Nursing Theory And One Counseling Theory Essay

Nursing Theory And One Counseling Theory Essay Nursing Theory And One Counseling Theory Essay Week 1: Assignment below Practicum Journal Entry: You will select one nursing theory and one counseling theory to best guide your practice in psychotherapy. You will explain why you selected these theories and support your approach with evidence-based literature. You also will develop at least three goals and at least three objectives for the practicum experience in this course. Nursing Theory And One Counseling Theory Essay As a future advanced practice nurse, it is important that you are able to connect your classroom experience to your practicum experience. By applying the concepts you study in the classroom to clinical settings, you enhance your professional competency. Each week, you complete an Assignment that prompts you to reflect on your practicum experiences and relate them to the material presented in the classroom. This week, you begin documenting your practicum experiences in your Practicum Journal. Permalink: https://nursingpaperessays.com/ nursing-theory-a…ing-theory-essay / ? Learning Objectives Students will: Analyze nursing and counseling theories to guide practice in psychotherapy* Develop goals and objectives for personal practicum experiences* Create timelines for practicum activities* * The Assignment related to this Learning Objective is introduced this week and submitted in Week 4. Nursing Theory And One Counseling Theory Essay In preparation for this course’s practicum experience, address the following in your Practicum Journal: Review the media Clinical Interview: Intake, Assessment,& Therapeutic Alliance in your Learning Resources. Select one nursing theory and one counseling theory to best guide your practice in psychotherapy. Note: For guidance on nursing and counseling theories, refer to the Wheeler textbook in this week’s Learning Resources. Explain why you selected these theories. Support your approach with evidence-based literature. Develop at least three goals and at least three objectives for the practicum experience in this course. Create a timeline of practicum activities based on your practicum requirements. Select one nursing theory and one counseling theory to best guide your practice in psychotherapy. Note: For guidance on nursing and counseling theories, refer to this week’s Learning Resources. Nursing And Counseling Theory Select one nursing theory and one counseling theory to best guide your practice in psychotherapy. Nursing Theory And One Counseling Theory Essay Note: For guidance on nursing and counseling theories, refer to this week’s Learning Resources. Explain why you selected these theories. Support your approach with evidence-based literature. For the assignment write on Nursing Theory (Hildegard Peplau’s Interpersonal Theory) and the Counselling Theory (Humanistic Approach) Members of a cohesive group feel warmth and comfort in the group and a sense of belongingness; they value the group and feel in turn that they are valued, accepted, and supported by other members. —Irvin D. Yalom, The Theory and Practice of Group Psychotherapy Laureate Education (Producer). (2017). Introduction to psychotherapy with groups and families [Video file]. Baltimore, MD: Author. Note: The approximate length of this media piece is 2 minutes. Accessible player Group and family therapy offers a unique sense of community and support that may not be achieved through other therapeutic approaches. As you help clients effect change within themselves, they are able to in turn help others within the group change. Although many clients thrive in this environment, it is important to recognize that group and family therapy is not appropriate for everyone. Like any other therapeutic approach, group and family therapy has limitations that must be considered. Nursing Theory And One Counseling Theory Essay This week, as you begin exploring group and family therapy, you examine legal and ethical considerations of this therapeutic approach. You also prepare for your practicum experience by examining counseling theories and developing goals to guide your practice. Learning Resources Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus. Required Readings Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice. New York, NY: Springer. · Chapter 11, “Group Therapy” (pp. 407–428) Nichols, M. (2014). The essentials of family therapy (6th ed.). Boston, MA: Pearson. · Chapter 1, “The Foundations of Family Therapy” (pp. 1–6) · Chapter 2, “The Evolution of Family Therapy” (pp. 7–28) Breeskin, J. (2011). Procedures and guidelines for group therapy. The Group Psychologist, 21(1). Retrieved from http://www.apadivisions.org/division-49/publications/newsletter/group-psychologist/2011/04/group-procedures.aspx Khawaja, I. S., Pollock, K., & Westermeyer, J. J. (2011). The diminishing role of psychiatry in group psychotherapy: A commentary and recommendations for change. Innovations in Clinical Neuroscience, 8(11), 20–23. Retrieved from http://innovationscns.com/ Note: You will access this article from the Walden Library databases. Nursing Theory And One Counseling Theory Essay Koukourikos, K., & Pasmatzi, E. (2014). Group therapy in psychotic inpatients. Health Science Journal, 8(3), 400–408. Retrieved from http://www.hsj.gr/medicine/group-therapy-in-psychotic-inpatients.php?aid=2644 