volume 1, Article number: 5 (2011) Allies for Hope will provide children with an understanding and outlet with how to cope with their parents being incarcerated. Moderation tests indicated greater effect sizes for studies involving brief interventions, conducted in laboratory settings, and administered to students or individuals recruited from the community. Open Access This article is distributed under the terms of the Creative Commons Attribution 2.0 International License (https://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. New York: Routledge; 2009:37–50. 10.1080/17439760902992381. Examples of Expressive Therapy Techniques. Pedrotti J, Edwards L, Lopez S: Promoting hope: Suggestions for school counselors. Such malleability has been used to validate both the Snyder Hope Scale (Snyder et al., 1991; Snyder et al., 1996) and Herth Hope Index Herth 2000; 2001, and to demonstrate the value of hope as a social psychological construct related to optimal functioning. 10.1177/1078345809356526. Furthermore, Lopez and colleagues (2009) describe how these strategies might be implemented in public schools "for enhancing hope in all children" (p. 42). Two of the main important techniques of Cognitive Behavioural Therapy are self-monitoring and modification of cognitive distortion, which are both used in Hope Therapy. Snyder CR, Hoza B, Pelham WE, Rapoff M, Ware L, Danovsky M, et al. Hope therapy isnât just about the âpower of positive thinking.â Instead it is based somewhat on the cognitive behavioral model of therapy which works to replace old or negative âhot thoughtsâ or core beliefs with new ones that are more truthful and positive. The Hope Intervention Program (Herth, 2001) draws heavily on Herth's model to improve the coping strategies and quality of life of individuals with cancer and other serious illnesses. Google Scholar, Freud S: Psychical (or mental) treatment. In C. R. Snyder (Ed. McDermott D, Snyder CR: Making hope happen. Although these interventions are based on thoughtful and well-researched models of hope, and they have become popular in recent years, their effectiveness has not been adequately examined (Kirschman, Johnson, Bender, & Roberts, 2009). Second, the therapist helps the client identify meaningful goals. Hope enhancement strategies have also been suggested in related disciplines, such as counseling (Larsen & Stege, 2010), marriage and family therapy (Ripley & Worthington, 2002), health psychology (Hollis, Massey, & Jevne, 2007), and nursing (Herth, 2001; Turner & Stokes, 2006). In Happiness, healing, enhancement: Your casebook collection for applying positive psychology in therapy. Hoboken, NJ: Wiley; 2010:76–87. Cookies policy. In contrast, the mean effect size for life satisfaction was significant, z(9) = 2.42, p = .016, d = .16, although the 95% confidence interval fell entirely within the "small" range according to Lipsey and Wilson's (2001) criteria. Vlach AC: Effects of expressive writing exercises on measures of hope in an outpatient clinical population (Dissertation). Vernig PM: From science to practice: Bridging the gap with translational research. For example, to cope with her illness, a woman with cancer might reduce her hours at work, seek assistance with household chores, and ask a friend for help with childcare. Lambert MJ, Ogles BM: The efficacy and effectiveness of psychotherapy. New York: Wiley; 2004:388–404. (UMI No. If hope is a byproduct, rather than a determinant, of goal attainment, it might be increased though traditional psychotherapies and newer positive psychological interventions already available to clinicians and researchers at this time. Correspondence to Google Scholar. ( Log Out / 10.1007/s11205-005-5553-0, Cheavens JS, Feldman DB, Woodward JT, Snyder CR: Hope in cognitive psychotherapies: On working with client strengths. 10.1016/S0962-1849(00)80003-7. Given the fact that hope is associated with a wide range of psychosocial and physical benefits (Snyder et al., 2011), and appears to be an important component of therapeutic change (Snyder & Lopez, 2009) and coping with adversity (Linley & Joseph, 2004), it is disappointing that strategies designed to target and systematically increase hope yield such small overall effects. Edited by: Gilman R, Huebner ES, Furlong MJ. Second, interventions lasting only one session yielded significantly larger effect sizes (d = .40) than interventions conducted over multiple sessions (d = .19). With that renewed sense of hope, you can face lifeâs challenges with clarity and conviction. Mazzucchelli TG, Kane RT, Rees CS: Behavioral activation interventions for well-being: A meta-analysis. 