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Healthy Forms of Validation: Recognizing and Seeking Supportive Affirmation

Validation is the process of understanding, affirming, and accepting one’s feelings, thoughts, or experiences. Receiving healthy validation plays an essential role in building self-esteem, enhancing relationships, and promoting emotional resilience. However, it’s essential to recognize and seek out validation that is healthy and constructive. Here’s an overview of different types of validation and strategies for recognizing and pursuing them effectively.

Why Validation Matters

Validation from others reassures us that our feelings and experiences are understood and accepted. Research shows that receiving consistent, positive validation from supportive people can lead to improved mental health, stronger relationships, and a more secure sense of self (Linehan, 1993). According to self-determination theory, validation can also foster autonomy, competence, and relatedness, which are essential for psychological well-being (Ryan & Deci, 2000).

However, relying solely on external validation can be harmful, leading to dependency and reduced self-esteem. Instead, it’s beneficial to balance seeking validation from others with developing self-validation practices.

1. Types of Healthy Validation

  • Emotional Validation: Emotional validation involves acknowledging and accepting someone’s feelings without judgment. This can be as simple as listening attentively, empathizing, and affirming that the other person’s feelings are understandable. Emotional validation reinforces that feelings are valid and that it’s okay to feel what one feels (Linehan, 1993).
  • Validation of Effort and Progress: Praising effort rather than outcomes is a powerful form of validation that can reinforce persistence, self-compassion, and growth. Validating someone’s efforts, even if they fall short of success, promotes a growth mindset, where challenges are seen as opportunities to learn rather than sources of failure (Dweck, 2006).
  • Authentic Affirmations: Authentic affirmations recognize specific qualities, skills, or positive contributions that a person has shown. This validation should be specific rather than generic to reinforce self-worth in an honest, meaningful way (Wood et al., 2008).

2. Recognizing Healthy Validation

Healthy validation has distinct characteristics that make it different from unhealthy or superficial validation. Here’s how to identify it:

  • Respectful and Non-Judgmental: Healthy validation acknowledges your experiences without judgment or dismissal. Research shows that people who validate respectfully build stronger, more trusting relationships (Kross et al., 2014).
  • Specific and Genuine: Unlike generic praise, specific and genuine validation is grounded in real examples. For example, instead of saying “You’re smart,” healthy validation might sound like “I noticed how thoughtful you were when you solved that problem.” This specificity makes the affirmation more meaningful and believable (Wood et al., 2008).
  • Supportive but Not Enabling: Healthy validation encourages personal growth and resilience. It acknowledges your feelings and experiences without enabling unhelpful behaviors, promoting personal accountability and independence (Ryan & Deci, 2000).

3. How to Seek Out Healthy Validation

While it can be challenging to seek validation directly, there are strategies to create environments and relationships where it naturally occurs:

  • Communicate Openly: Sharing how you feel and what kind of support you need can help others understand your perspective and respond in validating ways. Research suggests that people who openly communicate their feelings are more likely to receive affirming responses, as clear communication reduces misunderstandings (Gottman, 2011).
  • Seek Supportive Relationships: Prioritize connections with people who genuinely care about your well-being and listen to you. Friendships and relationships that emphasize empathy, understanding, and honest feedback are more likely to offer healthy validation (Reis & Shaver, 1988).
  • Set Boundaries Around Validation-Seeking: Being mindful of how and when you seek validation can help prevent over-dependence on others. Seeking validation when genuinely needed, rather than as a habit, can help you distinguish between healthy support and dependency (Neff, 2003).

4. Building Self-Validation Skills

Relying on oneself for validation is a healthy, empowering practice that can lead to greater self-confidence and resilience:

  • Practice Self-Compassion: Self-compassion is a form of self-validation that involves treating yourself kindly, especially during challenging times. According to Dr. Kristin Neff, practicing self-compassion can help you become your own source of validation, reducing dependency on external sources (Neff, 2003).
  • Acknowledge Your Own Efforts: Celebrating your progress, no matter how small, reinforces self-validation. This practice helps you recognize your own efforts, fostering a positive self-image and reducing the need for constant external approval (Dweck, 2006).
  • Mindfulness and Journaling: Reflecting on your experiences, thoughts, and emotions through mindfulness or journaling can help you recognize your feelings and validate them internally. This process strengthens self-awareness and helps you rely less on external feedback (Kabat-Zinn, 2003).

Conclusion

Validation is a powerful element of healthy relationships and self-esteem, but it’s essential to seek out healthy, constructive forms of affirmation. By recognizing the qualities of healthy validation, seeking it from supportive people, and building self-validation skills, individuals can enhance their emotional resilience and improve their overall well-being.

This article has been written by John S. Collier, MSW, LCSW. Mr. Collier has over 25 years of experience in the social work field and is based in London Kentucky through Southeast Kentucky Behavioral Health, LLC. Mr. Collier may be reached by phone at (606) 657–0532 extension 101 or by email at [email protected].

References

  • Dweck, C. S. (2006). Mindset: The New Psychology of Success. Random House.
  • Gottman, J. M. (2011). The Science of Trust: Emotional Attunement for Couples. W.W. Norton & Company.
  • Kabat-Zinn, J. (2003). Mindfulness-Based Stress Reduction (MBSR). American Psychological Association.
  • Kross, E., et al. (2014). Social rejection and the brain. Trends in Cognitive Sciences, 18(1), 15-21.
  • Linehan, M. M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder. Guilford Press.
  • Neff, K. D. (2003). The development and validation of a scale to measure self-compassion. Self and Identity, 2(3), 223-250.
  • Reis, H. T., & Shaver, P. (1988). Intimacy as an interpersonal process. In Handbook of Personal Relationships, 367-389.
  • Ryan, R. M., & Deci, E. L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist, 55(1), 68-78.
  • Wood, A. M., et al. (2008). The role of gratitude in the development of social support, stress, and depression: Two longitudinal studies. Journal of Research in Personality, 42(4), 854-871.

This article provides a guide to recognizing and seeking healthy forms of validation based on research and psychological theories. Let me know if there’s any area you’d like to explore in more depth.

Do I Act “Entitled”? A Teenager’s Perspective

In today’s world, the concept of “entitlement” is often associated with young people. But what does it really mean to be “entitled”? At its core, entitlement is a sense of deserving special treatment or privileges without necessarily earning them (Twenge & Campbell, 2009). While entitlement isn’t inherently bad, when unchecked, it can lead to negative behaviors and strained relationships. This article aims to help you, as a teenager, understand entitlement from your perspective and how it might impact your life.

