18 tips to get the most out of online counseling in CO

Video Transcript

Introduction- starts at 00:00

Hi, I’m Tia with Badass Therapy and today we’re gonna talk about zoom fatigue. As we’re doing online counseling, obviously, it’s been challenging for different folks. And there’s been a whole lot of discussion about Zoom fatigue. So as a somatic therapist part of what I notice is the difference in physical experience.

And the difference in the sense of safety when we’re doing online counseling. Little things like you probably just saw my dog walk out of the room. Cause that’s just part of our world with doing so many videos and video chat and all that stuff when we’re at home with our families. Where maybe our kids are knocking on the door or our partners are yelling for us. You know, it’s just a different experience these days. So I wanted to talk a little bit more about this experience and what are things that we can think about.

Eye fatigue during online counseling in Denver, CO- starts at 00:49

One of the biggest things for folks, especially when they’re doing online counseling for an extended period of time, like therapists. I’m online for typically anywhere from 6 to, Wednesday I’ve got 9 clients, so nine hours in a row sitting staring at a screen is really challenging. So one of the things that comes up from lots of folks is eye fatigue.

Blue light filters

With screens, blue light ends up making our brains feel like it’s day time. So for most of us that can be fine. But for lots of folks if you’re staring at a screen for extended periods of time, especially white screens. I was just talking to a student the other day about the fact that she does all of her student reading on the computer now. And so she’s been getting headaches. And so one of the things that she did was we talked about going in and changing her blue light filters.

Apples have this just automatically. Sorry, you can tell I’m not a Mac user because I think you call them Macs, not Apples. And then PCs, on Windows settings, there’s a setting called Night Light and you can go in and you can adjust your blue light filters. You can change it so that it’s just set for when the sun is up or the sun is down and then those settings change at those times. However, for those of us who are spending a lot of time on the computer, it really helps if we shift that so that’s actually happening for more of the day. So that particular student actually changed her screen settings. And she said that she’s been not getting headaches since then.

Blinking

One of the other things that happens with computer screens is that we don’t blink as often. I was just reading this statistic yesterday and I think part of it is that. I think it’s up to 1/3 less often that we blink when we’re looking at the screen. So I have ended up at points just like putting a sign on my computer. Like a sticky note on the bottom, that just says “blink” because it’s hard to remember to do that.

It’s something like they said once an hour, you should blink. Slow blink like you’re starting to fall asleep at least 10 to 15 times once an hour. So that’s one of the suggestions that I found helpful. For me, I just try to blink more often and intentionally through the whole thing. I did read that actually we also don’t blink fully, like we don’t close our eyes completely. So I’ve been trying to be more mindful of that since I read about that.

Screen brightness

One of the other things, also, is the brightness of our screen. So a lot of times what you’re setting your brightness at for if you’re working short times is not actually what you need if you’re doing this more often or for longer. So a lot of times what I do is I just work on adjusting my brightness down. And I sense these muscles around my eyes. I’m just kind of feeling this because I can feel them relax as I’m looking at the screen.

Look at things farther away

One of the other things that can happen is that your eyes can start to sort of like, I forget what they call it, focus locking or something. So what they suggest is the rule 20-20-20.  And so what that means is that you should look at something at least 20 feet away for at least 20 seconds at least every 20 minutes. So where that ends up challenging in my sessions is that I’m supposed to be like looking at something far away. I have my computer directly in front of a window so I’m able to look at things further away.

The catch is I don’t feel super comfortable doing that for very long because my clients start feeling like I’m not paying attention to them. Whereas, in a session sitting in the room with somebody, it’s a lot easier for me to look out the window cause they can see what I’m looking at out the window. Also, they’re typically farther away and so it’s not as much of a challenge.

Screen placement

Ergonomic guidelines are something like you’re arm’s length away from your computer screen. I tend to keep mine a little bit farther away because I noticed that I feel calmer. And I feel a little bit less eye strain for myself when I do that. So I know I’m not following that guideline. But I am paying attention to how it feels in my body as I’m sitting close to screens.

Switch your eye gaze

Another one of the suggestions is to switch your eye gaze back and forth. So you look at something 10 feet away for 10 to 15 seconds and you look at something close for 10 to 15 seconds. Something far away for 10 to 15 seconds and close for 10 to 15 seconds. Because that helps your eyes to help make sure that your muscles kinda do the shifting back and forth.