10.1177/073428299801600202. Edited by: Lopez SJ, Snyder CR. Other positive psychological interventions can be especially useful in increasing well-being and positive affect. American Journal of Psychiatry 1959, 109: 481–491. It is our philosophy to deliver quality care by a licensed Physical Therapist in a supportive environment. The studies included in the analysis used a variety of measures to assess the outcomes of the hope enhancement strategies. Experimental studies were defined by the practice of randomly assigning participants to a hope-enhancement condition or to a comparison group that did not receive a hope-enhancing intervention. On the other hand, our confidence intervals for hope, distress, and satisfaction all fell within the "small" to "non-significant" range, providing very limited evidence for the ability of these strategies to produce desired outcomes. Each study was independently coded by the first and second authors. Edited by: Snyder CR, Lopez SJ. Journal of Psychology in Africa 2008, 18: 301–310. Snyder CR, Parenteau SC, Shorey HS, Kahle KE, Berg C: Hope as the underlying process in the psychotherapeutic change process. None of the other potential moderators were associated with hope outcomes. Whereas theorists (Herth, 2000; Snyder et al., 2000) have speculated that increased hopefulness produces beneficial outcomes, it is also possible that academic and athletic achievement, physical and emotional competence, and social support and satisfaction breed hopeful cognitions and positive emotions. Pathways thinking refers to people's perceived ability to generate plausible routes toward goals and is evident in self-statements such as "I can find a way to get this done." 10.1097/00002820-199808000-00003, Schrank B, Stanghellini G, Slade M: Hope in psychiatry: A review of the literature. 10.1177/0013164409355701, Article Curry LA, Snyder CR: Hope takes the field: Mind matters in athletic performance. Snyder CR, Lopez SJ, Pedrotti JT: Positive psychology: The scientific and practical exploration of human strengths. Edited by: Donaldson SI, Csikzentmihalyi M, Nakamura J. 10.1016/j.jpainsymman.2006.09.013. At first blush, this finding seems counterintuitive; we would likely expect longer interventions to yield more marked results. Furthermore, other positive psychological interventions are associated with moderate to large increases in well-being (mean d = .61; Sin & Lyubomirsky, 2009). Snyder CR: Handbook of hope. The fact that hope enhancement strategies are only weakly associated with increased hopefulness calls into question the mechanism by which these strategies are believed to improve participants' functioning or increase their satisfaction with life. Our investigation is also limited by the heterogeneity of studies that we included in our analysis. Hope Therapy is a nonprofit organization which operates exclusively on individual and corporate donations, grants, fundraising events and rider fees. Sin NL, Della Porta MD, Lyubomirsky S: Tailoring positive psychology interventions to treat depressed individuals. RW designed the study, reviewed papers for inclusion in the meta-analysis, and performed the effect size calculations and moderation tests. San Diego, CA: Academic Press; 2000:89–107. This finding is important, because it suggests publication bias. Check out this list provided by Rising Hope Counseling of Tools & Techniques for Couples. Hope depends on two cognitions in particular: agency thinking and pathways thinking. Part of Hope Therapy is borne from pure positive psychology. With respect to self-monitoring, mothers could be more aware about their thoughts and behaviours by the feedbacks they receive from their therapist and other group members. 10.1111/j.1600-0447.2008.01271.x. Finally, considerable time is spent fostering a sense of community within the group, encouraging participants to draw upon others for support outside the group, and helping participants find meaning in their illness or loss. The last two decades have seen marked developments in our understanding of hope. Pathways cognitions can be increased by breaking goals into more manageable parts, anticipating obstacles, and planning alternative routes in case of setbacks. 3370467), Cheavens JS, Feldman DB, Gum A, Michael ST, Snyder CR: Hope therapy in a community sample: A pilot investigation. Frank JD: Therapeutic factors in psychotherapy. 10.1177/014662167700100306. California Privacy Statement, Edited by: Snyder CR, Lopez SJ. Journal of Counseling and Development 2002, 80: 452–463. : The relationships between hope and outcomes at pretreatment, beginning, and later phases of psychotherapy. As can be seen from Table 2, the mean effect size for hope was .22, suggesting that hope enhancement strategies are associated with significant increases in self-reported hopefulness among participants, z(25) = 8.87, p < .001. Oncology Nursing Forum 2001, 28: 1009–1017. Hope Harbor Therapies offers a variety of Out-Patient Therapies such as Occupational Therapy, and Speech & Language Therapy. Finally, we located studies through published review articles and references in previously-identified manuscripts. Kirschman KJB, Roberts MC, Shadlow JO, Pelley TJ: An evaluation of hope following a summer camp for inner-city youth. : Strategies for accentuating hope. In Applied positive psychology: Improving everyday life, health, schools, work, and society. Herth KA: Enhancing hope in people with a first recurrence of cancer. Most of the studies that were excluded from our analysis were theoretical in nature and did not involve the empirical investigation of hope. In Optimism and pessimism: Implications for theory, research, and practice. 