Barry's Leap
Siegfried Othmer
Barry’s Leap
The M.B. Sterman Career Achievement Award recognizes “thinking outside the box” as its first criterion. Yet what distinguished Barry’s work is that he labored entirely within the frame of established scientific methodology. His thinking was rooted in Pavlovian classical conditioning, migrated to Skinner’s operant conditioning, and rested on Thorndike’s Law of Effect, all from the first half of the twentieth century. He was as orthodox a Skinnerian as Skinner himself.
This made it doubly painful to come to terms with the ultimate rejection of his work by his academic colleagues at UCLA and in the world at large. Late in life, he lamented, “I did everything the world of science expected of me to prove this out, and in the end, it did not make any difference.” I remonstrated immediately with “We are making a difference, Barry.” But our labors did not count because they would not lead to general acceptance of NF. Our non-academic status had just made things even harder in that respect.
Jack Johnstone once arranged for a seminar on NF that drew together the UCLA Psychology, Neurology and Psychiatry Departments. Sterman had the first slot on the program. Gripping the lectern in the Neuropsychiatric Institute auditorium, he began: “I have not been up here in forty years.” He had never been asked to present his work even in his own department.
There is one leap out of paradigm that Barry was compelled to undertake, and the results have been consequential. The transition to working with human subjects meant translating the protocol to the human EEG, which wasn’t characterized by the unambiguous bursting activity seen in cats. Rewarding high-amplitude excursions in the SMR training band was the obvious choice, and the best argument in its favor is that it worked.
If B.F. Skinner had been looking over Barry’s shoulder, he would have said, “there is no event here to be rewarded.” In the case of the cats, the event was so readily discriminable that one could have varied the threshold over a wide range without significantly altering the results. Not so with human subjects. The outcome was ever so sensitive to even slight changes in threshold. Truth be told, we were in mushy terrain.
Barry undertook two designs, the extinction design and the reversal design, to prove out that operant conditioning had in fact been effective with the cats. The hypothesis was confirmed. If one envisions translating those same designs to human subjects, it becomes apparent that they would very likely fail to confirm the hypothesis.
It was also problematic that when we trained for an increase in SMR amplitudes, we often did not observe any such increase. The changes in band amplitude were not correlated with clinical results. In effect, the highly successful work with the cats had cast an aura of legitimacy to the procedure with human subjects that was undeserved. This also had the effect of freezing our model understanding.
Meanwhile, in the office of Margaret Ayers just down the hill from Barry’s house in Beverly Hills, the behavior of many brains in the chair had shaped her behavior over the years to be ever more generous with the rewards. The practical consequences were hugely favorable, but there was no accompanying theoretical frame in which to understand this new reality. What is directly apparent, however, is that the new approach further demolished the conception of the reward as indexing any kind of brain event that merited recognition.
My own training back in 1985 firmly established that the benefits I derived could be traceable solely to the fact that I was watching the within-band dynamics in the low-beta band. The discrete rewards had nothing to do with it. Our early work with severely impaired victims of near-drowning demonstrated, in turn, that infants could respond equally well to training only on the event stream of the beeps. The discrete rewards had lost their individual significance; their meaning emerged only within context. The brain was responsive to the slow dynamics characterizing the training band.
Individually and collectively over time, the human brain had effected a prison-break from the stultifying research design that was more suitable for rats and pigeons than for the human brain. (Barbara Brown had already come to this view back in the seventies, saying that operant conditioning was a very inefficient way to train the brain.)
Barry never came to terms with this new reality, and neither did Joel. As late as 2011, they subscribed to the view that “It is our contention that future applications in clinical work, research and development should not stray from the already demonstrated basic principles of learning theory until empirical evidence demonstrates otherwise.” This was an admonition from our founders to labor within the box even as confounding empirical evidence was already plentiful and mounting. This was a reactionary posture for the time, more of a last line of defense for a disintegrating paradigm.
Joe Kamiya, Barbara Brown, Elmer and Alyce Green, Barry and Joel were the right people to establish this field on a solid footing, and they did so at some considerable cost to their careers. But Barry and Joel did not oppose the imposition of a kind of lockdown of the intellect that constrained innovation rather than allowing it to flourish.
