenage child. Remember that during this period of development, your adolescent’s primary goal is autonomy and separation from their caregivers; therefore, they do not yet have the ability to create structure and boundaries for themselves and they rely on fully emotionally-developed adults to create this for them. Remember that resistance from your adolescent to this is completely normal and expected, and the tips mentioned above can assist you in addressing this resistance and successfully creating structure and household regulations (or enforcing established ones).
6. Be realistic in your expectations. Adolescents do not have a fully-developed brain during this period of development. Until your teenage child reaches their mid-twenties, the part of their brain responsible for time management, impulse control, and appropriate judgment (i.e., the frontal lobe) is not yet fully developed. This is in no way meant to “make excuses” for your teenage child if they are exhibiting problematic behaviors; however, it is important to keep this limitation in mind when you and/or your partner (if applicable) attempt to formulate realistic expectations and household regulations for your adolescent.
7. Check in regularly with your adolescent. This period of development is difficult for parents/guardians because it is extremely difficult for the adolescent experiencing it. Your adolescent is experiencing extremely strong emotions with a highly limited ability to regulate these internally. This can be an extremely intense experience for many adolescents and it is important that you make yourself available to them as a known primary support figure, even if they do not always choose to take you up on it.
If you are finding the above techniques particularly difficult to implement, or your adolescent is experiencing significant emotional distress during this period of development, it may be helpful to seek the services of a mental health professional to assist and support you and/or your teenage child during this process.
-Sierra Shapiro, MS, LPC, is a staff psychotherapist at Marsh Psychology Group. She can be reached at 248-860-2024 or at sshapiro@marshpsychologygroup.com.
Cognitive Distortions, irrational thoughts and how they fuel anxiety, depression and relationship problems.
As we grow up we develop thought patterns, or ways to synthesis information, to make sense of the world. Unfortunately, this can lead to cognitive distortion, or ways we twist information (mental gymnastics) to fit into these preferred ways of thinking. This results can lead to depression, anxiety, and relationship issues.
Common Cognitive Distortions
Cognitive distortions happen automatically – we don’t mean to think inaccurately – but unless we learn to notice them, they can have powerful yet invisible effects upon our moods and our lives. Most of us have used cognitive distortions at one point or another. To avoid negative feelings caused by these thinking errors, it is important that we learn to identify and modify or correct these faulty patterns of thinking.
The term, “cognitive distortions” is used to describe irrational, inflated thoughts or beliefs that distort a person’s perception of reality, usually in a negative way.
Cognitive distortions can take a serious toll on one’s mental health, leading to increased stress, depression, and anxiety
The terms below were conceptualized by Dr. David Burns. Much of his work is based on Dr. Aaron Beck’s research who was the first to reveal the potential impacts of distorted thinking.
Filtering
A person engaging in filter (or “mental filtering) takes the negative details and magnifies
those details while filtering out all positive aspects of a situation. For instance, a person may pick out a single, unpleasant detail and dwell on it exclusively so that their vision of reality becomes darkened or distorted. When a cognitive filter is applied, the person sees only the negative and ignores anything positive.
Polarized Thinking (or “Black and White” Thinking)
In polarized thinking, things are either “black-or-white” — all or nothing. We must be perfect or we are a complete and abject failure — there is no middle ground. A person with polarized thinking places people or situations in “either/or” categories, with no shades of gray or allowing for the complexity of most people and most situations.
Overgeneralization
In this cognitive distortion, a person comes to a general conclusion based on a single incident or a single piece of evidence. If something bad happens just once, they expect it to happen repeatedly.
Catastrophizing
When a person engages in catastrophizing, they expect disaster to strike, no matter what. This is also referred to as magnifying, and can also come out in its opposite behavior, minimizing. In this distortion, a person hears about a problem and uses what if questions (e.g., “What if tragedy strikes?” “What if it happens to me?”) to imagine the absolute worst occurring.
Personalization
Personalization is a distortion where a person believes that everything others do or say is direct, personal reaction to them. They literally take virtually everything personally, even when something is not meant in that way.
Blaming
When a person engages in blaming, they hold other people responsible for their emotional pain. They may also take the opposite track and instead blame themselves for every problem — even those clearly outside their own control.