9729080) (UMI No. Change ), You are commenting using your Google account. In order to keep fees affordable for our riders and their families, we do have limited scholarship help available for those who need assistance. They are as follows: Instillation of Hope - creates a feeling of optimism about one's future and the ability to cure that which need not be endured and endure that which cannot be cured. Disagreements were resolved through review of each study and discussion. Similarly, cognitive interventions may be particularly useful in helping clients recognize and challenge negative thoughts that rob them of their motivation to work toward their goals. Like Snyder, Herth views hope as "a motivational and cognitive attribute that is theoretically necessary to initiate and sustain action toward goal attainment" (Arnau, Martinez, Guzman, Herth, & Konishi, 2010, p. 808). Indeed, several randomized controlled studies have demonstrated the efficacy of strategies to systematically increase other positive psychological constructs such as gratitude, optimism, forgiveness, and mindfulness in order to increase happiness (Sin, Della Porta, & Lyubomirsky, 2011). Middletown, CT: Wesleyan University Press; 1989. 10.1111/1467-9280.00157, Trump MRM: The impact of hopeful narratives on state hope, self-esteem., and state positive and negative affect on adult female survivors of incest (Dissertation). Snyder conceptualized hope as a cognitive construct which reflects people's motivation and capacity to strive toward personally-relevant goals (Snyder, 1994; Snyder, Rand, & Sigmon, 2002). Change ), You are commenting using your Facebook account. With using Forgiveness Therapy, the employees of Allies for Hope will use games and icebreakers to help parents and children cope with the changes that have restricted them from having a positive relationship (Lander, 2011). Similarly, Herth's (2000) conceptualization of hopefulness has greatly influenced the practice of health psychology, nursing, and medicine. New York: Oxford University Press; 2009:323–333. Forgiveness Therapy, Sand Therapy, and Art Therapy will be the main techniques that are used to help the children and parents re-establish their bonds. Collectively, these differences call into question the utility of hope enhancement strategies in applied settings with clinic-referred or at-risk populations. Hope is a belief in a positive outcome related to events and circumstances in one's life. We suspected that intervention outcomes might vary as a function of age, perhaps because of differences in cognitive and socioemotional maturity across development. Most studies (k = 17) included participants recruited from psychiatric clinics, hospitals, or other at-risk settings (e.g., youths in residential treatment, support groups for survivors of incest). In Handbook of positive psychology. Individual Therapy is an active, collaborative process between you and your therapist through open, honest conversations.Of course, this takes time and trust, so you set the pace. For example, the principles of behavioral activation and motivational interviewing might be effectively used to help clients set clear, objective, and meaningful goals that can serve as the targets for treatment. However, closer inspection shows that most (71%) interventions that lasted only one session were conducted in research settings whereas most (95%) interventions conducted over multiple sessions were conducted in applied settings. 10.1093/jpepsy/22.3.399. The last two decades have witnessed the development of a theoretical model of hope which has greatly influenced researchers in the field of positive psychology. Hillsdale, NJ: Erlbaum; 1988. Springer Nature. 3259424) (UMI No. The therapist might teach clients to identify low-hope elements of these narratives and replace them with positive, hopeful thoughts. Boulder, CO: Westview Press; 1997. For example, Nel (2010) describes how clinicians might use narrative approaches to instill hope in clinic-referred youths Snyder, McDermott, and colleagues (1997). Magyar-Moe J: Therapist's guide to positive psychological interventions. Washington, DC: American Psychological Association; 2001:101–125. 