CONSUMER
INFORMATION

Philosophy of the Boulder Psychotherapists’ Guild, Inc.

• Psychotherapy is a valuable health care service that benefits many people.
• Informed consumers should make their own personal mental health caredecisions in consultation with the professional of their choice. These decisions include the selection of a therapist, the goals of therapy, and the length of therapy.
• The Guild strives to provide the consumer with clear information about the members’ psychotherapy services, the nature of psychotherapy, and Guild services.

The Informed Consumer of Mental Health Care

Why be an informed consumer?

• You are the only person who has the authority and right to decide what treatment you or your children receive.
• You know your own individuality better than anyone else. Experts base their knowledge on what most people are like, but you still know yourself better.
• You are the person who is in charge of following through on maintaining your
  own mental health.
  
  What do informed consumers need to know?
  

• What are the types of mental health problems or issues that you might have?
  
• What are the potential benefits of various treatments or other solutions?
  
• What are the possible risks of various treatments or solutions?
  
• What are the costs of the various treatments or solutions?
  
  How do you get information?
  
  
• Read this directory.
  
• Ask professionals for their opinions and recommendations. Ask
  them to explain. Make a list of questions because it is typical to forget questions when in a professional’s office.
  
• Read about your issues or problems.
  
  When you are informed, what happens next?
  
  
• You are able to make your choices.

What is Psychotherapy?

Psychotherapy is a powerful, time-honored and proven method of helping people change the way they feel and manage their lives. Therapy is the practice of talking things through with a skilled and trusted professional who, by using a variety of techniques, can help clients make positive changes in their lives. It is a healing method based upon both the science of psychology and the skills of understanding, teaching, supporting, and confronting.

In therapy, it is important for clients to be self-aware and open but for most people, this is difficult. Feelings of shame hinder self-awareness and openness. To be successful, the therapist must support the client and avoid shaming and judging. Over time, by openly and honestly talking about feelings, the client learns to trust that the therapist will be able to provide understanding and support even while discussing behavior about which the client and/or therapist may disapprove.

Psychotherapy is confidential and private. No information about therapy sessions can be released to anyone without client permission. (There are legal exceptions to confidentiality —when someone is a danger to themselves or others and when there is evidence of the physical or sexual abuse of children. These exceptions can be explained in more detail by a therapist.)
Psychotherapy is individual. A skilled professional has a knowledge of many therapeutic techniques and is able to use them to meet individual needs.
Effective therapy moves at the client’s individual pace. A therapist knows how to time interventions according to a client’s readiness. Together, client and therapist decide the frequency of sessions and when it is time to end the therapy.

Human beings have the amazing ability to control or alter the course of their lives. Furthermore, we are biologically programmed to control and change our fate most effectively when we discuss our feelings with a helping person. This is why the effects of talking to another person are more profound than the effects of talking to ourselves, especially when the other person can listen skillfully and respond empathically. Psychotherapists use the skills and knowledge of psychology. The power of the healing relationship between patient and therapist grows over time.

Research shows that with trained, empathic and experienced therapists, people can make great improvements in their personal, emotional, occupational and interpersonal lives. In fact, millions of people have benefited from psychotherapy. Solving problems in therapy can prevent many of the social tragedies of our time including depression, domestic violence, child abuse, school failure, substance abuse and suicide.

Psychodynamic Psychotherapy

by Cynthia Kale, Ph.D.
and Evelyn Bassoff, Ph.D.

In the present era of managed-care health care, the most commonly recommended therapy for people with emotional problems is brief and symptom-focused. Increasingly, the health insurance industry requires that mental health providers find quick solutions to reduce their client’s distres-sing symptoms. “Quick fixes,” however, often do not produce sustainable changes for complex human problems. A more effective treatment is psychodynamic psychotherapy.

What is psychodynamic psychotherapy? It is a therapy that addresses the client’s inner conflicts, which may, for example, derive from early traumas or troubled relationships with parents. Through a deepening and compassionate self-understanding, clients free themselves from the destructive aspects of their past. In psychodynamic psychotherapy, clients look beyond the symptoms of their unhappiness to their causes: they learn why they feel as they do and how their feelings came about. They see the big picture (which is why psychodynamic psychotherapy is also called “insight-oriented” psychotherapy) and they begin to make lasting changes that may have been impossible in brief therapy.

