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Walk + Talk Therapy by the Bay

Walk + talk therapy by the bay is one of my favorite approaches to mental health therapy. As a trauma-informed therapist, I utilize many different therapeutic techniques to best accommodate each client’s needs. I know that sitting on a therapist’s sofa doesn’t feel safe or comfortable for many people. That’s why I offer walk + talk. It’s just like going for a walk with a friend (if your friend was a highly trained mental health professional who knew therapeutic techniques that are clinically proven to improve your mood). ♡

For people who have experienced trauma, the idea of meeting an unknown person in a small office in a new building can feel paralyzing. With walk and talk, we are able to meet in a public park where we are surrounded with other people and beautiful views. While the name implies that we will walk the entire time, there are many seating areas along the route to enjoy the shade and the warm breeze from the bay.

Walk + talk therapy offers an opportunity to reduce stress, relieve body tension, improve circulation, breathe deep and clear the body-mind of intrusive, negative, and ruminative thoughts. These sessions can help you decrease anxiety, regulate mood, enjoy more restful sleep, and more. Additionally, you can receive the feel-good brain chemical benefits of exercise, mindfulness practice and eco-psychology. In session, you can enhance insight, release body trauma, and alter behavior patterns while verbally processing your authentic truth.

In urban planning, there is a concept of integrating waterscapes into cities called “blue spaces.

👫Studies have found that short, frequent walks along waterscapes (blue spaces) are good for your mental health.

👫There is a significant improvement in well-being and mood immediately after a person goes for a walk in a blue space, compared with walking in an urban environment or resting.

👫Waterscapes have healing effects that enhance psychological resilience to promote mental health.

👫Walk + talk therapy by the bay gives clients an opportunity to enjoy some blue spaces while boosting their mental health.

Similarly, when urban architects add nature elements to cities such as trees, plants, and grass, these are called “green spaces.

👫 Green spaces provide fresh, healing air to the body

👫 Some mental health benefits of green spaces include: lowered stress levels, reduced rates of depression & anxiety, reduced cortisol levels, and improved general well-being

👫 Enhance your cognitive functioning, improve your sleep, and increase your levels of physical activity.

👫Walk + talk therapy by the bay gives you an opportunity to spend some time outside connecting to nature while working on your mental health.

If you’re joining me for walk + talk therapy, here are a couple things to keep in mind:

👫We don’t have to walk the whole time!

👫There is plenty of seating along the route should we choose to sit by the water and/or stop to talk in the shade.

👫Walking shoes or comfy sandals are recommended.

👫Please bring a water bottle—we’ve got to stay hydrated!

Written by Kalli Portillo, IMH24576 – Registered Mental Health Counselor Intern, EDMRIA-Approved EMDR Therapist, Certified Prepare/Enrich Couple Counselor

To learn more, review the following open access research studies or google “blue and green spaces mental health benefits.”

Benefits of walking psychotherapy:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8892051/

Waterscapes for mental health:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8618438/

Importance of greenspace: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5663018/

Steps for Starting Therapy

Starting the therapy process can be simultaneously exciting and nerve-racking, especially if you have never done it before. There may be a lot of questions regarding what it looks like or what to expect. You might even be envisioning what we see in TV shows or movies where you have a client laying on a couch and staring at the ceiling while the therapist is sitting nearby, jotting things on a clipboard, and asking, “How does that make you feel?” In a space of many questions and uncertainties, I have found that these guidelines can help out tremendously in preparing for a therapy session and ensuring you feel comfortable and informed.

Identify the reason(s) why you want to receive therapy – This can include symptoms, life stressors, personal development, and so on.

Do research on providers – This part is twofold: (1) Find providers that are covered by your insurance or have rates that work best for you and (2) explore what the therapists of that practice specialize in; the aim is to pair your needs with someone who knows how to tend to them.

Schedule a consultation – If you have further questions you would like answered before your session (i.e. rates, scheduling, etc.), set up a phone call with the office manager to gather more information.

Test it out – Like a good pair of jeans, you want to test out your therapist to see if it is a good fit. While they are the experts of how to treat mental health issues, you are the expert on your sense of safety and comfort. You should never feel unseen, unsafe, or dismissed with your therapist.