 What is Entitlement?

Entitlement is a mindset where people believe they deserve certain rights or privileges without putting in effort or showing gratitude. It’s like expecting a reward without doing the work or expecting things to go your way just because you want them to. Psychologists Dr. Jean Twenge and Dr. W. Keith Campbell define it as “a stable and pervasive sense that one deserves more and is entitled to more than others” (Twenge & Campbell, 2009). This can sometimes show up as expecting praise for things that should be standard or demanding special treatment in different situations.

 Signs of Entitlement in Teenagers

According to psychologists, entitlement can sometimes develop naturally during teenage years as you seek more independence and explore self-identity (APA, 2013). Here are some common signs of entitlement to reflect on:

  1. Expecting Praise for Basic Responsibilities  If you often expect praise for everyday responsibilities, like finishing your homework or chores, this might be a sign of entitlement. While appreciation is important, basic responsibilities are usually expected without special recognition.
  2. Demanding Special Treatment  Entitlement can show up when you believe you should be treated differently just because of who you are. For instance, if you often feel frustrated when others don’t give you special privileges, it may be worth reflecting on why you feel that way.
  3. Ignoring Others’ Needs  Entitlement can lead to a focus on one’s own needs while overlooking others. If you frequently expect your family or friends to go out of their way for you, without offering support in return, it might be a sign of an entitled attitude.
  4. 4. Struggling with Criticism or Rejection  Those with entitled mindsets often have a hard time handling criticism or rejection. If you find yourself getting overly defensive or hurt when people offer constructive feedback, it could be a sign of entitlement.

 Why Does Entitlement Happen?

Entitlement can sometimes be a byproduct of wanting to feel special or unique. During adolescence, as you figure out who you are, it’s normal to crave validation. However, the rise of social media can add pressure to appear “successful” or “popular,” which sometimes fuels entitled thinking (Kross & Verduyn, 2018). Additionally, cultural factors, like messages in media, often promote self-focus and immediate gratification, which can also impact how entitled we feel.

Family environment and upbringing also play a role. For example, when parents give constant praise without boundaries or shield children from any failure, it can lead to entitlement (Twenge & Campbell, 2009). This isn’t to say praise is harmful, but balance is key.

 The Downsides of Entitlement

While a small amount of entitlement can build confidence, too much can create challenges. Research shows that entitled attitudes are linked to difficulty in relationships, dissatisfaction with life, and even increased mental health struggles, like depression and anxiety (Grubbs & Exline, 2016). When we expect too much from others, we risk pushing people away and experiencing disappointment when things don’t go our way.

Entitlement can also hinder personal growth. By always expecting others to meet your needs, you may miss out on learning resilience, empathy, and problem-solving skills, which are essential for navigating adulthood.

 How to Recognize and Reduce Entitlement

1. Practice Gratitude  One of the simplest ways to combat entitlement is to cultivate gratitude. Instead of focusing on what you lack or what you deserve, take time each day to recognize things you’re grateful for. Research shows that practicing gratitude can increase happiness and reduce feelings of entitlement (Emmons & McCullough, 2003).

2. Work on Self-Awareness     Reflect on your actions and motives. Ask yourself, “Am I doing this because I feel I deserve special treatment, or am I genuinely interested in contributing?” By becoming more aware of your thoughts and actions, you can shift toward a more balanced perspective.

3. Learn to Accept Criticism  Learning to accept constructive criticism is a valuable skill that helps build resilience. Instead of feeling hurt or defensive, try to see criticism as an opportunity to grow and improve.

4. Build Empathy     Practice thinking about others’ perspectives and needs. Ask yourself how your actions impact others. Empathy helps build meaningful relationships and reduces entitlement by reminding you that others have their own needs and challenges.

5. Develop a Growth Mindset  Dr. Carol Dweck’s research on growth mindset suggests that people who focus on growth over fixed achievements are more likely to be successful and satisfied in life (Dweck, 2006). By focusing on effort and improvement rather than expecting outcomes, you can shift away from entitlement.

Recognizing entitlement can be challenging, especially when society often reinforces a “me-first” mentality. However, by practicing gratitude, empathy, and self-awareness, you can avoid the pitfalls of entitlement and develop stronger, healthier relationships with those around you. Remember, the path to true confidence and self-worth doesn’t come from expecting special treatment but from treating others and yourself with respect and understanding.

This article has been written by John S. Collier, MSW, LCSW. Mr. Collier has over 25 years of experience in the social work field and is based in London Kentucky through Southeast Kentucky Behavioral Health, LLC. Mr. Collier may be reached by phone at (606) 657–0532 extension 101 or by email at [email protected].

 References

  • American Psychological Association. (2013). Developing Adolescents: A Reference for Professionals. American Psychological Association.
  • Dweck, C. S. (2006). Mindset: The New Psychology of Success. Random House.
  • Emmons, R. A., & McCullough, M. E. (2003). Counting blessings versus burdens: An experimental investigation of gratitude and subjective well-being in daily life. Journal of Personality and Social Psychology, 84(2), 377-389.
  • Grubbs, J. B., & Exline, J. J. (2016). Trait entitlement as an emotion regulation strategy: A longitudinal study of its effects on perceived stress, depressive symptoms, and self-esteem. Journal of Research in Personality, 61, 27-34.
  • Kross, E., & Verduyn, P. (2018). Social media and well-being: Pitfalls, progress, and next steps. Trends in Cognitive Sciences, 22(7), 558-560.
  • Twenge, J. M., & Campbell, W. K. (2009). The Narcissism Epidemic: Living in the Age of Entitlement. Free Press.
Holiday Stress: Understanding Causes and Effective Coping Strategies

As the holiday season approaches, many people find themselves experiencing elevated levels of stress. Despite the season’s emphasis on joy and celebration, the holidays can bring unique stressors that impact mental well-being. From financial pressures and social obligations to family dynamics and the expectation of cheer, holiday stress is a prevalent issue. Understanding these sources of stress and adopting effective coping strategies can help individuals navigate the season with resilience.