The quality of the relationship between therapist and client is a critical factor in successful psychodynamic therapy. The therapist becomes a true ally as well as a reliable and skillful collaborator in the healing process. In fact, as the best research in psychology has demonstrated, a successful outcome and a strong therapeutic relationship go hand in hand.

Some facts about psychodynamic therapy:

• Treatment typically lasts at least one year.
  
• It emphasizes autonomy, improved self-esteem, and self-understanding.
  
• For people who want to make sense of their whole life story and
  get at the root of their problem, it is a therapy of choice.
  
• It is a treatment with goals more ambitious than symptom relief;
  it aspires to increase personal awareness and growth.
  
• It is an alternative for those who have tried other treatment and found it unsuccessful.

What About Brief Therapy?

Consumers generally want their therapy to be as brief as possible, and today more people are talking about brief therapy techniques. Many researchers and therapists call 30 sessions of therapy—“ brief. ” Other therapists consider “brief”to be just a few sessions. It is important to know what a therapist means when referring to “ brief therapy.”

Research generally shows that therapy must be longer than a few sessions to be helpful. Studies suggest that at least 6-8 sessions are necessary for the benefit of psychotherapy to be measurable. The research that proved psychotherapy is beneficial was based on analyzing hundreds of studies of therapy that averaged 17 or more sessions.

Whether brief therapy works for you depends on what you are looking for from therapy and the kind of problem you bring to therapy. Many times people see a therapist for just a few visits. This can be successful if a client is looking for a brief consultation or is dealing with a temporary crisis. Sometimes a therapist can help individuals or families change very quickly. Most therapists use brief therapy when it is appropriate. What is important is making sure that your goals are accomplished.

Because it can be helpful with many people, it makes sense to consider brief therapy. However, long standing, difficult, complicated, or more serious problems often need more time. Long-standing problems rarely change overnight. But even for these difficult problems, there has been a trend over the last thirty years for therapy to be shorter.

Some insurance and managed care companies encourage almost everyone to use an ultra-brief therapy that lasts only a few sessions. Unfortunately, there has not been any research showing this kind of therapy to be effective. If you have experienced brief therapy that didn’t work for you, it may have been the wrong treatment, and a longer term therapy may be what you need.

As an informed consumer, you should ask your therapist about the length of therapy. Your therapist may not know the exact duration of your therapy but can help you understand how therapy moves forward and how you can tell when it is complete.

Individual Psychotherapy:
When to Start and When to Finish

by Ina Robbins, Ed.D.

When do I need outside help?

We each feel our emotional pain differently. Therefore, we must make a personal decision about when to enter therapy. We generally seek therapy when there is a crisis or a persistent disturbance in our thoughts, feelings, or behavior that interferes with our work or relationships. You may want to enter therapy when:

• You have trouble making or keeping satisfying relationships or
  have repetitive problems in your relationships.
  
• You have trouble obtaining or keeping a satisfying job or your
  behavior keeps you from advancing in your career.
  
• You realize that an emotional problem has gone on for too long or seems to be getting worse.
  
• You keep behaving in a way that is self-defeating, out of control, or a sign of addiction.
  
• You are often bothered by traumatic memories.
  
• You are preoccupied, worried, confused, or disoriented.
  
• You feel depressed, up and down, anxious, fearful, agitated, or too angry.
  
• You find that no one in your support system can help solve the problem, and you, yourself, are stuck.
  
• You are self-destructive or harmful to others.

When am I done?

Therapists and clients together plan the work of psychotherapy. Likewise, together they decide when therapy is finished. Some of the signs that therapy is finished are:

• You know the sources of your problems and can deal with them effectively.
  
• You encounter significantly fewer problems.
  
• You know how to take care of yourself and maintain your mental health.
  
• You can tolerate the pain and difficulties of life without developing symptoms like those that brought you to therapy.
  
• You handle your relationships and your work well.

Couples Therapy / Marriage Counseling

Partners in intimate relationships start out with many hopes, both realistic and unrealistic, for creating a rich, satisfying life together. Unfortunately, the stresses from life’s events, disappointments in the partner, and the reality of tedious routines often lead to disillusionment. When this happens, some couples fight, some grow apart, and some find themselves living in great pain, tension and suffering. These are the times couples enter therapy. Frequently, they have reached the point of considering separation or divorce.