Note: You will access this article from the Walden Library databases. Lego, S. (1998). The application of Peplau’s theory to group psychotherapy. Journal of Psychiatric & Mental Health Nursing, 5(3), 193–196. doi:10.1046/j.1365-2850.1998.00129.x Note: You will access this article from the Walden Library databases. McClanahan, K. K. (2014). Can confidentiality be maintained in group therapy? Retrieved from http://nationalpsychologist.com/2014/07/can-confidentiality-be-maintained-in-group-therapy/102566.html U.S. Department of Health & Human Services. (2014). HIPAA privacy rule and sharing information related to mental health. Retrieved from http://www.hhs.gov/sites/default/files/ocr/privacy/hipaa/understanding/special/mhguidancepdf.pdf Assignment: Practicum – Week 1 Journal Entry As a future advanced practice nurse, it is important that you are able to connect your classroom experience to your practicum experience. By applying the concepts you study in the classroom to clinical settings, you enhance your professional competency. Each week, you complete an Assignment that prompts you to reflect on your practicum experiences and relate them to the material presented in the classroom. This week, you begin documenting your practicum experiences in your Practicum Journal. Learning Objectives Students will: · Analyze nursing and counseling theories to guide practice in psychotherapy* · Summarize goals and objectives for personal practicum experiences* The Assignment related to this Learning Objective In preparation for this course’s practicum experience, address the following in your Practicum Journal: Select one nursing theory and one counseling theory to best guide your practice in psychotherapy. Note: For guidance on nursing and counseling theories, refer to this week’s Learning Resources. Explain why you selected these theories. Support your approach with evidence-based literature. For the assignment use please write on Nursing Theory (Hildegard Peplau’s Interpersonal Theory) and the Counselling Theory (Humanistic Approach) Nursing Theory And One Counseling Theory Essay The post Select one nursing theory and one counseling theory to best guide your practice in psychotherapy. Note: For guidance on nursing and counseling theories, refer to this week’s Learning Resources. appeared first on best homeworkhelp. In the past 100 years, the basic concept of psychology and counseling has been realized. During this period these concepts have evolved from several coarse psychological concepts to more inclusive interventions and methods. Along with the continuous development of professionals, it became possible for the original theorist to adapt to the development of human nature and personality. These adaptations continue to contribute to this field as well as the integration of new concepts and ideas. Nursing Theory And One Counseling Theory Essay (A) referral by counseling experts, (b) counseling and personality theory, (c) coaching skills, (d) group procedures and coaching theory, and (e) ethical and legal issues. In addition, students at MHC and MCFC courses must complete counseling diagnosis and treatment courses. MHC and MCFC program students must complete 63 credits, but SC students must complete 60 credits (if there is no certificate of education) or 51 credits (if there is a valid educational certificate) . Courses are offered by various counselors educators who decide course content and style according to their teaching methods. Counseling theory and counseling therapy are cornerstones of occupation. Perhaps each consultant has at least one tutorial theory course and the names of major theorists such as Sigmund Freud, Albert Ellis, Carl Rogers are legendary and well known. In this article I will explain the composition of counseling theory, why counseling theory and treatment are very important, and how these theories evolve. It is estimated that more than 350 counseling theories and treatments are being promoted. Most of them have not received much attention and verification, but the core group of about 10 major theories, and minor methods of minor theories have been revised or are less than 50. And they dominate consulting experts. Most of these theories have the following important elements. Nursing Theory And One Counseling Theory Essay As health professionals, every day we are invited to face patients presenting different problems and which need various solutions or therapies such as medical treatment, information giving, teaching, counseling, etc. I am a trained nurse in dialysis and renal pathologies management and I work in dialysis unit of our hospital. My main role is to receive patients with renal pathology and lead them to the Nephrologist, to plan and to execute prescribed treatment for those who are diagnosed with renal failure. That treatment concerns in general renal replacement therapies like hemodialysis or peritoneal dialysis. For the following work, I have chosen one of our patients because of the following reasons: He is a patient suffering of end stage renal disease and undergoing dialysis treatment since 2 years, he passed the first year under peritoneal dialysis but after developed chronic peritonitis and for this he has been transferred for hemodialysis. Nursing Theory And One Counseling Theory Essay He is waiting for renal transplantation but now lacks fund needed for the process Because of peritonitis