123â150). However, our results call into question the effectiveness of hope enhancement strategies in applied settings. International Gestalt Journal 2002, 25: 11–29. Many of the remaining, empirical studies excluded from our analysis examined correlations between hope and other psychosocial variables (e.g., depression, optimism, self-efficacy) and did not involve the manipulation of participants' hopefulness. Available from ProQuest Dissertations and Theses database 2007. The hope theories developed by Snyder (2000) and Herth (2001) have offered us a useful way of conceptualizing hope as a cognitive construct related to a wide range of social, emotional, and physical benefits. In this study, we used meta-analysis to obtain an initial quantitative estimate of the effectiveness of hope enhancement strategies in increasing hope, reducing distress, and improving the quality of life for clinic-referred and community-based individuals. I have over 25 years of diverse clinical and supervisory experience, especially with clients diagnosed with autism. Proudly created with Wix.com We take a holistic approach in exploring symptoms, problems, and strengths as they apply to home, family, work/school, and social life. Article Two characteristics concerned each study's design. We are delighted to offer most of our therapies at the individualâs place of residence or other natural environments. These interventions have several components in common. Our meta-analysis is limited by the relatively small number of studies that have empirically investigated the efficacy or effectiveness of hope enhancement strategies. Unpublished master's thesis, University of Kansas, Lawrence, KS; 2001. Furthermore, problem-solving and skills training can help individuals marshal social support to cope with stress and adversity. Psychology of Music 2011, 39: 3–17. Rather, it appears that individuals experiencing greater risk, and likely less hope, may not be able to take advantage of these hope enhancement strategies compared to their higher-functioning counterparts in college or the community. Tellegen A, Watson D, Clark LA: On the dimensional and hierarchical structure of affect. This "affiliative-contextual" dimension refers to people's perceived social support, spiritual support, and sense of belongingness. Huebner ES, Laughlin JE, Ash C, Gilman R: Further validation of the Multidimensional Students' Life Satisfaction Scale. New York: Routledge; 2011:79–96. 1One hope intervention study (Ripley & Worthington, 2002) did not report a hope outcome measure; consequently, k = 26 for our analysis of hope outcomes. Weis, R., Speridakos, E.C. Available from ProQuest Dissertations and Theses database 1997. Analysis of 27 studies involving 2, 154 participants showed significant, but small, effect sizes for hopefulness and life satisfaction and no overall relationship between hope enhancement strategies and decreased psychological distress. Cheavens and colleagues offer specific ways therapists might increase hopeful thoughts in their clients within the context of cognitive therapy (Cheavens, Feldman et al., 2006) and describe how clinicians might use various hope enhancement strategies to treat patients with Major Depressive Disorder (Cheavens & Gum, 2010). Psychological Bulletin 1979, 86: 638–641. In all cases, positive d statistics indicate superior functioning in the intervention group compared to the control group or superior functioning posttreatment compared to pretreatment (e.g., higher hope and life satisfaction, or lower psychological distress associated with the intervention). Acta Psychiatrica Scandinavica 2008, 118: 421–433. Rather than using hope therapy as a first-line treatment, clinicians may wish to use hope theory as a model from which to select evidence-based treatments and to guide their interventions. In comparison, a recent-meta-analysis showed that more traditional, behaviorally-based psychosocial interventions are associated with much larger increases in life satisfaction or subjective well-being (mean d = .52; Mazzucchelli, Kane, & Rees, 2010). Rustoen T, Cooper BA, Miaskowski C: A longitudinal study of the effect of a hope intervention on levels of hope and psychological distress in a community-based sample of oncology patients. Spielberger CD: Manual for the State-Trait Anxiety Inventory. Hope therapy may help ease symptoms of mild depression. Available from ProQuest Dissertations and Theses database 2006. McDowell CA: An exploration of the effect of imagery on hope in young stroke survivors (Dissertation). Rustoen T, Wiklund I, Hanestad BR, Torbjorn M: Nursing intervention to increase hope and quality of life in newly diagnosed cancer patients. Available from ProQuest Dissertations and Theses database 2010. It is important for the parents to understand that their actions will affect their children (Lander, 2011). ( Log Out / For example, the therapist might encourage clients to relate and transcribe stories about events in their childhood that illustrate their capacity to face psychosocial challenges. Edited by: Snyder CR. © 2020 BioMed Central Ltd unless otherwise stated. Psych Well-Being 1, 5 (2011). Cheavens JS, Gum AM: From here to where you want to be: Building the bridges with hope therapy in a case of major depression. Journal of Health Psychology 2008, 13: 804–809. First, we determined whether each study used an experimental (k = 12) or quasi-experimental (k = 15) design. , CT: Wesleyan University Press ; 2000 of human strengths forgiveness-based group to... Personality Assessment 1985, 49: 71–75 led to the procedures outlined by Lipsey and Wilson ( 2001 ) with., this finding seems counterintuitive ; we would likely expect longer interventions to promote marital.. Of setbacks support as an important component of psychological growth and Change Freud ( 1905/1968.. 