In the News: 30,000,000 Words

At a child’s birthday party one afternoon, while a few of us older folks were watching the kids play words pic1soccer and color masks, we were in essence discussing child development. The advancing skills of these children, aged four to six, amazed us. They were learning to play by rules, kick the soccer ball with authority, paste stickers in neat designs, cooperate, share, and focus. They made up cooperative rules for competitive games. They played together without frustration, aggression, or injuries. They played with almost no adult supervision.

Disparity in Childhood Verbal Experiences

Just as amazing is the realization that most children in this age group could master many of these self-control, self-regulation, and social interaction skills. The children we watched are from professional families. That brought to mind a remarkable piece of research. I referred to the study contrasting these children of affluence, from highly educated families, with the many children we see in the clinic who come from less well-off families which have less educational attainment. As I recalled, a study showed a three million word difference between how much verbal input higher income-higher education families provide their children by age four as compared to low income- lower education families. These are the words of interaction from the parents.

I was startled just repeating the number. The others were astonished by that magnitude of difference.

Later, a teacher at the party pointed out my mistake. That figure is not the enormous number of 3,000.000.

No, I was off by a factor of 9, namely, 27,000,000 words. The true figure is 30,000,000.

Thirty Million Words

I double checked the information. Indeed, a long term study by Betty Hart and Todd Risley found the difference by age 4 is 30,000,000 words, about 1200 words per waking hour throughout the first 4 years. Even if we criticize the study on the basis of a small sample or the manner of extrapolation from the limited observations in this study to the child’s entire early life experience, and even were we to do the study with a larger sample, the difference likely to be found in subsequent studies is still going to be so very enormous.   Plus the difference between these class groups is fairly stable over time.

The impact is that by age three, the vocabulary of children from the highest educated group exceed that of the lower economic group by a factor of 2 or 3.

Not only did the less advantaged children have smaller vocabularies. They added new words more slowly. In other words, the gap continued to expand.

Gaps remained mostly stable when the kids who were 2 or 3 were measured again at age 9 or 10. We know that vocabulary size is associated with higher levels of income and attainment. Hart and Risley raised the concern that children in the least advantaged circumstances may not have the vocabulary needed for understanding standard books and high school textbooks.

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Furthermore, educational efforts to overcome the disparities were dwarfed by the impact of family communication patterns. Educational experiences did not significantly close the gap.

The children in the study were observed interacting with their families. The children were equally nurtured and well cared for regardless of economic status.. So the findings cannot be attributed to factors other than the amount of verbal communication in the family.

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A Discouraging Word

We know that positive reinforcement, celebration of achievements, approval, recognition, and the expectation of succeeding are powerful motivators. Children often need a push in order to try tasks that are difficult. They need positive reinforcement for their new skills and learning. What might happen if they received less of those important positive words and far more negative words – words which prohibit activities, criticize performance, or point to what was not going well?

Children tend to live up to (or sometimes down to) what is expected of them. Expectations of success are often met with greater effort. Expectations of failure can be demoralizing. So the study’s findings about positive versus negative motivators were also astonishing. In the study, it was not merely the volume of words which differentiated the groups. Along with the sheer number of words, Hart and Risley counted words of encouragement and praise versus words of discouragement. They found a large difference in how much praise and encouragement children receive. Higher economic status was associated with about six words of encouragement to each word of discouragement. In working class families, the ratio was about 2:1, meaning life for those children was far less encouraging.

For thirty years, the authors had been focusing efforts on helping children from poorer families to achieve higher educational attainment. Much of their work was at a center which worked with children from poor families or on welfare. So, in what they termed “welfare” families, the ratio of encouraging-to-discouraging words was reversed from other families, that is 1:2, meaning twice as many discouraging words which, in effect, totally dominated the positive words. The authors observed a phenomenon we often see in the clinic, namely, these families used far fewer parent-child interactions, with more of the focus of interactions being centered on prohibiting behaviors, on socialization, and on disciplining. It is not that other families neglect these interactions, but they are more likely to control or socialize by reinforcing desired behaviors and encouraging appropriate responses.

Furthermore, higher economic class families spend a lot more of communications expressing encouragement, with its connotation of higher expectations.   In the professional families, the children heard 560,000 more words of encouragement than discouragement over four years. The gap for a working class family was only 100,000. The raw number of positives was less than half of that in the higher income families. So those children received a great deal less of positive reinforcement and positive expectations.