he has received painkiller drugs for a longtime to relieve pain but he finished by developing addiction to painkillers. Still now he continues to claim for painkillers while there is no valuable reason. He presents signs of anxiety and depression IDENTIFYING THE PROBLEM Identifying client’s problem is the key of the success of counseling process. Problem exploration is an important step, because it permits counselor-client initial contacts and to map out the client’s problem. For this, all the process has to be well prepared. The preparation concerns the client and the environment in which counseling will be given. Concerning my client preparation, to get his consent, I have before all explained him what is counseling and what its benefits are for people undergoing it. Concerning the environment, all counseling sessions have taken place in our service, in one of our offices that I have chosen because it’s calm, well illuminated and aerated and where distracting conditions have been eliminated. We used chairs permitting to have various positions but every time it was possible, I arranged them in manner to permit face to face interaction. This arrangement permits us to avoid distractions and to have a full opened interaction. Counseling sessions were arranged to have place before each hemodialysis session, and I tried to avoid they went over 30 minutes. This has the purpose to permit my client to begin quietly his hemodialysis session. Nursing Theory And One Counseling Theory Essay My client MV is a young adult presenting various problems. After a careful analysis, I found that my client has various problems which need to be resolved by himself or through assistance from other people. Here, I found that neededassistance could be categorized as following: Problem necessitating other help than counseling Treatment of End stage renal disease: the management of that condition is accomplished primarily by medication, diet therapy and renal replacement therapy. The initiators of the treatment are Physicians (Fink et al., 2001). Nursing Theory And One Counseling Theory Essay Problems which may find solution with counseling Addiction to painkiller drugs: treatment by painkiller began while my client was treated by peritoneal dialysis. He developed chronic peritonitis with intolerable abdominal pain. For the pain he received painkiller each time he claimed it. After stopping peritoneal dialysis and starting hemodialysis, my client continues to ask painkiller although we don’t see a real reason for it. We concluded that he has developed dependency to painkillers. Understanding a variety of models and theories of addiction and other problems related to substance use, describing helping strategies for reducing the negative effects of substance use, abuse, and dependency are among competencies of a counselor in addiction (U.S CSAT, 2005). Nursing Theory And One Counseling Theory Essay Problem which may find solution in combination of medical assistance and counseling: Anxiety and depression which according to my assessment are due to: Waiting a long time the renal transplantation without hope to find financial assistance for the process. Thinking to be useless for the family Anxiety and fear of the future: before he felt sick, he was going to begin university studies and has been obliged to stop them Brusque stop of painkiller treatment Cucor D. et al, (2007)recognized that depression is one of common mental health problem for people with End-stage renal disease. According to them, depression is one of factors influencing morbidity and mortality rates among those people. Various medications are used to fight anxiety and depression but to be more effective, medication need to be combined with other therapies like behavioral therapies. When associated, both medical and behavioral therapy, patient benefits from better decrease in symptoms and a lesser risk of setback (http://helpguide.org/mental/anxiety_types_symptoms_treatment.htm). Nursing Theory And One Counseling Theory Essay The client has developed dependency on painkillers drugs and has been obliged to stop them without any psychological assistance to help him to do gentle withdraw from drug taking. According to my assessment and a long time passed with the client, it’s for that problem that my client needs to be helped firstly and it’s about it I have chosen to work with him as also he has wished. It may be a hard task, but this will help the client and will help me to get more experienced because we are lacking experienced counselors. Nursing Theory And One Counseling Theory Essay TRANSCRIPT OF PART OF MY COUNSELLING INTERACTION WITH MY CLIENT During counseling sessions, the counselor uses various techniques to interact with his client. Communication and interaction management skills are used during counseling interaction and their use depends on how the session is going. Here below is a short transcript of one session I had with my client. Myself: you come just to present me problems which are stressing your life, could you tell me now about the intensity of each problem? Here I have used questioning skills to help my client to express himself and explore issues concerning his problems. Nursing Theory And One Counseling Theory Essay Client: As I told you in the last session, I have been suffering from chronic renal failure there are now more than 3 years. As you see it, I am