Saturday, December 31, 2011

Vision Therapy, Driving To Amish Country and Math Skills

Amish family riding in a traditional Amish bug...
Amish Buggy Image via Wikipedia
Drove out to Lancaster County for another session of vision therapy.  The funny thing is that as my vision improves, the scenery changes!  I am seeing more detail of the farm country as I go by.  I am incredibly aware of everything around me from seeing the various processing plants and trucking facilities that bring Lancaster County foods to the Philadelphia market to the scenery of farms and rural homes that line the secondary highways and main streets of Lancaster County.  As I was
arriving at vision therapy,  I got behind an Amish buggy.  In the cloudy haze, the buggy had its rear lights on.  As we approached the turn for the clinic's parking lot, the buggy put on its turn signal (yes, the Amish do have turn signals on buggies!) and pulled into the parking lot.  As the occupants of the buggy got out, I noticed that the child was one of my fellow patients.

Bernell Variable Tranaglyph
 Becky, the head therapist, was running the group today and was working my ornery old left eye.  We had started to work on some of the variable tanaglyphs that exercise binocular vision with polarized lenses and I found sometimes that I couldn't even see the "L" in a lineup with "R".  That means my left eye was flaking out on me.  I did OK with another variable tanaglyph where I only had to match up letters in a circle.

Thursday, December 29, 2011

Characteristics of Gifted Adults

Found an interesting catalog of gifted traits including those specific to gifted women.  This article is a bit of a compendium of other articles from the Gifted Resource Center and experts like Mary Rocamora

Assessment of First Round of Cellfield and Next Steps

Talked to Maude, my PT/OT,  the other day and we went over what we accomplished in Cellfield and we hatched some plans for next year.

Cellfield has really helped a lot with my vision.  I can see depth a lot better although I don't have a sense of space quite yet.   When I look at a forest, I can see rows of trees whereas before I would see some trees and then a grey-brown blur.  I see curbs on the road and sidewalks much better.  I have a much wider field of vision and can see more of the whole road.  My posture has changed and I don't have to hunch over a computer screen which is going to relieve a lot of my osteoarthritis in the neck.  

English: Field of View, Flame detection
Field of Vision Image via Wikipedia

Other things have changed as well.  I have also started to be more sensitive to textures and want to explore more texture.

I think my hearing has improved slightly as well.

Wednesday, December 28, 2011

Flapping Like Loons: Thoughts on Organization

Well, Rome wasn't built in a day; nor was complete organization achieved as quickly as we wanted.

My husband gets his train pass from his company.  So each month we await the ADP envelope containing the pass.  Before we started getting organized, every once in a while, he would misplace the envelope and then ring out the Botswain's call:  "All Hands on Deck!!!" "All Hands On Deck!!!" And we would both madly tear up our house in the hunt for the train pass. It's not an inexpensive pass and we don't get refunds if we lose it.  So it behooves us to find it.

So, the other night, at midnight,  Hubby declares the loss of the train pass and cries out for help.  There is nothing worse than a grown man wailing, so I help him out.   We start tearing up the joint looking for it.  It is our loon dance.  We start flapping around like crazed loony birds.  We look high; We look low;  We look far; and We look near.  We interrogate each other.   Hubby even goes through all the recycling and the regular garbage.  No train pass.  At 1:30 am, we call off the search.  We will resume the next day.

We had thought all this organizing that we had been doing would end this.  But no.

The next day, the train pass arrives in the mail.  I stuck it up on the wall in front of his desk. I texted Hubby immediately and called him an Idiot... as only a loving wife can.  I guess old habits die hard and he just wanted us to run around like chickens with our heads cut off.

When he came home, I made him dance the macarena in his Santa Boxer Shorts as a punishment.  If he wants to make an idiot out of himself, he can do so without me.  We both had a good laught.

Copyright © 2010-2011 Traveller Journey Through The Cortex

Friday, December 23, 2011

Happy Holidays from the Hubble Space Telescope: A Cosmic Snow Angel | Think Tank | Big Think

A Space Angel.

The image captures a compact star-forming region in the constellation Cygnus that is 2,000 light years away from Earth. All the commotion is being caused by the formation of a star called S106 IR that is found in the center of the image.

Organizing the Bedroom and Executive Function

We have left the office and have now moved onto the master bedroom.   So why should anyone care about this?  I mean, you are moving your crap around... so what's the big deal?

