Connecting with the Therapist
Transcription
Connecting with the Therapist
315 SANCHEZ ST SAN FRANCISCO, CA 94114 Bridge Bridge is a quarterly journal designed to provide Bay Area helping Y How To Choose A Therapist Z professionals with up-todate articles and Second Part of a Two-Part Series By Amara Glorioso Brown, MFT resources to help us help others. For more information, contact this publication at [email protected] Amara Brown, MFT 415-391-1741 www.camft.org/Therapists/ AmaraBrown Katie Cofer, MFT 415-826-2951 [email protected] Samantha Zylstra, MFTI 415-585-3132 www.samanthazylstra.com How to Choose a 1 Therapist by Amara Glorioso Brown EMDR: New 2 Possibilities for Clinical Change by Katie Cofer An Age of Connecting Therapist with the This is the second part of a twopart series on choosing a good therapist. In Part One I addressed where to find referrals and gave information on differentiating among the licenses and training under which therapists practice. (If you missed Part One, printed in the Winter 2005 edition of Bridge, feel free to contact me either by email at [email protected] or by calling 415-391-1741, and I will be happy to get a copy to you.) Have Three Referrals INSIDE THIS ISSUE: 4 Medication by Samantha Zylstra Professional Focus 7 Connecting Bay Area Professionals Spring 2006 Volume 1, Issue 3 The process of finding a therapist can be overwhelming to say the least. Hopefully, at this point you have located a few (I suggest two to three) names and nu mb er s of therapists from trusted sources, and you have taken some time to identify what you are hoping to get out of therapy and what attributes you might find helpful in a person. Now is the time to take what may feel like a big step and call the therapist. I suggest beginning by calling one potential therapist at a time. Start with the therapist you feel most drawn to based on whatever information you may have. Keep in mind that you are the consumer of a service. Obviously, give the therapist a chance, but know that if the “fit” is not good, you can always call someone else. Below are a few things you may want to know to expect and some things to look out for to help you in choosing a “good therapist” and avoiding those that are not so good. The First Phone Call Usually, when you first call a therapist you will hear a voicemail message. Remember that therapists do not answer the phone when they are in session. This voicemail should be private and confidential. Leave a message with your name, your number, and some times when you think the therapist might reach you and you will be available to talk. That’s it. The first step. Give yourself a pat on the back. call. It is not necessary to go into the details that bring you to therapy at this time but it is important to ask a few questions. • Find out what the therapist’s experience is with the types of issues you are facing. Depending on the issue, special training or experience may be very helpful. At the very least they should be willing to learn more about your issues to help with treatment. If they do not have experience in a specific area (i.e., drug treatment, eating disorders, suicidality, etc.), ask them for a referral to someone who specializes in the issues that you are facing. • Discuss fees. Fees charged can vary greatly in dif f er ent ar eas a nd depending on the experience, degree and license of the therapist. Choose a therapist that offers a fee that you feel you can realistically afford. If you have limited income, many therapists offer a sliding scale. • Don’t forget to find out about office location and available meeting times. Most therapists will make a As you ask these questions and few minutes to talk on the talk to the therapist, consider phone when they return your not only the answers they give Please turn to page 3 Y EMDR: New Possibilities for Therapeutic Change Z By Katie Cofer, MFT A man sees a therapist to deal with his long-standing fear of flying. After three sessions he is able to go on a fivehour flight without feeling any anxiety. A young woman who has been held up at gunpoint while on the job is experiencing flashbacks of the event and is unable to work. After five sessions the woman no longer has flashbacks and is able to return to her job. A nine-year-old girl, in the midst of a therapy session, suddenly remembers traumatic details of how her father died and becomes very agitated. The therapist asks the girl to beat rhythmically on a drum while thinking of some positive images, and ten minutes later, the girl is happily drawing pictures. A young writer has been seeing a therapist for writer’s block. When his therapist suggests a technique that involves tapping lightly on his knees while he follows his thoughts, images, and associations, he is somewhat skeptical. But after about a month he notices he has had some important new insights and feels more energized visuals, sounds, scents, thoughts, about his writing. feelings, and body sensations. Memories of successive distressing events are then layered on top of the What is EMDR? original memories in memory Different as these clinical situations networks of seemingly related may seem, in each case the therapist events. This can create blockages in was applying some form of EMDR the brain’s ability to process new (Eye Movement Desensitization and information adaptively, that is, to