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Healing Minds: Exploring the Power of EMDR Therapy

November 15, 2024 by

 

EMDR (Eye Movement Desensitization and Reprocessing) therapy is a psychotherapy approach that is primarily used to help individuals process and resolve traumatic experiences. It was developed by Francine Shapiro in the late 1980s and has since gained recognition as an effective treatment for trauma-related disorders, particularly post-traumatic stress disorder (PTSD).

Here are the key elements and principles of EMDR therapy:

1. Bilateral Stimulation:

One of the distinctive features of EMDR therapy is the use of bilateral stimulation, which can involve either side-to-side eye movements, taps or tones (using handheld devices), or other forms of alternating sensory input (such as hand tapping or auditory tones). This bilateral stimulation is believed to mimic the rapid eye movement (REM) sleep phase, during which emotional processing occurs naturally.

2. Eight Phases:

EMDR therapy is structured into eight distinct phases:

– History Taking: Gathering information about the client's history and identifying targets for treatment.

– Educating the client about EMDR therapy and developing coping skills to manage distress.

– Assessment: Identifying specific memories or experiences to target during EMDR sessions.

– Desensitization: Using bilateral stimulation to process traumatic memories and associated negative emotions.

– Installation: Strengthening positive beliefs and adaptive coping mechanisms.

– Body Scan: Assessing for any residual physical tension related to the targeted memory.

– Closure: Ensuring the client feels stable and grounded at the end of each session.

– Reevaluation: Reviewing progress and identifying any additional targets for future sessions.

3. Adaptive Information Processing Model:

EMDR therapy is based on the Adaptive Information Processing (AIP) model, which posits that many psychological problems are due to unprocessed memories that are stored in a maladaptive way. EMDR aims to facilitate the brain’s natural ability to process and integrate these memories, resulting in reduced emotional distress and improved cognitive functioning.

4. EMDR therapy is primarily used to treat PTSD and trauma-related disorders, but it has also been adapted for use with other conditions such as anxiety, depression, phobias, and more. It is considered an evidence-based practice and is endorsed by organizations such as the American Psychiatric Association (APA) and the World Health Organization (WHO) for the treatment of PTSD.

Overall, EMDR therapy is designed to help individuals reprocess traumatic memories and associated negative beliefs, allowing them to move towards a state of psychological healing and adaptive functioning. It is typically conducted by trained therapists who have completed specific EMDR training programs.

Written by Jennifer Freel, Registered Mental Health Intern IMH26129

Follow Jennifer – Well Space Holistic Instagram

*Coming soon, Jennifer Freel will be offering EMDR Therapy to further support her clients’ healing journeys.

Filed Under: Anxiety, Depression, EMDR Therapy, empower, Intimacy, marriage, Men's Issues, Mental Health, Women's Issues

Emotional Affairs and Personality Disorders in Marriage and Family Therapy

November 8, 2024 by

Navigating the Complex Terrain of Emotional Affairs and Personality Disorders in Marriage and Family Therapy
In the intricate landscape of marriage and family therapy, the challenges posed by emotional affairs can be even more profound when compounded by personality disorders. Whether you’re a therapist working with couples or someone navigating these issues personally, understanding the interplay between emotional connections and mental health is essential.

Understanding Emotional Affairs
Emotional affairs often begin as a friendship that deepens into a connection characterized by intimacy and secrecy. Unlike physical infidelity, emotional affairs involve a significant emotional investment in someone outside the marriage, which can lead to feelings of betrayal and profound hurt.

For couples, these affairs can signal deeper issues within the relationship, such as unmet emotional needs, communication breakdowns, or a desire for validation. In therapy, it’s crucial to explore the underlying factors that led to the emotional affair while addressing the couple’s dynamics.

Written by Danielle Fous, Marriage and Family Graduate Student

Filed Under: Anxiety, Communication, Couples/Marriage, Depression, Family, honesty, Intimacy, love, marriage, Mental Health

3 Habits Impacting Your Mental Health

November 1, 2024 by

Oftentimes, when we think about what could harm our mental health, our minds go to major life events—the loss of a job, the end of a relationship, or the death of a loved one. But small habits that often go unnoticed can also play a major role. Below are three common habits that could be negatively affecting your mental health:

1. Not Getting Enough Sleep
Sleep impacts your mental health in numerous ways—it can affect your cognitive skills, mood, and behavior. As such, failing to get enough sleep can increase your risk of anxiety and depression and make it more difficult for you to focus, solve problems, make decisions, remember things, and control your emotions and impulses. Try sticking to the same sleep schedule, keeping your bedroom cool and dark, and performing a relaxing activity before bed (e.g., taking a warm bath or reading).