Maintain open communication – If you have questions, concerns, thoughts, or anything at all, be sure to talk about it with your therapist and be as transparent as possible. The only way to fully assess your needs and come alongside you to lend support is to fully know what you are experiencing.

Work collaboratively – While the therapist is learning more about you, you will also be learning more about yourself. Some interventions might work and others might not, but so long as you continue collaborating with your therapist, the both of you will learn what works best and what helps you get to where you want to go.

While the logistics of each session may vary, these guidelines should become standard practice. If you are going to enter into a space where you are required to be vulnerable and open, you should ensure you take all the measures possible to be informed and feel prepared for what is to come.

Written by Cindy-Joy Rosado – Graduate Student in Mental Health Counseling

Guide Your Child Through Life

Figuring out the best way to guide your child through life can be scary. There is no perfect manual that tells parents what to do when your child throws a temper tantrum at the grocery store, when your child refuses to eat anything but cookies and chicken nuggets, when your child becomes curious about life, when your child experiences their “terrible twos or terrible teens.”
Ultimately, parenting is a ‘learn as you go” journey. There are several great books that teach parents some really useful strategies when navigating through different stages in your child’s emotional development. One thing that I suggest to parents is to assess their parenting approach. The beauty of a child’s development is that they are taking in their environment. A parent’s parenting style is a major source of influence on how a child will interact with others in their adult life. Children thrive off of high expectations while being supported and guided in a loving environment. When parents take an authoritative approach, parents recognize that their child and/or teen are still developing emotional maturity and depend on their guidance and limits to navigate through life. Through their guidance and boundaries, parents empower their children to make decisions. A because “I said so approach” is not taken but statements like “what do you think about..” “I do or do not think this is a good idea because…” ‘Which one would you choose…” “Help me understand…” “I can understand you are upset but it has to be this way because…”
Creating healthy parent-children relationships is important in creating healthy and secure adult individuals.
Written by Jessica Sagastume – Licensed Mental Health Counselor and Bilingual and Immigration Counselor

SETTING NUTRITIONAL NEW YEAR’S RESOLUTIONS THE HEALTHY WAY

 

It’s that time of year when most of us think about setting our New Year’s resolutions. If you’re like a lot of people, you may have a goal of “losing weight” or “getting healthier.” These are obviously great goals to have, and making changes to your diet is one of the best ways to reach both.

The problem is, too many people make the wrong changes to their diet. They want to lose 30 pounds and be healthy in an unrealistic amount of time. And so once January 1st comes around, they rely on fad diets that don’t provide their bodies with proper nourishment.

This is the number one reason people fail to reach their New Year’s goals.

Here are some ways you can set your nutritional New Year’s resolutions in a healthy way.

Rely on How You Feel, Not on Technology
I see more and more people using a tracking app to track how many calories they eat in a day. But most of these programs give you a caloric reward (you can eat more) on days you exercise and a caloric punishment (you must eat less) on days you don’t.

The thing is, this kind of “logic” goes against normal intuitive eating patterns. In fact, for most people, feel less hungry on days they are most active and vice versa. My advice is to listen to your own hunger signals and make decisions off of those instead.

Avoid Restrictive Fad Diets
I can’t think of anything less healthy than a diet that does not allow you to eat macronutrients. Fat, protein and carbohydrates are all important for our health. Some people do better with more fat and fewer carbs, and some people do better with more carbs and less protein. It all really depends on your age, activity level, lifestyle, and general health. Your best bet is to work with a licensed nutritionist who can create an eating plan that is right for you.

Take Baby Steps
No one becomes overweight and unhealthy overnight. It happens over the course of weeks, months, and years. Losing weight and getting your health back also will not happen overnight, so you need to be realistic.

And because weight loss and improved health can take time, it’s important that you focus on setting small goals and taking baby steps to get there. Reaching a set of smaller goals (lose 5 pounds, walk upstairs without becoming out of breath) instead of one big one (lose 50 pounds and look awesome in a bikini) will help you stay on track and committed.

Don’t be like everyone else and set yourself up to fail in the coming year. Be smart about your weight loss and health goals by following these tips. And if you’d like to work with a nutritionist who can help you reach your goals in a healthy manner, please get in touch with me.