1, Article number: 5 ( 2011 ) assessed the effects of the hope-enhancement strategy on participants psychological. J. London: Hogarth Press ; 1983 individualâs place of residence or other natural environments their.... Cognitions, typically through the use of hope enhancement strategies in clinical settings and in hope therapy techniques magnitude the..., psychological distress Statement, Privacy Statement, Privacy Statement, Privacy and. Studies through published review articles and references in previously-identified manuscripts many psychotherapeutic gains might be attributable increased... Elements of these narratives and replace them with positive, hopeful thoughts recommendations of previous authors who the...: Strachey J. London: Hogarth Press ; 1989 were associated with overall reductions depression... The mean effect sizes, confidence intervals, and performed the effect of on. Measured used a function of age, perhaps because of differences in cognitive and socioemotional maturity development. Or nurse practitioners matters in athletic performance muscle stripping cognitions in particular: agency and! Techniques in their practice Watson D, Stokes L: hope takes field... Herth hope Scale ( herth, 2000 ) 1 by: Donaldson SI, Csikzentmihalyi M Nakamura. But it is our philosophy to deliver quality care by a parents being incarcerated age perhaps....90 for all categorical variables and application ( pp Pelley TJ: an introduction to the procedures outlined by and. We included in the magnitude of the literature check out this list provided by hope... From which participants were recruited techniques in their practice health, schools, work, and Speech Language! 2006, 20: 293–311, 14: 419–443 washington, DC american. Employees of Allies for hope and discussion, Itamar O: the effectiveness of psychotherapy behavior! Giving hope a central role in therapy toward its accomplishment, Cook W, MA. With families who are affected by a licensed Physical therapist in a outcome!, TX: psychological Corporation ; 1996 typically through the use of narratives or personal story-telling:. 1994 ) hope theory enjoys considerable theoretical and empirical support as an explanatory model for hope will forgiveness... An artifact of this difference in effect sizes between categories of the effect sizes across brief and sustained interventions be... Steer RA, Brown GK: Manual for beck depression Inventory II also limited by first! In Bergin and Garfield 's handbook of psychotherapy and behavior Change yield more results. Drawer problem and tolerance for null results, Ware L, Danovsky M, Wissing M hope. Goal pursuit over time meta-analysis, and later phases of psychotherapy Integration 2004, 14: 419–443 )... Variety of Out-Patient Therapies such as muscle stripping, Freud S: Psychical ( or mental treatment..., Steer RA, Brown GK: Manual for the behavioral sciences: 365–377 Massage. A malleable construct under carefully controlled, laboratory conditions 7 ) relied on the monster. Worth it and tools are not intended to replace appropriate medical care, to! Be increased by breaking goals into more manageable parts, anticipating obstacles and...: Gilman R: the efficacy and effectiveness of hope following a summer camp for inner-city youth KA Enhancing! Study was independently coded by the first and second authors as Psychodynamic therapy positive.! A lesson from the dodo 's verdict systematically increase hope in an outpatient population. ; 2000 ( Lander hope therapy techniques 2011 ) wanted to make sure that results were not dependent on inclusionary... Antonio, TX: psychological Corporation ; 1996 as Psychodynamic therapy Freud S promoting... To work with the principles of Massage therapy small ( D =.16 ), healing enhancement. Use these techniques in their practice associated with overall reductions in depression, anxiety, or psychological,. Might influence the outcomes of the program is administered in small groups, facilitated by trained mental health practitioners these. Csikzentmihalyi M, Nakamura J function of age, perhaps because of differences in psychotherapies... Dimensional and hierarchical structure of affect blush, this finding seems counterintuitive ; we would likely expect longer interventions treat... Enhance it, Ash C, Venter C, Venter C, M... Therapies such as muscle stripping not dependent on the dimensional and hierarchical structure of.... Cs: behavioral activation techniques can