2. Being Inactive
In today’s busy world, it can be difficult to find time to exercise, but it’s important to stay active. Not only can exercise improve your physical health, but it can also boost your mental health. In fact, studies have shown that regularly exercising could reduce your risk of depression.

3. Scrolling Through Social Media
Social media can be beneficial—it can help you stay connected to long-distance family and friends and keep up with current events—but research suggests that spending too much time on it can lead to anxiety and depression. To reduce your screen time, try setting a timer, turning off notifications, or deleting apps from your phone.

Start Improving Your Mental Health
In addition to breaking the negative habits described above, one of the best things you can do to boost your mental health is speak to a therapist. Fortunately, you can entrust your care to the skilled team at our practice. Once we’ve learned more about you and any issues you may be experiencing, we’ll be able to provide you with customized advice for how to eliminate negative habits from your life and start implementing more positive ones. Contact us today to schedule your first appointment.

Written by Sherline Herard, Licensed Mental Health Counselor

Filed Under: Anxiety, Couples/Marriage, Depression, empower, Inspire, Intimacy, kindness, love, marriage, Men's Issues, Mental Health, Self-Worth, Women Empowerment, Women's Issues

My PhD Journey

October 25, 2024 by

Recently I embarked on a new journey in my PhD program. My qualitative course is one of the first three and the most challenging. This course has led to a lot of soul searching on the best way to present my research question. I decided that it may be best if I research a specific
group. I have chosen to narrow my research down to black married men. My question is currently still under construction. I want it to be a meaningful statement that articulates how the overarching theme of the study. I also do not want to lead participants to the conclusion that I am trying to make. Therefore, a vaguer description might be beneficial. My thought was “What are the communication barriers that black males face in marriage?”. I have been gauging the interest of men that I know, who are married and find communication in their relationship difficult.

So far, I have received a lot of inquiry on this topic and the idea of diving deeper into a man’s vulnerability with his wife. Specifically black men, who in my experience must consistently portray a strength. This is a very taxing façade to project at all times. An assumption of marriage is that both individuals are comfortable to show their true and authentic self. If this statement was an absolute, my assumption is that men would express more than just anger in their relationship. I tend to believe that men test the boundaries of how open they can be with their spouse. When their vulnerability is rejected through a critical reaction, disappointment, or lack of comfortability by their spouse; men tend to shut down.

As a boy growing up, I was taught that my emotions were not acceptable. This resulted in behaviors that caused more damage for my mental health. Because I did not feel safe expressing myself, I found it hard to be vulnerable with others. I also found myself in unhealthy coping mechanisms and hiding behaviors that were not seen as “good”. I longed for people that I could unpack the turmoil that I felt inside. I thought that in marriage I would find this safe space. What I found was my hiding of my true emotions gave my wife an unrealistic expectation of me as a man. I was always “strong and stoic” in our dating phase of the relationship. For 5 years before marriage my wife thought that nothing phased me. She later realized I was a ball of emotions. In the beginning of or marriage she did not know how to react to what I was saying. This led to me feeling alone and misunderstood within my own house, almost as if I was a teenager all over again. Though this sounds dramatic, it is natural for us as humans to relate our current reality to past situations. These trips back to spaces of emotional scarcity can limit our ability to be present in the moment, and while this sounds like a riveting crisis. It would be highly unproductive for
your mental health if I just left you with a problem and no way to work towards a different result.

If you find yourself in a place where you do not feel like you have the permission to be vulnerable in relationships; I believe it starts by creating a space for yourself. We have all heard the saying that you cannot give others what you do not give yourself. It is also very true that you cannot ask from others what you first ask from for yourself. If I do not think my voice matters, someone else saying it does will not validate the insecurity inside of me. As men, we must give our inner child the freedom to feel every emotion, no matter how uncomfortable. As we begin to accept, we are more than anger and excitement, we will be able to ask others accept that as well.

Written by Tim Nelson, Registered Mental Health Intern #25977

Filed Under: Anxiety, Couples/Marriage, Depression, empower, Inspire, Intimacy, kindness, love, marriage, Mental Health

Stay, Go or Fall for the Subtle Settle?