Written by Sherline Herard – Registered Mental Health Counselor Intern

SOURCES:

https://www.vitacost.com/blog/healthy-new-year-resolution-tips/

3 Reasons You Should Set Goals, Not Resolutions

Top 3 Nutrition New Year’s Resolutions for 2019

Tips for Planning for Self-Care

Reaching the point of burnout is, unfortunately, an all too common experience for many. Given the fast-paced, productivity-based work culture that exists in America today, burnout has essentially become the marker by which we measure success. The message we receive is this: “If you feel like you have exhausted your limits, then you are doing something right!” There is this tendency to equate how much we produce to whether or not our lives are worthwhile, but this could not be more untrue. Similarly, rest is often portrayed as something you earn once you have put in the work, but this is also false. Rest is not something we need to work toward, it is something our bodies and minds require in order for us to make it through life. With this in mind, I have compiled a list of helpful tips to utilize when planning for self-care. While I wish I could tell you I picked this up without error, the only reason I am able to make such a list is because I have tried and failed many times… And this is what I have learned!
1. Identify the difference between things that make you feel rested versus what makes you feel fulfilled. Some activities might fall into both categories, but it is helpful to distinguish between the two. Restful activities often alleviate stress and induce a sense of tranquility. Fulfilling activities are things one enjoys and are often fun. For example, meditating or going on a walk might help one feel rested, whereas painting or gardening might be fulfilling.
2. Identify the people and things that hinder your ability to unwind. For instance, if you are a parent and being around your child is stressful in that you focus solely on their needs, you may need to find someone to care for your child during your self-care time. Similarly, having your work phone on you while you attempt to rest might prevent you from being able to relax as your phone might go off or you might feel compelled to check it regularly.
3. Review your weekly schedule and identify spaces of time in which you are able to engage in self-care. Whether your schedule is wide open or packed with commitments, making time for self-care is something one has to be intentional about planning because it will not always “just happen” or “work itself out.”
4. Once you have decided on a restful or fulfilling activity, have ensured you will not be distracted by certain people or things, and have chosen a date and time for self-care, make sure all of your regular responsibilities are tended to prior. As an example, one might handle all of their house chores, clear out their inbox, and predetermine dinner plans in order to set themselves up for nothing but rest on the day of their self-care. This is important because “past you” is taking care of “future you” in a way that will make you feel even more taken care of.
5. Finally, make sure you plan for self-care at least once a week. While there are ways to find rest and fulfillment in small ways throughout the week, it is imperative that you care for yourself and separate blocks of time. If you are able to give so much to others (i.e. work, school, family, etc.), you need to be able to give yourself much as well.
Written by Cindy-Joy Rosado – Graduate Student in Mental Health Counseling

Six Dimensions of Wellness

On the heels of world changing events like a global pandemic, many communities were intensely affected by Hurricane Ian in September. As we adjust to new challenges and situations which have arisen from these, we continue to experience the problems that existed before pandemics or natural disasters. Now, as we approach holidays and other stressful situations it is more important than ever to focus on key concepts for maintaining wellness.

Mental health counseling focuses on striving for wellness in all areas of our lives as foundational to managing stress and other mental health concerns. If you currently feel overwhelmed, lack direction, or simply don’t ‘know where to start try using the six dimensions of wellness listed below daily to gain control over your mental health and wellbeing.

Environment: First, take a look at your daily routines throughout the week and on the weekends. Your environment is your home, your commute, your workplace, etc. As you evaluate your space, you may feel calmer when your space is tidy and organized. This would become an area of focus each day by spending time to clean and organize and then to maintain this space. If your commute is stressful, take a look at areas you can improve. For example, choose calming music, an entertaining audiobook, or podcast to reduce the focus on the stressful aspects of the ride. Or turn the music off and use this time to transition from work to home.

Emotional: A daily focus on emotional wellness may begin with noticing your emotions throughout the day. Are you in control of your emotions? Do you struggle maintaining your level of calm, anxiety, happiness, sadness, or anger? Journaling is a great way to record your thoughts and learn more about the emotions you are experiencing. Therapy is a great place to jump start or explore this focus and to gain insight into how you are feeling and how you are currently managing.

Physical: Physical health is a dimension most of us are aware we need to focus on. A daily focus on physical health means eating foods that are nourishing, establishing a sleep schedule for adequate restorative sleep, going for a walk or taking time to stretch between activities throughout the day. These can be simple, but it requires us to make them a priority consistently to achieve wellness.

