Finding the Compass in Compassion: A New Model of Caring for Others and Ourselves

When I first came to therapy as a client at the age of twenty-one, I worried at the end of my initial session that my suffering would burden my therapist in some way. “Isn’t it too much,” I asked, “to be constantly listening to the painful stories of others? How do you do it, hour after hour, day after day – doesn’t it wreck you? Isn’t it a burden? Are you sure you want me to continue?” My therapist closed her eyes for a moment, then opened them before deciding to speak. Her reply, which I have thought about many times over the years, was a revelation. “No,” she replied thoughtfully. “I don’t feel burdened. I feel . . . connected. I feel . . . moved.” This response was incredible to me, one I would not have considered. But I immediately grasped what she was saying, and believed her insight to be credible. From that point on, I knew that I was going to be okay, because she was going to be ok. After that pivotal moment, I knew we could both move forward, and that I could begin my work.

I share this true story with you with a specific purpose in mind: to give you the same glimpse, the same hope, the same pivotal moment, so that this can be your starting place as well. This internal shift – to be deeply moved by someone else’s pain – is the compass I would like to offer to you. Learning to become moved rather than overwhelmed can be the key to your emotional freedom, allowing you to be helpful and present without exhausting yourself in the process. This is the instrument you can use to assist you while you are in the process of assisting someone else.

The Circuit-Breaker.

I’ve had some unusual requests over the years, and this is one of them: some of my clients have specifically asked me to help them to care less – to not feel so much – because whatever they were experiencing was too painful. They were hoping that I could “dumb them down,” so to speak, in regards to their emotions. They were worried about someone, and it was wrecking them. Or, they weren’t feeling loved in their relationship, and wanted to diminish their longing. Whatever the circumstance, they were trying to suppress their feelings. Not only did they think this was an option – that it could actually be done – they thought I was somehow capable of helping them. They were hoping that I could find the circuit breaker to their emotions, and just switch it off.

You can only imagine my dismay. Isn’t the goal of therapy – or of life in general – to experience more instead of less? More integration, more awareness, more insight, more range of emotion, more balance, more fulfillment? I had to break it to them: “Even if I could help you to feel less, even if it were possible – which of course it is not – I wouldn’t do it. Because you can’t remove something that’s essential to you, something connected to your innermost self. Your feelings are precious, they’re authentic. They can’t, and shouldn’t, be killed. I’m sorry, but I can’t.” (This news never goes over very well).

Dr. Steven C. Hayes has proposed that in contrast to emotional avoidance, we should instead practice “experiential acceptance,” which would allow us to have a fuller range of authentic emotions.¹ If you are one of those people who feel reluctant to having a broader range of feelings because it feels too overwhelming, you may want to read my other article, entitled, How to Practice Willingness. Suffice it to say, one of the main reasons we feel a barrage of negative emotions is because we refuse to feel them, and it’s the internal struggle to keep them at bay that keeps them so strong. I’ll say a little bit more about this later.

The slippery slope begins when we overestimate the powers of our giving, blurring the boundaries between caring and controlling. This “offense” may be quite forgivable, however, and it happens to the best of us – especially the kind-hearted.

To be fair, I get it. The most characteristic thing about the heart may very well be its expansive nature. And the fact that it aches. Caring about others comes certainly with a cost. It can leave us feeling depleted, disoriented, and overwhelmed – consumed by the problems of others. Ironically, certain acts of giving can even “backfire” to the point of producing unintended consequences or strained relationships. How did it happen that we had a certain intention in mind when we first started to be helpful, but suddenly ended up in a different spot? Surveying the fallout of depleted resources or strained relationships, we claim never to have foreseen the flaws in our well-meaning gestures. Believing our assistance was sure to be constructive, it can be difficult to comprehend just when or where “too much support” occurred, the “help” that inadvertently impeded the recipient’s success or independence in some way.

The Heart’s Trajectory.

Perhaps it is the amenable nature of kindness itself that has the ability to overextend us. Perhaps it is the enigmatic and existential condition of our hearts – that they are, by nature, boundary-less. Compassion can be limitless, and for better or for worse, the heart has the ability to spread out, seemingly forever. “Love knows no bounds,” as it were. The heart may not tell us when to stop and take inventory; it may not even notice when the recipient stopped benefitting, has given up motivation, or is using our good nature against us. The same may be true for guilt, a close relative of kindness, that offers no “sell by” date to indicate when our obligation has expired. It’s hard to know how far to extend ourselves.

