Lauren Schiffer, LICSW, MPH

To Skype or Not To Skype- Part One

I recently received a phone call from a former client in distress. We met for almost two years and ended our work together a few months ago because he was finishing his graduate program and moving out of state for a fellowship. It was good timing. He had been doing well emotionally for months, had transitioned off of medication with very little trouble and stayed stable, we had been meeting less frequently as a result and the upcoming move involved a great deal of excitement and happiness. He would be doing a prestigious fellowship at a well-known hospital and would be moving in with his partner after six years of long distance. As far as terminations (the therapy word for ending treatment) go, this one was a “web-gem.”

When he called last week, he was a few weeks into his fellowship, feeling very overwhelmed, afraid that he could not “cut it” in his program, was paranoid that he would make a mistake that would hurt a patient, was having trouble falling asleep, was waking up repeatedly throughout the night, and was having ongoing chest tightness. Not his best day. At the start of our conversation he stated he felt like he did when we first met, like all the work we had done flushed down the toilet and that he was back to square one. I disagreed. While he was most definitely having a flare-up of anxiety, which is pretty normal when someone with a history of anxiety makes a major change, he was not at square one. I reminded him that while physical and cognitive anxiety symptoms had returned, the coping skills (taking medication, regular exercise, talk-therapy, positive self-talk) he developed and used in the past were still in there, he just need to be reminded to use them. We discussed options, which included the possibility of finding local providers and resuming medication or talk-therapy. He was open to the medication suggestion, but was reluctant to find a new therapist, “I’m not sure I want to start over with someone else, that I could connect with someone like I did with you. Maybe we could do phone or video sessions over Skype?”

Hmm… Maybe we could do sessions over Skype? Prior to this phone call, I had met a few clinicians personally and discovered many more on-line who conduct sessions via Skype, using the video conferencing feature. I found the idea interesting, but did not consider trying it myself. When my former client suggested it, I began more actively entertaining the idea. Could we do video sessions via Skype? More importantly, should we?

The issues of ending work with a particular therapist because of moving away or moving on, client attachment issues, boundaries in the therapeutic relationship, ethical concerns, transference (the unconscious feelings in the client that are brought up and projected onto the therapist) and counter-transference (the unconscious feelings brought up within the therapist) all needed to be considered in this decision. I would do that, but before deciding whether or not I should provide psychotherapy using video-chatting over the internet I needed to find out if I could. What are the laws for social workers providing therapy via internet video chatting? Are there any? Federal? State? What does my licensing board think?

So I began to research, like the good student that I always was….. and then I fell down a legal and internet rabbit hole, involving MA and VA social work licensing boards, the National Association of Social Workers (NASW) legal counsel, the NASW Massachusetts chapter’s ethics committee, and a non-profit called the Center for Tele-Health and E-Health Law. I got a few answers, still have a few questions unanswered and was left to ask myself even more questions. I’m going wait for a few more folks to call me back, let all the new information marinate in my brain for a few days, make a decision and then post again. Stay tuned……

It Could Be Worse

Out of pure coincidence I happened to spend my most recent vacation in both north and south New Jersey the same time as Hurricane Irene. Over the course of four days I was at the Jersey Shore, where the ocean and strong winds did less damage than expected, and in Northern New Jersey, where the onslaught of rain caused rivers to crest to record levels, washing out roads and flooding homes. An annual summer-send-off beach weekend turned into hurricane prevention, bringing lawn furniture and potted plants inside, tying down anything loose, evacuating from a barrier island, and keeping fingers crossed. Clean-up involved using a wet vac in the basement and collecting five garbage cans worth of fallen branches. Not the vacation I had planned, but all-in-all not so bad for a hurricane.

When the rain and heavy winds finally stopped, I practically sprinted out of the house to avoid going stir-crazy. There was a crystal-blue, cloudless sky, a perfect-ten day that almost made you forget about what happened twelve hours before. Walking through the suburban community, we observed the full range of impact. There were large tree branches on top of cars, downed power lines and blown transformers that left a block of neighbors without power for the weekend. Others had piles of belongings, ruined by basement flooding, out on the curb for trash pickup. On our walk we stopped to chat with friends, neighbors and anyone out cleaning up. Stories about the damage were swapped and jokes about my poorly timed beach vacation were made. However, what really stuck with me was that every conversation ended with, “Well, it could be worse.”

