This is in response to Anthony D’ Ambrosia’s viral blog post about the state of marriage. http://legacy.abc10.com/story/life/2015/12/30/columnist-5-reasons-marriage-doesnt-work-anymore/78093780/
I appreciate your brave and honest post. I’m sorry about your divorce and all the pain you endured. The challenges you outlined are real, but the conclusion you drew—marriage is over—is misguided.
It’s true: Technology is often not good for marriage. In fact, it’s not good for relationships, period. This is because an emotional bond requires emotions—both the ability to feel emotion and the willingness to talk about it. Technology is an immediate feel-good distraction from negative emotion. People stop feeling deeply, and without the ability to feel deeply, they can’t bond.
But that doesn’t mean we should just give up.
The same could be said for parenting. Technology makes parenting more difficult, but we don’t just throw in the towel. We make conscious choices about how to limit its influence. Similarly, I encourage couples to put away their phones during dinner and dates. Practice just sitting and being a person without checking the sports scores, trolling Facebook, and endlessly texting. This requires a conscious decision not to let technology be the main vehicle of conversation.
Regarding access to pictures of sexy people via the Internet:
If you are not a pornography addict, there is no research that sexy pictures of other people on the Internet actually make you want your spouse less. Good sex is less about how much your partner resembles the magazines and more about how well you are able to attune and respond.
You also mentioned financial hardship.
Limited finances increase stress, which can strain a marriage. I’m pretty sure this isn’t a new problem, however. Our grandparents did live through the Great Depression. From my perspective, the challenges in the world make marriage more important. If you are able to reach for each other for comfort and care when stressed, then the marital bond actually strengthens.
It’s not the stressful event that breaks up a marriage, but how it’s managed. The most difficult problems can create a more enduring connection.
This isn’t me being overly optimistic. I successfully teach skills to help couples be vulnerable with each other so they aren’t withdrawing or lashing out when the going gets tough. And no matter what generation, there will be tough times, tragedy, profound loss, and 9-to-5 grinding boredom. You are not the only generation that has suffered, even though the circumstances may be different. It’s how the struggle is dealt with that determines whether the marriage will strengthen or be broken.
Your final point about privacy being out the door is also well-taken. We can get caught up in wanting to be popular on the Internet for a day and become less focused on the most important relationship of all—the one with our spouse. We are busy showing off and waiting for applause from the world, and then are disappointed that our spouse doesn’t offer the same standing ovation when we come home from work.
Here is the main point I want you to hear: WE ARE WIRED TO CONNECT. The need to be loved and love a significant other isn’t icing on the cake or some socially constructed pact we’ve all implicitly agreed to, like moving the clocks forward in the spring. It’s not a decision or even a choice. Through millions of years of evolution, love has become a wired-in survival code. You can’t outrun it, and it’s not going to be stamped out by technology, finances, sexy pictures, or the Internet.
You mentioned a longing you’ve had ever since you were a little boy to have deep abiding love with a partner or soul mate. You were touching this biological survival need. You were clear about it before you grew up and had your heart broken, before life happened and disillusionment set in.
That place is still in you, buried but alive, and you can trust it. The generational challenges are real but not insurmountable. Love still exists and can thrive despite everything.
Jennifer Olden, LMFT
My dad encouraged me always to confront a company that has unfairly charged me for a service poorly rendered. He recommended that my approach be friendly and assertive, and when/if I don’t get results, ask to talk to the manager. He believed that it’s better to use a carrot than a stick, and that the phrase, “Can you help me?” pulls for support instead of defense.
I consciously ask for advice from the wise ones in the world, and I always have some good advice just ready to be shared with the world.
Go ahead: ask me anything.
So believe me when I say it’s unfortunate that advice has serious limitations.
For example, when I work with couples, if one person is speaking from a deeply vulnerable place and the other gets nervous and wants to solve the problem by giving advice, it inevitably backfires.
The person sharing wants connection, closeness, understanding; to be seen and accepted even for this part, the part that doesn’t make it out into the world very often.
The person sharing wants to be vulnerable and loved in the exact same moment.
That is the ultimate redemption, and can be the antidote to past historical relationship trauma. It’s the big taco and the whole enchilada.
The person listening wants closeness, too. They love and care for their partner, and suspect (mistakenly) that it’s the vulnerability blocking the connection. They’ve got some advice, and it might even be fantastic advice. It could be the perfect fix. But that’s not the point.