But love as a “feeling” is far different than the “doing” aspect of love, and if we fail to notice this distinction, the “doing” part can hijack love’s unending flight. The slippery slope begins when we overestimate the powers of our giving, blurring the boundaries between caring and controlling. This “offense” may be quite forgivable, however, and it happens to the best of us – especially the kind-hearted.

In trying to keep pace with the heart’s trajectory, certain acts of generosity can go “above and beyond” until we find ourselves lost or over-extended. As we will discuss, there are numerous aspects of caring we will want to keep, since compassion has so many benefits, even to the giver. Although caring can indeed be risky business, I still believe we should remain open-hearted, allowing the heart to keep its expansive nature. But I would propose that instead of trying to turn it off, to limit something that can’t be diminished, we really just need to add something to the act of caring. That something is humility, the admission of being powerless. Because no matter what we tell ourselves, we really aren’t that influential over other people’s lives.

Blind Spots.

Unlike the heart, which may genuinely possess an infinite capacity for love, the mind has marked limitations, although it will never admit that it does. The mind possesses a built-in deficiency that it cannot see, where it overestimates its own capacity in a variety of ways. These are sometimes referred to in psychological literature as “blind spots.” One of these – the overconfidence effect – is a well-known bias that includes the subjective belief that one’s judgment is better than it actually is.² If this appears as a quirky or harmless tendency, consider instead how overconfidence could lead to serious catastrophes – such as housing bubbles, stock market crashes, excessive litigation, and even war.

There are numerous times that we aren’t necessarily “right” when we think we are, and this may also apply to our conviction that we know what’s best for others. Admittedly, when a scenario is laid out in front of us, it’s easy to have an opinion about what the other “should” do. But we are spectators at best, and we should let this voice quiet down a bit.  Ask yourself whether you have correctly predicted everything in your own life, and if you can admit to being periodically surprised, why would you be so confident in your predictions about the lives of others?

Psychologists have also identified another blind spot which has to do with motivations, and this relative cluelessness about what drives us is another area of overconfidence. While we often assume we know ourselves well, the truth is that we can be deeply biased without even knowing that we are.³ To appreciate how we might be governed by hidden motivations, consider another question: What if our certainty in believing we know what’s best for others is really a protective “shield” – a defensive armor that prevents us from feeling too much discomfort or despair? We might be seeing something heartbreaking or chaotic, and it scares us. From here, we might suddenly be motivated to start advising or directing, aware only of our desire to be generous rather than our desire to feel less out-of-control.

“Preferred” emotional states, like feeling knowledgeable or superior, can push us toward the temptation to judge or to blame. This position might produce a sense of being momentarily powerful when we might otherwise feel overwhelmingly impotent. Likewise, feelings of “certainty” may temporarily remove our experience of disorientation, so it makes sense that we could be internally motivated to defend this style of thinking. In this way, our frantic attempts to create semblance in another person’s life may provide a sense of control when circumstances look exceedingly bleak or chaotic. As such, our drive to “fix” someone else’s pain can distract us from feeling desperate about their circumstances. “Helping” is a perfect camouflage for worry or despair, and for that reason, it can produce a blind spot. When this occurs, our rescuing can feel like a welcome distraction, and our assistance could possibly be more about saving ourselves rather than the other.

The Picket Line.

When the unconscious veil of overconfidence disintegrates, it can be a bit of a shock. Shifting abruptly from over-involvement to sheer resentment, it’s tempting to detach in an exasperated gesture of “I’m done!” This is the visceral equivalent a “no more” gesture, of throwing up our hands and taking a step backwards as we put up an emotional wall. Interestingly, it isn’t until burnout starts to appear that we even begin to assess the landscape – searching for our compass, retracing our footsteps, and taking inventory. But as clear and decisive as this voice first announces itself, “I’m done!” often comes a little bit late. Despair and exhaustion have already culminated as a protest, signaling some sort of wear and tear. Like erecting a sign on a picket line, our objection indicates that something went wrong, that there was a breakdown of sorts, that we can no longer function on previous terms.