Reprocessing). EMDR is a relatively resolve distressing or traumatic new therapeutic method that makes events. use of the connection between body, A psychologist named Francine brain, and emotions to help resolve Shapiro discovered that it was anxiety or memories of distressing or possible to stimulate the brain’s two traumatic events. hemispheres through “alternating What is dramatically different about left-right visual, audio and tactile EMDR as compared with traditional stimulation” (for instance, through psychotherapies is that with simple hand movements, flashing lights, traumas it can yield positive results in alternating tones or “buzzes” from a much shorter time-frame, often in vibrating devices, or by simple hand anywhere from one to five sessions. taps). This sort of bilateral sensory More complex traumas, such as stimulation, coupled with the childhood sexual abuse, take longer to therapeutic procedures of EMDR, resolve. can reduce the “charge” of disturbing memories and emotions, and enhance the brain’s ability to How Does EMDR Work? respond adaptively to situations by Memories of distressing events are creating links to different memory stored by the brain as a “gestalt,” networks. This process is also complete with all the related sensory, referred to as neuronal integration. emotional and cognitive information: Please turn to page 6 From Trauma to Transformation Powerful Therapy with EMDR Traumatic experiences can become imprinted on a person’s brain and body in such a way that they can cause symptoms like nightmares, flashbacks, disturbing body sensations, and limiting beliefs about life. EMDR, Eye-Movement Desensitization and Reprocessing, is a powerful and well-researched therapeutic technique that helps to process and release these traumatic memories. Depending on the type of trauma, treatment can be much faster than with traditional therapy. EMDR can also be very effective with other issues such as anxiety, phobias, depression, grief, and blocks to performance or creativity. Once these old emotional residues are cleared from the body/mind, people often experience increased aliveness and a sense of transformation in various areas of their lives. I use EMDR, along with methods of body awareness, mindfulness, expressive arts, and traditional talk therapy, to help clients release emotional pain and blockages that keep them from achieving their full potential for growth and self-expression. For more information, please give me a call: Katie Cofer, MFT (Lic. MFC #35856) Tel. 415-826-2951, [email protected] BRIDGE, PA GE 2 V OLUME 1 ISSUE 3 How to Choose a Therapist Continued from page 1 but also how the questions are answered. Does the therapist seem comfortable and available? If a therapist seems defensive, irritable, ill at ease or scattered, these may be red flags. If, on the other hand, you feel a beginning connection with the therapist on the phone, schedule a first appointment. If you don’t feel that connection, tell the therapist that you may call them back if you decide to make an appointment and call another referral from your list. Remember, you are the customer. Feel free to shop around a little if need be to find a good connection. As I mentioned in Part One, studies show that it is the relationship formed between the therapist and client, more than any other factor, that makes therapy work. The First Session Consider the first session as a sort of interview for the therapist. It is a chance for you to meet the therapist in person and decide if he or she is someone you can work with. Studies show that it is in the relationship between the therapist and the client that therapy happens. I cannot stress this enough. The relationship, more than any training or experience, is key. During this first session, take note: Does it feel like a beginning connection is being established? Does it feel safe? Does he or she seem like a person that you will be able to let your guard down with and confide in? The first session is also a chance for the therapist to assess whether he or she can be helpful to you. Take the time to let the therapist know about the issues that you are facing. You should expect to fill out a few forms and go over office policies regarding confidentiality, cancellations, payment, and contact between sessions. If you have questions ask them. A professional and ethical therapist will have no problem discussing his or her office policies. This is also the time to ask questions about what to expect therapist will be open to discussing what is or is not working for you in the session and may even take responsibility for their own part if they have made a mistake. Developing a relationship with your therapist which involves this kind of “feedback” can make the work deeper and more rewarding. In general, it is a good idea to stick with a therapist for two or three sessions while you are attempting to sort out your feelings, but don’t forget that you are a consumer and should feel, in general, satisfied with the service you are paying for. The exception to this is in regards to a therapist who is acting illegally or Assessing a “Good Fit” unethically. These therapists should It is important to notice how you feel be reported immediately to their about therapy and a therapist in order licensing board. to make a good choice in providers. Remember that, although most people