Yes, it can always be worse. If your beach vacation was ruined by a hurricane, you can be grateful that you didn’t have to evacuate from your hotel. If you had to evacuate, you can be glad it wasn’t your hometown or city that was hit. If the basement flooded, you can be grateful that your whole house wasn’t destroyed. If your house was destroyed you can be grateful that no one was hurt…. AND ON AND ON AND ON. But when do you get to stop that Look-On-The-Brightside-Pretty-Princess-Routine? Staying healthy emotionally does not mean being happy or staying positive all the time. Being emotionally healthy means having the right feelings, in the right amounts, at the right time. While it’s not good to spend your whole life complaining about your bad luck, feeling that you are being punished for something, or believing that you can’t catch a break, can you at least be allowed a week, a day, or even five minutes? In early sessions of treatment, I often encounter clients who feel embarrassed or ashamed that they are wasting my time with a problem that is “silly” or “not a big deal.” It’s as if their problems are not serious enough, or that they are not allowed to talk to a therapist because “It could be worse.” They censor themselves before our work has even started.

It doesn’t have to be so dichotomous. We can be upset, cry, and shout, “It’s not fair,” while also acknowledging that it could be worse. Yes, you could be homeless, paralyzed from a car accident, a starving orphan in Africa, or a victim of human trafficking. But you’re not. You are only you, and the only pain you can feel is your own. It’s good to have proper perspective, to be able to count your blessings, to feel and show gratitude. However, responding to every negative feeling and comment with “It could be worse” is invalidating. Allow yourself to have a negative emotion, acknowledge your feelings and then start moving on. Try this next time, “I know it could be worse, but this still really sucks.”

Don’t Tell the Point Guard to Hit a Home Run

A friend and I were recently discussing comparative religion on a road trip, a conversation inspired after listening to The Book of Mormon, this year’s Tony Award winning best musical by Trey Parker and Matt Stone of South Park fame. My friend, a PhD candidate, has been doing an excessive amount of academic reading this summer (“excessive” to me, but probably a normal amount for a PhD student) and she shared with me an analogy she loves and has been using all summer, which she came across in the introduction of Stephen Prothero’s God Is Not the One. From what I gather, Mr. Prothero wants his readers to understand that the major religions are not playing the same game, but very different ones, with different rules, different scoring systems and different outcomes. To compare and communicate between religions one needs to under stand this.

Later that weekend she brought out the analogy when giving another friend advice about how to deal with a family conflict. Our mutual friend was having a hard time figuring how to support her brother through a difficult time, while also dealing with all the mixed feelings that tend to arise when family dynamics are involved, such as frustration, love, resentment and concern. She wanted to help her brother as soon as possible and wanted to know what she could say or do to get him to seek out the help he needs. But it’s never that simple, and the analogy was fitting. “Right now, the two of you aren’t playing the same game. It’s as if you play baseball and he plays basketball. Your advice, suggestions and encouragement come across to him as if you were telling a basketball player that he should score a lot of runs.”

The analogy really appeals to me. Although the concept is not new in social work or mental health, it’s funny, simple and is a nice replacement to the overused, seventies-cheesy, social work phrase, “Meet the client where they’re at.” Honestly, it felt like this phrase was tossed out a daily basis in social work school, so over used and groan-worthy that even professors could be caught wincing, making air quotes or practically apologizing for saying it. However the phrase couldn’t be avoided because the concept was so appropriate, important to our training and clinically rich.

As clinicians we have to remind ourselves regularly that the goal of treatment must be the client’s agenda, not our own. It’s not about us and it’s not up to us to decide what is best for someone else. Despite our best intentions, if we don’t understand what matters to the client, how they see the world, how they define success, or what type of changes they think are important, we miss the mark. Ultimately a major goal in my session is not to tell someone what to do, but to help them decide what they want to do and how to get there. To coach you or cheer you on, I have to understand the game you are playing.

What’s In A Name?

A friend and colleague has begun making plans for a private practice and was recently kicking around company names with a few of us over e-mail. As often happens in the field, the decision about how to refer to the work arose. Counseling? Therapy? Mental Health? Behavioral Health? At my various Social Work internships and jobs I’ve worked under each one of those departments, the role being the same but the name always changing. In my experience the name choice is always purposeful, can sometimes date the organization, might give you a quick glimpse into the mission, philosophy and style of the folks in charge, and might even give you a sense of the type of client a company or agency is trying to attract. That is of course, if you know what you are looking for. More often, it creates a great deal of confusion for the average consumer, client, patient, or however else you wish to be described.