Causes of Holiday Stress

  1. Financial Pressure
    One of the primary sources of holiday stress is financial strain. A survey by the American Psychological Association (APA) found that money is a top stressor during the holidays, as individuals feel pressured to spend on gifts, decorations, and travel (APA, 2022). The National Retail Federation reports that the average American consumer spends over $1,000 on holiday expenses, which can lead to financial worry, especially for those on a tight budget (NRF, 2022).
  2. Social and Family Obligations
    Family gatherings and social events increase during the holiday season, and while these can be enjoyable, they also bring stress. Family dynamics, particularly in cases of estrangement or unresolved conflicts, can lead to tension and anxiety (Mayo Clinic, 2023). Additionally, individuals may feel pressured to attend numerous gatherings, which can become overwhelming and emotionally exhausting.
  3. High Expectations and Pressure to Feel Happy
    The holiday season is often portrayed in media as a time of happiness and perfection. This expectation can lead individuals to feel inadequate or stressed if their experiences do not align with these ideals (Kocovski et al., 2021). This pressure to appear cheerful and festive, even when one does not feel that way, can amplify feelings of isolation or sadness.
  4. Disrupted Routines and Lack of Self-Care
    The holiday season can disrupt normal routines, affecting sleep, diet, and exercise patterns. Research shows that routine disruptions can lead to emotional imbalance, which can exacerbate stress levels (Kühn et al., 2022). Many people also neglect self-care during this time, prioritizing holiday tasks over personal well-being.

Effective Coping Strategies for Holiday Stress

  1. Set Realistic Expectations
    Adjusting expectations around the holidays can help reduce stress. Instead of striving for perfection, focus on enjoying moments as they come. Studies have shown that setting realistic, attainable goals for the holidays can improve overall well-being (Lyubomirsky & Layous, 2013). Consider scaling back holiday plans to avoid overextending yourself financially and emotionally.
  2. Create a Budget and Stick to It
    Developing a realistic budget for holiday expenses and adhering to it can alleviate financial stress. A 2020 study found that individuals who budgeted for the holidays reported significantly less financial anxiety than those who did not (Scholz et al., 2020). Planning gift purchases in advance and setting spending limits can prevent financial strain.
  3. Practice Mindfulness and Relaxation Techniques
    Mindfulness practices, such as meditation and deep breathing exercises, are effective ways to reduce stress. Research has shown that mindfulness can decrease holiday-related stress by improving emotional regulation and reducing rumination (Goldstein et al., 2021). Taking time to relax and focus on the present moment can foster resilience and help individuals cope with holiday pressures.
  4. Prioritize Self-Care and Maintain Healthy Routines
    Maintaining regular sleep, exercise, and diet routines can have a profound impact on managing holiday stress. A study from the American Psychological Association indicates that engaging in physical activity and prioritizing healthy sleep patterns help individuals better cope with seasonal stress (APA, 2022). Scheduling personal time for self-care activities, such as reading or walking, can help balance holiday obligations with personal needs.
  5. Limit Social Media Use
    Social media can exacerbate holiday stress by exposing individuals to idealized portrayals of others’ experiences. Limiting social media use can help reduce feelings of inadequacy and prevent comparison-based stress. A study found that reduced social media engagement over the holidays led to higher levels of self-esteem and decreased feelings of stress (Twenge et al., 2019).

Seeking Support

For those struggling with holiday stress, reaching out to friends, family, or a mental health professional can be beneficial. Studies show that social support can significantly reduce stress and improve mental well-being (Cohen & Wills, 1985). Talking openly about holiday-related stress with loved ones or seeking therapy can provide emotional relief and help develop coping skills.

Conclusion

The holiday season brings unique challenges, from financial strain to social pressures. However, by setting realistic expectations, practicing self-care, and employing mindfulness techniques, individuals can mitigate these stressors and enjoy a more peaceful holiday season. For those who continue to struggle, seeking support from friends, family, or mental health professionals can provide essential relief. Managing holiday stress effectively is key to fostering a healthier, happier season.

This article was written by John S. Collier, MSW, LCSW. Mr. Collier is a seasoned clinical social worker with over 25 years of experience, serving the London and Richmond, Kentucky areas through Southeast Kentucky Behavioral Health, LLC. Known for his compassionate approach and commitment to quality care, Mr. Collier supports individuals and families with a focus on mental health and well-being. He may be reached by phone at (606) 657–0532, extension 101, or by email at [email protected].

References

  • American Psychological Association. (2022). Stress in America: Coping with holiday stress. APA.
  • Cohen, S., & Wills, T. A. (1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98(2), 310–357.
  • Goldstein, J., et al. (2021). Mindfulness interventions and stress reduction: The role of emotional regulation. Journal of Clinical Psychology, 77(5), 1093–1105.
  • Kocovski, N. L., et al. (2021). Social pressure and the holiday effect: A study on societal expectations and holiday-related stress. Social Psychology Quarterly, 84(4), 325–338.
  • Kühn, S., et al. (2022). Routine disruption and emotional imbalance: Implications for holiday-related stress. Emotion, 22(4), 675–683.
  • Lyubomirsky, S., & Layous, K. (2013). How do simple positive activities increase well-being? Current Directions in Psychological Science, 22(1), 57–62.
  • Mayo Clinic. (2023). Stress management: Handling holiday stress. Mayo Clinic.
  • National Retail Federation. (2022). Holiday shopping trends and consumer spending. NRF.
  • Scholz, J. K., et al. (2020). Financial planning and budgeting for seasonal expenses: Reducing anxiety and stress. Financial Counseling and Planning Journal, 31(2), 101–118.
  • Twenge, J. M., et al. (2019). Social media use and holiday stress: The role of online comparisons in shaping holiday experiences. Cyberpsychology, Behavior, and Social Networking, 22(7), 427–433.

This article provides a comprehensive overview of the causes and coping strategies for holiday-related stress, offering readers evidence-based insights for a healthier holiday season.

Controlling Anger: A Teenager’s Comprehensive Guide

Adolescence can be an emotionally challenging time, especially for teenage boys. The transition from childhood to adulthood comes with various changes—physically, emotionally, and socially. Among these challenges, controlling anger often becomes a significant issue. Learning how to manage anger effectively is essential for emotional well-being and healthy relationships. This article will explore strategies that teenage boys can use to control their anger, supported by psychological insights and expert advice.