The big deal is that little by little everything is getting categorized and put into a certain place. The chests of drawers are now organized and stuff is folded neatly.  Heaps of clothes got recategorized to go to the thrift store.

So... what's the deal with executive function?

Well, let's see.  Organizing depends on Executive Function:  Planning, Marshalling Resources, Executing and Reviewing.   Lack of the ability to do this got me into this mess and led me to go to Columbia for a neuropsych evaluation.  But we Plan what we are going to do; we Marshall necessary resources like boxes, trashbags, etc.; we Execute by sorting (i.e. categorizing -- more on that later) and putting stuff away; and Reviewing what we did.

We can break down sorting into:
  •  concept formation -- "identifying commonalities across stimuli that unite them into a common category".  In other words, we play the Mister Roger's game of "One of these things is not like the other; one of these things just doesn't belong".  
  • rule making -- "identifying commonalities requires learning ‘rules’ about which stimulus attributes are essential to category membership." So we sit down and look at crap around the house (stimulus) and try to figure out what characteristics are the important characteristics.    One of the rules that we find with the organizer is to "group multiples together".  Also, put everything that belongs to a project together.  Put a project(s) in a project box.

Copyright © 2010-2011 Traveller Journey Through The Cortex

Huffington Post: Art Therapy Gets The Royal Treatment


Art Therapy Gets The Royal Treatment
Kate has been visiting a number of charities and organisations in recent weeks in preparation for her new role as a working Royal. The purpose of this particular visit to Islington's Robert Blair primary school in on Wednesday was to find out more about The Art Room - an arts therapy charity with a branch at the school that works with children who are disruptive, withdrawn, or have learning difficulties, to 'increase self-esteem, self-confidence and independence through art'.

Thursday, December 22, 2011

Star of Wonder, Star of Hope

Deutsch: Herrnhuter Sterne auf dem 571. Dresdn...
Moravian Stars Image via Wikipedia
 O Star of wonder, Star of night,
Star with royal beauty bright,
Westward leading, still proceeding,
Guide us to thy perfect light.
            We Three Kings of Orient Are

Upon hearing of my progress with my vision, my Occupational Therapist, Wilma, decided to check me out.   So, she had me make a Moravian Star.   

Moravian Stars were first made at the Moravian School at Niesky, Germany, about 1850, to teach young boys about geometry.   There are many types of Moravian Stars but the most common is the 26-point form, composed of eighteen square and eight triangular cone shaped points.  
Image via Wikipedia
Geometrically, this type of star is a  "Great Stellated Rhombicuboctahedron" Bet you didn't know that!

According to Wikipedia:  In Moravian Stars,  "Each face of the geometric solid in the middle, the Rhombicuboctahedron, serves as the base for the "stellations" or starburst points. No matter how many points a star has, a Moravian star has a regular shape, based on polyhedrons such as  the Great Stellated Rhombicuboctahedron. Each face of the geometric solid in the middle, the 
Rhombicuboctahedron Net
Rhombicuboctahedron Net
Image via Wikipedia
Rhombicuboctahedron, serves as the base for the "stellations" or starburst points. No matter how many points a star has, a Moravian star has a regular shape, based on polyhedrons."

Froebel Star
Wilma had me make my Moravian Star out of 4 ribbons.  If you want to be absolutely technical about it, we didn't make a Moravian Star but a Froebel Star as my star had 18 tips and not 26.  However, we will go with the word Moravian as most references on the web are for Moravian Stars.  Making a Moravian Star is kind of like origami with a lot of folding and turning of paper but we did it with ribbons.  

So, why would an occupational therapist make me work on a Moravian Star?  

Letting Our Light Shine

Before I left on vacation, I was feeling a bit of the sophomore slump that you can feel in the middle of the semester when you are studying for mid-terms.  Just feeling like I was trundling through the mill a bit and a bit of woe is me.   I'm wasting my life etc.  Oh, and a bit of, "Why Can't I Just Be Like Everyone Else?"  I went to school with some people who have achieved phenomenal things;  some of these folks are, like, in the newspapers.  And where am I?  Kind of a bit stuck. 

Then, it occurred to me that, like Lady Gaga says, "Baby, You Were Born This Way!"  A lot of this stuff would have been caught in the school system these days and I am making up for lost time because I have to.   But I don't have much of a choice.  I was born this way.