Advice won’t help until the emotional connection is made. Everyone needs to feel loved, accepted, cherished, understood. Then and only then is it time for advice.
First, though, you build the emotional bank account. First, you reflect and understand and love and share a similar vulnerability. Then you give advice. Your partner is much more likely to be open and ready to respond if they feel heard and understood. And if you’re patient enough to really understand the struggle, who knows? Your advice might even change.
Love Strong Love Long,
Jennifer Olden, LMFT
Most couples that come into my office for therapy tell me they need help with communication, and they are right. Just not in the way they are implying when they tell me “he never listens to me,” or “all she ever does is nag me.” I know, when I am working with them I am going to move them from a defensive, self-protective style of communication to one of vulnerability and intimacy. But, for the first couple of sessions I let them tell me their complaints about communication. It is very insightful to me, I learn all about their hidden fears and desires in those complaints and they don’t even know they are revealing them. It is my job to point that part out.
So why do so many couples come in with the same complaint? Think about it, you wake up in the morning talking to your spouse, you spend the morning getting ready talking to your spouse, you probably text, talk, or Email throughout the day. You probably call on your way home, check in with each other after being away all day, spend the evening divvying up who is going to do what, maybe sit, down after the kids are down and enjoy some quite time together, go to bed together hopefully with enough energy to have sex, staying in some kind of contact all night with a foot or hand, then waking up and starting all over. On special nights you go out and enjoy each other’s company and on busy weeks you feel the pressure of not spending time together. This is the norm for a lot of relationships, and on some level you know that, so when it is not happening like this, you can tell something is wrong.
This is where couples get stuck. Someone might ask their partner “why aren’t you spending time with me”? This partner might feel attacked, hearing he or she is doing something wrong, actually want to stay away from those attacks, perpetuating the problem. Another person might say “We aren’t having sex enough.” That partner might think “why would we have sex when you don’t even want to spend time with me”? Again, perpetuating the cycle. So, it is easy to see where communication could break down and even turn into a blaming, attacking, defending, withdrawing cycle, and why couples come in telling me they are having problems communicating.
So what can you do about this? You can start by making time to have this discussion and talk about how you miss being in contact with the other person. You could also purchase the book Hold Me Tight: seven conversations for a lifetime of love by Sue Johnson and have those conversations. I have had many clients tell me this book changed their marriage. I promote the book so much I offer a full weekend workshop on it. Finally, if it feels like you are just too stuck to do this on your own, make an appointment with an EFT couple’s therapist.
Live Long Live Strong,
Robin Blair, LMFT
Certified EFT Therapist
Everyone knows when couples struggle, it affects the kids just as much. It is hard enough for us as parents to manage the weight of not getting along with our partner, but to also carry how much it is affecting our children can feel overwhelming at times. We understand that when our children see parents fighting, it takes away their sense of security. Parents are a child’s main source of security, so to have that taken away is very distressing. Then, we also have to consider the type of behavior we are role modeling to our kids. What relationships look like, what is an acceptable way to treat a spouse or a spouse to treat them. Sometimes I think “if a girl ever treated one of my boys the way I treat my husband sometimes, I would become a horribly interfering mother in law.” And even though I know all of this, in the moment, when my husband has done something that pushes me over the edge, I am going to let him know in whatever “F_ _ _ing” way I feel is necessary to get my point across.
So, considering we are not always capable of being perfect partners or perfect parents and knowing it is affecting our kids in whatever big or small way, family therapy is a really, really great option to help our kids resolve some of these issues. The one thing I really want to say about family therapy, from my perspective as a family therapist, is that family therapy is for the kids. Couple’s therapy is for the parents, but family therapy is really about the kids. It’s about helping parents be there for their kids. In couple’s therapy I help individuals relieve the stress of a disconnected relationship by turning the relationship into a source of reassurance, support, safety, and comfort instead of a source of anxiety and heartache. In family therapy, I help parents attune to their children and hear and support their children in a way the children need. Children are affected by distressed marriages, so in my opinion both should be happening. If you need couples therapy and have kids in the house, chances are you need family therapy as well.