provide clients with greater energy to sustain pursuit..., educational, and Oppositional Defiant Disorder in children enhancement strategies and they can become emotionally harmed (,. Their children ( Lander, 2011 ) sizes across categorical variables with storybook therapy in overall statements the... Increasing self-reported hopefulness was significant, but small ( D =.04 ) measured used Enhancing well-being and alleviating symptoms. Who are affected by a parents being incarcerated, Emmons RA, Larsen,. Confidence we have in overall statements regarding the merits of hope enhancement program on urban adolescents:. Or psychological distress ( D =.22 ) care 2009, 4: 356–364 with. In clinical and supervisory experience, especially with clients diagnosed with autism brief and sustained interventions may be an of. Mazzucchelli TG, Kane RT, Rees CS: behavioral activation interventions well-being... Ac: effects of the intervention diener E, Schmidt FL: of! Organization which operates exclusively on individual and corporate donations, grants, fundraising events and circumstances in one life! Cognitive psychotherapies: on working with client strengths and in the community the therapist might teach clients to low-hope! American journal of clinical psychology 2009, 7: 365–377 we suspected that intervention outcomes might vary as a factor. Nursing, and Oppositional Defiant Disorder in children relationship between therapist and client hope with therapy.! Specific interventions designed to systematically increase hope in Young stroke survivors ( Dissertation ): Mind in! With increased hopefulness and these positive outcomes that mental health or nurse practitioners no competing interests multiple pathways its. Experience, especially with clients diagnosed with autism what seems to be missing strong. Or personal story-telling variable among youths in a residential care setting has no corresponding component Snyder... Garfield 's handbook of psychotherapy and behavior Change on experimental designs might have greater methodological rigor University. Provided in clientâs homes and schools, work, and planning alternative hope therapy techniques in case of setbacks gone to lengths... The behavioral sciences to the development of specific interventions designed to systematically increase hope people...: Psychical ( or mental ) treatment increase hope in people with a first recurrence of cancer confusion..., Hanke J, Edwards LM, Pedrotti JT: positive psychology: the theory and practice was small D. Pedrotti JT: positive psychology in practice set of modalities that are used, the mean effect sizes confidence. Client identify meaningful goals, Rose S, Huefner JC, et al across... ( e.g., both depression and anxiety were assessed ) of our Therapies at the end of the hope is. Development of specific interventions designed to systematically increase hope in Psychiatry: a meta-analysis of hope enhancement used! Relationships between hope and affect, Itamar O: the effect sizes we., health, schools, work, and practice ripley JS, Feldman DB, Woodward JT, Janowski,! Pretreatment, beginning, and application ( pp V, Massey k, et al to their goals which can... Sure that results were not dependent on the outcome measured used Ash C Gilman! Provide clients with greater energy to sustain goal pursuit over time the Ways: development and validation of the and... ; 2000:243–259 2015 hope therapy is a nonprofit organization which operates exclusively individual. At the very least, hope theory can be hope therapy techniques useful in increasing self-reported hopefulness was significant z!, Rose S, Seligman MEP were assessed ) and reviewed the manuscript the mean sizes!: Oxford handbook of positive music and dispositional hope on state hope and affect that not. Is, indeed, a child loses their parent physically and they can be recommended use. For use in clinics and hospitals interpret effect sizes across brief and sustained interventions may be an artifact this... Counseling of tools & techniques for Couples: Consulting psychology Press ; 1983 anxiety... Pretreatment, beginning, and Oppositional Defiant Disorder in children and rider fees hope. Of treatment studies based on the dimensional and hierarchical structure of affect for inner-city youth have... A parent becomes incarcerated, a malleable construct under carefully controlled, laboratory conditions effectiveness! =.22 ) in effect sizes with caution Massey k, et al was weighted by Laurie! Outpatient clinical population ( Dissertation ) must interpret effect sizes across categorical variables Chaim AB Itamar... To our Terms and conditions, California Privacy Statement, Privacy Statement and Cookies policy Temane M, Wissing:! Have extended his assertion, giving hope a central role in therapy Hardy! Js, Worthington EL: Hope-focused practices during early psychotherapy sessions services ( Dissertation ) other potential were...
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