However, life is not so simple.  It is very easy to mope a bit and focus on all the deficits.  Because, well, therapy is designed to identify and patch up what's wrong.  But, that's not the whole story.  

I think because I just didn't develop the way that other people did that I ended up finding other talents along the way.  Unfortunately, many of these talents don't lead themselves to a mainstream life in corporate America.  I just couldn't talk about the things that I discuss in this blog.  Heck, I couldn't talk about the vacation that I just had other than to say, "I had a nice time in Italy.  Ate a lot of Pasta.  Saw the Coliseum"  Change the subject to "And, how are your kids doing?" "How's your latest house project?".  And never mind talk about safari.   To many of the outside world, I think I will just say something along the lines of "Saw a lot of lions and elephants. It's not as far-fetched as all that.  It's a big Business down there.  You can do it kind of like Yellowstone Park with lodges and minibuses". And Change the subject again to Your Kids. Your House Project. 

In short, do what is called "masking" in autistic or "gifted and talented" circles.  Hide the things that are important to you.   Put on the social mask. Mirror and Reflect.  But, masking only goes so far.  It gets you through a cocktail party but it stops short at real membership in groups or friendship.  At some point, people catch on and move on to people who they feel a genuine connection.  So for all the hiding that's been done, what does it really buy you?   Not a whole lot more than the ability to get through a casual conversation.  

So, what I am wondering if it is not better to show your gifts and look for the gifts in others.   Or, maybe the other way around is better. Look for theirs first, get people to understand that they are truly appreciated for what they are and what they can be if they let themselves go, and then reveal yours.  

Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure. It is our light, not our darkness that most frightens us.' We ask ourselves, Who am I to be brilliant, gorgeous, talented, fabulous? Actually, who are you not to be? You are a child of God. Your playing small does not serve the world. There's nothing enlightened about shrinking so that other people won't feel insecure around you. We are all meant to shine, as children do. We were born to make manifest the glory of God that is within us. It's not just in some of us; it's in everyone. And as we let our own light shine, we unconsciously give other people permission to do the same. As we're liberated from our own fear, our presence automatically liberates others." (A Return to Love: Reflections on the Principles of "A Course in Miracles", Harper Collins, 1992. From Chapter 7, Section 3])-- from wikiquotes

Copyright © 2010-2011 Traveller Journey Through The Cortex

Saturday, December 17, 2011

Occupational Therapy: Collages and Swings

Had another visit with my occupational therapist.  We started brain storming my collage for my husband. As I said last time, he had a choice of picking something or he would get stuck with some chewing gum wrapper art or a macramed  lanyard, so he chose collage of our trip to Italy.

We were brainstorming other gifts for other people. I will do a brush painting, something to do with rabbits, some paper bead jewelry among other things.  

We worked on a little needlework today as well.  I started working with a very large needle with a very large eye.  Just trying to keep my threads nice and even.  I explained about some of my problems with embroidery where I was pulling way too hard on my threads.  Wilma told me to bring it in and she would take a look at it.  

We also did some eye tracking and vestibular rehab.  She had me throw different size and weight bean bags into a barrel.  It was a little hard to judge how hard to throw the bean bag because
bean bags 016
Image by roger_mommaerts via Flickr
we were switching bean bags around so I couldn't rely on the previous toss to readjust my effort.  Also, I had to sit cross-legged on a  rectangular swing and toss my bean bags into a barrel.  No easy feat.

Copyright © 2010-2011 Traveller Journey Through The Cortex

Wednesday, December 14, 2011

The World is a different Place

Well, the world is certainly a different place.   I sure have missed an awful lot of what's going on.

Really, everything.  From what's around me in my own neighborhood, the everyday drives on the PA turnpike, my flower arrangements, and the expressions on people's faces.
English: visual cortex
Visual Cortex Image via Wikipedia

I am in the world and things in the world have relationships to each other.  Before my eyes changed, I saw only so much of my neighborhood.  But, with better depth perception, I can see that my neighbor's house abuts a playing field.  And that the historic house where the painter, Edward Hicks, lived is diagonal to my house.  And that the fence around the tennis court is like a box.  Everything used to be just fuzzed into the background.