young and I was about to begin my university studies when I felt ill. At the beginning, I was confident even though my doctor had told me that I will need long term treatment. Now when I think about my future, I feel hopeless. My studies stopped, I lost a lot of money with medical treatment, and I don’t have money for renal transplantation, and for my unluckiness although he knows that I am suffering the doctor has stopped my injections of painkiller. Myself: I understand you feel overburden by all those problems; according to you which problem is mostly troubling your life? What are your main concerns? Nursing Theory And One Counseling Theory Essay Client: actually it’s my continuous unrelieved pain. Myself: Can you briefly speak about that pain? Here, focusing skills to bring my client to give a clear definition of the problem for which he needs our help. Client: as you know it, I have started treatment with peritoneal dialysis. After 5 months of treatment I developed peritoneal infection which was causing me serious pain. Other patients who had the same problem in the past advised me to ask to my doctor to prescribe me Pethidine which relieves pain and permits to sleep. Nursing Theory And One Counseling Theory Essay Here, active listening skills helped me to show to my client that I am attentive to what he is telling me. Myself: how did you appreciate the treatment with Pethidine? Here also I used questioning skills to get full information which can help me to analyze the relationship between my client’s problems and his medical history. Client: at the start it was wonderful to not feel pain and I was again able to close my eyes and sleep. Nursing Theory And One Counseling Theory Essay Myself: and after? Client: after, it became impossible for me to sleep without my injection and one injection a day was not sufficient for me. For this, all the day I was harassing my nurse to provide me Pethidine. Myself: You told me that when you begin treatment with Pethidine everything was ok, no pain and you were able to sleep. So, how did you take it when the Nephrologist decided to stop Pethidine injection for you? Here I used summarizing skills to help my client to stay fixed on our subject; ‘pain’. I asked him that question as a challenge to see if he will continue to tell me that he still needs Pethidine injection. Nursing Theory And One Counseling Theory Essay Client: it has been a bad moment for me and up to now I don’t understand him because I am still feeling pain. Myself: how do you feel when you are at your home? His family members have told me that he is quite at home and claims to feel pain only when he arrives in medical facilities. I wanted to get deep information about his pain. Client: Not very bad. I feel exaggerated pain when I come for treatment. THEORETICAL UNDERPINNINGS In this work, I have been using the client-centered approach. That approach of counseling has been conceptualized by Carl Rogers (1946). The fundamental belief turns around the idea that each individual innately strives towards self actualization, in the other words to be the best that he can. Nursing Theory And One Counseling Theory Essay Find out how NursingAnswers.net can help you! Our nursing and healthcare experts are ready and waiting to assist with any writing project you may have, from simple essay plans, through to full nursing dissertations. Essentially the person or child centered approach extends the central conditions of empathy, no conditional positive regard and congruence to the client, facilitating, in a reflective and non directive way the client’s exploration and harmonizing of his emotional and personal issues that have been arisen from his life’s experiences. Nursing Theory And One Counseling Theory Essay The target is, to help the client to give up the personal image which he has built around his individual experiencing (Mearns D. & Thorne B, 2000 p5). This approach considers a client as an active agent, able to take responsibility for his own condition. Palmer reinforces this when he notes ” clients are encouraged to explore their most intimately held opinions and values, in order to discover for themselves, what it is that really matters to them, what it is worth living for or what would be worth dying for” (Palmer, 1996:p31). The respect of client is essential in this approach. According to Corey (1977) the strength of this approach come from its capacity to focus on preferences and pathways headed for personal growth. Emphasis is on freedom, responsibility and the person’s ability to redesign his life through attentive choice. Nursing Theory And One Counseling Theory Essay The counselor-client relationship is also essential to good practice of client-centered approach. To participate effectively in counseling, Freshwater (2003) claims that nurses necessitate to recognize the client as an equal, though as clients often view nurses as experts it can make this relationship difficult to obtain. Through this work I have been using the theories of motivational interviewing counseling, in which the main objective of the counselor is to identify and work with the client’s motivation to change. Motivational interviewing builds on Carl Rogers’ optimistic theories about people’s capabilities for exercising free choice and changing through a process of self-actualization (Alcohol answers, 21.8.2009). Nursing Theory And One Counseling