When we’re looking at somebody in the room, we don’t stick to the same spot. First, we look at their eye and then we look at their shoulder, and then we look at their foot. And so it’s not often that we’re just sitting and staring at something. Whereas Zoom calls and all these online platforms, we’re staring at one spot the whole time and we’re not moving. Especially when we’re trying to look like were engaged or we’re trying to look like we’re paying attention. We end up doing this thing where we just stare.

When I first started doing it, I realized that I was holding my head very still. And I was holding my shoulders very still. And everything was very stuck and none of it was like, you know, being more fluid and more motion. So I had to put a sticky note on the bottom of my computer screen that said “move!” So that I would be my more animated self and wasn’t quite so stiff. And trying to make sure that they knew that I was paying attention to them. So that’s challenging.

Video size and cues of safety in online counseling in Denver, CO- starts at 5:45

One of the other things that I’ve really played with is the size of the person’s picture on my screen. So typically it fills up your whole screen. That can be really disconcerting when it’s first there because we don’t sit that close to people. We typically sit further away and we typically see more of the person. And so the challenge is that I’ve ended up making mine smaller so that it feels a little bit more natural. And so that I’m not having to look at quite so much of the screen. But then I lose the detail of the person.

And that’s the challenge even in choosing how much of your body you’re showing within the screen frame. Is that sometimes we lose details in faces and things that we can easily see in person. And then we’re not able to see those when we’re online.

So all of these things are things that sort of give us signs that things are safe. We are pack creatures and so we are constantly assessing whether or not the other person we’re talking to is safe. We’re assessing whether or not the things that they’re looking at or the things that they’re paying attention to are things that are dangerous for us. So that is really one of the biggest challenges of online counseling is that we are losing a lot of those cues of safety.

Eye contact and paying attention during online therapy in Denver, CO- starts at 7:00

Eye contact

So one of the things, I actually was just talking to a client about this right before this. Was that it’s harder to feel somebody’s empathy. So when you’re not able to see my eye gaze, it doesn’t feel like we’re directly making eye contact.

There’s a lot of tips and tricks about how to fake eye contact. Like if you’re looking down people don’t notice it as much as if you’re looking up. If you’re, I think it’s something like at least 4 feet away from your webcam. Then your downward eye gaze to look at the screen instead of your camera isn’t quite as noticeable. So there’s ways to kind of fake eye contact a little bit more effectively. But some of those challenges then is the distance from the camera and angle of the camera. And all of those kinds of things that can be frustrating as well.

Paying attention

So for me I take notes during my sessions. My memory since COVID world hit and I’m doing online counseling, my memory is shit. So I have to take notes while I’m talking to people. Even just to remember something that they said earlier in the session. So they may think that I’m looking at them because my eye gaze hasn’t changed but I’m looking down a little bit further on the screen at the notes.

Sometimes also like I’m double checking things like. Did I get somebody’s pronouns in their note correctly or did I get the pronouns correct of the person that they’re talking to? They maybe said something earlier in the session and they’ve been just kind of on a roll of sharing things. And there’s something I want to make sure I go back to or I want to make sure that I don’t miss. And so sometimes I’ll be rereading my notes while they’re talking.

Divided attention tasks

You know, there’s this interesting thing, research that came out of DU actually. And so they found that kids who had a trauma history did better on divided attention tasks. Meaning they were paying attention to more than one thing versus when they’re paying attention to one thing. For some clients, when I’m doing sort of a divided attention task where I’m typing at the same time that I’m talking to them. They may feel like I’m not paying as much attention to them. It really varies from therapist to therapist of what this looks like. For me in undergrad I did transcribing and so I got to the point where I can type as fast as somebody talked. And I’m still listening and very much paying attention to what they were talking about. We all know I have my own trauma history. And so for me, I’m much more of a divided attention task kind of person, and I function better. I’m better able to pay attention when I’m doing that.

But when I’m staring at the print, my eye gaze goes kinda flat. It’s one of the challenges of doing videos also. Like I’m talking to a little computer like webcam thing. Maybe looking at myself on the computer screen. It’s hard to look with your eyes like you’re talking to somebody. So that definitely can be one of the things where like our eye gaze, it feels different when we’re looking at a computer. And so that’s just really one of the challenges of it is feeling like the other person is looking at you. Connecting to you. Obviously, that depends on culture also. In lots of cultures you don’t look somebody directly in the eyes. So, I think different people’s experience of eye contact is different with this.