Having said that, I want to reassure you that as a family therapist I am not here to judge your parenting skills. The fact that you are willing to lay them all out on the table with a perfect stranger who has the authority to call CPS if I deem the children are unsafe, shows me the minute you walk in the door, you have the children’s best interest at heart. I know it can be scary thinking the kids are going to tell the therapist the kinds of things you say to your spouse or them for that matter, when you have lost it; or that you drink, or are always on your phone, or work 7 days a week, or don’t work at all, or that you spank your kids, or slam doors and throw things when your mad. Not only have we as therapist heard almost all of it in individual, couples, or family therapy, we have probably lived most of it as well. I want to reassure you that your kid’s mental and emotional wellbeing is well worth it. Family therapy is not about you not being a perfect parent, it really isn’t much about you at all, it is about helping your kids process and deal with things most families don’t know how to talk about. It is about making your kids feel heard, seen, cared for, safe, valuable, lovable, and worthy. I am not here to judge your parenting, only to help your kids know that you are ok and that they are ok.
Love Long Love Strong,
Robin Blair, LMFT
Certified EFT Therapist
Self-soothing or auto regulating your emotions has long been seen as an important part of independence and maturity. It’s the idea that we should be able to deal with our emotions on our own and not require comfort from other people to feel better. Some therapist like to call it differentiation, and clients who are not fully differentiated are labeled co-dependent. So, is this strongly held American belief that we should be able to make it on our own, without any help from others really what our brains thrive on? Is this how the human brain is wired?
According to research on this very topic (Love Sense by Sue Johnson) the answer is no. Our brains were wired to function in tribes, not independent or isolated. According to Johnson, being emotionally isolated is as bad for our health as smoking a pack of cigarettes a day. She even has research that shows cuts on people’s hands will heal faster when they are a part of a healthy relationship. What she is trying to prove is that the human brain is wired to require the comfort of another individual. We already knew this about children, but what Johnson is proving is that we need it as adults also “from the cradle to the grave” she likes to say. She is going against the cultural norm that we need to be independent adults that do not rely on anyone, and instead saying people who can depend on a significant other are healthier, happier, and more successful.
So, the important question is “how do I know if I am in an emotionally healthy relationship”? And the problem with this question is that most people instinctually know the answer, but our society tells us we should be independent enough to not care. If our fear comes up about not getting our needs met in our relationship we instantly think “there must be something wrong with me, why am I so needy” It’s even worse for men, because they have the desire to be emotionally close with their partner, but the only skill they were ever taught to express their desire for emotional closeness was sex. So they ask for it often and wear their partner out, making her feel like a means to an end or get rejected by her and completely shut down emotionally. My personal opinion is that this is why porn addiction is so prevalent in our culture. And porn is just one example of self-soothing. If a man’s only way of emotionally bonding with his partner is going to get shot down, of course he is going to turn to an imitation of it. Unfortunately, like any drug that rapidly releases dopamine, the reward chemical in the brain, over time his brain will become desensitized and require more and more to get the same result. Eventually, making love to his partner will no longer be sufficient, causing all kinds of sexual dysfunction and feelings of shame. Not to mention the havoc this will create in his relationship and in his partner.
Porn may be one of the most devastating self-soothing techniques to a relationship, but it is far from the only. Really, addiction of any kind is going to devastate a relationship. A key indicator to an emotionally healthy relationship is the ability to turn to your partner in a vulnerable way in time of need. Using the man above as an example, when his partner turns him down when he asks for sex, he would be able to say “it is so hurtful when I want to be close to you and you reject me, I feel like you don’t desire me and don’t want to be close to me, and I just can’t think of anything worse than you not wanting to be with me.” Another example could be of a woman who is feeling hurt by her partner who seems to be spending most of his time on the computer or out in the garage. In an emotionally healthy relationship she could say to him “I really miss you, it feels like you are not that interested in just spending quality time with me and I am getting really lonely here.” In an emotionally healthy relationship the partners would be able to respond in a way that shows they are accessible, responsive and engaged. Sue Johnson calls this a “Hold Me Tight” conversation. The acronym ARE represents the most basic question couples ask “Are you there for me”? Are you accessible, are you responsive, and will you engage with me emotionally?