As you can tell from my website address and my business cards, if I’ve ever given you one, I refer to myself as a therapist, the work as psychotherapy, and the field as mental health. My goal is to convey that I work to promote the health of the mind. My description would freak some providers or executive directors out. The fear is that saying things like “mental health” and “psychotherapy” scare clients away, make them think of crazy people, make them worry that you think they’re crazy, or that by coming to see you it means they are crazy by default. I have been told by former supervisors that “counseling” or “behavioral health” makes people less anxious, and more likely to come in.

>SIGH<

I’m not a fan of euphemisms. I don’t use nicknames to refer to body parts when talking with children, don’t like saying “passed away” or worse the medical term, “expired” when someone has died, I don’t whisper the word cancer, and I don’t refer to “the incident” when something terrible has happened. The whole point of a euphemism is to substitute a more comfortable word or expression for one that could make people feel uncomfortable or represents something unpleasant. But that’s the problem right there: many things people discuss in therapy, events from their past or their current worries ARE unpleasant. You don’t usually see a therapist because life was and is totally awesome. My worry is that euphemisms in the therapeutic setting support and promote shame, and so I want to avoid them. I think that’s where my knee-jerk objection to using “counseling” as a substitution originates. Why are we removing terms like “mental health” and “psychotherapy” out of fear they make people uncomfortable? How do we begin to destigmatize mental health if we avoid these terms ourselves? Shouldn’t we be leading by example, letting our clients know that working on your mental health is not something you need to be embarrassed or ashamed of?

Since I think they are good at everything, I’ll leave you with the World Health Organization’s definition of mental health for inspiration.

“Mental health is not just the absence of mental disorder. It is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.”

Don’t Feed the Beast

Sometimes a client and I come up with an expression or phrase in session that we then refer to for the rest of our time together. It becomes part of our therapeutic language, a memento of our work together. If it is something I think will be helpful to other clients, I’ll repeat it, but in my mind it will always be connected to the client and session where it was created.

This happened recently with a client who is dealing with a very difficult break-up that has left her feeling not only devastated, but lonely, unwanted and totally undesirable. While in this state, she agreed to join a friend for drinks with a guy who expressed interest in my client’s friend. The friend wasn’t sure how she felt about the guy, so she wanted back up. That’s right, my client knowingly agreed to be the third wheel, at a time when the last thing she wanted or needed to see was to see a budding romance up close. When I asked her why she agreed to this, she wasn’t sure, but she knew before even going that it would make her feel bad. We decided to name this behavior “Feeding the Beast.”

Feeding the Beast is doing things that support or reinforce your self-deprecating thoughts. It’s a set-up, with no way for you to get out of the situation without feeling worse. It’s acting against your best interests, creating a situation that everyone else can see is a bad idea. Although it’s the last thing you would ever want, you wind up deepening your pain. Feeding the Beast is:

-Spending an hour on your ex’s facebook page, combing through her photos of her vacation in Tuscany with her new boyfriend who happens to be a Brazilian underwear model

-Weighing yourself when you are feeling badly about how much you ate at yesterday’s office potluck

-Working as a bartender when you are trying to stay sober

-Attending every baby shower you get invited to while you are struggling with infertility

-Taking your mom to an all-you-can-eat buffet for Mother’s Day brunch when you are struggling with bulimia

Sometimes the Beast is hungry, it needs to be fed, and it feels like we are helpless to resist. Depression is like wearing dirty glasses, it makes it hard for us to believe we deserve to feel any differently. Having an eating disorder can feel like living with a demon, tricking you into weighing yourself fifteen times a day, feeding the obsession and shame. Don’t misunderstand me; eating disorders, infertility, and depression are real problems, brought on by various medical, neurological, psychological, environmental, and social causes. We don’t ask to feel this badly and we didn’t bring them on ourselves. However we sure can make things a hell of a lot worse for ourselves. If at all possible Don’t Feed the Beast.