Unfortunately, many of our intuitive responses end up becoming self-defeating. Psychological research shows that when we try to numb our feelings or block something from awareness, we create a “rebound effect” where intrusive thoughts and images attack with a vengeance.⁴ The surge of worry that ensues, the decrease of positive emotions we didn’t intend to lose, and the loss of our connection with others – all these things come at a dear price while bringing us no closer to equilibrium. Trying not to care, it seems, isn’t feasible. “Suppressed caring” – if that’s what we’re trying to do – will inevitably break through and show up in some other form of wear and tear.⁵

The Bandits of Burnout.

“Compassion fatigue” is a known hazard to helping professionals, but any generous person can feel it every bit as much.  While this particular brand of burnout can feel depleting and exhausting, it would be a mistake to assume that it resulted from caring too much. On the contrary, compassion fatigue is caused by certain identifiable culprits that behave a little bit like gypsies. They are the “bandits of burnout,” drifters who seize our good nature and cause us to lose our compass. Easily unnoticed, they have a unique and disarming way of seamlessly creeping up on us. In order to catch them in the act, we need to notice these bandits before they take over, and if we pay close attention, we can begin to recognize them by the way they make us feel. We will know we have been emotionally hijacked when we:

• Believe that we ultimately know what is best for another person.
• Become too invested or attached to specific outcomes for the person we are concerned about.
• Feel indispensable; attached to an identity that is heroic or “right.”
• Feel resentment towards the person we were trying to help.
• Feel dismayed that our efforts ultimately did not give us a sense of self-worth.
• Feel hurt that our efforts did not produce any gratitude.
• Feel frustrated or disappointed that our efforts did not produce significant changes.
• Feel disoriented about unexpected outcomes.

So, what do we do once we recognize these culprits? We can learn more about what makes us particularly susceptible, and slow down before we get lost in our giving. We can develop the insight that this was never a matter of caring “too much.” Because the truth is, burnout sneaks up on us when we stop focusing on ourselves. If our desire is to help the other person re-engage with their own life, we must also work on re-engaging with our own. And it doesn’t need to happen in a radical, “I’m done!” gesture. Defending against worry or concern may seem like the right reaction, but ask yourself honestly: can you really decide to feel less – of anything – especially when considering your tremendous heart? I would argue that the answer is no, and I have something quite different in mind.

Compassion and powerlessness are two essential and complementary instruments of the compass. When used together, they keep us balanced and steady so we don’t topple over the landscape of other people’s lives.

The Paradoxical Role of Compassion.

While ‘suppressed caring’ can cause a host of undesirable consequences, increased caring can allow a broader range of emotions that includes more richness, more ease, more space to breathe. It’s a feeling of being more connected to the self and the other – of feeling awake, flexible, and free. It feels like truth and presence and complexity. I recommend it.

If you need a more down-to-earth, practical reason for caring more, you should know that compassion and self-compassion contain enormous payoffs. Most notably, they generate what are called “protective factors” – things that actually enhance our wellbeing. Yes, compassion can provoke painful empathy, but it also has the ability to produce tremendous benefits, both physical and emotional.⁶ In one study, warm, gentle and soft vocalizations were scientifically shown to reduce cortisol (a chemical released during stress), and release oxytocin (a beneficial chemical).⁷ Oxytocin – the chemical that is released in moments of love and caring – reduces pain, blood pressure, and even anxiety.⁸

Thinking more kindly towards ourselves when we are worried about others would do wonders in a difficult situation, and speaking in gentle tones out loud or even inside our own heads might possibly be more beneficial than any concrete advice or negative judgment we would be tempted to convey. Forgiving others’ imperfections as well as our own is another aspect of caring more, and this is a more understanding position that acknowledges our common humanity.⁹   This would require a softer outlook, where we would refrain from harsh outward criticisms and self-recriminations. This qualitative shift would allow us to treat ourselves with more patience and kindness, and to accept our own limits.

The Paradoxical Role of Powerlessness.

Here is both good news and bad news: The bad news is that we never really had much control over others. And the good news is that we still don’t. Think about what this could mean to you, that you have limited power, and that you are not ultimately responsible for circling around another person’s life, holding their entire world together with duct tape.

Admitting powerlessness over others is neither apathy nor indifference. Rather, it is about respect. This acknowledgment is a key to emotional freedom; it provides more freedom and ease, a more flexible way of relating to others. As my therapist so willingly shared, the experience of feeling moved by another’s relationship to their suffering can be uplifting, energizing, and inspiring. We find that through powerlessness we feel less of a struggle, less need to control suffering. We are less susceptible to the bandits of burnout.