So you can see how addictions or any self-soothing behavior would get in the way of creating an emotionally healthy relationship. First, because instead of turning towards their partners when they have a need, they turn towards an addiction to calm their fears and satisfy their need. So this could block any possibility of creating emotional intimacy. Second, if an individual turns towards his or her partner, asking ARE you there for me, and the partner is drinking or disconnected because of other self-soothing behaviors the answer is going to be no. This will keep the individual from asking this question in a vulnerable way, and instead the next time they ask it, it is going to be in a defensive guarded way. The partner is not going to hear there is a need being asked to be met, but instead they are going to hear how they have disappointed and failed in some way and respond accordingly with their own defenses up. I’m sure you can see how quickly and devastatingly this is going to take a toll on the relationship.
So, because culture is telling us we should be able to handle our emotions without the comfort of another individual and that we should not depend on other people, we are fighting our natural wiring to be in emotionally intimate relationships. A man should be able to say to his partner “I want you to hold me tonight.” And a woman should be able to request that the rest of the world just melt away so she can have all of her partner’s attention on just her. I think addictions are being created because we need this at the deepest level but feel weak and ashamed about it, so we drown out our natural tendencies so we don’t have to face our true vulnerability.
If you are interested in learning more about this, sign up for my January Hold Me Tight weekend workshop at The Attach Place.
Disagreements, miscommunications, failures, and fights are going to happen in every relationship. We are two different people, with different upbringings, and different ways of perceiving and interpreting the world around us. We are not going to see everything the same way. That is actually a huge benefit to succeeding and raising a family. It also can be very frustrating at times. Just this morning my husband walked in our room and proceeded to tell me about something he had just done and I said “sometimes, I have no idea how your brain works.” Most of the time, after 14 years, my husband and I are pretty much in sync with things. But, sometimes he says or does something that makes me do a double take. So, when these things happen, like last week when he left our 12 year old at school for over an hour because he wanted to finish cleaning out the gutters before the storm, and I lost it with him, how do we recover? In my mind, my husband committed a horrible parenting offense, and in his mind, I am an incredibly mean person who doesn’t care about his feelings and doesn’t appreciate the hard work he was doing getting ready for this “supposedly” horrific storm.
Well, first let’s talk about what happens when couple’s do not know how to come back from a fight, or, if they sweep it under the rug and never address the real issue. In the case I mentioned above, I could continue to believe my husband isn’t a responsible parent, and continue to feel like he isn’t someone I can count on with the most important people in our lives. I could start putting him in this box of being irresponsible, undependable, untrustworthy, and I could continue to be upset about it even when it isn’t happening. So when he does little things that upset me, I will see it through this much bigger lens and make a big deal every time I perceive him as being irresponsible. I will react in a way that will make no sense to him at all.
He, on the other hand, will have heard me yell at him about leaving our son there, calling him irresponsible, undependable, untrustworthy, and basically not a good parent. Which he is actually an amazing dad, but in that moment I was so flooded with empathy for my son waiting for the hour, I was enraged and could only speak to what had just happened, and not what kind of dad my husband has been for the last twelve years. So in my tunnel vision, I said all kinds of outrageous things.
If we were unable to go back and make sense of all of that, my husband would feel completely defeated by what I said. He would think, in all of my effort to work hard, wake up in the morning and make the kids lunches, read to them at night, fix bikes and take them on bike rides, hold them when they are hurting, spend weekends at sports games, and make most of my decisions on what is best for them, their mom thinks I am an irresponsible parent. That would be devastating to anyone. He knows he is a good dad, so he would begin to imagine that there must really be something wrong with me if I couldn’t see that. He would think I am impossible to please, I don’t appreciate who he is as a dad, I don’t respect the fact that he provides for this family, and that I must not understand that everything he does, is for us. And as with anyone, it is really hard to want to be close to someone who sees them that way. So, he would shut me out, do other things that give him a sense of pride, and stay away from the feeling that he is a failure.
Now, we can see, how over time if I continued to get upset at little things, and he continued to stay away from me being unhappy with him, we would eventual create the cycle of disconnection that would lead to a very unhappy relationship. And, if we were like most couples, couples therapy wouldn’t even be an option we would consider. Even though, as EFT therapist, we know how to get couples out of this cycle. Instead, most couples will live this way until an affair happens, an addiction is created, a divorce is presented as an option, or the kids move out. So I want to emphasize the importance of how to recover from a fight. Because little things turn into big things over time.