Children in the ‘welfare’ families received 144,000 less encouraging words than discouraging words. That means they heard 300% more discouraging words than the children from the more educated homes. The number of encouraging words was also far less than those heard by working class families, actually about 140,000 fewer.

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Lastly, the authors report the ‘welfare’ families showed far fewer “back-and-forth” conversations, more one-way conversations. This tends to sound as if effort, abstract reasoning, presenting a reasoned argument, discussion, and listening to children were less valued in those families.

We know that a baby’s brain over-produces neurons, those potential connections it will need in life. Then the brain prunes away potential connections which prove to be unnecessary for adaptation to the child’s environment. We know that an enriched early environment leads to more connections, meaning more memory, more verbal capacities, more learning. The brain whose adaptation is stretched in order to manage a richer environment should be better able to manage a variety of environments in the future and to accomplish more problem-solving, more achievement. In earlier life, this would translate into higher school readiness by age 5. In the study, it translated into higher educational outcomes across the board.

Clinical Implications

We want to put these stunning findings to use in our work. Where Hart and Risley are concerned with early childhood education, we are concerned about mental health and behavior change. Psychotherapy has often been mainly a verbal endeavor. But this study is a reality check on the methods clinicians value.

  1. Our methods must be adapted for children who may not be as verbally-oriented as may be needed for standard individual therapy or even for cognitive therapy. Clearly, in clinical work with children, we should always check that the child fully understands the clinician’s comments. Children may take language which is figurative in its concrete sense. We also assume children use oral, verbal methods for thinking through problems and making changes. But that may not be the preferred channel for behavior management for the child and family where the child is not used to positive verbal management of behavior.
  2. Also cogent is the finding that the parents and children are highly matched in verbal patterns. More of the families in the study relied on approaches which are only somewhat positive and encouraging or predominantly not positive at all. Since we know that positive reinforcement of behavior increases its frequency, and we know it is a more effective strategy than punishment, so our methods must help transform family interaction toward the positive. That means reinforcing both generations for positive behavior, the parents for positive strategies and words as well as the children.
  3. Many parents will expect a “disciplinary” or punitive or negative approach. We do not want to argue about that. It may be that the alternative we offer is outside the family’s framework. The clinician will need to find ways to demonstrate a new approach and to shape new interactional behavior without using persuasion or argument.words pic5
  4. When we use play or activity-based methods of therapy, it seems we should verbally mediate the play – labeling every feeling being expressed, re-stating the child’s actions in words, highlighting in words each skill used by the children. By verbalizing, we are demonstrating a new way of interacting. We are also increasing the reproducibility of the behavior. The same principle applies to the behavior of parents!

I leave it for others to think of even more creative or effective ways to use the 30,000,000 word findings.

For more information, check these sites.

Hart, B. & Risley, T.R. “The Early Catastrophe:The 30 Million Word Gap by Age 3” (2003, spring). American Educator, pp.4-9 http://www.aft.org/sites/default/files/periodicals/TheEarlyCatastrophe.pdf

http://centerforeducation.rice.edu/slc/LS/30MillionWordGap.html

https://www.facebook.com/TMWproject

http://thirtymillionwords.org

https://bridgethewordgap.wordpress.com/white-papers-other-resources/

 

The Lingering Effects of Teasing and Bullying:

I. Traumatic Impacts

Bully pic 1I asked Howard, a 60 year-old man with a history of depression, about the social shyness for which he sought my help. Then, he told me the story of how he had been teased and bullied years before.

“When I was in the fifth grade, we moved from a neighborhood where I’d grown up the first 10 years f my life. I had friends and felt pretty good about myself. One of the fastest runners in the school, I could hit a baseball far for a 10 year-old. In retrospect, I guess I felt very equal to my friends. It was back at a time when kids had free run of the neighborhood from the library about half mile away to the big park across a busy street to a neighborhood shopping strip a few blocks away where there was a popular deli. My father used to take me there for breakfast before we would go for an outing on a Saturday. Or give me ten dollars and a list of things to buy from the bakery counter and bring home.