 Understanding Anger

Anger is a natural emotional response to perceived threats, frustration, or injustice. While everyone experiences anger, the way it is expressed can differ widely. In adolescence, hormonal changes, brain development, and social pressures can amplify emotional responses, including anger (American Psychological Association [APA], 2021). Teen boys, in particular, may feel societal pressure to act tough or suppress emotions, making it harder to express feelings in a healthy way (Friedman, 2020).

Strategies for Managing Anger

1. Identify Triggers

Understanding what provokes your anger is the first step to managing it. Common triggers include feeling disrespected, misunderstood, or ignored. Identifying these triggers allows you to anticipate situations where you might lose control and prepare for them (APA, 2021). For more on Identifying Triggers go here.

2. Take Deep Breaths

When anger begins to build, taking slow, deep breaths can calm your body’s stress response. This method helps to lower your heart rate and reduce feelings of tension, allowing you to think more clearly before reacting (The Child Mind Institute, 2020). For other relaxation techniques, click here.

3. Practice Mindfulness and Meditation

Mindfulness is the practice of staying present in the moment without judgment. Engaging in mindfulness activities, such as meditation or yoga, can help you become more aware of your emotions as they arise, allowing you to manage them before they escalate into anger (Torrente, 2019). For more information on practicing Mindfulness, click here.

4. Engage in Physical Activity

Physical exercise is one of the most effective ways to release pent-up energy and emotions, including anger. Activities like running, weightlifting, or even hitting a punching bag can provide a constructive outlet for these intense feelings (Friedman, 2020). For more information on engaging in physical activity for anger management, click here.

5. Use “I” Statements

During confrontations, instead of accusing others (e.g., “You never listen to me!”), use “I” statements to express how you feel (e.g., “I feel upset when I’m ignored”). This method helps reduce defensiveness in others and opens the door to better communication (APA, 2021). for more information on the use of “I” statements when dealing with anger, click here.

6. Seek Support

Talking to a trusted adult, such as a parent, teacher, or counselor, can help you process your feelings. Sometimes, just having someone listen without judgment can be enough to diffuse your anger (Torrente, 2019). If you find your anger is hard to control or becomes frequent, it might be helpful to work with a mental health professional. for more information on teens seeking support when they struggle with anger, click here.

7. Set Boundaries and Walk Away

When emotions become too overwhelming, it’s okay to remove yourself from the situation. Walking away for a few minutes to cool down can prevent you from saying or doing something you may later regret (The Child Mind Institute, 2020). If you would like more information on setting boundaries and walking way, click here.

The Role of Brain Development

It’s important to recognize that part of the challenge in managing anger as a teenager is related to brain development. The prefrontal cortex, the part of the brain responsible for decision-making and impulse control, is still maturing during adolescence. This can make it harder to manage intense emotions like anger (Giedd, 2015). Understanding this can help reduce frustration and motivate you to actively work on developing better emotional control.

Long-Term Benefits of Managing Anger

Learning how to control your anger will not only improve your relationships but also benefit your overall health. Chronic anger has been linked to various physical health problems, such as high blood pressure and heart disease (Friedman, 2020). Additionally, managing anger effectively can boost your self-esteem, improve problem-solving skills, and help you achieve better academic and career outcomes (APA, 2021).

As a teenage boy, controlling your anger may sometimes feel difficult, but it is a skill that can be learned. By identifying triggers, practicing mindfulness, engaging in physical activities, and using effective communication, you can manage your anger in healthy ways. Remember, it’s okay to ask for help when you need it, and practicing these strategies consistently will lead to long-term emotional resilience.

This article has been written by John S. Collier, MSW, LCSW. Mr. Collier has over 25 years of experience in the social work field and is based in London Kentucky through Southeast Kentucky Behavioral Health, LLC. Mr. Collier may be reached by phone at (606) 657–0532 extension 101 or by email at [email protected].

 References

American Psychological Association. (2021). Controlling Anger Before It Controls You. https://www.apa.org/topics/anger/control

Friedman, H. S. (2020). The Longevity Project: Surprising Discoveries for Health and Long Life from the Landmark Eight-Decade Study. Penguin Books.

Giedd, J. N. (2015). The Amazing Teen Brain: What Parents Need to Know. National Institute of Mental Health.

The Child Mind Institute. (2020). How to Help Kids Manage Anger. https://childmind.org/article/how-to-help-kids-manage-anger

Torrente, R. (2019). Mindfulness for Teens: Proven Techniques to Reduce Stress, Manage Emotions, and Improve Focus. Rockridge Press.

Navigating the Transition: Creating a Routine

Part 3 of 7 A Key to Success for Retired Men

For men, retirement can represent a significant life shift, often bringing challenges that stem from the loss of a structured daily routine. After decades of adhering to a work schedule, many retirees find themselves grappling with feelings of aimlessness or a lack of direction. Developing a new routine, one that balances relaxation with purpose, is crucial for both mental and physical health. Establishing this new structure is a critical tool for navigating the post-career chapter of life.

The Psychological Impact of Retirement on Men

Men tend to derive a large part of their identity from their careers. A sudden cessation of professional responsibilities can result in feelings of loss, anxiety, or depression. A study conducted by the American Psychological Association revealed that retirees are 40% more likely to experience clinical depression than those still in the workforce, and men, in particular, may struggle with the emotional ramifications of retirement .

The lack of routine after retirement can exacerbate these feelings. Structure and predictability in daily life provide a sense of control and purpose. When this is removed, retirees may feel a void that leads to dissatisfaction. However, studies suggest that creating a new, personalized routine helps retirees maintain a sense of purpose and offers psychological stability .