So what is the formula, for moving from yelling at your partner and losing it because a major offense happened, or doing something that made your partner feel insecure in the relationship? How can you affectively apologize in a way that lets them know how important they are to you? Well, in my case, we both did something that hurt the other person. I know some of you are thinking “so who has to apologize first”? It doesn’t matter. This is your relationship and you need to do whatever it takes to protect it. The formula starts with you being very clear on what was triggered in you, when the offense took place. For me, it was that my husband would put my son in that position. And for my husband it was that I could say all of those things after 14 years of knowing none of them were true about him. So, when you can figure out the underlying meaning to you, you talk only about that. Some common meanings are “I am alone in this,” “I am not appreciated,” “I am not valued,” “I am not lovable,” “I am not seen,” “I am inadequate,” “I am a failure.” If you can get to the root of your hurt and fear, then you can say “when I reacted that way it was because I felt alone in this, and I need you to be here for me,” or “when you said that, I heard you saying I was inadequate and not enough for you, then I get afraid you are going to leave me.”
So, once you find yourself in a fight or negative pattern, stop everything, take a couple of deep breaths, and then take a minute to figure out what is really going on. Protect your relationship, put the value and energy it deserves. Make a cup of tea and ask your partner to sit down with you and figure out what is really going on here. If you feel out of control during a fight, it is because our brains code our partners as a part of our survival. And when that gets threatened, our sense of safety is threatened and it feels like life or death. So stay close and calm that fear in each other’s brains first, then tackle the problem.
Love Long Love Strong,
Robin Blair, LMFT
I have a lot of people tell me they act a lot different around their partner than they do anyone else. Some of my clients are ashamed of the way they act around and towards their partner, they can’t quite make sense of it. They see is as irrational, immature, dysfunctional, cruel, I could go on and on about the way this behavior has been described by both partners. These behaviors could be yelling, name calling, stone walling, staying away from, being cold, having an attitude, ignoring, etc. There is one common denominator here, the energy behind it. It isn’t loving, caring, “you are so important to me” energy. My couples’ know that much. What they don’t understand is what exactly is behind this behavior. It seems so cruel and unloving, but they love their partner so why are they acting this way?
I am here to clarify what is actually behind this behavior that can seem very loving. It is fear! And a lot of it. Humans are tribal beings, we exists in groups and depend on these groups for survival. Americans have shrunk these groups down to just two people, you and your partner. This means your survival, as far as your brain is wired, is dependent on this one other person. So you can imagine, if this relationship feels threatened in any way what that is going to do to your brain, and what your brain is going to tell you to do about it. Animals, including humans, have three basic fear responses: fight, flight, and freeze.
Now, let’s put these basic fear responses back into those behaviors we talked about. If you are afraid you cannot depend on your partner to be there for you when it really matters, what might you do to fight against this? Maybe yell, protest, get angry, aggressive, debate, negotiate, slam doors, be pissy, name call, get critical, anything to fight against the belief that you can’t count on your partner. Well, as far as your brain is concerned, this makes perfect sense to act this way, you are fighting for the relationship because it is so important to you. Now we know your partner will notice these behaviors. What he or she will not know, is that you are doing these behaviors because he or she is so important to you.
So, let’s move to the flip side of this, say you are more likely to flee or freeze when you are afraid your partner is not going to be there for you. Let’s just say you hear your wife call you undependable, irresponsible, uncaring, or a failure. What else is your brain supposed to think other than, “I am not good enough for her”, “she is going to leave me because I keep letting her down”, “she has impossible standards that I cannot reach.” And let’s say when you feel this deep fear, your reaction is to freeze or go away from it (flee). The rational for this is, if you go away from her, you will stop making her so angry. Or, if you freeze, at least you won’t continue to make it worse. So, either way, you are trying to stop the message that you are going to lose her because you are inadequate.
The problem here is that all your partner sees is you ignoring her, abandoning her, leaving her, not caring about her fear, not caring about the relationship. Which unfortunately increases her fear that you are not going to be there for her when it really counts. The chances of her seeing your fear about losing this relationship are slim. Especially if she is stuck in her own fear of losing you. I know I am using a male partner example here, but it could go either way.