Siegfried Othmer
The quotation is from a review paper titled “Neurofeedback and basic learning theory; implications for research and practice,” published in 2011 in the Journal of Neurotherapy and authored by Leslie Sherlin, Martin Arns, Joel Lubar, Hartmut Heinrich, Cynthia Kerson, Ute Strehl, and Barry Sterman.
J Lucas Koberda, MD,PhD,
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Salvatore Barba
On Dec 5, 2025, at 6:44 AM, 'J Lucas Koberda, MD,PhD,' via ISNR_Members_Forum <isnr_memb...@googlegroups.com> wrote:
Thank you for this beautiful summary!
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John Anderson
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Siegfried Othmer
Erik Olesen
Auburn, California 95603
On Dec 5, 2025, at 4:08 PM, 'Siegfried Othmer' via ISNR_Members_Forum <isnr_memb...@googlegroups.com> wrote:
John—
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Siegfried Othmer
John Anderson
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Erik Olesen
Auburn, California 95603
On Dec 6, 2025, at 8:41 AM, 'Siegfried Othmer' via ISNR_Members_Forum <isnr_memb...@googlegroups.com> wrote:
Salvatore Barba
On Dec 6, 2025, at 11:54 AM, John Anderson <qeeg...@gmail.com> wrote:
Rustam Yumash
1. Operant conditioning is a simplified laboratory construct that cannot capture the deeper reality: living systems naturally repeat what feels pleasant, safe, or rewarding.
Or
2. Operant conditioning is a reductionist framework derived from captive, artificial laboratory settings that lack ecological validity; in real biological systems, organisms simply repeat behaviours that feel pleasant, safe, or stabilising.
Because operant conditioning arises from reductionist, captive laboratory paradigms, it lacks ecological validity and cannot capture the first-person experience or agency intrinsic to human self-regulation. The deeper biological law is simpler and more universal: organisms repeat states that feel pleasant, safe, or stabilising.
Thus — in his view — what we call “choices” or “free will” are heavily constrained behind the scenes by factors outside conscious control.
So the core dilemma of neurofeedback is to identify neural mechanisms that are measurable and grounded in modern neuroscience, while ensuring they correspond to the subjective shifts clients actually experience—bridging objective dynamics and lived phenomenology.”
Siegfried Othmer
Rustam—
Thank you for your questions. That allows me to clear up some things, but I’ll have to do it in my own words rather than fitting into your framework. I hold no brief against operant conditioning. With tongue in cheek, I might say “If we had nothing better to do, we’d still be doing it.” But in fact we are still doing it! It has its place for targeted, event-based, threshold-based training such as Alpha-band synchrony, gamma-band synchrony, ILF synchrony, and Alpha-Theta. The inhibit protocol is also event-based, although here the training is non-prescriptive. It alerts the brain to adverse events, but leaves the response entirely to the brain’s discretion.
Operant conditioning testifies to the amazing powers of the brain. The occasional appearance of an odd-ball event engages the brain’s correlational mechanisms for any connection with its internal state. In its prediction mode the brain goes into hypothesis testing, by means of which the provisional correlations are gradually whittled down to the one that is most consistent, which then becomes an action item. Correlations are registered across stretches of time; the variable space is huge; the memory burden is immense. It’s just awesome that the brain can pull this off.
The real-world problem here is that SMR-training in humans by way of operant conditioning is a much more challenging task for the brain—and much more subject to confounds—than SMR-training in the cats. The shift to training based on the slow and within-band dynamics gives us a new vantage point, one from which the standard SMR-training just looks terribly inefficient. Further, we have finessed the issue of the confounds that plague traditional SMR-training in the presence of highly dysregulated EEGs. The even bigger issue is that training on the dynamics is context-sensitive in a manner that prescriptive training cannot be.
That really gets us to the nub of the matter. Training on the dynamics gets us closer to what the brain is actively managing, and all the information we need is available in real time. Hence the efficiency. On the flipside, the brain really doesn’t care how big the signal is, so this is not under active management. What will be will be. Does it not tell you something that infant brains can handle this as readily as adults? The infant is just gazing out into the world and its brain seizes upon the information that it is already prepared to look for.
Years ago, I tried to get Sapolsky interested in neurofeedback, after he published his book titled “Why zebras don’t get ulcers.” Sadly, he has come to the view that we don’t have free will. As Daniel Dennet says, we have all the free will that we need. This is not in conflict with determinism. On the contrary, the existence of free will rests on a deterministic universe. How I act in this world is highly predictable to me, by virtue of all the factors that you mention. That’s comforting. All those constraints ‘beneath consciousness’ are what make me who I am. Collectively, they constitute my neurophysiological support system. They are not perceived as constraints because they are ego-syntonic.