There is a Buddhist saying: “Pain is inevitable, suffering is optional.” This means that without our interference or our rejection, pain will arise and dissolve on its own. (Yes, even other people’s pain). But suffering, on the other hand, is what happens when we struggle, when we try to fix or “improve” things, and here we may be talking about getting too involved in managing other people’s lives.

Many people who have been lost in the process of giving will have a huge reaction to the notion of powerlessness, mainly because they have begun to over-emphasize their role in influencing someone’s life. And perhaps this sneaky suspicion of powerlessness has presented itself before, and not in a pleasing way. To be sure, we can become so painfully worried that doing for others seems essential. But as with many profound axioms, there is a paradoxical element here: Admitting we are powerless can be very empowering. And the same is true on the other side of this paradox: believing we are powerful may blind us to our relative powerlessness.

It is difficult, and yet essential, that we come to terms with the fact that we really aren’t so powerful. As a therapist, I have to humble myself on a regular basis, realizing even though my clients are giving me express permission to help them, I do not have much – if any – control over their circumstances. For my clients’ sake and for mine, I need to not inflate my sense of importance, to not overstate my influence. Admitting our powerlessness over others is a humbling and ongoing practice that puts us back into reality. It asks us to take inventory, to remain aware of our personal limits. And luckily, it happens alongside caring, so our hearts can remain open. Admitting our powerlessness is different than the harsh stance of “I’m done.” It’s a gesture of respect that acknowledges the boundary between self and other. It makes us reasonable and humble; it helps us let go.

In the literature of Co-Dependents Anonymous, Step One reads: “We admitted we were powerless over others – that our lives had become unmanageable.”¹⁰ This step can be a revelatory goldmine when applied to our tendencies toward “helping.” If you have ever talked to an addict who is very sincere about their recovery, you will quite often hear them say, “I’m doing great, but I’m back to working on Step One.” As a therapist and recovering co-dependent, I can completely understand why someone would say that. Because Step One is, in my opinion, the most important step.

Compassion and powerlessness are two essential and complementary instruments of the compass. When used together, they keep us balanced and steady so we don’t topple over the landscape of other people’s lives. These stabilizing practices can help us to avoid succumbing to enabling behaviors, falling through the cracks of burnout, or overstepping our bounds.

Creative Hopelessness.

Now that the word “powerlessness,” may not trigger the same jolt, perhaps you won’t be so easily disheartened by the term “hopelessness.” In many ways, this is similar to the notion of “hitting bottom,” as the phrase is often used in 12-step recovery. Dr. Steven C. Hayes discusses the value of admitting how our repeated attempts to control outcomes can ultimately be defeating.¹¹ Advising, directing, or rescuing others are short term strategies that may eventually fail. Approaches we are tempted to repeat in an effort to make things “better” can produce a feeling of change, but this can be a seduction more than anything else. Time and time again we exert our most valiant efforts, only to discover than nothing much has improved. Instead, by admitting our own limitations, new and creative solutions can emerge, often for ourselves and for the other person.

Too often we overstate our confidence in changing another person’s situation, ignoring the fact that they have free will and are on a very personal journey that may be only meaningful to them.

This is when “hopelessness” becomes a beautiful word, not something demoralizing. The openness, the feeling of surrender, the experience of hitting bottom – all occur when real change begins to happen. Interestingly, we have arrived at another paradox: by giving up, things suddenly begin to look hopeful again.

A similar concept, “radical acceptance,”¹² is offered by Dr. Marsha Linehan, who recommends the simultaneous practice of both acceptance and change. We can thus radically accept the reality of our loved one’s circumstances while being proactive with our own self-care. Likewise, we can radically accept our powerlessness while increasing our compassion, exercising our ability to comfort without “fixing.” To be sure, powerlessness, creative hopelessness, and radical acceptance should not be confused with apathy or complacency. They are part of the delicate equation for creating balance so that we can care more without depleting ourselves. They are the more intricate inner-workings of the compass.

Circumstances Don’t Define Us. Or Them.