Is it the intent of marriage counselors to prevent couples from splitting up? No—that’s the couple’s decision. Because the counselors are skilled outside professionals, they can help most couples greatly improve their relationships. However, the improvement may not be enough for the couple to choose to stay together. Because many couples see counselors when they are contemplating divorce, couples often decide to work on their marriage for a while before making the commitment to remain married.

A counselor may see the couple together at each session or may want to see the partners individually. Counselors also vary in the amount of privacy they encourage each person to maintain. Some focus on childhood issues, expectations, and relationship patterns. Some therapists focus mostly on communication and problem solving.

When Does a Child Need Therapy?

Contrary to the wishful myth we have often heard, children are not more adaptable and less affected by problems than adults. The opposite is true—children have fewer coping skills and less control over themselves or their environment. They are not able to verbally describe emotional problems but exhibit their distress in a number of symptoms that include irritability, sleeping problems, eating problems, personality change, physical complaints, disregard for personal safety, school problems, problems getting along with
others, acting younger than their age, and acting older than their age.

Every child will be distressed at times. How does a parent know when psychotherapy is needed? This depends on how severely distressed a child is, how long the child has been distressed, the child’s personal strengths for handling problems, and what kind of help is available. Child therapists can help evaluate if therapy is necessary. If therapy is needed, therapists may work in several different ways: sometimes they assist the parents and teachers design techniques for helping the child, sometimes they see children and parents together in family therapy, and sometimes they see children alone.

How Much Does Psychotherapy Help ?

Psychotherapy can help almost everyone. Studies show that, on the average, people with emotional or interpersonal problems who use psychotherapy do better than those who don’t. The amount of improvement depends on the person, the type of therapy, the length of therapy, and the type of problem.

People often ask if psychotherapy can “cure” a person. They are thinking of a person’s emotional problem as an illness. Medical tradition leads us to think in terms of illness and cure. This is often useful, particularly when treating some emotional problems that are like illnesses and may be called a mental illness. However, this is not always the best way to think about using psychotherapy. Some problems can be completely solved by psychotherapy and can be thought of as “cured.” At other times psychotherapy helps people solve emotional or interpersonal problems. In many of these situations, it
does not make sense to think that the person is “sick” when they start psychotherapy or “well” when they finish. A useful way to think about therapy in these cases is that the person has grown, improved, gained insight, or solved specific problems.

Sometimes people have a chronic mental illness, and psychotherapy helps the person to cope with the illness. In many of these cases, the symptoms and problems cannot be completely cured. But here, psychotherapy is helpful because it can make an important difference in improving the quality of a person’s life.

Each person is different and unique. The amount of improvement you should expect is something to discuss with your therapist.

What Can a Client Do When Therapy
Does Not Seem To Go Well
— A Second Opinion —

Occasionally a client in psychotherapy does not improve or even seems to get worse. At times clients may question if their therapist is providing the right treatment. Often there is an uncomfortable period of emotional turmoil during therapy. Other times clients may become angry or feel hurt because of something their therapist said or did. These situations can be difficult for a
client to evaluate.

Even in the best of therapy, there are difficult times. When people discuss personal and sensitive topics, they often become very sensitive to the therapist’s reaction. In these situations a client may be easily hurt or angered by their therapist. Trusting anyone is difficult for many clients. Frequently, the reliving of past emotions happens in therapy, and past conflicts may seem to be repeated in therapy. This is called transference. A major part of therapy is separating these past feelings from the present. The process of experiencing these difficult feelings with new skills is healing—but it is difficult.

When problems or concerns do come up in therapy, it is important to discuss them with your therapist. Remember that therapists are professionals, and part of their job is to answer your questions about therapy. If the answers your therapist gives don’t seem satisfactory, then getting a second opinion is a good idea. Second opinions are your right and also a good way to take care of your health.

To get a second opinion, contact another therapist and ask for a second opinion evaluation. This can be done either with or without the knowledge of your current therapist. However, if you decide to continue in therapy, it is important to be open and honest with your therapist about your concerns, and the second opinion should be discussed with your ongoing therapist.

What About Medication?

Making a decision to use medication is individual and complicated. Some problems get better primarily with medication and other kinds of problems get better primarily with psychotherapy. Still other problems respond best to medication and psychotherapy combined. Most often, when people take medication for emotional problems, they do better if they also seek psychotherapy.