Siegfried
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Siegfried Othmer
Ed Hamlin
Current evidence in the neurofeedback literature indicates that nonspecific factors play a substantial role in the outcomes we observe. While some have taken this to mean that neurofeedback effects are simply the result of placebo responses, the data suggest a more nuanced picture. Research shows significant overlap in the brain networks engaged during both genuine and sham neurofeedback—particularly the central executive and salience networks. These same networks are also prominently involved in the high-quality neuroimaging studies conducted by Ruth Lanius and her colleagues. Together, these findings point not to “mere placebo,” but to shared engagement of robust regulatory systems that support therapeutic change.
Ed D. Hamlin, Ph.D., BCN
Clinical Director
Institute for Applied Neuroscience &
Center for the Advancement of Human Potential
90 Acton Circle
Candler, NC 28715
Tele: 828-251-2882
Fax: 828-633-7073
e-mail: eha...@ian-asheville.com
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tse...@tmsemplepsychologist.ca
- isn't the above just a description of operant conditioning . . . or a "Skinnerian" process <g>?
Terence McL. Semple PhD
Psychologist.
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Rustam Yumash
Thank you all for sustaining this deeply enriching discussion. I would like to offer a publication that directly illuminates the issues we are debating:
“Evidence that instrumental conditioning requires conscious awareness in humans.”
(link + attachment)
This paper is highly relevant because it empirically demonstrates that instrumental learning does not occur without conscious access. Humans cannot adjust behaviour toward rewards or away from punishers when stimuli remain unconscious. The authors summarise convergent neuroimaging evidence showing that:
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Conscious processing involves global, long-range network activation,
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Whereas unconscious processing remains local and short-range
(Baars 2002; Baars et al. 2003; Dehaene & Naccache 2001; Dehaene et al. 2001, 2014; Melloni et al. 2007).
In earlier discussions with Siegfried, we converged on the idea that Endogenous Neuromodulation in ILF reflects a precognitive stage of neuroplastic adjustment, which must then be integrated into conscious experience to become adaptive, meaningful behaviour.
This article provides the missing empirical bridge between these two levels: precognitive modulation alone is insufficient for selective behavioural change; consciousness is required for global integration.
So Neuroimaging and EEG studies may be our best evidence and way forward for resolving the dualism of conscious / unconscious aspects of Neurofeedback.
There is quite a bit of evidence in the neuroscience literature that supports a role for both infra-slow / infraslow (ILF / ISO / slow cortical potentials) and gamma-band (or fast oscillatory) activity in processes related to consciousness, large-scale brain integration, and potentially self-regulation. that ILF and gamma together contribute to consciousness. Below are several of the most relevant findings from peer-reviewed research — with notes on strengths and open questions.
Infraslow oscillations (ISO / ILF / slow cortical potentials) coordinate large-scale network states (https://www.frontiersin.org/journals/systems-neuroscience/articles/10.3389/fnsys.2018.00044/full
I think this angle offers the most all encompassing resolution of our inquiry into mechanisms of Neurofeedback . All comes to networks!...
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Rustam Yumash, BMed, Dip. Neurology
Director, Brain Mind & Memory Institute
Authorised representative for BEE Medic in Australia
Contact: Mobile+61413181147 | Email: ryu...@beemedic.au
Website: www.beemedic.com/en| www.braininstitute.com.au |
Address: PO Box 935, Tweed Heads, NSW 2485, Australia
Siegfried Othmer
Ed—
You write: “There was a time in our field's history when conversations like this one were more common.”
At the first Futurehealth Conference in Key West in 1993, the conversation around the spa was so lively, and extended so late into the evening, that the police were summoned to quiet us down… The biofeedback list in yahoogroups also served as a communal watering hole for many years, until yahoogroups folded. The fact that innovation was so intimately connected with hardware and software development only exacerbated the subsequent trend toward the siloing of the various initiatives.
Clearly psychologists are not only empowered by NF but complement it in important ways. But I am also getting backpressure—from nurses and others—for always talking within the frame of a mental health model. NF is going to look different in the hands of the various health professions and now in the educational arena as well.