“Then we moved up to a more affluent area where the kids were way more sophisticated than where I had grown up. They dressed in the latest clothes, knew all the latest popular music, even knew how to dance. The athletic boys knew how to play basketball. There was no basket in the play ground at my old school, and I didn’t know anything about the game.

“So, I remember being teased by the popular kids for what we would now call being a nerd. How being clever turned into a bad thing puzzled me completely. My clothes didn’t fit in; I was ashamed of that. Someone teased me for my facial features, which were ordinary, I guess. I have to admit that a couple of years later I joined in picking on another kid for his looks. I guess we knew we were being cruel for no good reason. No, I didn’t have one particular villain. Just that there were several kids who had nothing to do with me except to say derogatory things. That hurt.

“But there was this one kid, Billy, a real troublemaker, who took everything one step farther. He was scary. He ended up in a reform school. That’s what they called it in those days, you know, for the dangerous kids. If one kid would only go so far as to say I was a bookworm – an old term for nerd, I guess – Billy went further, knocking the books out of my hand. Once, he knocked them into a puddle. If a kid might just say my nose was too big, that Billy put his palm over my face and pushed me. He always took it farther than anyone else. If some one said something about my clothes, he’d pull me by a shirt, ripping off a button, or yank the back of my collar until I fell. A real piece of work. We was a mediocre athlete, but he liked to show off that he had the best looking girlfriend or the biggest entourage. So, he would come by the school yard, but not right after school. Later. So, I got to play baseball or learn basketball. I knew to clear out by 4:30 or so, if I remember right, and keep out of his way.

“I tried so hard to excel at what seemed important there. Like learning to dance. Spending hours learning to dribble and shoot baskets and field baseballs. I got some cool clothes – one of the kids who befriended me showed me how to pick.

“But I became a follower, and did not have the same level of self-esteem as in the old neighborhood. I became self-conscious, I always worried about my impression on others. I still am. That was not part of my thinking before moving there. So, then I got to be shy in the sense of afraid to approach people. I thought they would feel I was a bother. I defined myself as unpopular. That’s what I was. My friends could criticize me and I’d take it; I’d think there actually was something wrong with me which I had to fix. As time went on, my distance from the popular kids became a universe; so I just thought of myself as part of the unpopular and different group.

“Even over four decades later, what stands out most immediately from those days is the memory of the ‘lowlights!’ I mean the various teasing comments. I can remember a lot of good things, but the unpleasant stuff is what comes up in my mind first.

“It was not just the kids. My three most immediate memories of high school are a teacher of Spanishbully pic 2 mocking me on the first day. It seems the teacher from the previous year must have said to her that I was good in Spanish and I raised my hand a lot. So a source of self-worth by being smart got put down on the first day in her class when she said in a critical way which was, I am sure, meant to put me down, “Oh, Howard ______, I heard about you, yes, Howard _______, I heard about you.”

“I remember feeling now there was almost nothing I could do to be accepted anymore. An English teacher made fun of me in class for a silly mistake on a test. I guess being a good student gets you blasted when you screw up. And a physics teacher did the same. I had winged it on a test – my fault for not studying more – and got a very poor grade. But the teacher didn’t have to announce it in class. I spent a week feeling two feet tall.

“After that, I felt equally bad when I aced a test and set a curve. Like no one would like me for that.”

“Fortunately, the skills I had shown when we moved to the neighborhood, which included spending hours practicing and a determination to master skills, helped me a lot. In my mind, getting near perfect grades in physics, a compulsion with me the rest of that year, showed up the teacher. Of course, that’s how the bullied think, that any future performance is in some kind relationship to the teasing. Proving you are better than they say. Or confirming you are as bad as they say. Now, it dawns on me the teacher probably felt reinforced by my improvement; she could get the impression that, if you mortify the kid, then he’ll do better!

Howard concluded, “I’ve been reasonably successful. But still I am afraid to approach people for fear of what they may say. Still I wonder if someone will sting me about my hair, of which there is obviously so much less, or my features or my clothes. So I pay too much attention to trying to impress people with my sports car, my bold colored clothes, art work, my upscale address, being in shape, playing great golf, trying to fit in. It’s a battle that can never be won. Each day that feels good and I think I am something special runs into the next when I am low and have to prove myself. So I’m depressed.”