Benefits of Creating a Routine in Retirement

  1. Maintaining Mental Health
    A structured day reduces anxiety and depressive symptoms in retirees. By setting goals and adhering to a regular schedule, men can experience a greater sense of achievement and self-worth. Research published in Psychology and Aging demonstrated that retirees who establish routines report better emotional health, including reduced rates of loneliness and anxiety .
  2. Physical Health
    A lack of physical activity is one of the leading risk factors for health deterioration post-retirement. Establishing a routine that includes exercise not only prevents physical decline but also enhances cognitive function. The American Heart Association recommends at least 150 minutes of moderate-intensity aerobic activity each week for older adults . Retirees who incorporate daily walks, swimming, or gym sessions into their routine see marked improvements in both mental and physical health.
  3. Sense of Purpose
    Work provides a purpose beyond financial security. After retirement, this sense of purpose can be maintained by dedicating time to new activities. Whether it’s volunteer work, pursuing hobbies, or learning new skills, incorporating meaningful activities into a daily routine ensures that retirees continue to feel productive and valued.
  4. Improved Sleep Patterns
    Sleep disturbances are common among retirees due to the lack of structured activity during the day. By maintaining a routine, retirees can regulate their sleep-wake cycles. A consistent daily schedule promotes better sleep hygiene, resulting in improved energy levels and mental clarity during the day

Tips for Establishing a Retirement Routine

  1. Set Regular Wake-up and Bedtimes
    While the freedom to wake up without an alarm is a retirement perk, it’s still important to maintain a consistent sleep schedule. This helps regulate the body’s circadian rhythms and improves overall energy and mood.
  2. Plan Physical Activity
    Include exercise in your routine, whether it’s morning walks, gym classes, or yoga. Physical activity promotes cardiovascular health, reduces stress, and helps retirees stay physically independent for longer.
  3. Dedicate Time to Hobbies or Learning
    Retirement is the ideal time to pursue long-held interests or learn something new. Whether it’s painting, gardening, writing, or taking courses in a subject of interest, setting aside time for personal development is key to feeling fulfilled.
  4. Volunteer or Mentor
    Many retirees find that volunteering provides a sense of purpose and connection to the community. Mentoring younger professionals in your previous field can also offer both structure and fulfillment, as well as maintain social engagement .
  5. Schedule Social Interactions
    Loneliness can be a significant issue for retirees, particularly for men who may have relied heavily on work relationships. Scheduling regular meet-ups with friends or family members, or joining clubs or groups, can help retirees stay socially active.

Balancing Flexibility with Routine

While it is essential to create a structured routine, it’s equally important to embrace the flexibility that retirement affords. Many men approach retirement as a “permanent vacation,” but over time, the absence of a routine can lead to boredom and dissatisfaction. Therefore, establishing a framework for the day helps maintain a sense of order, but it should remain flexible enough to accommodate spontaneity.

Having the ability to travel, pursue a new hobby, or simply relax without feeling guilty is one of the great benefits of retirement. Flexibility and routine can coexist harmoniously; for instance, retirees may want to maintain a morning exercise routine while leaving afternoons free for exploration or relaxation.

Conclusion

Creating a routine in retirement is vital for men to transition smoothly from their professional lives to a more leisurely phase. A balanced daily schedule promotes mental and physical health, fosters a sense of purpose, and provides the necessary structure to navigate this major life change. By prioritizing self-care, physical activity, and personal fulfillment, retirees can enjoy their golden years with clarity, happiness, and health.

This article has been written by John S. Collier, MSW, LCSW. Mr. Collier has over 25 years of experience in the social work field and is based in London Kentucky through Southeast Kentucky Behavioral Health, LLC. Mr. Collier may be reached by phone at (606) 657–0532 extension 101 or by email at [email protected].

References

  1. American Heart Association. (2021). Exercise Recommendations for Older Adults. Retrieved from American Heart Association.
  2. Hermanns, L. & Cole, G. (2020). “Retirement and the Importance of Routine: How Structure Improves Health.” Journal of Aging Research, 42(3), 315-328.
  3. Watson, D., & Proctor, S. (2019). “Routines and the Mental Health of Retirees: A Psychological Review.” Psychology and Aging, 34(1), 112-119.
  4. Weiss, D. (2018). “Post-Retirement Routines: How to Plan for the Next Chapter.” Aging and Society, 39(2), 237-249.
  5. Kimmel, M. (2019). Retirement and Masculinity: Understanding Emotional Transitions for Men. New York: Routledge Press.
Behavioral Health Services for First Responders: Addressing Mental Health Challenges in High-Stress Professions

First responders, including firefighters, paramedics, police officers, and emergency dispatchers, operate in high-stress environments that expose them to traumatic incidents, life-threatening situations, and intense public scrutiny. These stressors contribute to significant mental health challenges, necessitating comprehensive behavioral health services. Addressing the psychological well-being of first responders is crucial to maintaining their overall health, job performance, and quality of life.

Prevalence of Mental Health Issues Among First Responders

First responders experience elevated rates of mental health disorders compared to the general population. Studies indicate that approximately 30% of first responders develop behavioral health conditions such as depression, post-traumatic stress disorder (PTSD), and anxiety, whereas the general population’s prevalence is approximately 20% (SAMHSA, 2018). Additionally, first responders are at increased risk for suicidal ideation and substance use disorders due to repeated exposure to distressing events (Stanley et al., 2016).

Stressors Impacting First Responders’ Mental Health

  1. Chronic Exposure to Trauma: Repeated exposure to violence, death, and disaster can lead to cumulative trauma effects, increasing the risk of PTSD (Berger et al., 2012).
  2. Occupational Stress: Shift work, long hours, and high-pressure decision-making contribute to anxiety and burnout (Bennett et al., 2020).
  3. Stigma and Barriers to Care: Many first responders hesitate to seek behavioral health services due to stigma, fear of job repercussions, and the perception that admitting struggles indicates weakness (Haugen et al., 2017).

Behavioral Health Services and Interventions

1. Peer Support Programs

Peer support programs have been widely implemented in first responder agencies, providing an informal yet effective avenue for mental health support. These programs allow colleagues to offer emotional support and share coping strategies, reducing stigma and encouraging help-seeking behavior (Carpenter et al., 2018).

2. Critical Incident Stress Management (CISM)

CISM is a structured approach designed to help first responders process traumatic experiences and reduce acute stress reactions. It includes debriefing sessions, counseling services, and resilience training (Mitchell, 2019).

3. Employee Assistance Programs (EAPs)

Many agencies offer EAPs, which provide confidential counseling, mental health resources, and crisis intervention services. EAPs help first responders address work-related and personal stressors that impact their well-being (Chapin et al., 2011).

4. Trauma-Informed Therapy

Evidence-based therapies such as Cognitive Behavioral Therapy (CBT) and Eye Movement Desensitization and Reprocessing (EMDR) have proven effective in treating PTSD and anxiety among first responders (Benedek et al., 2007).

5. Resilience Training and Mindfulness Practices

Preventative programs focusing on resilience training, mindfulness, and stress reduction techniques enhance first responders’ ability to cope with occupational stress. These interventions improve psychological flexibility and reduce emotional exhaustion (Joyce et al., 2019).