I wish our psychologists would proselytize with the APA. The field of psychology used to own biofeedback, but it has backtracked. NF/BF should be so closely integrated with psychotherapy that it should not require a separate procedure code. No one outside the treatment room should have a say in the matter. That’s the way psychiatrists like it in Switzerland. That’s standard for OT’s.
At the Evolution of Psychotherapy Conference in Anaheim two years ago, I listened to couples therapists talking about their toughest cases. They each involved a partner who was a likely case of early trauma with attachment issues. Such trauma is physiologically encoded and will not be resolved in the absence of physiologically rooted remedies. Would the principals here look back on the therapy experience and regard themselves less as failures in their relationship than they did before? I wasn’t sure.
Siegfried
Rachael Cavegn
I’ve appreciated these conversations over the past couple of weeks very much. The opportunity to respectfully share knowledge, perspectives, experiences, openness to learning from and with each other, is just how we get better as providers and as a discipline. One additional perspective I thought I would contribute, which may be somewhat unpopular, is actually in defense of the placebo effect itself which I believe actually serves in support of our work rather than as an obstacle. In many ways I have come to regard it as neurofeedback’s greatest ally (and achievement) rather than a dreaded enemy and here is why.
Research has shown that the placebo effect is not for nothing. It is actually becoming understood as one of the most critical components of ANY “successful” human designed health intervention that currently exists. It is essentially about catalyzing the human organism’s extraordinary capacity for self-healing. If we understand it in that context then isn’t placebo doing exactly what we would ideally hope for our clients to experience as a result of neurofeedback? Aren’t we arguing that self-healing (placebo) is possible through self-regulation?
In a 2018 study about leveraging the placebo effect in medical interventions (attached) the authors highlight some of the many now measurable physiological shifts placebo (which I now affectionately refer to as self-healing) routinely achieves including “driving measurable changes in both endogenous opioid and nonopioid neurotransmitter systems and modulates metabolic activity in many regions of the brain.” “Recruits the involvement of disease-specific biological neurotransmitter systems, such as components of the immune system and endogenous opioid system,” pain relief “that corresponds with reduced activity in the thalamus, somatosensory cortices, insula and anterior cingulate and reduced activity in the rostral portion of the anterior cingulate, the amygdala and the periaqueductal gray,” and measurable shifts in blood pressure, weight loss, cortisol response and hormone secretion.”
We now understand that self-healing (placebo) is not just a moot dynamic, nor is it about denial of the existence of an ailment, but rather actual, measurable shifts in our neurophysiology and functioning. So maybe instead of focusing on beating the placebo effect we could look through a different lens and consider the possibility that neurofeedback’s most valuable contribution to improved health is its capacity to enhance placebo (self-healing) itself.
I work at a clinic with a lot of providers from various disciplines across the health sciences including many prescribers. I was brought into the group as these clinicians had come to recognize that the “pure” medical sciences were not cutting it- medications, dietary strategies, even medical procedures were OFTEN not really succeeding in helping clients get to a space of significant and enduring positive health outcomes. I brought some pieces of these listserv conversations to my discussions with our prescribers last week. They agreed that they heavily rely on the critically important role placebo (and nocebo) plays in their medication recommendations. When first asking their patients if they have formed an opinion about a drug, our providers quickly know whether or not that drug will likely be helpful to them. They told me that they will not prescribe a medication if the patient has a negative perspective of it regardless of the research on its apparent efficacy for the client’s condition. They understand the inextricable relationship between mind and body, conscious and unconscious. I am fortunate to work with some cool people.
Our prescribers continue to refer their patients to me because they are seeing improvement with the combination of our interventions. Neurofeedback clients are more aware of how medications are influencing them, more inclined/capable of collaborating with providers on the process of medication selection, and seem to be responding better to those medications. I am also noticing how medications support the efficacy of neurofeedback. Sometimes it’s the influence of the medication that allows a client the capacity to even walk through my door or sit long enough for the training to begin with. I could give many examples of how collaborating with other specialists (MD’s, dietitians, etc..) has bolstered all of our efforts in the collective desire to help our patients/clients improve their health/functioning. I have long believed neurofeedback is uniquely positioned to bridge the divide between the health specialties and thus improve overall actual healthcare.