As I have been roaring along the PA turnpike, I am truly on the open road.  I can see how Walt Whitman wrote such a poem.  Before, when I was driving, I had my eyes firmly fixed on the bumper of the car ahead and the stereo on.  Now, I still keep the stereo on because I want some stimulus on these long drives but I have some idea of what's around me as I am going past.  For example, I've never realized that there are  car dealerships near the turnpike.  I knew that there was a Jaguar dealership because there was a great big metallic Jaguar statue leaning out at me.  But I didn't know that the Jaguar had muscles.   Or that the Jaguar leaned forward.  Or, that there is an Audi dealership.

I get a much better sense of the open road.... like up hills and down valleys.  I look out towards the horizon.

I'm not too happy with my flower arrangements because I am noticing  a big hole in the middle of them.  I thought the flower arrangements were nice enough before and reasonably well balanced but apparently not.

The other thing I notice are people's eyes and facial expressions.  There's a lot more going on with people.  I noticed a very nice interchange between one of my therapists and the receptionist when they were trying to help me.  Their eyes looked at each other and looked at me and looked away when they were thinking.  It was really nice.

Copyright © 2010-2011 Traveller Journey Through The Cortex

Monday, December 12, 2011

I Got Some Binocular Vision Going!!!

Apologies to my Gentle Readers:  I haven't been posting this week because I have been very tired... Actually more than tired.  The word for it is overtaxed.  But I am seeing a certain amount in 3D!!!  Yippee!!!

I have been doing Cellfield and on Tuesday, I went to my regularly scheduled appointment and continued working with two eyes.  The week before I had blocked (occluded) each eye for 2 hours each and stared at a screen.  Boy, do I realize how much I was suppressing with my left eye!  This week, I am working with two eyes.

Cellfield has me listen to words said very slowly and then click on the word.  I am also realizing that I am having problems with f, h, and th.   Then I work on Pig Latin.  I am getting to be a master of pig Latin as the exercises are timed.  We do three to 7 word phrases of pig Latin.
English: Example of hazel-green eyes. Photo ta...
Image via Wikipedia
Also, I work on copying a matrix of black squares.  All of this is done with funny graphics that have these small circles in different colors in the background or wavy lines.   This process is patented and not well described in the literature.

I was pretty tired when I left A Total Approach.  Went out to my favorite locavore restaurant and had a nice organic meal of spare ribs and a beet salad.  Fell off the Gluten Free - Casein Free Wagon a bit and had cheese with the beets.

After lunch, I went to my new Occupational Therapist and had an interesting session that I will tell you about in a later post.

I was exhausted.  When I walked out of A Total Approach, it was like I had never seen the place before.   I was living in a new world of space.  There was space between the trees and the buildings.  There was space between my therapist's head and the wall.  All the world is very new to me.  I was very overwhelmed by the whole deal and was a bit rude to my waitress at Harvest and kept my head down and tried not to look at her.   I stared at my plate.  It was pretty comforting to me to keep my head down as I had reduced 3d vision (binocularity) for near objects.  So things close to me weren't popping out at me.

Interstate 376 forks off from the westbound Pe...
Image via Wikipedia
On the drive to the Occupational Therapist (which fortunately was on the way home),  I really just focused on the road and didn't want to look around too much.  I just wanted to get to her office in one piece.  I didn't play any music in my car either.  After the appointment, I was so exhausted on the way home.  My eyes were hurting me.  I  felt so hot and dizzy that I almost pulled over on the Pennsylvania Turnpike for a rest.  But I was relatively close to home so I just white knuckled my way home.  I kept telling myself "Five More Minutes".   I got home, yanked my clothes off, put my nightgown on and crashed into bed.  I had a pounding headache and my eyes just hurt. I was very dizzy and nauseous and weak. I lay there for half hour and then finally told myself that if I got up and took some aspirin for my headache I would feel better.  I hauled myself up and got my aspirin and then plopped into my bed and just quivered for an hour before I fell asleep,

I had definitely waaaaayyy  overdone it.  I wasn't just tired this time.  I was overtaxed.  I decided from that point that I was just going to cut back on everything for the week except Cellfield.  Pushing yourself to this degree is just no good.

On a happier note, I can see a heck of a whole lot more.  Will be blogging about my new world anon.

Copyright © 2010-2011 Traveller Journey Through The Cortex

Wednesday, December 7, 2011

The Office is Finally Organized!