Be Courageous find that therapy helps them to make lasting positive changes in their lives, As I mentioned in Part One, a most people also have periods of general rule of thumb with therapy resistance, frustration and anger in is: The more that you put into it, the their therapy. This resistance can be a more that you will get out of it. If normal part of the process. Even when you have carefully chosen a therapist change is positive, it is difficult. Most and have found one that is a “good of us react to difficulties by protecting fit” with your needs, you have laid a ourselves from the pain the change will good ground work for your cause us. If, at the beginning or during experience in therapy. Many people find that beginning therapy is the “Studies show that it is the most difficult part. Therapy is an relationship formed between investment of time and money and the therapist and client, more energy. That investment is one that you make in yourself and will than any other factor, that positively affect your relationships makes therapy work.” with others. Step forward into this the course of therapy, you find yourself investment with courage, and be thinking: “This therapist is terrible!” or proud of the positive change you are “He doesn’t know what he is doing!” choosing in your life.∞ or “How dare she think that about me!”, it may be worthwhile to take some time and try to separate what you may be feeling in reaction to your attempts to change from what may be Amara Brown, MFT is in signs that the therapist is “not good” or private practice in San Franthe fit could be better. Ultimately, the cisco. She can be reached at choice is always yours. I strongly 415-391-1741 or at bridgesuggest talking to the therapist about [email protected] your concerns. This may lead to greater insight for you. A good during therapy and anything else that may concern you. Some questions might include: • What can I expect during a usual session? • Are you open to feedback along the way? • How will we know when to end therapy? • Do you have any policies related to ending? • Do you have any special skills or training that might augment the therapy? For example: Expressive Arts therapy, dream work, EMDR, etc. BRIDGE, PA GE 3 Y An Age of Medication Z One Professional’s Thoughts on Psychopharmacological Treatment By Samantha Zylstra, MFT Intern We live in an age of medication. Television advertisements sell us a simple pill that can do anything from fixing a sleeping problem to enhancing erections. The internet makes purchasing drugs easy, with or without a prescription. As professionals working in this modern age, I believe it is important to take a closer look at the implications of medication and treatment, specifically regarding mental illness. This article addresses recognizing our own biases towards medication, making referrals for medication, discussing medication with our clients, and our own working knowledge of current psychopharmacological medication. To begin, I share my own experience with a client and her struggle with depr ession. (H er name a nd identifiable information have been changed for confidentiality.) although she was still bothered by the underlying lack of desire, interest, or enjoyment while with her friends and her inability to sleep. She wanted to know what else she could do to feel better. We discussed the aspects of treatment that had worked well and then I suggested as a further addition to therapy a referral for a psychiatrist. Sally immediately responded, “Do you think I am so sick that I need drugs? Am I truly that pathetic?” I explained to Sally that I don’t view medication as a last resort, but as an adjunct to therapy that in some cases is very useful. I recommend she think about it and we continue the conversation at our next appointment. One week later, Sally reported she had a horrible week, and she was willing to do whatever it would take to feel better, even take drugs. Sally’s Story Sally, a 21-year-old woman, began therapy because of a persistent problem with depression. She reported an inability to experience any pleasure, significant weight loss, insomnia, isolation from friends and difficulty functioning at work. Sally said, “All I want to do is stay in bed all day with the sheets pulled firmly over my head.” Sally reported she remembered other times in her life when she felt a lack of desire to do much but she had never felt this “low” before. After my initial assessment, I began therapy and recommended Sally make an appointment with her physician for a full medical evaluation to rule out any medical reasons for her depression. After several months of therapy, Sally began to improve. She had made a few new friends with whom she wanted to spend time socially. She was back to her usual weight and was regularly getting to work on time. Sally noticed the improvement, BRIDGE, PA GE 4 Responding to Medication to pay for them? All of these questions are valid. Depending on who you are and whom you talk to, ther e are differ ent answers. Nonetheless, the answer to these questions directly influences our clients; therefore, I believe it is crucial for us, as professionals, to know our own bias regarding medication. Our personal bent on the use of medication directly impacts our clients. When we refer, if we ever refer, and the type of referral we are likely to give are all