The best reason to take medication is that for many people it can cure their symptoms without side effects or other adverse consequences. There are, however, some reasons people choose not to take medication. Some people prefer to avoid medications, some have tried medication and had unpleasant side effects, and others find that medication doesn’t help enough to be worthwhile.

It is important to be an informed consumer. Ask your psychotherapist for advice and information about referral to a medical doctor for a medication evaluation. Ask your medical doctor for advice also. Get as much information as you can about the different treatments for your own individual problem. Then use this information to make your personal decision about when and how to use medication and/or psychotherapy.

Who Should You Talk to About Medication?

When considering medication for mental health problems, a person must ask a medical doctor for a medication evaluation. Sometimes the family doctor or a general practitioner is consulted, and other times it makes sense to see a specialist - a psychiatrist. If a person has a therapist, the therapist can be helpful in making the decision to try medication and may recommend a specific doctor or assist with the referral to a doctor of your choice.

Why do people choose to ask a family doctor for medication? Many people prefer to ask their family doctor for a medication evaluation because they know their doctor, feel comfortable with their doctor, and can easily make an appointment with their doctor. Much of the psychiatric medication prescribed in this country is prescribed by family doctors, and generally they charge less for an evaluation than a psychiatrist.

Why see a psychiatrist for medication? Sometimes people prefer to consult a specialist rather than a general practitioner. Psychiatrists usually can offer both psychotherapy and medication management, but often, patients will see a psychiatrist just for medication and see another professional for psychotherapy. Before prescribing medication, the psychiatrist generally will take a thorough history and conduct a comprehensive verbal evaluation. As a specialist, the psychiatrist is more knowledgeable than a family doctor about how treatment can be effective and will usually spend more time with each client than a family doctor. If the medication or diagnosis is complicated, consulting with an expert is a good idea.

Why do some patients have a one-time consultation with a psychiatrist? Although patients may receive medication from a family doctor, there are still times that it makes sense to consult with a psychiatrist. If the medication and treatment are not working as well as hoped, patients may decide to consult with a specialist about additional ideas for treatment. Sometimes the psychiatrist can give the general practitioner recommendations for changes in medication or treatment that will give better results. When patients would like an additional evaluation from a psychiatric specialist, patients may ask their therapist or family doctor for a referral to consult a psychiatrist or may independently choose to call a psychiatrist. Sometimes after the consultation, patients continue medication follow-up with the psychiatrist, and other times, the patient continues with the family doctor. Usually family doctors are happy to have the consultation and helpful advice from a specialist.

Why Pay for Your Psychotherapy
Rather Than Use Your Insurance?

You want privacy.
Whenever insurance is used, some information (such as your diagnosis) is available to the insurance company and at times to employers. Managed care companies often ask for detailed personal information about clients in order to make payment decisions. This judgmental review can undermine the sense of privacy necessary for effective psychotherapy. When clients pay for psychotherapy out of pocket, there is no loss of privacy to managed care
companies, insurance companies or employers.

You want to choose your own therapist.
Many insurance companies limit the choice of therapists. Some of these “preferred providers” offer good treatment, keep their clients’ interests foremost, and try to keep treatment brief without sacrificing quality. At times however, the insurance company asks the preferred providers to divide their loyalty between the client and the insurance company. Many clients prefer to choose their psychotherapist personally and avoid seeing a therapist with a
potential conflict of interest between the client and the insurance company Other clients may want to work with a therapist who was highly recommended but may not be on the company or preferred provider list.

You want to choose the type and length of treatment.
Managed care programs often limit the choice of therapy. While some interfere very little with the consumer’s choice of type or length of therapy, others make many of the important treatment decisions -the length of treatment, the type of therapy, the use of medication, and referral to self-help groups instead of professional services. Some companies provide only ultra-brief therapy and referrals. Self-paying for therapy may be necessary in order to receive the type and length of treatment needed.

You don’t want a managed care employee making judgments about you.
When managed care is responsible for payment, they have the power to influence your treatment. A company employee evaluates your motivation, the severity of your problem, and your progress and makes treatment recommendations. The therapist must take the company’s recommendations into consideration or risk losing the contract to work with the company altogether. Many clients prefer paying for their own treatment to eliminate influence from an outsider.