July 26, 2024 by

Did you even notice that talking about the ups & downs of relationships is not easy? In fact, most adults have bits and pieces of past relationships that they haven’t shared with another soul. Have you explored relationship status discussions as of late or do you (like many) avoid them at all costs? There is an old joke in which one partner says to the other…”I said I loved you forty years ago, if that changed, I would have let you know!” This may be funny but it is a recipe for disaster and dissolution of unions! Hence, it may be time for you to take a closer look. I believe you are worth it and relationship exploration can help understand past history which affects future success.

Let’s have an honest, open-minded look at your past & present romantic relationships?
Happiness and fulfillment for most couples includes good communication, faith, empathy, patience, forgiveness, intimacy and more. Romantic relationships can come in many forms, some good, some great, some meh, some bad and others downright terrible! All have the power to change our lives, for better or for worse. Most directly correlate with the desires of our heart. This accounts for the fact that romantic attachments often include the most incredible and unfortunately, some of the absolute worst moments and days of our lives.

Truth be told, most adults know when our romantic relationships rock.
What’s more, our “wise minds” also recognize when our relationships become unsatisfying, uninspiring or even toxic.
We may struggle to verbalize or even admit it to ourselves but few can deny relationship status after a careful examination of conscience. For this reason, we should call it what it truly is and do something if it is not working in our life stories.

Rating relationships might look something like this…
Your partner makes you a better person, lifts your spirits, treats you well, listens with empathy, shares interests, etc.
In this case, you are blessed with a good match.
Better yet, if your heart skips a beat when your eyes connect across the room…BINGO! BANGO!!!
On the other hand, if your partner brings you down, is emotionally, mentally or physically abusive, cheats, lies and repeatedly leaves you unsatisfied, this match may be toxic and you may need to (as the expression goes) RUN!!!
It is easy for most to identify the toxic, knock-down, drag-out fighting, manipulating, gaslighting,
cheating, crying, etc. but what about the not so obvious troubled relationships?
The relationships that contain little, if any, spark. They are less threatening, less exciting, less
dramatic and produce less or zero butterflies in our bellies. I’m talking about the subtle settle partnerships.
The links that beg us to ponder,
“Should I stay or should I go?” or “Am I settling for less than I deserve?”
The subtle settling in a mundane or less than satisfying affair may include complacency, familiarity and a bit of boredom. Perhaps this is a relationship that started out slowly and failed to launch. It may be a friendship that formed when one or both parties feared being alone more than being a part of a couple that often contemplates what might be missing. If your relationship is falling short of your expectations or your core values are not in line with your actions and behaviors, it may be time to reinvent, reboot or remove this relationship for better mental health.

American psychologist, John Gottman has labeled Four Horsemen, or hooks that interfere with relationship success. They are criticism, defensiveness, stonewalling and contempt. These behaviors can devastate and wreak havoc on romantic unions. Careful attention to the reduction or elimination of these behaviors can build strong, healthy attachments. Additionally, hard work and focus can lead to recovery and reunion for struggling couples that brave these destructive behaviors.

Some say that being alone is better than being in a relationship with the wrong person.
What do you say? As a Couples Counselor, it is not my job to answer that question or even offer advice.
I can only make observations and pose thought-provoking questions that help to reveal next best steps.
Some of these questions may include:
Do you love yourself enough to go it alone indefinitely?
Do you believe that you are already whole and that a partner should supplement and spark joy?
Do you trust your Higher Power to place your person in your life at the appropriate and well appointed time?
Does your partner make you a better person?
Are you settling for less than you deserve?
Does thinking about your partner evoke feelings of joy, peace, safety, indifference, fear, sadness or discord?
If you are unsure, you may need to explore your thoughts and feelings with the use of an emotions wheel, similar tools and a
trained professional.
If you need assistance processing or would like to have help sorting and working through issues
heavy on your heart, please reach out to one of our fabulous relationship counselors.
We care and think you deserve the very best intimacy, happiness and fulfillment in relationships near and dear
to your heart. We consider it a privilege to help create and maintain solid, stable connections and thank you for the opportunity to serve. You and your relationships are worthy of a love that meets or beats your expectations! I will leave you with this and please remember that self love is ALWAYS a part of true love!

“We’ve got this gift of love, but love is like a precious plant. You can’t just accept it and leave it in the cupboard or just think it’s going to get on by itself. You’ve got to keep watering it. You’ve got to really look after it and nurture it.” -John Lennon

Author & Photo Credit: Ria Ruane, MA, LMHC

Filed Under: Anxiety, empower, Inspire, Intimacy, love, marriage, Mental Health, Self-Worth

The Silent Struggle: Unraveling the Mental Health Consequences of Infidelity

May 16, 2024 by

Infidelity is a complex and emotionally charged issue that can have profound effects on individuals involved in a relationship. While the impact on trust and the relationship itself is widely acknowledged, the mental health consequences of infidelity are often underestimated and overlooked. In this blog, we will delve into the silent struggle that many individuals face when grappling with the aftermath of infidelity and explore the psychological toll it can take.