So, what are couples supposed to do if this is such a common patterns? The answer is so simple. Know what is really going on with you and talk about it. Can you imagine saying “you are so important to me and when I get the message you think I am not good enough for you, it freaks me out and I just want to get away from that feeling” Or, “when you go away from me when I am trying to talk about something that is important to me, it gives me the message that you are not going to be there for me in a way that really matters. I need to know I can count on you to be there for me.” This takes a lot of vulnerability and safety in the relationship. It is something you should sit down and talk about when you are not in a heated argument. So when the argument comes up, you already have some practice of talking in this way. The reason you are not like this with anyone else is because your partner is the most important person in the world to you, and no one else even comes close.
Robin Blair, LMFT
Certified Emotionally Focused Couples Therapist
Americans already live in a state of chronic stress, between the job, the bills, the kids, the house, the spouse, and everything else we pile on top of ourselves. Stress is not a bad thing, in small bursts that results in the expulsion of that energy, and then long periods of rest to follow. We were actually built for this type of stress. What we weren’t built for is this chronic stress, no expulsion of the energy, and no rest or relief from the stress. And then we add holidays on top of our already stressful lives. The shopping, the cleaning, the family, the traveling, the lines, the crowds, the money, the time. This time of year has a tendency to take a lot of us down.
So, what can we do to manage this intense time of year, without running away and hiding until it is over? First, we need to know the types of things we are doing to manage our stress that is actually adding more stress to our life. Things like drinking too much caffeine, working out too much, drinking alcohol, eating fast convenient food to give us more time, or trying to get more work done before bed, these may feel like time managers but they are actually increasing your stress levels and then requiring you to handle more stress in your life. Cutting back on the caffeine, only working out 3-4 days a week, clean eating, giving up the alcohol, and cutting yourself off from work and screen time at a certain time each night will drastically reduce the stress hormones from being released. These are things we need to be aware of all of the time.
But, this is a special time of year that requires a lot of extra stress management. So I am going to introduce some of my favorite stress management tools that I use in addition to the daily ones I listed above. First, meditation, this useful practice has been shown to decrease anxiety, depression, and increase your ability to handle stress. An easy beginner practice is called the 16 second meditation. It is a breathing practice that actually slows your heart rate down instantly. All you need to do is inhale for 4 seconds, then hold that breathe in and count 3 seconds, then exhale for 6 seconds, then hold that exhale for 3 seconds. Having a longer exhale than inhale slows your heart rate down, and having to count your breath requires mindful attention which increases your ability to handle stress. Another great practice that achieves these same goals is yoga. It opens up your lungs and your ability to get a deeper breath while forcing you to focus on your pose. Tara Stiles has great yoga videos that I love doing at my house.
But I have to say, I get the most stress relief from spending quality time with my husband. When the kids are in bed, and the house is quiet, and we can just hang out and let the rest of the world melt away, nothing relieves the pressures of the day than feeling like I am loved and treasured, and deserving of someone’s undivided attention. The phones, the TV, the kids, the housework, all of it gets put aside so we can just be the center of each other’s universe. Now, I know not everyone is in a place in their relationship where they can actually get stress relief from their partner, it’s actually quite the opposite. If this is the case, then do yourself, your stress hormones, and your family a favor and come in to The Attach Place and see me for a couple of sessions of couple’s therapy. Or, you can even do some Skype sessions with me if you are not in Northern California. And if you are single, this can still apply with a loving attachment figure in your life; a good friend, a sibling or parent, even spending time with your beloved animal can be a stress reliever. There are many other ways to reduce stress this holiday season, these are just some of my favorite. Find what works for you and then make a point to actually do it. Your body, mind, and spirit will thank you; not to mention all of the people around you. I hope this helps you get through the next month.
Robin Blair, MFT Registered Intern
Supervised by Jennifer Olden, LMFT for one month, as she has just passed her MFT licensure exams. Congratulations Robin!
This blog is dedicated to couples who know how much love matters and how hard it is to be in the couple’s attachment dance while living in our incredibly complex, fast paced world.
Jennifer Olden, LMFT is a certified Emotionally Focused Couples Therapist and EFT Therapist Supervisor at The Attach Place Center for Strengthening Relationships, which specializes in attachment-based therapies for individuals, couples, and diverse bio and adoptive families. Jennifer provides Emotionally Focused Therapy exclusively for couples.
All information contained within this website is intended solely for educational purposes and is not a substitute for professional medical advice relative to specific conditions or questions. We provide professional mental health assessments, diagnoses, and specific treatments for mental health conditions, including referrals and on-site resources by appointment.