Too often we overstate our confidence in changing another person’s situation, ignoring the fact that they have free will and are on a very personal journey that may be only meaningful to them. When we become hyper-focused on the details of someone’s life rather than its potential for meaning and discovery, we might be thinking too literally, too superficially. We may simply be seeing the broken mechanisms of the compass rather than the beauty of its design, or the direction it might still be pointing.

But our concrete thinking is a limited perspective. We are not expected, nor are we entitled, to know what is ultimately best for another human being. Suspending our judgment and embracing a sense of not knowing, we can begin to appreciate the significance of another’s suffering – that it has courage, poetry and meaning – and is part of a significant and greater story that is largely mysterious. It is a story whose meaning may only be revealed later, and only to them.

I have heard it said that in one’s final moments, when looking back over the totality of one’s life, people who are dying tend to focus not so much on the significant events that transpired, but more on their responses to those events. Apparently, it is not the literal happenings that matter as much as the ways in which we reacted. The highs, the lows – the accidental circumstances that include both good fortune and bad – these do not carry as much weight as our responses do. Circumstances are not just imposed on us, they summon us, asking that we reveal or reinvent ourselves. They do not define us, nor the person we are trying to help.

Choosing Reality.

After listening to others’ stories over many, many years, I can tell you that Reality usually has something different in store than what we think “should” happen. I’m also both sorry and pleased to tell you that not one of us is a true contender against Reality itself. If we can’t completely rule over our own lives, how on earth do we think we can influence somebody else’s?

I saw a saying once: “Everything will be ok in the end. If it’s not ok, then it’s not the end.” So, before you say you know how some outcome will be, or how it will be if someone doesn’t approach things in the way you would have them do, consider that Reality often produces something better, something more personal, something that’s tailored to the unique story of a person’s life.

Take a look at your own life, and consider the most astounding things that have ever happened, both good and bad. They were always things that were previously unknown to you. Music is a great metaphor for this, because while you are the authority on your musical taste, you are also not literally the person that composed your music collection. If you’re so clear about your preferences, then what prevented you from writing all the songs in your music library? Not even your own imagination could have designed your favorite song, your happiest moment, your soulmate, or your greatest lesson.

If you are tempted to believe you know how another person’s future should unfold, take a moment to consider that you could not have predicted the details of your own life in their entirety. And if you are tempted to think you know what’s best for another human being, consider again the limitations of your own sense of control and your imagination. The meaning of another person’s life is something that may be knowable and reachable only to them. And it will be far different and more meaningful than anything you can possibly imagine.

Extras: Further Suggestions for Balancing Compassion with Powerlessness

If I’m Not “Helping,” What Should I be Doing Instead?

Breathe. Do less. Offer a walk, a hug, a movie, a dessert, or cup of tea. Offer your warmth, your company, but don’t give any advice. Here are some healthy practices you might try in the alternative:

• Cultivate equanimity. When caught by excessive attachment, untangle yourself by considering, “My loved one has free will, and their life has meaning that may only be knowable to them. It is their choice how they move through their pain or suffering.” This may sound like indifference, but it isn’t – it is respectful of the other person’s journey and is a key to emotional freedom.
• Try “lovingkindness” mantras, such as: “May I be safe. May I be happy. May I live with ease.” And then, “May my loved one be safe. May they be happy. May they live with ease.” Compassion means simply wishing well for the intended recipient. It needn’t be gushy, over-the-top, or complicated. As you reflect on their circumstances, try to generate some sincere well wishes. Keep it simple, and let it go.
• Listen to free self-compassion meditations, such as on Kristen Neff’s website at self-compassion.org.
• Practice “Step One” (admitting powerlessness over others). Or explore the idea of “radical acceptance,” embracing the other’s journey as really their own. If you are interested in the mindfulness and acceptance-based practices, work with “creative hopelessness,” where you take an honest look at the control strategies you may use around trying to “fix” others. Write them all down, and review whether or not they actually worked. Notice all your “shoulds” – both for others and for you. Let go of your control, your agenda, your need to be right, and the temptation to think about what’s best for the other person.
• Practice mindfulness, acceptance and willingness. Stay in the present moment, feel more of your feelings, and don’t try to suppress a thought. But at the same time, remember the overconfidence effect, and beware of your blind spots. Stay a little guarded when it comes to your mind, since our thoughts cannot always be trusted. Attachment to outcomes, worrying about the person’s future, and judging their experiences or behaviors as good or bad – are a few common pitfalls of the “mind” that are also connected to burnout.
• Embrace your humanity. Practice forgiveness toward yourself, for your limitations and your imperfections. It is enough for you to show up with your authentic presence; it’s ok not to have all the answers or the resources. It’s also ok to slow down. Refrain from harsh criticism and negative self-judgment. Above all, treat yourself with patience and kindness.