I FULLY agree that we need evidence-based research to help inform our practices. As mentioned in these threads, we are only just beginning to understand our own functioning. Maybe the self-healing effect is not the measure to overcome, but rather the one to continually embrace, nurture and enhance through our work with neurofeedback. We have many measurable ways to understand the extraordinary influence of placebo. Maybe those are the markers we should aim for. Maybe we need a new or at least an additional measure of an intervention’s efficacy like how well it may support the efficacy of other interventions. In the end is the patient/client living more fully?
Rachael Cavegn LMFT, BCN
Licensed Marriage and Family Therapist
Board Certified in Neurofeedback
AAMFT/BMFT Clinical Supervisor
Adjunct Faculty-St. Mary's University
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John Anderson
Siegfried Othmer
Rachael and Rustam—
I appreciate the discussions that gently suggest a course correction or augmentation of my narrowly targeted, mission-driven perspective. No question the placebo is a positive compounding factor in NF. Therefore it is not our adversary, and thus we should never have allowed ourselves to be lured into supporting a research design that treats it as such. But the placebo is not a mechanism. It is a word that substitutes for the discussion of mechanisms. As Skinner once said, the placebo is not (generally) an invitation into a discussion, but rather one to bring it to a halt. It has utility in drug research, where discussion of what the placebo involves serves no useful purpose. In that role it is simply a strawman. In the realm of neuroscience, the word that has served so long as a shape-shifter has no utility and should be ushered out of our discourse.
Skora and Scott’s proposition that instrumental conditioning requires conscious awareness is readily testable. First of all, only reward-based training is under consideration here. We have the evidence of successful reward-based training in persistent vegetative state and in coma. Further, the results of such conditioning may well be contrary to the trainee’s intention (SMR up-training leading to lower amplitudes). Consider persons in a state of episodic suicidality, still plagued by the compelling urge to end their lives during the session, yet coming out of the session having banished all thoughts of suicide.
Why is our modern society still stuck in Cartesian dualism despite the existence of the neurosciences? The field of education is still failing to take into account that there is a brain involved. Psychology has absented itself from any involvement with neurophysiology. Psychiatry still treats the brain largely as if it were an endocrine gland making neurotransmitters and neuromodulators. The system of justice has not moved forward in recognizing brain involvement since it made room for the insanity defense nearly two centuries ago.
This is traceable to the fact that our consciousness is blind to the mechanisms that give rise to it. The brain preserves us from the complexity of such an awareness. The dualistic divide is our lived experience; it is not the brain’s reality, in which consciousness is not some separable entity but a biological possibility with neural networks of sufficient complexity.
Let me prove the proposition by way of a contradiction. Brian might come for his NF session complaining of elevated delta band activity in the right frontal region (don’t hold me to the particulars…). He was aware of these deviations because they impinged on his brain function, and he had had a chance to become acquainted with his own EEG over the course of many sessions. I told him at the time that with further recovery he might lose those insights, and so it was.
Our adversaries in the mainstream are fully willing and able to be obscurantist. They are on a mission. We have unfortunately accepted their terms of engagement for all these years, with the result that our field is stuck in a kind of quicksand from which we cannot readily extract ourselves. The Achilles heel of the placebo model of NF is that it must explain everything. If we present even a single contradiction of that proposition, then we must have a different conversation.
Consider the following report from the mother of an infant, herself a neurofeedback practitioner:
“This was a very colicky baby, with severe constipation and poor sleep, who would cry inconsolably for hours, from 7 PM to midnight. She calmed down in her very first session and stopped crying 18 minutes into it. She then slept through the night. Sleep improved and constipation resolved. She was three weeks old when we started the training.”
There is no placebo model for this, and there isn’t even space for the involvement of consciousness. The training process—which unfolded entirely in the neurophysiological realm—induced a state shift toward calmer states, and then the system sustained residence in that calmer state, thus enabling sleep onset. We need to challenge the critics from our positions of strength—the existence of ‘black swan’ events that yield to no other explanation than the effectiveness of NF as a neurophysiological phenomenon.
Mathematicians have one key advantage in their discipline. They are free to prove their theorems in any way they can. They can only be challenged on their own terms. As the founders of a new discipline, we must claim the same privilege, even at this late date. It is the phenomenon itself that determines how it is to be proven out. We must challenge critics with our best evidence.