SHOULD STATEMENTS
Thoughts that include “should,” “ought,” or “must” are almost always related to a cognitive distortion. For example: “I should have arrived at the meeting earlier,” or, “I must lose weight to be more attractive.” This type of thinking may induce feelings of guilt or shame.
Here are some ways to begin challenging cognitive distortions.
1.Identify Our Cognitive Distortion: We need to create a list of our troublesome thoughts and examine them later for matches with a list of cognitive distortions. An examination of our cognitive distortions allows us to see which distortions we prefer. Additionally, this process will allow us to think about our problem or predicament in more natural and realistic ways.
Here are some questions to ask yourself if you think you might be engaging in cognitive distortions.
Am I confusing a thought with a fact?
Am I jumping to conclusions?
Am I assuming my view of things is the only one possible?
What are the advantages and disadvantages of thinking this way?
Am I thinking in all-or-nothing terms?
Am I condemning myself as a total person based on a single event?
Am I concentrating on my weakness and forgetting my strengths?
Am I taking something personally which has little or nothing to do with me?
Am I expecting myself to be perfect?
Am I assuming I can do nothing to change my situation?
If you feel that one or more of the above cognitive distortions are contributing to feelings of anxiety, depression, or other mental health issues, consider finding a qualified therapist you trust who can help transform your negative thoughts and beliefs into empowering, realistic thoughts that inspire and uplift you.
Carol Van Kampen, LMSW
Carol Van Kampen, LMSW is an individual private practice psychotherapist who specializes in anxiety, depression, grief, and trauma treatment at Marsh Psychology Group. Carol is EMDR trained. Contact her at marshpsychologygroup.com
cvankampen@marshpsychologygroup.com
https://marshpsychologygroup.com/carol-van-kampen-lmsw/
What To Do About COVID Fatigue In the early stages of the pandemic, people met up on zoom cocktail hours, took online classes, talked about the bread they were baking. When summer and nicer weather hit, I could barely drive through my neighborhood there were so many people outside walking. As the holidays neared and […]
What To Do About COVID Fatigue
In the early stages of the pandemic, people met up on zoom cocktail hours, took online classes, talked about the bread they were baking. When summer and nicer weather hit, I could barely drive through my neighborhood there were so many people outside walking. As the holidays neared and passed, people were focused on how to spend their first COVID Christmas without extended family. After New Year’s, with colder weather and shorter days, it’s possibly felt more difficult to get through the days.
Getting easily frustrated or irritated with people, feeling like you want to cry, or just feeling numb, along with physical ailments like headaches, stomachaches, difficulty sleeping or concentrating, can be signs of long-term stress, in this case, the stress of COVID fatigue. It’s been nearly 11 months since the pandemic started, along with the various stages of shut downs we’ve been in. We’ve not been able to see family, friends, or even go to stores like we used to. So what can we do right now to combat COVID fatigue?
MOVE – walking outside (even when it’s frigid) can do wonders for your perspective. If you don’t want to be in the cold, put on some music and dance or find a yoga video on YouTube. Moving your body helps improve your mood and can make you feel like you’re in control of something.
GRATITUDE – it may not feel like we have a lot to be grateful for, but even if you can pause over your first cup of coffee in the morning and really be thankful that it’s there, that can help start your day off right. Finding little things throughout your day to be grateful for can help get you out of your funk.
CENSOR – be careful what you’re watching and listening to. If you’re overwhelmed by the pandemic, stay away from the news. Find uplifting movies or podcasts to spend your time on.
CONNECT – it might be hard to consider another way to look at the screen, but joining online groups where you feel supported, or reaching out to family and friends, can remind you that you are not alone.
TALK – if you feel like none of the above helps and you’re not sure what to do, look for a trained mental health specialist that you can talk to. We all need extra support at different times of our lives and many therapists are meeting virtually to accommodate clients.
Although we are all in this pandemic together, it has affected each of us differently. While there seems to be hope for a more normal future, don’t wait to try out ways to help you feel better now.
Julie Lublin, MA, LPC
Julie Lublin is a staff therapist at Marsh Psychology Group. She can be reached at jlublin@marshpsychologygroup.com or 248-860-2024.