Intellectual: Learning something new every day can be the goal here. Or it can mean reading a new book, exploring a subject of interest at the library or online. Learn more about yourself as well by seeking to learn a new skill or hobby. Overlap between the dimensions might be helpful here, so use that long commute to listen to an audiobook or podcast.

Social: Focus on the social dimension might include calling a friend or a loved one just to check in and say hello. It may mean making time to visit a friend or family member. This could also be a time to overlap dimensions with the intellectual and join a group and learn to cook or paint. Volunteering your time is also a good way to develop friendships and make lasting contributions to the community.

Spiritual: This dimension is about your connection to your belief system. Meditation, prayer, or taking time to commune with nature are ways to recharge your batteries in this dimension. This also allows you to explore how you find meaning and the ways in which that meaning is influencing your life.

The six dimensions of wellness focus on our environment, emotional wellbeing, physical health, intellectual pursuits, spiritual involvement, and social interactions. Remember, we are individuals and our needs in each area will vary from person to person. Also, being flexible with how we focus on each dimension daily will help with making these a priority in some way every day. If you are having difficulty finding or maintaining balance in your life, reach out to a qualified mental health professional for assistance.

Written by April Daniel – Registered Mental Health Counselor Intern

Holly Jolly Stress

It’s the most wonderful time of the year! Right? For some, the holiday season is a time to be anticipated. It’s a time for family, friends, celebrations, and thankfulness. Christmas carols boast of joy, love, cheer, family traditions and light hearts. This, however, is not the reality for some. The holiday season can be a time of extreme stress, exacerbated loneliness, depression, anxiety, and even grief. To make matters worse and the burden heavier, the holidays are also a time during which people tend to compare their lives to those around them, magnifying and compounding those negative feelings. Here are some important tips and reminders for those who struggle during the holiday season:

1. Consider creating new traditions for yourself if the old ones aren’t working.

2. Surround yourself with people who may be in a similar mindset during the holidays and need like-minded friendship and support. Focus on connecting with others even if it is not by conventional means. Avoid isolation and disconnection.

3. Recognize and accept your feelings without judgement. You are absolutely not alone. Be gentle with yourself and go out of your way to avoid potential triggers even if that means declining certain invitations.

4. Prioritize your self-care. Remember, the holiday season is just that: a season. If this time of year is particularly difficult for you, remember it will pass.

Written by Nicole Geddie – Graduate Student in Mental Health Counseling

🌊🌊FLOODED🌊🌊

by Ria Ruane, M.A., LMHC

I’ve always been attracted to and captivated by the sea. The therapeutic, lulling sounds of the waves, the glistening sunshine as it kisses the surf and the incredible, fascinating life within, such a gift, an absolute pleasure to behold!

For as long as I can remember, I found peace and serenity in, on or under the water. Swimming, beachcombing, boating, snorkeling, you name it, I’m in.

     When I was 5 years old, I crossed three beaches collecting colorful seashells. When my mom called her seven children in for lunch, she realized her youngest was gone and thought for sure I had been swallowed by the sea. In fact, I was in the police station, eating ice cream and waiting for her to pick me up with my new, shiny treasures.

     Over half a century has passed and I am fortunate enough to own an awesome condo on the sand in SWFL’s lovely Bonita Beach. So perfectly named as the word  ‘Bonita’ translates to beautiful in Spanish and Portuguese. They say, “If you’re lucky enough to have a place by the sea, you’re lucky enough.” On September 28, 2022, meteorologist and Hurricane Ian said differently. Don’t get me wrong, I still feel incredibly blessed. I now have the loss of a home to add to my life experiences. At least, it will help me build empathy for clients and after all, things can be rebuilt and replaced.

     September 27, 2022 and Mandatory Evacuation meant take very little and leave. I took a few photos, secured Hurricane shutters and headed inland for hours and hours of 150 mph wind, water and wait. The salty, snappy sea swelled and surged, tore out my shutters, blew out six sliders and took out every inch of my happy place. All that was left was covered in glass, sand and muck.