“Being An Adult”- Part Two

As I mentioned in part one of this post, I believe a big part of being an adult means doing things you don’t want to do. That means sucking it up and finding the motivation you need to get things done.

A good old dictionary.com search for “motivation” comes up with “to provide with a motive; incite; impel.” Digging deeper, the word motive is defined as “something that causes a person to act in a certain way, do a certain thing.” The origin is linked to medieval Latin for “serving to move,” which is the part of the definition I find most helpful, providing the visual concept. People who are motivated appear to be in motion, convey a general sense of movement. They set goals, meet them, and do it all over again the next day. Sometimes the motivation is internal sometimes external, but often not related to a positive feeling. Fear, anxiety, the collection agency, the approval of others, and vanity all get some people to do things that are not intrinsically fun.

How do you become one of those people? What does one do about those day to day motivation struggles like flossing, finishing thank you notes after your wedding, or calling your grandma more often, like you promised? The basics are nothing new or mind blowing: set small and measurable goals, track your progress, have someone or something to which you hold yourself accountable, reward yourself when you meet a goal. BLAH BLAH BLAH. We’ve all heard it all before and it sounds like a great plan, and we’ll get around to, but maybe later, because So You Think You Can Dance is on right now, and we had a long day at work and besides, we’re grown ups and we want to do what we want to do, when we want to do it. So there. However, if your looking for a gentle nudge, coaching or a little forcing, there’s always the internet.

Most of the time people make resolutions or set goals related to losing weight or getting in shape. If that’s your goal, there are a gazillion women’s magazines, websites, and companies out there where you can log on, set goals, chart progress and feel alternately good and bad about yourself depending on the day. I decided not to research weight loss specific on-line tools for this post because I’d rather not fall down that rabbit hole on a Monday in the middle of the summer, nor do I want to drag you down there with me either. Instead, I decided to set a goal for myself unrelated body image and be the guinea pig. My goal was to “actively blog” and since that’s too vague, I quantified it as writing one new post a week. SPOILER ALERT!!!! It’s Monday night and my last post went up last Sunday, so you can guess how I did so far, but I’m not giving up that quickly on my dreams. Better late than never. Here’s what I found:

stickK (stickk.com)

After years of unsuccessful attempts, an econ professor at Yale decided to really get serious about his health and loosing weight, so he decided he would pay a friend $500 a week every time he failed to get closer to his goal. The contract continued when he met his goal, focusing on maintaining a healthy weight. It worked for him because loosing 500 bucks a week was pretty painful, as it would be for most of us. He then decided to take this idea public and created an “online commitment store,” stickK. At stickK you sign up, set a goal, decide how much money you will loose, and pick a referee who checks up on you. You can donate your money to charity, which will randomly donate to a list of charities stickK supports. To make loosing even more painful, you can donate to an anti-charity, one’s who’s mission you don’t support, like the NRA or Planned Parenthood, depending on your politics. You also have the option of giving money directly to a “friend or foe.” I went with the no money down option and was reminded by a pop-up that putting money on it DOUBLES (their caps, not mine) my success. Basically it was a nice way of saying, “Are you really that serious about meeting this goal if you’re not willing to throw down the cash?” Touche. While I did not meet my once a week goal, I did get an email from stickK this morning, telling me to fill out my first “report” which will go to my referee. My referee then tells stickK how I did. I lied on the report and said that I met my goal, with the hopes that I would finish this post before my husband (my designated referee) checks my blog to verify. So although a day late on my goal and with a new lying habit, the report card and time crunch pulled me off of facebook and back to editing this post.

HassleMe (hassleme.co.uk)

The most humorous of all the sites I explored is HassleMe. The site’s tag line says it all, “Because sometimes in life you just need to be nagged.” You simply write in your “hassle, ” give them your e-mail and tell them approximately how often you would like to get a nagging e-mail related to your goal. The idea is that the site will be unpredictable with the timing of the e-mails so that you are annoyingly surprised. It is very easy to sign up and beautifully simple. You can also put in your husband’s, teenager’s or roommate’s e-mail address and nag someone else about getting something done. I once had a client who put a sticky note on her husband’s mirror, reminding him to tell her that she is beautiful. This would be the digital equivalent. The website is also really entertaining, as it lets you read other people’s hassles (anonymously of course), which can be hilarious. I loved this feature, but it was basically anti-motivation, giving me yet another internet procrastination destination.