Theory Essay The therapeutic relationship counselor-client is a reciprocal partnership. The counselor’s role in motivational interviewing is directive, with a goal of eliciting self-motivational statements and behavioral change from the client in addition to creating discrepancy to enhance motivation for positive change (Miler and Rollnick, 1991). As healthcare providers, we are often asked to act as change agent for our patients, students, and colleagues. When we play that role we try to help people make necessary behavior changes by instructing them in the whys and hows of making them. We may have been trained to believe that if we simply teach our patients what they need to do to change and do it effectively enough; they will change (Ellen R. Glovsky, and Gary R., 2007). Nursing Theory And One Counseling Theory Essay In our daily work, tendency is to think that our clients need only medical assistance, but when we try to analyze the situation, we may find that we are wrongful. All clients’ needs are not answered by medicines or other medical and nursing interventions. Most of the time, we ignore the socio-psychological aspect of the problem. This is remarkable with chronic renal diseases like end stage renal failure, diabetic nephropathy, cancer, etc. Sensky (1993), in his work, showed how renal failure impacts on person’s life. The impact doesn’t only concern the physical condition but the whole person. With renal failure, various alterations come in the life; the patient has to learn new skills and strategies which can help him to cope with his condition. The patient has to attempt to adapt to his chronic illness and the necessity to deal with dependence on dialysis machine or other else’s kidney to continue to live. Nursing Theory And One Counseling Theory Essay In their works, (Levenson, 1991; Kimmel, 1993, and Finkelstein, 2002) recognize that anxiety and depression are the most common psychological problems in dialyzed patients. The same idea can be found in the work of Chilcot and his colleagues. They found 20% to 30% of End stage renal disease patients with signs of depression at various levels (Chilcot, & Al., 2008). The other problem found in patients undergoing long term dialysis is a possible addiction on pharmaceutical drugs like painkillers (Manjula, Bennett, Chertow, 2003). Addiction is defined as a state characterized by impaired controlover the use of chemical substance and/or behavior. This lead the addict to seeking and abuse of drugs, a need to continue to take drugs to which some one has become habituated following a repetitive utilization because it produces some special effects like euphoria and other types of mental status alteration. Clinical manifestations occurbeside physical, psychosocial and spiritual dimensions (College of Physicians and Surgeons of Saskatchewan, 2008). Nursing Theory And One Counseling Theory Essay Addicted substances are like alcohol, stimulant substances like cocaine, heroine, marijuana, and medicines like tranquilizers and painkillers.Others may habitually mix prescribed drugs with alcohol to numb the mind from staying on disappointments or personal conflicts. Many people persist in taking medications to feel better physical or psychologically even when no ailments are present; and some insist that they can’t function without them. Statistics indicate that, the number of visits in emergency room for prescription and illegal drugs overdoses are the same and that individual abusing medical drug like codeine can be just as addicted as the one who abuses of illegal drug like cocaine. While prescribe medicines is absolutely legal, ethical and moral laws prohibits the use of medicines for purposes other than the original aim. Addicted people need therapists specialized in chemical dependence counseling and who can help them to recover from the addiction by reviewing past medical history and patterns of substances abuse. Most of the time counselors discover that long term abuse has produced undesirable psychological and physical effects. The case presented above concern a patient addicted to Pethidine, a painkiller of opioids pharmacological family. Addiction to opiates like morphine can occur after chronic pain suffer is given dosages to control acute discomfort, and continues its use long after pain has collapsed (ChristiaNet, 2009). Nursing Theory And One Counseling Theory Essay Many people with long-lasting pain receive treatment by opioids. But, there are evidence throwbacks and side effects that may follow this treatment. Developing tolerance to drugs is one major risk, sometimes at short time. The second major risk is the development of addiction. Addicted people to painkillers becomeso fixated on getting more of them that the obsession prevail over the medical target of relieving pain (Media Planet, 2009). COUNSELING IN ADDICTION The focus of individual drug counseling is on the symptoms of substances addiction. It also relates areas of weakened function and the structure and content of the client’s ongoing rehabilitation program. The first target of counseling in addiction is to support the addict to achieve and maintain abstinence from addictive substances or behavior. The second target is to aidthe addict to recover from damages which have caused by addiction in his life (Delinda E. & Georges W., 1999). Nursing Theory And One Counseling Theory Essay The