Hallellujah!!!!   I feel like breaking out a New Orleans string band and strutting my stuff.  Our Office is finally organized.  We are through with it.

NEW ORLEANS - FEBRUARY 16:  Members of the Mon...
Image by Getty Images via @daylife

Free at last!  Thank God Almighty, we are free at last!

Our organizer, Audrey, is now moving onto our bedroom.  She has started attacking the closet.  Fortunately for me, the mess in the closet belongs to hubby.  I have been too tired today to contribute much more than kibbutzing and supervising so it suits me to sit on the sidelines.

My Closet
Image by kian esquire via Flickr
Good God, we can finally see the floor in the closet.  There are now tons of clothes to go off to the thrift shop.  My husband has lost lots of weight so all of his "Big" clothes are going to find a new home.  Someone is going to get some awfully nice Robert Graham shirts and Italian sweaters.  There is a high-end boutique near my house that has dramatic sales when they want to move merchandise so that's where I buy hubby's goodies.

Our dining room is now full of stuff to be taken to the thrift stores.  Sometimes, this organizing just makes one area clean at the expense of another part of the house.  But we get through it.

If we master our bedrooms and office that is most of the mess of the house.  Most of the rest of the house will need just a bit of tweaking with the exception of the pantry, linen closet and the ever popular offenders of the basement and garage.  But it is much easier to keep things clean when everything has a home for it.

Believe it or not, the exercises I have been doing with the "Captain's Log",  have a lot to do with categorizing which is at the heart of a lot of this organizing.  It makes it a lot easier to sort when many of the categories are defined for you.  Executive Function to the rescue.

Copyright © 2010-2011 Traveller Journey Through The Cortex

Tuesday, December 6, 2011

Now For Something Completely Different: Visit with Occupational Therapist

Yup.  This visit with the occupational therapist ended up as a line out of Monty Python:  "Now For Something Completely Different!"

English: Occupational therapy. Toy making in p...
Toy Making in Hospital Image via Wikipedia
Sat down in  Wilma Dorfman's office and she thumbed through my thick file of doctors' reports.  Then she said,  "This doesn't tell the whole story" and in so many words, she asked, "What's right with you?". I told her that I am very good with patterns and trends in a variety of disciplines and gave her a few examples.  She asked how I came up with things and I said visually, auditory, and kinesthetically.  That the thoughts can come from different areas of my body.  I can get very excited about doing things and get into what Positive Psychologists call "flow", being fully immersed in a feeling of energized focus, full involvement, and success in the process of the activity.  Sometimes, however, my cup can runneth over and there is a compulsive, driven feeling to it or I can get distracted and go off on a tangent and get nothing done.

 Also, that I have a good eye for design in that I have been complimented by somebody who works in couture.  I told her about my "rocket dress"!    Also, while on safari, I rummaged through the discount bin for African sculpture and the owner complimented me on my choices and told me I had an eye for artistic pieces.

Wilma noted that while the list of symptoms I gave her was quite detailed and specific, my description of what I am good at is global and operates in a high level of systems.  I have increased level of arousal that is sensory driven with multimodal sensory inputs, which can be "driven" or can operate in a state of flow.

So this is where we will start working.  I really would like to get my sensory integration problems together, and get some fine motor skills and go back to work.

Monday, December 5, 2011

A Funny Thing Happened to Me On the Way to Therapy

English: Monaural beats
Image via Wikipedia
Last Thursday was the most discombobulated day that I have had in a long time.  I don't know whether the stars were misaligned or that I had played some sounds on my sound oasis that weren't right for me, or what.  But I was totally whacked out.

I had gotten a new sound oasis by accident.  I thought my old one had stopped working and so I ordered a new one on  I got the Sound Oasis 650 which has all kinds of neat sounds including brainwave entrainment.  Brainwave entrainment cause brainwave frequencies to fall into step with a periodic stimulus having a frequency corresponding to the intended brain-state.   The night before therapy,  I tried the Delta Voyage which  uses  DELTA frequency entrainment (.5, 1 and 2 hz) to adjust the delta waves from your brain to coax you into a restful sleep.  As far as sleep is concerned, it worked fine.  Both hubby and I slept really nicely.