What fascinates me about stickK and HassleMe is that they go against basic behavioral treatment theory. The first and only thing I remember from the one day I studied behavioral therapy in social work school, is that rewards work better than punishments. Both sites actually operate against that theory, getting you to act to avoid punishment. StickK uses negative punishment, taking something you like (money) away from you, while HassleMe goes with positive punishment, giving you something painful or annoying (spam) until you change. Not sure how the sites are tracking their “success rates” but they could be challenging years of behavioral treatment theory.

Mint.com

Because financial savvy is both sexy and trendy, I wanted to be sure to include a site that helps with money management. Purchased by Intuit, the company that makes Quicken, around 2009 (proving the best way to beat your competition is to buy them), Mint.com gives you a web-based, free, money management system. You can’t see what Mint does until you log on, which means you must give them your bank account and credit card information right off the bat. Since my e-mail account was hacked the same day I started researching the post, there was no way I was doing this. However, a good friend who loves the site and was comfortable enough to let me see all of her financial information, walked me through a webinar, showing me her account. If you take the leap of faith and let them have access to all your accounts, Mint tracks, categorizes and charts your spending for you. It will group expenses into categories like food, clothing, entertainment, and pet care. You can also use it to help you set goals, like saving $200 a month, and it will track your efforts with a bar graph as the month progresses. Green, yellow, and red indicators tell you how close you are to going over budget on each category, and provide a nice visual. Because Mint is free it is ad supported, and the ads are cleverly disguised as financial “advice.” If you click on a link that says, “Learn more about controlling your credit card interest rates,” you will get an ad for a new credit card. Once you know that “advice” really means “advertisement” you can avoid them completely. There is no messing around on Mint; no underestimating how much you spend on cocktails last Friday and no denying that you bought a pair of Spanx off of Amazon your lunch hour. Like Santa it knows if you’ve been bad or good, down to the penny, and in pie chart form.

Hope that gets you started down the path of healthy life changes. Now put down that Ho-Ho and get back to the library.

“A Big Part of Being an Adult is Doing Things You Don’t Want to Do.” – Part One

Sometimes a session has a hilarious one-liner, from either you or your client. After disclosing my age (this is not a post about self-disclosure, but yes, I am usually pretty comfortable telling a client how old I am if they ask), I had a client say, “Wow, you’re aging well.” Thanks…I guess… Sometimes the gem comes from my mouth and, while there is nothing but best intentions behind the statement, there are times when it could have come out better. Once, when a client was expressing frustration and a great deal of self-deprecating comments regarding her lack of progress recovering from a trauma, I told her that she was a glacier. The intent was to remind her that the healing process can be slow, yet still moving along even if the progress isn’t obvious. Needless to say, it wasn’t a moment for the highlight reel.

Recently a client was struggling to find motivation for studying, explaining that each morning she set a goal to review her work, catch up on reading or do problem sets when she gets home from class. However she usually ended up taking a nap, watching episodes of Glee or getting lost on facebook. Since there was always a list of things she preferred doing over studying, she usually didn’t get to it. While she was passing her classes, studying the night before exams and keeping up with deadlines, she was concerned that this behavior was going to come back and haunt her, that she would eventually fail a class or not pass her qualifying exams. She was convinced that to change her behavior, be motivated to study daily, she needed to really enjoy it. In her mind her classmates were all much more excited about a night in the lab than she was. She had this image of other students skipping off to the library in a fit of joy, and she believed that because she did not masochistically love the heavy workload, she was never going to be able to change her behavior. I felt this reasoning was getting her stuck. Who wouldn’t rather relax? Yet many people manage to find motivation to study or write a paper even if they would prefer to be doing something else. I mentioned that I thought her image of her peers was inaccurate and then, in my own frustration, blurted out, “A big part of being an adult is doing things you don’t want to do.”

This wasn’t a fresh statement, but actually one I’ve said quite a few times in my work with college students. It originated during an argument with a roommate years ago. I can’t remember what the conflict was about, probably household chores, but at peak frustration she said, “I want to do what I want to do, when I want to do it.” The simplicity of this statement, mixed with the convoluted language, provided comic relief that diffused our argument, but not until I came out with what would become my classic buzz-kill statement. I still use it in sessions because I believe it’s true. Adult life is filled with doing things you don’t want to do.