Bayesian inference presents a fully competent, even preferable alternative to frequentist analysis with group designs (as Peter Rosenfeld argued in his last publication in the AAPB journal). We can now show CPT data on over 15,000 clients trained according to the same paradigm. Comparison can be made with the best available evidence. Controlled studies are not needed. The existence of the frequency rules that we have uncovered is categorical proof of parametric specificity, which in turn is proof of efficacy. Trainees are blind to the frequencies that are dialed in. The only information we have to optimize the training is what the trainees can articulate, and what we observe or measure directly.
Why are existentially deprived custodians of the published literature in the academic monasteries entitled to decide whether a therapy works? It is because the entire process, from research funding at the NIMH to publication in the major journals, is now subject to control by the pharmaceutical industry. It is a scandal on a scale beyond human comprehension. That is how we get to this:
Neurofeedback for ADHD: Time to Call It Quits?
https://psychiatryonline.org/doi/full/10.1176/appi.ajp.20220861
James J. McGough, M.D., M.S. jmcg...@mednet.ucla.edu
Siegfried
Rachael Cavegn
I thoroughly appreciate the dilemma you are presenting Siegfried and the enormous amount of brilliant and extraordinary work you have put into demonstrating our validity in the field(s). You have helped to enhance my own confidence that what I do with neurofeedback is indeed something real, distinct and effective. I think in addition to presenting our case for our own efficacy is the ability to understand the other interventions and also speak to their dependence on multiple variables. Not to discredit them, but rather to be able to highlight the influence of our universally shared constraints.
None of our human designed specialties can really say they stand alone in their influence- really nature’s interventions probably can’t claim that either when we understand them from the limited confines of the human perspective (divide and conquer). At the most basic level we need balance in diet, sleep, exercise and social engagement for our organisms to stay alive much less be able to learn, grow, change or thrive. These could all be classified as different specialties and interventions but they each need the other in order to effectively do their own job. We are one unified organism.
I have thought a lot about the comatose clients, infants and even the cats that you reference, and can’t help but wonder what else potentially influenced neurofeedback’s impact. I have reflected on some of the consistent variables I have recognized as distinct between my clients who seem to progress rapidly with the training and those who need much more time to benefit from its influence. The difference in access to basic needs (financial stability, food, housing, physical safety etc…) are always reliable factors. But one of the most consistent influential variables I have discovered regardless of all the others is the degree to which they have access to healthy relationships and healthy, safe, physical touch.
We know that healthy relationships and healthy touch initiate a series of “unconscious” changes in our physiology -for example the secretion of oxytocin (inducing a sense of calm, connection and safety) vs that of say cortisol (induced in response to a sense of danger and alarm). In states of calm, we are best suited to be receptive to learning (consciously and unconsciously). So I am always curious about the quality of the relationships of those who authorized these individuals to participate in these studies.
Both inside and outside of the lab to what degree did the authorizing people in the subject’s lives (parents, partners…I assume) engage the subjects in healthy and nurturing interaction? Were they speaking with them in a soothing tone of voice? Were they providing experiences of healthy and caring touch? I assume the infants were being held and spoken to before, possibly during and after the training. I anticipate the same is possibly true for the comatose patients. I even wonder about the way in which Sterman and his staff interacted with the cats…were they kind to them? Did the cats generally like them and have a sense of safety with them allowing the cats to focus on the training? Did these interactions serve as signals to the overall system that the situation in which a stranger was attaching sensors to my head or propping open my eyelids was safe and acceptable?
Even if the subjects did not have the agency to consciously choose to engage in the study, was their whole organism processing signals and making changes accordingly that allowed for neurofeedback’s influence? Were their systems flooded in oxytocin or cortisol? (I apologize for my ignorance if the studies themselves note if these things were indeed measured). Research shows that our systems (our MANY systems) have awareness of environmental influences and make decisions and shifts accordingly even if not “consciously.” The documentary series Human: The World Within speaks about the many “brains” throughout our organism that process information and make decisions accordingly. Is this kind of awareness not a kind of consciousness? Is consciousness exclusive to recognition and use of a language -the capacity to explain what is happening in interactions with others and/or ourselves?
In understanding and justifying my work with neurofeedback I have found it much more valuable to be able to speak to and honor the multiple interdependent factors that facilitate health and transformation. I am better prepared to defend/justify how as a marriage and family therapist, using this intervention allows me to better assist my clients in improving their relationships with others, with themselves and improve overall health functioning
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Siegfried Othmer
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Andrea Eberly
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Rachael Cavegn
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