  1. Betrayal Trauma: One of the most significant mental health consequences of infidelity is the experience of betrayal trauma. The discovery or revelation of a partner’s infidelity can shatter a person’s sense of security and trust. Betrayal trauma often leads to symptoms similar to post-traumatic stress disorder (PTSD), including intrusive thoughts, hypervigilance, and emotional numbness. The betrayed individual may find it challenging to rebuild a sense of safety and security, impacting their overall mental well-being.
  2. Emotional Rollercoaster: The emotional rollercoaster triggered by infidelity can be intense and prolonged. Feelings of anger, sadness, confusion, and despair may cycle through an individual’s mind, making it difficult to find stability and emotional balance. The constant oscillation between different emotions can lead to heightened stress levels, anxiety, and even depression.
  3. Self-Esteem and Identity Crisis: Infidelity can inflict a severe blow to one’s self-esteem and identity. The betrayed individual may question their worth and desirability, leading to a profound sense of inadequacy. This crisis of identity can trigger feelings of shame and guilt, further contributing to mental health challenges. Rebuilding self-esteem after infidelity requires a delicate and intentional process of self-reflection and self-compassion.
  4. Trust Issues and Fear of Intimacy: The breach of trust caused by infidelity can result in long-lasting trust issues. Individuals who have experienced infidelity may struggle to trust others, even in new relationships. The fear of intimacy and vulnerability can hinder the ability to form deep connections, perpetuating a cycle of isolation and emotional distancing.
  5. Coping Mechanisms and Unhealthy Behaviors: To cope with the emotional pain, some individuals may turn to unhealthy coping mechanisms such as substance abuse, overeating, or excessive work. These behaviors, while providing temporary relief, can exacerbate mental health issues and contribute to a cycle of self-destructive patterns.

Infidelity is not just a breach of trust within a relationship; it leaves a lasting imprint on the mental health of those involved. Acknowledging and addressing the psychological consequences of infidelity is crucial for individuals to navigate the path toward healing. Seeking professional help, fostering open communication, and practicing self-care are essential steps in rebuilding mental well-being after the tumultuous experience of infidelity.

Written by Catherina Rosen

Filed Under: Anxiety, Communication, Couples/Marriage, Depression, Family, honesty, Intimacy, marriage, Mental Health, Self-Worth

Breaking Free: 3 Tools to Transform Your Relationship Dynamics

March 21, 2024 by

Walking on eggshells in your relationship? Here are 3 tools to change everything.

We all want to feel free to trust and love our other half, but sometimes find it difficult if they’re controlling, scrolling on their phones during “quality time” or making us work hard for the scraps of love and attention we crave.

Sometimes we get to a place in our lives where we wonder how much longer we can be living this way. Most of us have lived enough life to know that yesterday might be starting to look permanent, causing us to wonder, “How do we change our tomorrow?”.

These simple tools, when used correctly, can help improve your relationship and point you on a
path to a greater sense of self:

Transform your habit of thinking:

We all have an inner critic that lives inside of us, made up of fearful thoughts that keep us feeling stuck. These thoughts are not who we are, but have been wired into our subconscious to keep us safe. Who we really are knows we deserve more than what we are getting, but somehow we keep moving back into our old habits. To get the relationship we want, we need to get curious about how our inner critic thinks it’s helping us through presenting the negative, fearful thoughts, and retrain our minds to replace them with faith in ourselves. You are not
your thoughts. You are the one who is aware of your thoughts and has the power to change them to create the life and relationship you know you deserve.

Change where you put your energy:

One of the most terrifying feelings we can experience is the feeling of helplessness. This is especially true in our relationships. To avoid this feeling, our human nature is to try to control external factors outside of our control. We sometimes put a lot of energy into trying to change (or control) our partner, leaving us feeling burnt out and resentful. The fastest way to reclaim our inner peace is by gaining clarity on what we do have control over, and what we do not. Once we realize we only have control over our own actions and choices, the magic begins to happen. Redirecting all of the energy that was once used to try and change our partner, we can focus on building the life we want, and if our partner is willing to come along for the ride, they
will rise to our level.