addict’s counselor works firstly by helping the client to be aware of the reality of a problem and the connected unfounded thinking. In the next steps, client is stimulated to achieve and uphold abstinence from addicted substance or behavior. This can help to develop needed psychosocial abilitiesand spiritual growth to remain in recovery process (Delinda E. & Georges W.). ADDICT INDIVIDUALIZE COUNSELING PROCESS Counseling as a helping process consists of 3 main phases. Each phase has its distinct aims although the same skills may be used in those 3 phases. Those three main phases are: Nursing Theory And One Counseling Theory Essay Exploration, assessment and planning phase In this phase, the main objectives are to apprehend the client as a whole person, to plan counselor’s interventions, and to arrange an agreement between counselor and client. Rehabilitation counseling and goal achievement phase Counselor’s objectives in this phase are the initiation and implementation of his treatment plan in collaboration with his client. Nursing Theory And One Counseling Theory Essay Termination and evaluation phase In the closing phase, objectives are to conclude treatment process and deliberate its outcome with the client, and to arrange agreement on upcoming actions. Rehabilitation and relapse prevention In addiction counseling, the objectives of the all process are to rehabilitate the client from the addicted substance or behavior and to prevent the relapse. Rehabilitation Rehabilitation may be defined as the process consisting in recovering the capacities that have been reduced due to injuries or illness. The recovery is sustained only when there is no relapse or return back to addicted substance or behavior. Here, the goal of counseling is to lead the client to a full reintegration into his community as dynamic and valued person. Each time it’s possible, detoxification comes first, and after can be started the laying of the basis of rehabilitation process. Abstinence from addicted substance or behavior is not enough in itself. The addict has to see the profits of staying abstinent; otherwise he can relapse at short or long term (United Nations International Drug Control Program, 2003). Nursing Theory And One Counseling Theory Essay Individual addiction counseling doesn’t only focus on stopping or reducing addicted substance or behavior. It will also address the other related domains of impaired functioning and those are such as social relations, illicit activities, employment status, etc. When additional helps are needed, the counselor is advised to refer the client (U.S National institute of Health, 2009). Relapse Above, I have mentioned that counseling process has to help client to maintain abstinence after the recovery period, otherwise the client can relapse and return back in addiction. What is a relapse? There is a relapse when, a client in recovering period or in post recovery, returns to the addicted substance/behavior or becomes addicted to a new substance. Nursing Theory And One Counseling Theory Essay Prevention of relapse in counseling process Preventing relapse is a very important element of recovery. When the client becomes able to establish some constancy in abstinence, he could begin to develop skills to put off future relapse to addicted substance/behavior. To prevent relapse, the addict has to be taught how to identify in advance, when he is headed near a relapse and to modify course of events. Through counseling process, by education, the addict can identify indicators of coming up relapse. Those indicators are like negatives changes in client’s behavior, feelings and attitudes. Once the client became conscious of the environment of relapse process, his next mission is to build up the skills to intervene and change any occurring negative behavior or feelings (Delinda E. & Georges E.) SELF-EVALUATION I am not a professional or trained counselor. I am only a student in nursing studies who is trying to apply learnt counseling skills. I have chosen to work with my client about his addiction. I know it’s a very complicated subject for a beginner in counseling, more experience is needed.Difficult to handle that subject has stimulated and encouraged me to do further reading and researches concerning addiction; what is it, its causes, its management by a combination of counseling and other ways of help like pharmacotherapy. During my counseling process, in my client’s needs assessment; I was more influenced by medical side of my client’s problems. The social situation of the patient has not been full analyzed and I think that this can a bit weaken the problem exploring process. The second difficult is to know borderline between intervention domains of a professional counselor and a health professional who applies counseling skills to help a client. We may think that it’s easy but in practice it’s very complicated. You ask yourself: “Does the client’s problem need a professional counselor or a skilled health professional can help?” Nursing Theory And One Counseling Theory Essay This can lead us to be fluctuating in our practice. I suggest here to insist on this point during elaboration of “Professional practice and counseling skills module”. My strength now reside in fact that I can now lead counseling process without apprehension, methodically and without asking about the beginning or next stages. To help my client, I di