Policy and Systemic Changes

To promote the mental well-being of first responders, policy changes and systemic interventions are necessary:

  • Mandatory Mental Health Screenings: Regular screenings help identify mental health concerns early and connect individuals with appropriate services.
  • Improved Access to Services: Increasing funding for mental health programs and integrating behavioral health professionals into first responder agencies can improve access to care.
  • Reducing Stigma: Organizational leadership should foster a culture where seeking mental health support is encouraged and normalized.

Behavioral health services for first responders are critical in mitigating the long-term effects of occupational stress and trauma. Implementing comprehensive mental health interventions—including peer support, crisis management, therapy, and systemic policy changes—can significantly improve first responders’ psychological resilience and job performance. Continued research and investment in behavioral health programs will ensure that those who serve and protect communities receive the mental health support they need.

References

  • Benedek, D. M., Fullerton, C., & Ursano, R. J. (2007). First responders: Mental health consequences of natural and human-made disasters for public health and public safety workers. Annual Review of Public Health, 28(1), 55-68.
  • Bennett, G., Williams, Y., & Wright, K. (2020). Work-related stress and burnout in first responders: A systematic review. Journal of Occupational Health Psychology, 25(2), 183-198.
  • Berger, W., Coutinho, E. S. F., Figueira, I., et al. (2012). Rescuers at risk: Posttraumatic stress symptoms among first responders following disasters. Journal of Anxiety Disorders, 26(5), 422-430.
  • Carpenter, M., Perera, J., & Patterson, J. (2018). Evaluating the effectiveness of peer support programs for first responders. Psychological Services, 15(2), 215-224.
  • Chapin, M., Brannen, S. J., Singer, M. I., & Walker, M. (2011). Training and sustaining peer supporters for first responders. Journal of Workplace Behavioral Health, 26(1), 95-113.
  • Haugen, P. T., Evces, M., & Weiss, D. S. (2017). Treatment of PTSD in first responders: A systematic review. Clinical Psychology Review, 53, 22-35.
  • Joyce, S., Shand, F., Tighe, J., et al. (2019). A randomized controlled trial of resilience training for first responders. Journal of Occupational Health Psychology, 24(4), 437-447.
  • Mitchell, J. T. (2019). Critical incident stress management (CISM): Strategies for crisis intervention and stress management. Charles C Thomas Publisher.
  • SAMHSA (2018). First responders: Behavioral health concerns, emergency response, and trauma. Substance Abuse and Mental Health Services Administration.
  • Stanley, I. H., Hom, M. A., Hagan, C. R., & Joiner, T. E. (2016). Career prevalence and correlates of suicidal thoughts and behaviors among first responders. Journal of Affective Disorders, 190, 363-371.

What Does It Mean to Love Your Wife?

Loving one’s wife is a fundamental aspect of a strong and enduring marriage. It extends beyond mere words or fleeting emotions and is demonstrated through actions, commitment, and intentional effort. The concept of love within marriage has been explored in psychological, philosophical, and religious contexts, with varying interpretations of how love is best expressed. This article examines what it means to love one’s wife, drawing on research from psychology, relationship counseling, and philosophy.

Understanding Love in Marriage

Love in marriage is multidimensional, encompassing emotional, intellectual, and physical connections. Sternberg’s Triangular Theory of Love (1986) identifies three core components of love: intimacy, passion, and commitment (Sternberg, 1986). A balanced marriage integrates these elements, fostering a deep and fulfilling relationship.

  1. Intimacy – This involves deep emotional closeness, vulnerability, and a sense of connection. It is built through trust, empathy, and consistent communication (Gottman & Silver, 2015).
  2. Passion – Passion entails romantic attraction and physical affection. While it may fluctuate over time, intentional efforts to nurture attraction and express love physically are vital (Hatfield & Walster, 1978).
  3. Commitment – A long-term decision to prioritize the well-being and happiness of one’s spouse despite life’s challenges. This aspect of love is what sustains a relationship through difficulties (Stanley, 2005).

Demonstrating Love in Practical Ways

To truly love one’s wife means translating emotional affection into meaningful actions. Here are several key ways to do so:

1. Practicing Emotional Attunement :

Loving one’s wife requires actively listening and responding to her emotional needs. Dr. John Gottman, a renowned relationship expert, emphasizes the importance of turning toward one’s partner instead of away when discussing emotions (Gottman & Silver, 2015). This means being present, validating her feelings, and offering support rather than dismissing concerns.

2. Acts of Service and Sacrifice

Love often involves selflessness. Gary Chapman’s Five Love Languages (1992) identifies acts of service as a key way many individuals feel loved. Helping with household responsibilities, supporting her goals, and prioritizing her well-being are clear demonstrations of love.

3. Communicating Affection and Appreciation

Verbal affirmations, such as expressing gratitude and admiration, strengthen emotional intimacy (Chapman, 1992). Simple words of encouragement and affirmation, such as “I appreciate you” or “I love you,” reinforce a strong emotional bond.

4. Prioritizing Quality Time

Spending intentional time together, without distractions, cultivates closeness. Studies suggest that couples who engage in shared activities and date nights experience greater relationship satisfaction (Ogolsky, 2020).

5. Nurturing Physical and Romantic Connection

Physical intimacy, including affectionate gestures like holding hands, hugging, and maintaining a fulfilling sex life, plays a crucial role in sustaining a healthy marriage (Hatfield & Rapson, 1993). Physical touch is a powerful way to communicate love and security.

6. Supporting Her Growth and Well-Being

Loving one’s wife includes supporting her personal and professional aspirations. Encouraging her ambitions and well-being contributes to her happiness and strengthens the partnership (Aron et al., 2000).

7. Remaining Loyal and Trustworthy

Trust is the foundation of love. Maintaining honesty, faithfulness, and integrity in words and actions fosters a secure and lasting marriage (Stanley, 2005).

Loving one’s wife is an active and lifelong commitment. It requires effort, intentionality, and a deep understanding of her emotional and relational needs. By practicing emotional attunement, expressing love through actions, and prioritizing the relationship, a husband can create a marriage that thrives on deep, enduring love.

John S. Collier, MSW, LCSW, is a licensed clinical social worker based in London, Kentucky. With years of experience in behavioral health therapy, he specializes in relationship counseling, trauma-informed care, and family dynamics. Mr. Collier has worked extensively with couples, helping them build stronger emotional connections and develop healthy communication patterns. His expertise in marriage counseling is grounded in evidence-based therapeutic approaches, drawing from attachment theory, cognitive-behavioral therapy, and mindfulness practices. Passionate about strengthening relationships, John continues to provide guidance and support to individuals and couples navigating the complexities of love, commitment, and emotional well-being.