     After the storm, our community took a huge hit with catastrophic damage and destruction. Despite our best efforts to prepare, protect and defend, we flooded. Our homes and the days of our precious lives were overwhelmed and placed on hold by the same sea water that also provided everlasting moments of joy, serenity and peace. Now, like beach sand through an hourglass, we must move on to recover. In fact, we are a resilient community that will overcome and grow stronger because of this experience.

      My work as a realtor, leaves me scrambling to help the many displaced residents of SWFL find a place to stay, a place to call home.  Maslow’s hierarchy of needs sums up our situation quite nicely. As humans, we need to have our basic physiological needs met in order to survive. Think about it, how can we survive, never mind thrive, if we don’t have a place to stay, to be, to eat, to sleep, to live? It is also a basic human need to feel safe…safe from the storm. These needs are the baseline. Warm soup and a cozy blanket will always trump talk therapy. Safety, security, shelter, food, water, clothing, warmth, even sex rate high on our human needs check list. During this and other difficult life cycles, please remember self care. It is nonproductive to pour from an empty cup. Fill your cup and schedule time in your days (post-IAN daze) for activities that make your spirit soar.

     As a mental health counselor, specializing in grief and loss, I clearly recognize  the stages and cycle of grief that people are presently experiencing. Kubler-Ross’s Five Stages of Grief, Denial, Anger, Bargaining, Depression and Acceptance, it’s all right here in our community. Many think the stages of loss are linear. In fact, the stages are cyclical and like a child’s water spray park, we can’t determine or plan for if, when or where any will pop up. One thing is for sure, it is virtually impossible to avoid emotional flooding when dealing with experiences that involve catastrophic loss.

     In addition to the stages of grief, I acknowledge the very real connection between storm flooding and emotional flooding that coexist with this type of trauma. In both instances, there are precautions we could and should take.

     An analogy I often use with clients is applicable here. During times of increased physical, emotional and mental stress, imagine a traffic light. The norm is green (Go) as we attend to our daily lives with manageable anxiety. As the storm gates open and the water begins to pour in (a.k.a. emotional arousal), we are signaled to pause. We need to be cognizant of the impending destruction that may occur if we continue without taking a ‘time out’ to consider calming, next best steps. Self soothing is an important part of the amber (Proceed with Caution) stage. Finally, as we near the red (Stop) zone, emotional relaxation becomes a matter of survival. This stage is where flooding is bound to occur. It is very difficult to make good decisions, communicate effectively or make healthy choices when flooded. Senses may shut down to a point where it is difficult to see, hear or even think as you would normally.  In the red zone, it is common for people to feel dissociated, fuzzy, extreme anger or fear, etc. Working with couples in crisis, we often see this during our Vacation Counseling Retreats. One person might feel as if they are moving in slow motion. Others might react with Flight, Fight, Freeze or Fawn during these difficult moments. Oftentimes, this is simply our minds’ way of dealing with red zone situations and/or trauma.

     When exposed to an overwhelming, high-anxiety situation, we must tend to basic physical survival. It is also imperative to incorporate evidence-based practices to prevent emotional damage and protect our mental health. These calming techniques include deep breathing exercises, guided visual imagery, progressive muscle relaxation, meditation, prayer, mindfulness, music, art, positive thinking, etc. Solution Focused Therapy suggests we create an imaginary tool box in which we store helpful techniques that elicit the relaxation response. When one doesn’t work, we search for another until we find one that fits just right for each unique, stressful situation. Solution Focused Brief Therapy (SFBT) works best when we simply utilize positive, helpful strategies that have worked in the past and reduce or eliminate techniques that haven’t worked. Which works best for you? My absolute favorite relaxation “tool” is gratitude.

     I try to begin my day with a big stretch and count my blessings on the fingers of both of my hands. An example of some of the ten things I am grateful for might include the sunshine, my ability to get out of bed, my health and awesome music. Heck, I might include my toothbrush, toothpaste and flossers! Gratitude is a great way to start a great day even in the midst of storms that life might send our way.

     I’d like to end by thanking you for allowing me to share my story. First and foremost, I thank God for all of my blessings. I am grateful to all those that assisted others during this difficult time. I consider them angels on earth. I thank my mom for finding me when I am lost and always being there for me. I thank my siblings, my friends and my children for caring. I am grateful for my clients, for trusting me with their stories. I appreciate being in a position where I can help others who are experiencing grief and loss. It is an honor and a privilege to walk with them even for a little while on their journeys.