Brittany told a different story.   At 56, she told the story of events 40 years before. More emotional than Howard, she was too upset to get into all the details. “I was slow to mature. So already when I was 13 or 14, I was noticed for being different, the outsider. But then the acne came. All kids got it in those days. Is it my imagination or it way less prevalent today? Look,” she said, pointing to her face, “pock marks. Lots of them. That’s why I wear a lot of make up.”

“The boys would call me names I won’t repeat. The girls, well, some took pity, which made me feel worse somehow. A few understood. There just wasn’t much you could do for it. Antibiotics. Washes. Visits to the dermatologist. Didn’t help all that much.

“Then there were the girls – nowadays we would call them ‘Mean Girls.’ Wow. They were brutal. I also had big cystic pimples on my back and the girls could see that in the locker room. They said and did things to make me feel contaminated, like it would infest them. I still can’t stand being looked at too much.

In fact, Brittany did far more to compensate than her story suggested. She developed an obsession bully pic 3with her appearance and a ritual compulsion to armor herself with medications, makeup, scarves, and a hairdo which would mask her scarring as much as possible. She had to get up an extra hour early in the morning in order to go through the ritual. Spontaneity was forbidden in her world.

These stories came to mind when I read a Chicago Tribune article, “The debilitating scars of bullying” by Candy Shulman (February 8, 2015)*.   Her brave disclosures demonstrate the inner experience of someone being teased. She notes that some years later, the bullied continue to think about the mistreatment while the bully often remembers nothing of his or her behavior.

Shulman’s story mirrors the stories of Howard and Brittany*. Particularly noteworthy is how the object of teasing and bullying develops a mindset that she is being bullied and has to protect herself from it even when it is no longer happening. Shulman thinks of it as a victim mind set.

She also points out how bullying shapes social perception and expectations. For example, she mentioned the expectation of hurt and loss, behaviors engendered by her childhood bully, which generalize to new situations later in life and throughout adulthood.

Similarly, Howard and Brittany spent their adult lives continuing to stave off teasing and trying to achieve a feelings of acceptance, feelings of which they had felt deprived during adolescence. Each forecast a likelihood that new situations and new people would treat them in the same humiliating and hurtful ways as they had experienced in adolescence. They compensated in ways they imagined would fend off attacks. This is classic avoidance behavior – continue to react as if the assault is coming even after the threat no longer occurs. We carry the threat around mentally and act as unremitting victims.

One of the most extreme reactions to bullying is to identify with the perceived violence of it and then to perpetrate violence upon the self or upon others. That makes the news. Suicidal thinking and suicidal actions as a result of bullying are amongst the strongest of reactions to it. Completed suicides attributed to bullying are often reported by the media. Mass shootings by teens and young adults are often explained as associated with chronic bullying. They have led to a movement to shift the attitudes of educators from overlooking bullying or rationalizing it to the expectation they will prevent it or stop it.

But one in five children report being bullied. Sometimes, the damage may be significant enough tobully pic 4 shape lives, as we see with Howard, Brittany, and Ms Shulman.

In these days, one can cyber-bully, namely, leave teasing or hurtful comments on the Internet or in a chat or email or on Facebook. The cruel words do not vanish, but remain visible. Rather than delivering teasing in person, the comments can be hurled from a safe distance.   I wonder if that makes it easier to issue teasing. I wonder if the words are more impactful when on the Internet.

bully pic 5Another example comes to mind. Jesse* was 16 when his mother brought him to see me. It was March. He went to school for sophomore year for about two weeks back in September. Since then he had not been back to school. This was before schools had to have programs for children who were unable to go to school due to illness or, in Jesse’s case, emotional problems.

I had previously treated a number of children with school phobia, a form of separation anxiety in which the child is afraid to be away from parents or home. Often the child fears some dire event may take place when he or she is away or the parent may leave the family.

With Jesse, we found no evidence for school phobia. He was depressed, sad, and soft-spoken. He showed little emotion overall. A behavioral analysis of his problem with school showed that he feared two situations. 1) If kids in the hallways were loud, the noise startled him. He expected a fight would break out. He assumed it would become violent, and he could be hurt in the melee. While he had seen fights, he had never actually been harmed. 2) If he walked into class and anyone was already in the room, he expected to be watched and judged. He thought the other kids would think he was strange. He would feel embarrassed. He then thought that he would be singled out to be victimized. The escape from social situations due to the fear of being judged by others is a symptom of a mental disorder known as Social Phobia.