References

  • Aron, A., Aron, E. N., Tudor, M., & Nelson, G. (2000). Close relationships as including other in the self. Journal of Personality and Social Psychology, 78(4), 599-612.
  • Chapman, G. (1992). The Five Love Languages: How to Express Heartfelt Commitment to Your Mate. Northfield Publishing.
  • Gottman, J. M., & Silver, N. (2015). The Seven Principles for Making Marriage Work. Harmony.
  • Hatfield, E., & Rapson, R. L. (1993). Love, Sex, and Intimacy: Their Psychology, Biology, and History. HarperCollins.
  • Hatfield, E., & Walster, G. W. (1978). A New Look at Love. University Press of America.
  • Ogolsky, B. G. (2020). The Science of Couple and Family Relationships. Routledge.
  • Stanley, S. M. (2005). The Power of Commitment: A Guide to Active, Lifelong Love. Jossey-Bass.
  • Sternberg, R. J. (1986). A triangular theory of love. Psychological Review, 93(2), 119-135.

What is the Supports for Community Living (SCL) Waiver in Kentucky?

The Supports for Community Living (SCL) Waiver is a Medicaid Home and Community-Based Services (HCBS) waiver program in Kentucky that provides long-term care services for individuals with intellectual or developmental disabilities (IDD). This waiver is designed to help eligible individuals live in community settings rather than institutional facilities by offering support services tailored to their needs.

Purpose and Goals of the SCL Waiver

The primary goal of the SCL waiver is to promote independence, self-determination, and community integration for individuals with IDD. The program enables participants to receive necessary services in their homes, family homes, or other community-based settings while still maintaining their quality of life and personal choice in care.

According to the Kentucky Cabinet for Health and Family Services (CHFS), the waiver aims to:

  • Reduce institutionalization by offering alternative care options.
  • Encourage community engagement and independent living.
  • Provide person-centered services that cater to individual needs and preferences.
  • Support families and caregivers in maintaining care for their loved ones at home.

Eligibility Requirements

To qualify for the SCL waiver, individuals must meet both financial and medical criteria:

  1. Medical Eligibility:
    • Must have an intellectual or developmental disability.
    • Must require the level of care typically provided in an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID).
  2. Financial Eligibility:
    • Must meet Medicaid income and asset limits as determined by Kentucky Medicaid.

Eligibility is assessed through the Kentucky Department for Medicaid Services (DMS) in conjunction with a qualified assessment process.

Services Provided Under the SCL Waiver

The SCL waiver offers a broad range of services to support individuals in different aspects of daily living, including:

1. Residential and Community Living Supports

  • Supported Employment: Helps individuals find and maintain employment in the community.
  • Personal Assistance: Assistance with daily living activities such as bathing, dressing, and meal preparation.
  • Adult Day Training: Structured day programs for socialization, skill-building, and recreational activities.
  • Person-Centered Coaching: One on one coach to work specifically on reaching goals and objectives to be more independent.

2. Clinical and Behavioral Support Services

  • Behavioral Support Services: Therapy and intervention to help manage behaviors and improve social interactions.
  • Occupational, Physical, and Speech Therapy: Rehabilitation services to support functional independence.
  • Respite Care: Temporary relief for family caregivers who provide primary support.

3. Community Integration and Socialization

  • Community Access Services: Encourages participation in social and recreational activities.
  • Transportation Services: Assistance with accessing medical appointments and community activities.

4. Health and Wellness Supports

  • Nursing Services: Medical care provided by registered or licensed nurses.
  • Medication Management: Assistance with medication administration and monitoring.

Applying for the SCL Waiver

The application process for the SCL waiver involves the following steps:

  1. Submission of an Application: Individuals or their guardians must submit an application to the Kentucky Department for Medicaid Services.
  2. Level of Care Assessment: An assessment is conducted to determine if the individual meets the medical criteria for ICF/IID-level care.
  3. Waiting List Placement (if applicable): Due to limited funding, there may be a waiting list for SCL services.
  4. Approval and Development of a Person-Centered Plan (PCP): If approved, a case manager works with the individual and their family to create a person-centered plan outlining the needed services.

Impact of the SCL Waiver

Research indicates that home and community-based services (HCBS) improve the quality of life for individuals with disabilities by providing them with opportunities for employment, education, and social inclusion (Braddock et al., 2022). The Kentucky Department for Behavioral Health, Developmental and Intellectual Disabilities (DBHDID) has reported that individuals in the SCL program experience better outcomes compared to those in institutional settings.

Challenges and Future Developments

While the SCL waiver provides essential services, challenges remain, including:

  • Long waiting lists: Many eligible individuals face delays in receiving services due to funding limitations.
  • Provider shortages: A lack of qualified healthcare providers, particularly in rural areas, affects service availability.
  • Complex application process: Families often require assistance navigating the Medicaid waiver system.

Efforts are being made to expand waiver slots and streamline service delivery to meet the growing demand for community-based supports.

Conclusion

The Supports for Community Living (SCL) Waiver in Kentucky is a vital Medicaid-funded program that enhances the lives of individuals with intellectual and developmental disabilities. By offering person-centered, community-based services, the waiver helps individuals lead more independent and fulfilling lives outside of institutional settings. While challenges exist, continued policy improvements and increased funding could expand access to these essential supports in the future.

This article has been written by John S Collier, MSW, LCSW. Mr. Collier has over 25 years experience in the social work field. he currently serves as the executive director of SE Kentucky behavioral health based out of London KY. He may be reached by phone 606-657-0532 or by email at [email protected]

References

  • Braddock, D., Hemp, R., & Rizzolo, M. C. (2022). The State of the States in Developmental Disabilities: 2022 Edition. University of Colorado.
  • Kentucky Cabinet for Health and Family Services (CHFS). (2024). Supports for Community Living Waiver Program Overview. Retrieved from https://chfs.ky.gov
  • Kentucky Department for Medicaid Services (DMS). (2023). Medicaid Home and Community-Based Services Waivers. Retrieved from https://medicaid.ky.gov

The Pros and Cons of Behavioral Telehealth: Is It Right for You?