     If you are in need of emotional support after Hurricane Ian, please take advantage of Cape Coral Therapist Free Drop-In Support Groups for the Community. It helps to know that others may be struggling to get back on their feet and experiencing similar issues. Here at Cape Coral Therapists, you matter! We care and are here for you. We are all in this together as we discover how resilient we really are and move towards Recovery.

Every Voyage Needs a Captain’s Log

Do you ever get swept up in the momentum of a day, week, or month, then pause and try to make sense of the blur? Does tunnel vision ever make things blend and get jumbled for you? Life often takes us on voyages, grand journeys toward big picture goals. But without taking notes along the way, things can get disorienting. That’s why every voyage needs a captain’s log. And the good news is that these days we all carry one in the form of our smartphones.

Journaling is well-documented as having tremendous benefits on our mental health and can help us notice patterns, connections, and opportunities that we may otherwise miss. Like many good habits though, it can be challenging to get started and stay consistent with it. Recently, many people are finding success in journaling by linking it with a smartphone use many of us know all too well: checking social media.

So, you get the urge to lift your phone and check your favorite app. But now that you remember every voyage needs a captain’s log, you go first to your notes app or a journaling app of choice. You jot down things like what time you woke up, how you’re feeling today, what things you want to get done before bed, and even some things you’re grateful for. Now, feeling grounded and mindful, you can click over to social media or move on with your day. Either way, taking brief moments to jot down where you’re at can be a great way to turn your smartphone use into something restorative and beneficial.

When journaling becomes a daily habit, it can be a fantastic resource for growth and direction. Ever get into a slump? Look back on your notes and find a time when you were feeling well. What were you eating then? How were you spending free time? Who was fostering your positive mindset? Let your past self remind you of the things that bring you joy and fulfillment, as well as some things you may want to steer clear of. Start building your captain’s log today and see where the voyage takes you.

Written by Louis Nicholas – Graduate Student in Mental Health Counseling

Feminist Theory and Self-Care in the Modern Age

Rebranding the “Bimbo”

In 2022, young people have abandoned traditional theories of feminism and equality. Instead, they’re concentrating on something far more optimistic and unexpected: “bimboism.” But what exactly is a bimbo? Isn’t “bimbo” a derogatory term? And what does this have to do with mental health? The answer is, shockingly, quite a lot.

Traditionally, “bimbo” was defined as an attractive but insipid or “dumb” woman. Nowadays, young people are looking to reclaim the word. Feminist Theory has been prevalent in mental health counseling for decades; The work of Karen Horney comes to mind. But Millenials and Generation Z have a new take on feminism. Shot into the zeitgeist by Tiktok and Generation Z, the modern “bimbo” is the lovechild of social media and third-wave feminism. She stands for equality for all and, surprisingly, self-care & mental health. Syrena, a Tiktok creator known as @fauxrich, defined a bimbo as a traditionally or hyper-feminine woman often villainized for her love of traditionally feminine things, including self-care, caring for one’s physical appearance, and being in touch with one’s emotions. Griffin Maxwell Brooks, a Tiktok content creator, expanded on “the study of bimbology” in a video, saying, “nobody can tell you how to be a bimbo, since it isn’t about how people see you.” They continued, “There is no gender, class, color, or ability in the bimbo. The only prerequisite for bimbofication is embracing and reclaiming your body in the name of independence.”

For years, psychologists, therapists, and other mental health workers have worked for equal rights for both men and women. Unfortunately, in modern media and Western culture, traditionally feminine interests (such as watching romantic comedies, enjoying a spa day, or participating in any form of feminine activities as self-care) were seen as superficial, shallow, and for the unintelligent. Even in medical and mental health fields, the deep disdain for female emotions can be seen. For example, the verbiage of Histrionic Personality Disorder, with “histrionic,” originating from the Greek prefix hystera, meaning “womb” or “uterus.” Extreme emotions, attention-seeking behavior, and even being excessively consumed with grooming are all female-coded symptoms of HPD.

While the sub-culture of the new-age bimbo is relatively new on social media, what she represents is clear: a new, radical acceptance of all things traditionally feminine, including the full spectrum of her emotions, interests, and preferred self-care.

Written by Victoria Baker, Graduate Student in Mental Health Counseling