That particular situation in class had actually never happened. However, he had often been teased by an older brother. So the memory of that teasing was being generalized to the school setting. Furthermore, Jesse believed his father sided with his brother. So Jesse generalized that school employees – teachers and administrators – would not protect him. He expected they would join in the negative behavior. So in his world, there was no protection except to avoid the situation and hide at home. In his belief system, he had defined himself as a vulnerable victim.

At home, he did not feel entirely safe. His imagined fears made him anxious even there. But he felt relief that as a result of his avoidance no new episodes of harm could occur.

In order to motivate him, Jesse’s father took a stance many parents might take. In hopes of motivating the young man, Father admonished him, told him that at this rate he would not amount to anything, and said high school should be a good time in life. To Jesse, however, these efforts confirmed his feeling of being misunderstood, unprotected, and not measuring up to other children. In contrast to Father, Jesse’s mother tried to comfort him. She pleaded with him to go to school. She felt helpless to motivate him. As a result, many days would pass when she said nothing about his avoidance. When she backed off, Jesse experienced what we call intermittent negative reinforcement, namely, the relief that he could stay home while the unpleasant interactions in the family would not occur that day. Such avoidance behavior is remarkably stable and long-lasting.

bully pic 6Jesse’s mother had gone to school to complain to the Assistant Principal. However, the latter did not give her and Jesse a sense that the young man could be protected. Rather, the school threatened the family with repercussions for their son’s truancy.

In contrast to school phobia, Jesse presented with Social Phobia and school avoidance, failure to attend school due to a fear of the school setting or of other children. He had experienced some teasing, and he had witnessed bullying.

Can one be affected vicariously by witnessing bullying? Yes, indeed. Jesse projected himself into the shoes of kids he witnessed being bullied. He imagined what it would be like if that happened to him. He felt terrified by his thoughts. He imagined the helplessness that he felt standing by as a witness would be magnified if he were the actual victim. By remaining on the periphery of his school mates, he had few ties at school to motivate him to go just for positive social interactions with friends.

Whereas Howard’s and Brittany’s stories show the lasting effects of teasing and bullying, Jesse’s story shows the impact at the time it is happening. It even shows how witnessing others being bullied can affect bystanders. The story demonstrates how difficult it can be for parents to select an effective strategy to manage the situation.

The good news here is that Howard and Brittany had compensated effectively. So for them, the task in therapy was to help them desensitize the memories, change beliefs about themselves, and free themselves to experience contemporary life as it is, not as an echo of the past. In contrast, the therapeutic task for Jesse was more challenging. Namely, he did not have the successful life experiences Howard and Brittany could use in order to shift their thinking. He had limited emotional and family resources.   Furthermore, the changes needed to help him were not going to be mainly internal changes as we saw with Howard and Brittany. Jesse actually had to overcome inertia, avoidance, and fear and start going to school. In school, he would need a more positive set of experiences so that he would experience positive reinforcement for going rather than negative reinforcement for staying home. Also, both of his parents would need to learn more effective strategies for managing the situation.

And they did. While Jesse participated in a program of reprocessing his fears, Mother was willing tobully pic 7 participate in a graduated program in which Jesse dressed for school and she drove him to the school, then home, without going in. When his anxiety at that subsided, she could escort him to the door, then home. After a few days of that, she escorted him through the hallway to the office. Later, she stood by the office and watched him walk through the hall on his own, even when other kids were present. Meanwhile, we reprocessed the fear of walking into a classroom and rehearsed going into class. Eventually, Jesse managed to go and to sit through a class. He used some tools we had discussed and practiced, including some 3 X 5 cards on which we wrote statements to help him cope, such as, “I can sit quietly. After one minute, when I look around, I see no one is paying attention to me.” “My prime job is listening to the teacher.” The following September, Jesse was going to school full days. We had rehearsed strategies for having his parents interrupt any negative interactions with his brother, and family life became more pleasant for everyone in the home.

As a psychotherapist, I come into the picture after the damage has been profound. The treatment approach is to desensitize memories and experiences of teasing and bullying, overcome avoidance, increase skills to manage the situation, shift thinking from victimhood and defectiveness to assertiveness and adequacy, re-design family interactions, and enlist supports from school personnel. In a follow-up essay, we will discuss some ways for parents to work with children to prevent or stop teasing and bullying before damage occurs, before psychotherapy may be required.