But did my roommate have a point? Isn’t that what’s great about being a grown-up, the trade-off for 9 to 5 (9 to ?!? is more accurate for most people I know), bills and crow’s feet? As adults we can consume beverages, products and media that we didn’t have access to as a child, we can eat ice cream for dinner every night, and we can refuse to clean the bathroom for months if we choose. We can do these things, although most of us don’t. Instead we grocery shop, listen to our boss, visit in-laws and meet obligations with or without a real desire to do so. We are motivated by something besides pleasure. Where is the balance? What is it about each of us that makes this balance so personal and how do we find it? Would tipping in one direction or the other make us happier?

BLOG?!?

I know, I know! “A therapist blogging!? Really!? Does she know what she is getting herself into?!!!”

I’ve been asking myself the same question since I set up my website. The ultimate goal of laurenschiffertherapy.com is to give current, potential and past clients a way to find out how to contact me, answer quick and easy questions they might have about working with me and get a general sense of how my private practice operates. Initially it was meant to only be a website, like any other business would have. However, the site host offers this handy blog feature and I was intrigued. Then I read this article by Keely Kolmes, PsyD, on psychotherapy.net, was even more intrigued and a bit inspired: A Psychotherapist’s Guide to Facebook and Twitter: Why Clinicians Should Give a Tweet!

My blog is intended to be a place where I share information about what I am doing professionally, such as articles I’ve recently read, continuing education courses I’m taking, or my thoughts on current events in the behavioral health field. I will not be discussing clients and I will not be discussing my private life. The blog is intended, like my website, to give current and potential clients a general sense of what it would be like to work with me and a glimpse into my professional style and clinical approach.

It’s important to me that readers know this blog IS NOT therapy. While the internet is a powerful tool for sharing information, it is not a substitute for treatment and should not replace direct medical, psychiatric, or psychotherapeutic care. This blog should also not be a substitute for treatment. It is BY NO MEANS my intention to dispense therapy via the internet. Reading my blog doesn’t make me your therapist and commenting on posts does not make you my client. If you are interested in working with me in individual therapy, that is through face to face sessions in my Cambridge office, please see the “Scheduling and Payment” section of my website.

Phew! Now that the dramatic part of this post is out there and it is clear what this blog is not, I want to end with a quote from Dr. Kolmes above mentioned article, which motivated me to add the blog feature to my website and describes my philosophy about therapists and their professional on-line presence better than I could myself.

“I see one’s professional online identity—so long as the interactions are professional and not personal—as a form of community outreach. I have compared it to working in a college counseling center and then visiting a class that your client may be a student in, such as when a community event affects the campus and you provide information or do a presentation. Sometimes we are visible in the community as mental health professionals and clients may see us acting in this role outside of therapy sessions. An online professional presence can be similar. Some of us are teachers, writers, and lecturers, as well as clinicians. This is our professional life. Perhaps we do not have to exist in a vacuum, only functioning as clinicians in our therapy sessions. Existing online does not have to mean we cannot hold the frame with our clients, nor does it have to mean we are incapable of boundaries or talking about the effects of our online visibility on clients, when necessary. But we are going to have to develop tools and systems to learn to take care of boundaries in new ways and be present to talk with clients about the effect our online lives have on the clinical relationship.” -Keely Kolmes, PsyD http://www.psychotherapy.net/article/psychotherapists-guide-social-media#section-personal-vs.-professional-space

About Me

Private Practice

I am a licensed independent clinical social worker (LICSW) providing individual therapy. While I have experience working with a variety of clinical issues such as depression and anxiety, I am particularly interested in weight and body image issues, identity development, relationships and young adult transitions.

I received Master’s Degrees in both Social Work and Public Health from Boston University in 2005 and my Bachelor of Arts in Sociology and Theater from Colgate University in 2002. I have worked with teenagers, young adults and adults in college, hospital, community health center, and high school settings.

My style as a therapist is energetic, interactive and casual. I believe the therapist and the client should be working together, and I work hard to create a supportive and comfortable therapeutic environment.

My office is located at 129 Mt. Auburn Street, Cambridge, right in Harvard Square and easily accessible from the Red Line and many MBTA bus routes. If you would like to learn more about my practice please contact me at laurenschiffertherapy@gmail.com.