You don’t want to be labeled “ sick.”
Whenever insurance is used for psychotherapy, the treatment must be “medically necessary,” which means that your therapist must give you a psychiatric diagnosis. When you pay directly, you may seek consultation from a mental health professional for any reason you choose. People use therapy for personal growth, for help coping with stressful life situations, and for marriage and family difficulties, as well as for chronic and serious psychological problems.

Comparison of Self-Payment and Managed Care

What You Should Ask if You See
A Managed Care Therapist

Because of the rapid increase in the cost of health care, most insurance plans are using Health Maintenance Organizations (HMOs) or “Managed Care Companies” to control costs. These companies promise to control costs by cutting waste and lowering rates. Because insurance often requires that consumers use a managed care company and the co-payment is very low, many consumers use the mental health benefits under their managed care plan.

The management company hires or contracts with the psychotherapist and then encourages the therapist to follow cost-reducing policies. This is a problem when the managed care company makes choices different than the consumer. A concern for many therapists is that some companies ask the therapist to end treatment sooner than the therapist feels termination is advisable. When therapists do not follow the company directives, they risk losing their contracts.

There are many good therapists working for managed care and many clients receive good treatment from managed care. However, therapists working for managed care companies do have split loyalties. They are working for both you and the company. It is important to know about the therapist’s obligation to the managed care company and how this may influence your treatment.

Questions you can ask of a managed care therapist

• Ask what kind of arrangements your therapist has with a managed care company. Psychothera pists have codes of ethics that require them to be honest with their clients and reveal information
  about how managed care companies are involved in treatment.
  
• Ask specifically about financial arrangements in which the therapist makes more money by seeing you less. One of these arrangements is called a “capitated contract.” With this arrangement, the therapist is paid a certain amount regardless of the number of times you are seen. Under these contracts the therapist has no financial incentive to see you after the first meeting. Sometimes there are bonuses for quickly discharging clients.
  
• Ask if your therapist or other therapists would make different treatment recommendations if you were paying directly.
  
• Find out if there are any policies that limit or restrict the treatment available to you.
  
  If the answers to your questions about your treatment are not satisfactory, you have a right to a second opinion.
  
  Good therapists will be open and honest about the involvement of managed care in your treatment. You have a right to know about alternative types of treatment and everything that the managed care company does to influence your personal mental health care decisions.

Is Therapy a Wise Way to Spend Your Money?

If people have a need for psychotherapy, the improvements they make through therapy often result in so much financial benefit that therapy becomes a wise use of their time and money. How is it that therapy can lead to financial benefits?

One of the financial benefits comes from reduced future medical expenses. Because so many long-term health care expenses are a result of stress or untreated mental health conditions, proper mental health treatment greatly lowers the overall cost of health care. In fact, many research studies show the medical cost savings are so great that when a large group’s medical costs are measured over a period of three to five years after treatment, therapy lowers overall health care costs so much that it more than pays for the cost of therapy.

Therapy can also improve a person’s performance on the job. Employers are becoming increasingly aware that mental health problems can increase the number of sick days, interfere with the quality of an employee’s work, and decrease an employee’s productivity. The financial benefits of treatment are great enough that many employers have hired employee assistance programs to provide short-term therapy and identify employees who can benefit from longer-term therapy. Executives and some other people now use a form of psychotherapy - coaching - to improve their effectiveness and performance. Moreover, psychotherapy helps many individuals succeed in gaining promotions or becoming ready to change to a better job.

Problems with relationships and family issues can be very expensive. There are enormous costs that can result from divorce, child adjustment problems, or other relationship problems. Individual and family therapy can often help in averting these costs.

So how should you decide if therapy is a wise use of your money? Of course, individuals are different and need to decide this for themselves by making some educate guesses. To figure this out for yourself, try to estimate the total cost of your therapy and compare it to the long-term reduction in costs or increases in income. You can ask your therapist to help by estimating how long it might take to accomplish the kind of changes that you hope to make in therapy. Use this information to estimate the cost of therapy.

To estimate the financial benefits, consider the changes that you are making in stress levels that may affect your long-term health care costs. Look at whether the therapy is helping you be a more productive employee or enabling you to earn more money through promotions or by changing jobs. Look at the relationship and family problems that you are working on in therapy and evaluate if the therapy is likely to avert expensive problems in the future.