influenced by our opinions on drug treatment. For example, because I believe medication can be an appropriate adjunct to psychotherapy, I referred Sally to a psychiatrist, but only after I had worked with her for several months. If I believed a full psychiatric exam was important at the beginning of therapy, I would have referred Sally sooner. If Sally had a physiological-biological deficiency and medication was the only thing that would help her, did I do a disservice to Sally by waiting three months? My ultimate goal is to journey with my clients down their road to recovery, empowering them to make the best choices for their own healing. In order to do this, I must keep my own opinions and beliefs in check. It was not my intention to deny Sally any form of treatment nor to persuade her into making a choice that she did not feel was completely appropriate for her. It is my hope that we, as professionals, always have our clients’ best interest in mind. Keeping our own opinions and beliefs in check seems an appropriate method for maintaining a focus on what is best for each individual client. Sally’s response to medication is not uncommon. Many people do not wish to be medicated or believe that medication means they are crazy and beyond hope. Alternatively, some people believe that medication is a quick fix on their road to recovery; If they can just get a prescription, they will feel fine and not need any adjunct psychotherapy. Others prefer nonwestern approaches to treatment. We, as professionals, also have opinions and hold beliefs about medication. In the past ten years, there has been a 700% increase in the amount of psycho-stimulants prescribed to children and a 250% increase in adolescents. (Dr. Mark Schiller, February 12, 2006) Is this rise in prescriptions due to better diagnosis or to better drug availability and options? Are we over-prescribing Sally’s Outcome drugs because they seem like an easy fix and insurance companies are likely Sally was prescribed the SSRI V OLUME 1, ISSUE 3 (s el ect iv e s er ot onin r eu pta ke inhibitor) Prozac. After about three weeks on the drug, she experienced a lift in her mood. Most prominently, she felt she was able to enjoy life again. Sally and I had discussed the need to take an antidepressant for sever a l weeks befor e f eeling symptomatic relief. Therefore, she was not surprised when she didn’t feel a change immediately. Sally was pleased with the result, but she did not want to remain on the drug for her lifetime. We discussed the options and I asked her to check in with her psychiatrist. As a Marriage and Family Therapist Intern, I cannot prescribe drugs or make specific drug recommendations to my clients. But it is appropriate for me to discuss my clients’ feelings and thoughts around drug treatment, side effects they are experiencing, and concerns that they may have. I also work to empower them to have a voice with their psychiatrist so that the psychiatrist knows how they are doing and their desired course of treatment. Further, I have found it very useful to have all clients sign a release form so I can speak directly with their psychiatrist in order to best meet the needs of my clients. In Sally’s case, after nine months of drug treatment, she began to taper off the drug. Sally, the psychiatrist and I decided that there was no reason why Sally should not begin tapering. She had not experienced any depressive episodes since beginning the drug and was planning on staying in therapy on a weekly basis. Sally’s story is a success. Her goal for therapy was to overcome her lack of pleasure and inability to function socially or at work. Through psychotherapy and the use of medication she was able to attain her goal. Further, she was willing to take Prozac for awhile, but did not want the medication to be a lifelong necessity. In her case, this was a possibility. In some cases, medication ma intenance is a necessity. It is important to discuss this reality with clients who have symptoms or relapse while on the medication or during the tapering cycle or whose diagnosis is known to respond best to continuing use of medication. An Overview Management of As well as inquire about their regularity in taking their medication. Sixth, keep a record of the prescription and dosage. Remember that while you see your client weekly, if your client is lucky they see the treating psychiatrist once a month, but more often once a year. Therefore, you have an opportunity to help your client advocate for themselves if the drug is not working and to contact their doctor immediately if they are having any severe side effects. As professionals in the modern age, I believe it is imperative to know and to have articulated your own biases towards or against medication. We are better able to serve our clients and meet them in a place they can find most helpful when we understand our own beliefs.