*Reference for the Schulman story:

http://www.chicagotribune.com/news/opinion/commentary/ct-bully-bullies-anxiety-panic-attack-perspec-0208-jm-20150205-story.html?dssReturn

*Note: The names and details of the stories of Howard, Brittany, and Jesse have been altered in order to substantially disguise the identities of real individuals.

Post Traumatic Stress Disorder

PTSDPosttraumatic Stress Disorder (PTSD) is a reaction which often occurs when a person has been exposed to extreme stress, trauma, or painful experiences. In other words, the person has experienced or witnessed actual or threatened bodily injury or some other extreme situation.
Click here to learn more about PTSD!

Psychotherapist / Counselor – In Home or Outpatient Therapist Shorehaven Behavioral Health, Inc – Milwaukee, WI

A leading mental health & psychotherapy clinic seeks dedicated CAREER
employees for our in-home mental health treatment departments, including
our dual disorders program. Shorehaven Behavioral Health, Inc, is an
innovative, growing company, the only FUTURE FIFTY company in our industry
(a 3-time award winner) , and BBB A+ rated. We have psychotherapist
positions for mental health and substance abuse treatment professionals.
These positions are open for Licensed Psychologists, LCSW, LPC, LMFT.
Those with SAC or CSAC MUST ALSO have a mental health license. Those with
a training license or APSW will be considered for a position of Qualified
Treatment Trainee. Continue reading

EMDR: Eye Movement Desensitization and Reprocessing

EMDR pic3

Brochure on EMDR

Did you know that most emotional problems derive from earlier life experiences? EMDR is a complex method that can assist in bringing about changes in how the nervous system processes experiences. To learn more about EMDR, please read our brochure, which can be accessed by clicking on the link above. 

EMDR pic1 EMDR pic2

Introducing Our Administrative Assistants

Rachel Niyonsaba, In-Home Administrative Assistant

Rachel Niyonsaba is our new Administrative Assistant for In-Home Services,
helping Carol Trout, Director of In-Home Services, to manage a program
which has nearly 60 staff in 24 counties.  We welcome Rachel to the
Shorehaven team.  She has been diligently working on learning all the
policies and procedures and getting up to speed on our in-home services.

 

Rachel Nionsaba's office sign

 

 

 

 

 

 

Alyssa Korsch is our Executive Assistant for Lynn Godec, Executive
Director, and Don Rosenberg, President.  With cheerfulness and eagerness,
Alyssa does all those important tasks that keep us going, such as trackingAlyssa Korsch
clinician productivity, coordinating repair and maintenance, setting up
the projector for meetings, managing Relias learning materials and
creating courses, coordinating psychological testing referrals, and
whatever else may come up. Recently, she spent most of the night at the
office working with a painting crew and repairmen getting the offices
fresh and lovely, and then putting up all of our new signs.

Introducing Shorehaven’s Referral Department

Most people who call Shorehaven for help will feel therapy has helped
them.  Whether the problem is with a child’s behavior, a couple problem,
anxiety, depression, substance abuse, or any number of other behavioral or
emotional problems, psychotherapy helps.

When you call Shorehaven to make your first appointment, your call will go
to our Referral Department.  Let’s introduce our Referral Coordinators:

Ryan Van Remmen
Leader In-Home Referral Coordinator

Laura Henning
In-Home Referral Coordinator

Antoinette Morrow
Outpatient Referral Coordinator

Cheronne Burks
Outpatient Referral Coordinator

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Antoinette (“Toni”) and Cheronne (“Ronnie”) set up appointments for clients who need psychotherapy, substance abuse treatment, or psychiatry.

Your Referral Coordinator will ask for all the information necessary to
start your treatment.  We will ask about your problem and your insurance.
We will check on your insurance coverage. Usually, we can make an
outpatient appointment for you while we have you on the phone.

Most clients who need help from a psychiatrist and who will be taking
medications also benefit from psychotherapy.  In order to make sure
psychiatry clients receive a thorough assessment, we will have one of our
mental health therapists do an initial assessment and recommend the best
services to help with your problems.

We hope to hear from you.  Call 414-540-2170 or write
referrals@shorehavenbhi.com.