When you estimate the cost/benefit ratio, remember your personal improvements may yield financial benefits over many years to come, and the therapy costs are usually spent up front. If you are like most people, as long as there is a need for treatment, you will find that the potential financial benefits probably justify the investment in psychotherapy even when insurance does not pay for the treatment. In addition, think about the possible intangible improvements in your quality of life that cannot be measured financially.

What You Need to Know to Choose a Therapist

Is this psychotherapist qualified to help me?
There are many kinds of problems that people bring to therapists. The license provides proof of basic qualifications, but many professionals have additional training. A professional’s experience, interests and specialties also help you decide about the qualifications that are important to you as an individual.

Does this person use a type of therapy that fits for me?
Does the therapist work with the right age group? Are they able to offer what I’m looking for—individual, couple, family, or group therapy? There are many effective types of psychotherapy. Each type may put a different amount of emphasis on feelings, thoughts, relationships, or the unconscious. Some value brevity while others value thoroughness. Ask how a therapist would help you work on your problem and see if it
makes sense to you.

Do I feel comfortable with this person?
It is very important for you to feel comfortable, respected and supported by your therapist. How you feel talking to a therapist is very important because a therapeutic relationship must have trust, openness and honesty.

What does the therapist charge?
For the member’s listed in the directory, the Guild’s 20% “no administration” discount applies to outpatient individual, couples or family therapy if there is no insurance or other paperwork, and you request the Guild discount when agreeing to fees at the beginning of therapy. Find out if the therapist has a sliding scale and if they take your insurance.

How does someone go about arranging for therapy through the Guild?

Phone call—After getting a few therapists’ names, you may call to ask some
questions or schedule an appointment. Most therapists are have voice mail. Be
prepared to leave a clear phone message with both daytime and evening phone numbers.
Get-acquainted interview—Some therapists offer a brief chance to meet and
get acquainted free of charge. Ask if this is possible. Some clients prefer to make a choice and get started right away by scheduling the first therapy session.
Questions to ask—Think of the questions you would like to ask on the
phone, in the get-acquainted interview, or in the first session. You may want to write them down to make sure you can remember them. The ideas in this directory should help you think of some questions that are important to you.
The first meeting—When you first meet with a therapist, don’t be surprised
if you are nervous - most clients are. Inner feelings and thoughts are hard to talk about and it takes time to trust and feel comfortable with a therapist. Don’t be surprised either if you open up almost immediately and share personal concerns. Many clients experience great relief in finally having a chance to talk with a professional.

Licensing Credentials

A license to practice psychotherapy indicates that the state of Colorado has verified that a psychotherapist has completed a professional training program, has completed a period of supervised experience, and has passed a formal examination in a specific profession. The Guild Members have one of the following five types of licenses.

Clinical Nurse Specialists in Psychiatric Nursing must complete a two-year master’s degree in nursing, complete a supervised clinical and psychotherapy training internship as part of the degree program, pass an oral examination, and be licensed as an advanced practice nurse.

Licensed Professional Counselors must complete a two-year master’s degree in counseling and the practice of psychotherapy, one year of supervised post-degree experience, and pass a written counselor’s examination.

Licensed Clinical Social Workers must complete a two-year master’s degree in social work and the practice of psychotherapy, two years of supervised post-degree experience, and pass a written social work examination.

Licensed Marriage and Family Therapists must complete a two year master’s degree in family therapy and the practice of psychotherapy, two years of supervised post-degree experience, and pass a marriage and family therapist examination. While their training specializes in marriage and family therapy, they may also be qualified as individual therapists, and psychotherapists with other licenses may be qualified to conduct marriage and family therapy.

Licensed Psychologists must complete a four year doctoral degree in psychology and the practice of psychotherapy, one year of supervised post-degree experience, and pass both a written and an oral psychologist’s examination.

Psychiatrists must first become licensed medical doctors. Additionally, they must complete a three-year program in psychiatric medicine and the practice of psychotherapy.

The following pages are provided for your benefit:
 
Eleven Unethical Managed Care Practices Every Patient Should Know About.
© Ivan Miller 1998.
 
End Secret Treatment Guidelines
by Ivan Miller, Ph.D.
© American Psychological Association Monitor 1997.
 
Dealing with Insurance Refusal to Pay for
Couples Therapy
© Ivan Miller 2000.
 
The Time Has Come to Choose the Replacement for Managed Health Care
© Ivan Miller 2000.