∞ Medication Managing medication begins with the treating professional having a clear understanding of his or her own bias. Second, meet your clients where they are with their opinions, fears, hesitations, and excitement regarding medication. Third, get signed releases to effectively collaborate with any other treating professional and your client. Fourth, have a working knowledge of the most commonly prescribed medications. Fifth, talk to you client about the effects that they are experiencing with the drug and any side effects that they are noticing. Sources and Resources: ● Peter Kramer (1997). Listening to Prozac ● Peter Kramer (2005). Against Depression ● Des maisons (1998). Potatoes not Prozac ● J. Preston, N. Varzos, D. Liebert (1998). Warning: Psychiatry May Be Dangerous to your Mental Health. Make Every Session Count Samantha Zylstra is an MFT Intern in private practice in San Francisco. She can be reached at www.samanthazylstra.com, or 415-585-3132 Practicing Psychotherapists ♦ ♦ ♦ ♦ Are you looking for a way to bring new energy and depth to your work with adults? Need a creative way to engage resistant adolescents? Want to expand your skills in working with children? Seeking a way to bring activity and interconnectedness to a group? Adding Expressive Arts to your practice can be an exciting way to reenergize, increase insight and self expression, and creatively contain difficult feelings in your work with clients. ♦ Amara Glorioso Brown, MFT is available to provide consultation to assist you weaving a wide variety of arts modalities in to your current work. She is happy to suggest specific activities for clients, provide instruction in the use of arts modalities and/or provide on-going consultation regarding the clinical application of the arts in your practice. Call to set up an appointment: 415-391-1741 BRIDGE, PA GE 5 EMDR: New Possibilities for Therapeutic Change Continued from page 2 Uses of EMDR in Therapy First of all, EMDR should only be performed by licensed clinicians who have undergone training approved by the EMDR Institute. Practitioners should have at least Level II training, while certified EMDR therapists will have received more advanced training and extensive consultation from an EMDR-certified facilitator or trainer. The effectiveness of EMDR with traumatic incidents and PTSD is well documented (see www.emdria.org). T he Amer ican Psychological Association has designated EMDR as one of three “probably efficacious treatments” for civilian PTSD. Tra uma exp er t s such as neuroscientist Bessel van der Kolk consider EMDR, along with other somatic trauma therapies, to be the standard of care for trauma treatment. Because of the way EMDR acts on the brain, it is effective with any complaints that are accompanied by an activation of the nervous system, such as anxiety disorders, phobias, stress/tension, sleep disturbances, or restlessness. EMDR can also help with unresolved grief, depression, psychosomatic symptoms, blocks to creativity, and any experience of feeling “stuck.” EMDR in Action EMDR can be used on its own or int egr at ed int o convent iona l psychotherapy. Treatment is possible in a conventional 50-minute session, but it can be beneficial to use longer sessions, often 75 or 90 minutes. Before embarking on EMDR treatment, a therapist will want to know the history of the client’s presenting issues, plus information about family and developmental BRIDGE, PA GE 6 background, any traumatic events, substance use, and the client’s social support system. At this point, the therapist will usually experiment with the client to see what form of bilateral stimulation he or she prefers. Then the therapist will spend some time on “resource installation.” Here the therapist helps the client to identify various resources and strengths, and to focus on these while the therapist does several sets of bilateral stimulation to “install” or anchor the resource in the client’s neurophysiological system. A resource might be a real-life figure, such as a trusted person, a pet, a beloved place, or something imagined, such as a special safe place or sanctuary or some symbolic, protective figure. The therapist wants the client to be able to access a positive internal state in case the processing brings up difficult emotions. Then the therapist and client will spend some time developing the “target” that they will be working on. Generally, therapists try to find the earliest possible related memory, in the belief that the overlying memories will be cleared along with the earlier ones. When therapist and client have found an appropriate target, the therapist helps the client to activate the memory, or “light up” the neuronal network, by asking questions evoking different aspects of the event. The client gives a subjective rating, on a scale of 0 to 10, of the current intensity of distress, which will serve as a reference point during the processing for decrease of the traumatic charge. After this preparation or set-up, the processing can begin. The rest of the session will consist of a series of “sets” of bilateral stimulation, during which the client usually focuses on the experience in silence and then debriefs with the therapist. Here the therapist’s skill in deepening the exploration and interweaving new elements is key. Periodically the therapist will ask the client to return to the original target and check to see how much the distress level has decreased. Ideally, the emotional charge will have gone down, and often negative beliefs or subject ive exp er ienc es of helplessness or victimization will have been replaced by spontaneous insights and positive cognitions. When this is the case, the therapist “anchors” the new positive beliefs with a few more sets of bilateral stimulation. If some issues still seem unresolved, the therapist will help the client find ways to contain them until they can be processed in another session. EMDR therapists often say that EMDR diminishes distressing emotions and enhances positive ones. In the hands of a skilled clinician, EMDR is like a power tool that can free clients from the debilitating effects of traumatic experiences and enhance well-being by facilitating natural growth and healing processes. EMDR truly has the potential to transport clients from trauma to transformation.