• Dare to care more. Explore your own healthy balance between compassion and letting go. Find a sense of awe and reverence for your loved one’s story, however painful or triumphant. Appreciate it, but don’t own it. Care more and control less, for your own wellbeing and the wellbeing of your loved one.
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Notes

1. Walser, Robyn D., Westrub, Darrah. (2007). Acceptance and Commitment Therapy for the Treatment of Post-Traumatic Stress Disorder and Trauma-Related Problems, a Practitioner’s Guide to Using Mindfulness & Acceptance Strategies. Oakland: New Harbinger Publications, Inc., 200-201, 223-224.
2. Moore, Don A., Healy, Paul J. (2008). “The trouble with overconfidence.” Psychological Review. 115(2):502-517; Hoffrage, Ulrich. (2012). “Overconfidence.” In Pohl, Rüdiger. Cognitive Illusions: a Handbook on Fallacies and Biases in Thinking, Judgement and Memory. New York: Psychological Press, 351-4; Kahneman, Daniel. (2011). “Don’t Blink! The Hazards of Confidence.” New York Times; Plous, Scott. (1993). The Psychology of Judgment and Decision Making. USA: McGraw-Hill, Inc.
3. Pronin, Emily, Lin Daniel Y., Ross, Lee. (2002). “The bias blind spot: perceptions of bias in self versus others.” Personality and Social Psychology Bulletin, 28(3): 369-381; Pronin, Emily. (2008). “How we see ourselves and how we see others.” 320(5880): 1177-1180.
4. Wegner, Daniel M., Schneider, David J., Carter, Samuel R., & White, Teri L. (1987). “Paradoxical effects of thought suppression.” Journal of Personality and Social Psychology 53 (1): 5-13.
5. Gross, James J., Levenson, Robert W. (1997). “Hiding feelings: The acute effects of inhibiting negative and positive emotion.” Journal of Abnormal Psychology 62 (4): 565-85; Cioffi, Delia, Holloway, James. (1993). “Delayed costs of suppressed pain.” Journal of Personality and Social Psychology 64 (2): 274-82; Feldner, Matthew T., Zvolensky, Michael J., Eifert, Georg H., & Spira, Adam P. (2003). “Emotional avoidance: an experimental test of individual differences and response suppression using biological challenge.” Behaviour Research and Therapy, 41(4): 403-411.
6. Neff, Kristen. (2011). Self-Compassion: Stop Beating Yourself Up and Leave Insecurity Behind. New York: HarperCollins Books, 47.
7. Seltzer, Leslie J., Ziegler, Toni E., & Pollak, Seth D. (2010). “Social vocalizations can release oxytocin in humans.” Proceedings of the Royal Society B: Biological Sciences, DOI: 10.1098/rspb.
8. Lee, Heon-Jin, Macbeth, Abbe H., Pagani, Jerome, & Young, W. Scott. (2009). “Oxytocin: the great facilitator of life.” Progress in Neurobiology 88 (2): 127-151.
9. Brown, Brené. (2012). Daring Greatly: How the Courage to be Vulnerable Transforms the Way We Live, Love, Parent and Lead. New York: Gotham Books, 128, 133; Brown, Brené. (2010). The Gifts of Imperfection: Let Go of Who You Think You Should Be and Embrace Who You Are. Center City: Hazelden.
10. Co-Dependents Anonymous, coda.org/pdfs/Fellowship_Service_Manual.pdf.
11. Hayes, Steven C., Strosahl, Kirk D. (eds.). (2004). A Practical Guide to Acceptance and Commitment Therapy. New York: Springer Science and Business Media, Inc., 36, 47, 65, 70, 85-87, 99-100.
12. Hayes, Steven C., Follette, Victoria M., & Linehan, Marsha M. (eds.). (2004). Mindfulness and

Acceptance: Expanding the Cognitive-Behavioral Tradition. New York: The Guilford Press, 30, 38, 62.

©2017 Heather Stone, Ph.D.

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