However, the next day, I was all aflutter.  My executive function was just whacked and in a very similar fashion to what had happened with neurofeedback.  My sense of time scheduling was just not working.  I got up in the morning and started going about my morning routine to go down to A Total Approach.  I know what time I must cook my breakfast, get dressed, etc so that I get to my appointment on time.  I was up early enough and looked at the clock and noted the time and then frittered my time away.  Looked at the clock again, noted that it was 20 to the hour so that it was time for breakfast.  Ok. Frittered around some more.  And  then realized that it was 20 to 9 as in five minutes before I should leave the house.  Started thinking about leaving for therapy.  Then at 9:00, I said "Oh My God!  I am running way late!!!!"  Jammed some food into myself.  Threw my clothes on and jumped in my car.

Told Ann at therapy what had happened and she chalked it up to the stars being out of alignment.  She was feeling a bit whacked out today herself and noted that in the past few days alot of  her clients were off their game.   She was chalking it up to the changes in weather that we have been having from hot to cold to hot.   Never thought about weather and neurology connection.  Maybe there's something there.

Sunday, December 4, 2011

"Neurons that Fire Together, Wire Together"

Photograph of a stained neuron in a chicken embryo
Neuron Image via Wikipedia
and "Neurons that Fail to Sync, Fail to Link".

Brain imaging research shows that the rapid link into meaning, needs reading functions to be grouped closely together near the language centres, on the left side of the brain. Only this configuration can provide the high interconnectivity and processing speed needed. Brain imaging shows the reading impaired do not have such left brain neural grouping.

Cellfield creates this group configuration by means of a neuroscientific, brain plasticity based computer intervention. The multiple functions necessary for reading are provided as simultaneous tasks. This synchronises the firing of neurones between functions, which interconnect.

Saturday, December 3, 2011

Beaten Like a Rented Mule

Sorry about not blogging but I have been exhausted.  Completely rung out.  Beaten Like a Rented Mule.

I have been doing Cellfield therapy all week and it has been kicking my sorry tail.  It has a been very sorry tail all week.  It is a 100 mile round trip from my home to Glen Mills where I do my Cellfield therapy.  On Thursday, when I do vision therapy, it is 45 miles from Glen Mills to Leola, PA and then 89 miles from Leola to home.   I almost thought about getting a hotel room on Thursday but I managed to haul myself home.  Oh yeah, I also went to another appointment with a new occupational therapist but that was on the day that we were getting a new TV delivered so I had to run home from Glen Mills and then run back to Plymouth Meeting, a mere 29 miles from home.  I did take one day off but I went down to Philadelphia by train to feed the homeless and then walked to the Pennsylvania Academy of Fine Arts to visit the exhibit there and then went to an alumni meeting that night.

Friday afternoon and much of Saturday were spent in bed.

Cellfield therapy has been helping me out.   I am making some progress in vision.  Vision therapy by itself seems to have stalled out a bit for me.  I am continuing it but I think I need a boost somewhere.  Cellfield therapy starts with occlusion, that is, obscuring vision in one eye with special lenses  for one hour per day for the first four days.  On Monday, I will go back to using both eyes for the lessons.  Well, occlusion has been an eye-opener!  I can read things on the screen just fine with my right eye.  But, I have severe problems with my left eye.  At times, I literally, just can't see the words on the screen or have to work extremely hard to see them.  No wonder I am suppressing my left eye.

Thursday, December 1, 2011

Neurocognitive Psychotherapy for ADHD

Structuring the Psychotherapy Session

Not only is it important to introduce structure into the living environment of an individual with ADHD, it is equally important to introduce structure into the therapy session itself. Structure, compensatory strategies, 
English: A child not paying attention in class.
Image via Wikipedia
and reminders are needed in daily life as well as within the therapy session.
For example, just as unfocused activity rarely helps an individual with ADHD reach a goal, unfocused, rambling interaction during a psychotherapy session is rarely productive. A neuro-cognitive psychotherapy session should be structured to help a client review issues discussed in earlier sessions, review issues related to other treating professionals (medication issues, coaching issues, etc.), set priorities for the focus of the current session, and set goals or tasks to work on between sessions.
Memory difficulties are very common in adults with ADHD. There may be no real sense of continuity from session to session without added structure from the therapist. Audio-taping or note-taking during sessions can be extremely helpful, allowing the client to review issues and goals between sessions. Each session needs to involve setting goals and priorities and then establishing realistic steps to work toward those goals.