∞ Sources and Resources: www.emdria.org ● La ur el Par nell (1997). Transforming Trauma: EMDR. ● Francine Shapiro (2001). Eye Movement Desensitization and Reprocessing, Basic Principles, Protocols and Procedures. (2nd ed.) Katie Cofer, MFT is in private practice in San Francisco. She specializes in work with trauma and is EMDR trained. Katie can be reached at 415-826-2951 or [email protected]. V OLUME 1 ISSUE 3 Couples Counseling A Journey To Hope and Healing Eating Disorder and Body Image Support Groups “I only see a fat, ugly body in the mirror.” ♦ ♦ Relationships are Sacred Work. Sacred, because we are engaging in loving another person and empowering them to be their best self. Work, because it is daily effort that enables us to grow in connectedness. I believe relationships are worth this sacred work. If you and your partner are stuck in an impasse, don’t wait. Hope and healing are possible. For more information and to schedule an appointment, contact Samantha Zylstra, MFT Intern 46427 at 415-585-3132 or visit www.samanthazylstra.com • • • Learn to empower your true self and overcome the eating disorder struggle. Develop positive outlets for self-expression. Be comfortable in your own skin. Samantha Zylstra has been running support groups for women with eating disorders since 2004. She incorporates the arts into all of her groups. For group or individual therapy, call today at 415-585-3132. Professional Focus Amara Glorioso Brown, MFT (#39414) is a depending on the needs and inclination of each therapist in private practice in San Francisco. She welcomes referrals for children, adolescent or adult clients. In her work, she focuses on meeting each client where he or she is and provides opportunities for insight and client-directed positive change. She is trained and experienced in both traditional, psychodynamic psychotherapy and in expressive arts therapy. Her office is arranged with materials and space to support work in a variety of artistic modalities ranging from dramatic enactment, sand tray, painting, collage, and play therapy Katie Cofer, MFT (#35856) is a Licensed Marriage and Family Therapist in private practice in San Francisco. Her work is based on a fundamental belief in the interconnectedness of mind, body, heart and spirit. She integrates relational talk therapy with somatic, transpersonal, and expressive arts approaches. She is also trained in EMDR, a powerful technique that facilitates the clearing of traumatic client. Her current clients come from many cultural and socio-economic backgrounds and face a wide variety of issues including: depression, anxiety, loss, trauma, abuse, relationships, anger issues, compassion fatigue and adolescent adjustment. She offers a sliding scale for those with limited income and is able to accept some insurance. Please call with any questions, to make a referral or for an initial appointment. 415-391-1741 memories and emotional stuck points. Through these processes of self-discovery and healing, clients may feel more connected with their core self and regain access to their innate vitality and creativity. Some of Katie’s areas of expertise include trauma, depression, anxiety, phobias, unresolved grief, blocks to creativity, and cross-cultural issues. Katie also works with children and adolescents and is fluent in Spanish and German. She can be reached at 415-826-2951 or [email protected]. Samantha Zylstra, MFT Intern (#46427) has a insight and client-directed choices for change. private practice in San Francisco. She provides services for couples, adults, and children who desire healing in their lives. Samantha believes therapy is an opportunity for personal growth and lasting positive change. Samantha’s approach to therapy is informed by her desire to meet each client where they are at, creating space for them to strengthen their core self. Her role, as she sees it, is to listen deeply and responding empathetically to help facilitate opportunities for Samantha has a certificate of specialization in the treatment of eating disorders. She runs eating disorder support groups and expressive arts therapy groups for developing healthy body image. For more information regarding her therapeutic approach or specialties, please call 415-585-3132 or visit www.samanthazylstra.com Samantha is under the supervision of Lori E. Opal, MFT #35754. BRIDGE, P AGE 7 ♦ Amara Glorioso Brown ♦ Katie Cofer ♦ Samantha Zylstra Connecting Bay Area Professionals 315 Sanchez Street San Francisco, CA 94114 Bridge Bridge Quarterly Journal, Spring 2006 Issue Bridge is a quarterly journal designed to provide Bay Area helping professionals with up-to-date articles and resources to help us help others. Please contact us at [email protected] or Amara Glorioso Brown, 415-391-1741, www.camft.org/Therapists/AmaraBrown Katie Cofer, 415-826-2951, [email protected] Samantha Zylstra, 415-585-3132, www.samanthazylstra.com