Train people how to treat you:

We all know the true saying “Actions speak louder than words”, but sometimes this idea gets lost when it comes to our relationships. We may tell our partner that we won’t put up with something anymore or we are going to leave… but then we don’t follow through. We may say, “That’s not okay”, but continue to give them what they want. To get the changes we require, we need to reward our partner with their love language when they show behaviors we want or desire. When unwanted behaviors show up, we limit any reinforcement of that behavior. With the help of a therapist to navigate the intricacies of relationships, we can make a healthy plan to limit our presence and/or attention in a specific way. Over time, if they truly are our person, their behaviors will shift into what we have been asking for but haven’t been following up with our actions until now.

Written by Kellie Hatch – Mental Health Graduate Student

Filed Under: Couples/Marriage, empower, Inspire, Intimacy, kindness, love, marriage

CBT and The Cognitive Triangle

October 5, 2023 by

Cognitive behavior therapy is a widely utilized and popular form of therapy based on the cognitive model of psychopathology. CBT states that our emotions, body responses, and behaviors are influenced by our perception of events that we are currently experiencing or have experienced in the past. According to the CBT model, situations do not initially determine what people feel or how they behave. However, it reflects how our perception of these events determines the emotions we feel, resulting in patterns of behavior. In contrast, it is the interpretation of the event or situation that contributes to our feelings of distress which is referred to as the cognitive model triangle. According to this model, the cognitive triangle illustrates how thoughts, emotions, and behaviors affect one another. This idea forms the basis of cognitive behavior therapy (CBT). In addition, an important aspect of CBT is centered around “automatic thoughts” which shape our perception of an event that is taking place. This implies that when we change our thoughts, we will also change our emotions and behaviors. By focusing on irrational or maladaptive thoughts, mood, and behavior can be improved, therefore shifting our understanding or perception of the events that have or are currently taking place. Educating a client on the importance of their automatic thoughts can lead them to understand how past traumas and significant experiences have shaped their current worldview. This realization can lead to the healing required to overcome past traumas and assist in the treatment of PTSD. CBT is known to be quite effective for depression, anxiety, stress, and trauma. In conclusion, the cognitive triangle shows how thoughts, emotions, and behaviors affect one another. This means changing your thoughts will change how you feel and behave.

Written by Dr. Jason-Anthony Prendergast – Doctorate in Pastoral Psychology and Registered Mental Health Intern

Filed Under: Anxiety, Couples/Marriage, Depression, Family, marriage, Men's Issues, Mental Health

Therapy Goals

September 21, 2023 by

We have all experienced moments in which we felt we were at a loss for handling a situation or a feeling. It is during these times we seek outside assistance, be it from friends, loved ones or with a therapist. Because these are difficult and stressful times, problem solving, positive thinking, or solution finding can seem impossible. However, in therapy this is exactly what we strive for in the midst of these chaotic moments.

This first requires an individual’s awareness they have exhausted their mental and emotional resources and acknowledge the need for professional guidance through this process. Finding a therapist with whom you can share this space continues this process through the sharing of these experiences, feelings, and struggles. It is through this exchange of honest and often difficult information the therapeutic alliance is formed. This alliance between therapist and client is the foundation on which therapy goals are created and refined.

Many individuals do not have clear therapeutic goals at the outset of this journey. Taking the time and making space to sort through uncomfortable situations and emotions brings clarity to one’s thoughts, feelings, behaviors, and therefore, their goals. Therapeutic goals can and will change throughout the process but having a goal on which to focus allows us to see solutions, successes, and areas of improvement. Therapy goals could be considered the mile markers on the journey to wellness.

Working with a therapist to achieve these goals requires individuals, couples, and families to join together, taking the information and insight acquired in sessions into their everyday lives. This day-to-day application solidifies new skills, new ways to view or assess problems, and ultimately achieve goals. Once the goals for therapy are achieved, the skills and benefits of these changes can be applied to future issues and concerns resulting in lifelong improvements in one’s well-being.

Written by April Daniel MS, NCC, LMHC – National Certified Counselor (NCC) and a Licensed Mental Health Counselor

 

Filed Under: Anxiety, Communication, Couples/Marriage, Depression, empower, Family, honesty, Inspire, Intimacy, kindness, love, marriage, Men's Issues, Mental Health, Self-Worth, selfless, Sexual Health, Uncategorized, Women Empowerment, Women's Issues

Walk + Talk Therapy by the Bay

September 8, 2023 by

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/

Filed Under: Anxiety, Communication, Couples/Marriage, Depression, empower, Family, Inspire, Intimacy, kindness, love, marriage, Men's Issues, Mental Health, Self-Worth, Women Empowerment, Women's Issues