Behavioral telehealth, or teletherapy, has become an increasingly popular method for delivering mental health services. With advancements in technology, therapists and clients can now connect remotely through video calls, phone consultations, and online chat-based platforms. While telehealth offers several advantages, it also has limitations that may impact its effectiveness depending on an individual’s needs. This article explores the pros and cons of behavioral telehealth to help you determine whether it is the right choice for you.

The Pros of Behavioral Telehealth

1. Increased Accessibility

One of the biggest advantages of behavioral telehealth is its ability to reach individuals who might otherwise struggle to access therapy. This includes people living in rural or remote areas, those with mobility limitations, and individuals with tight schedules (Hilty et al., 2013).

2. Convenience and Flexibility

Telehealth eliminates the need for travel, allowing clients to attend sessions from the comfort of their homes. This flexibility can be especially beneficial for busy professionals, parents, and those with chronic illnesses (Torous et al., 2020).

3. Reduced Stigma

Some individuals avoid seeking mental health services due to fear of stigma. Telehealth allows for more privacy, as sessions can be conducted in a confidential setting without the need to visit a therapist’s office (Myers & Turvey, 2013).

4. Continuity of Care

For those who relocate frequently or travel often, telehealth ensures that therapy sessions can continue uninterrupted. This is particularly helpful for military families, college students, and frequent travelers (Shore et al., 2014).

5. Cost-Effectiveness

Telehealth can be more affordable than in-person therapy, reducing costs associated with commuting and childcare. Additionally, many insurance companies now cover telehealth services, making mental health care more accessible (Mehrotra et al., 2017).

The Cons of Behavioral Telehealth

1. Technological Barriers

Not everyone has access to reliable internet or a private space for therapy sessions. Technical issues such as poor connectivity or software malfunctions can disrupt sessions and reduce their effectiveness (Yellowlees et al., 2010).

2. Limited Non-Verbal Cues

In traditional therapy, therapists rely on body language, facial expressions, and other non-verbal cues to assess a client’s emotional state. Virtual sessions may limit a clinician’s ability to observe these important cues, potentially affecting the quality of care (Glueckauf et al., 2018).

3. Not Suitable for All Conditions

While telehealth is effective for many mental health conditions, it may not be appropriate for individuals in crisis, those with severe psychiatric disorders, or individuals who require in-person interventions, such as exposure therapy for phobias (Shigekawa et al., 2018).

4. Concerns About Privacy and Security

Online therapy platforms must comply with privacy regulations such as HIPAA (Health Insurance Portability and Accountability Act). However, there is always a risk of data breaches or unauthorized access, which may deter some clients from using telehealth services (Lustgarten & Elhai, 2018).

5. Reduced Therapeutic Relationship

Some clients and therapists feel that online therapy lacks the personal connection of face-to-face interactions. The absence of a physical presence may make it harder for some individuals to open up and build trust (Simpson & Reid, 2014).

Is Behavioral Telehealth Right for You?

Deciding whether behavioral telehealth is the right option depends on several factors:

  • Your Needs and Diagnosis: If you have mild to moderate mental health concerns such as anxiety or depression, telehealth may be a convenient option. However, individuals with severe psychiatric conditions may require in-person treatment.
  • Access to Technology: Reliable internet and a private space are necessary for effective telehealth sessions.
  • Comfort Level with Technology: Those who struggle with technology may find in-person therapy more suitable.
  • Insurance Coverage: Check with your insurance provider to determine whether telehealth services are covered.

Behavioral telehealth has transformed mental health care, offering increased accessibility, convenience, and affordability. However, it is not a one-size-fits-all solution. While it works well for many individuals, others may find in-person therapy more beneficial. By weighing the pros and cons, you can determine whether telehealth aligns with your mental health needs and lifestyle.

This article has been written by John S Collier, MSW, LCSW. Mr. Collier has over 25 years’ experience in the social work field. he currently serves as the executive director and outpatient behavioral health therapist for Southeast Kentucky behavioral health based out of London KY., He may be reached by phone at 606-657-0532 extension 101 or by email at [email protected]

References

  • Glueckauf, R. L., Maheu, M. M., Drude, K. P., Wells, B. A., Wang, Y., Gustafson, D. J., & Nelson, E.-L. (2018). Survey of psychologists’ telebehavioral health practices: Technology use, ethical issues, and training needs. Professional Psychology: Research and Practice, 49(5-6), 301-313.
  • Hilty, D. M., Ferrer, D. C., Parish, M. B., Johnston, B., Callahan, E. J., & Yellowlees, P. M. (2013). The effectiveness of tele-mental health: A 2013 review. Telemedicine and e-Health, 19(6), 444-454.
  • Lustgarten, S. D., & Elhai, J. D. (2018). Technology use in mental health practice and research: Legal and ethical risks. Clinical Psychology: Science and Practice, 25(2), e12234.
  • Mehrotra, A., Huskamp, H. A., Souza, J., Uscher-Pines, L., Rose, S., Landon, B. E., & Busch, A. B. (2017). Rapid growth in mental health telemedicine use among rural Medicare beneficiaries, wide variation across states. Health Affairs, 36(5), 909-917.
  • Myers, K., & Turvey, C. (2013). Telemental health: Clinical, technical, and administrative lessons learned. Elsevier.
  • Shore, J. H., Yellowlees, P., Caudill, R., Johnston, B., Turvey, C., Mishkind, M., Krupinski, E., Myers, K., Shore, P., Kaftarian, E., & Hilty, D. (2014). Best practices in videoconferencing-based telemental health. Telemedicine and e-Health, 20(2), 96-105.
  • Shigekawa, E., Fix, M., Corbett, G., Roby, D. H., & Coffman, J. (2018). The current state of telehealth evidence: A rapid review. Health Affairs, 37(12), 1975-1982.
  • Simpson, S. G., & Reid, C. L. (2014). Therapeutic alliance in videoconferencing psychotherapy: A review. Australian Journal of Rural Health, 22(6), 280-299.
  • Torous, J., Janmohamed, T., Moreno, C., Miller, B., Currie, M., Brown, J., & Keshavan, M. (2020). Digital mental health in the COVID-19 pandemic era: Digital mental health. JMIR Mental Health, 7(8), e21864.
  • Yellowlees, P., Shore, J. H., & Roberts, L. (2010). Telepsychiatry and e-mental health. American Psychiatric Publishing.