Sound and video for online therapy in Denver, CO- starts at 10:00

Sound

So one of the challenges with this is that, as we’re looking at people. Sound, with the Internet like it cuts out. It spreads it out over 16 beats for something that usually would’ve taken two beats. And so those sessions I just find myself so much more exhausted by the end. Because I have been working so hard and focusing so hard to be able to pay attention. And to be able to hear the person’s words, which is tough.

It’s even worse when the sound in the video gets disconnected. They’re coming through at different rates. Somebody’s screen froze. But you can still hear their voice or you can see their mouth moving. But the sound isn’t coming through for another minute. For us physiologically, we’re gonna have a little bit of a fight or flight kind of panic anxiety response to that. In real life, if I’m talking to you and your mouth starts moving at a different rate than your words. Like we’re talking demonic possession or something, right!? It is not okay. So we do have this physiological reaction just to the fact that those two things don’t match up.

Video

Whether your screen’s pixelated. Or I had one client at one point who was like “Dude, that is the coolest thing ever. With the way like the Internet stuff is working.” He’s like “your hair looks like it’s moving in these snake movements,” which just cracked me up at the time. And luckily he was okay with that, but at times it can be super distressing.

Particularly when folks are using their phones, often times their picture disappears. It can be much more disruptive to a session if all of a sudden in the middle of me talking, all of a sudden your phone’s ringing. If you’re using your phone for that device, you have to pause what you’re talking about. You have to like switch your screen back over. Or your picture suddenly disappears or it freezes up. And you have to leave the session and come back in for it to come back together.

Webcam

For me, some of that picture piece with my old camera, it wouldn’t adjust to the brightness or the darkness. So in the afternoon when the clouds would be like in front of the sun. Out of the sun, in front of the sun, out of the sun. My brightness and darkness would constantly change. And yet there was nothing I could do to get my camera to work. So, I bought a separate webcam, specifically, just so that adjusts better to the brightness and darkness in my room.

Lighting

So those things are just challenging with videos. When people are backlit and/or side lit, so that you end up with this sort of weird lighting. For me, oftentimes, because I’m facing the window, I have the blinds closed. And so I’ll end up with these like tons of lines across. And sometimes when I look I realize that like it’s adjusting into that. So I’m having to stand up and go adjust my blinds while I’m talking to people.

Microphone

Depending on the microphone you’re using, you end up further or closer. I tend to use over the ear headphones so that I can always hear people just as well with the built-in microphones so that folks are able to hear me. Whether I’m adjusting the blinds. Whether I’m having to close the door cause the cat’s being annoying or whatever. So some of those things with lighting can be really challenging.

So there’s just a lot of difficulties with sound and picture when we’re doing online that just create this kind of anxiety. If I can’t see your face, like okay I can see your outline, but that’s not super great. Some of those pieces also of things being brighter or darker around that also can affect some of the eye fatigue. So if my screen is super bright and the background’s dark, or the background’s super dark and it’s super bright. An article that I was reading was saying that most offices need to be lit about half as bright as they typically are in order for our eyes to be able to adjust to the computer screen well. So there’s just a lot of challenges when you’re spending more time doing this.

Zoom Backgrounds and annoying sounds during online counseling in Colorado- starts 14:00

Zoom backgrounds

That’s another one of my pet peeves. Where people are doing the Zoom background and like they’re waving their hands and all of a sudden like part of their finger is there. And then it’s not, but there’s sort of this weird thing. Those are the things that draw our attention, especially in video and especially in COVID world where we don’t have much stimulation.

We are often exposed to or our attention draws to those things that are new or different. And our brain gets focused on trying to make sense of that thing, instead of being able to focus on the person and what they’re saying. When I was watching her bun. I think it was on the top of her head, like kept appearing and disappearing, which is just super distracting. And I understand that people don’t want you to see what their background is. They want something more calming, soothing, whatever. I noticed for myself that it’s way more disruptive when people have Zoom backgrounds.

Annoying sounds

Another one that happened during a training last week was that when other people have their sound on and you get the echo. That gets super grating, particularly when you’re like listening to somebody for an hour. Another one that happened during the training I was in last week, she was using her mouse on her keyboard and was using the microphones that were on her computer. And so it was just this super loud click click click click click. She was constantly clicking her mouse through the whole thing. Like I was ready to scream.

Sensory sensitivities

Obviously, I have some sensory sensitivities. If you do too, you definitely should check out about the Safe and Sound Protocol that I offer. It’s something that helps. It’s something that has helped me some. It helps people on various levels. It definitely helps with the sound sensitivities. Last week completely reinforced to me that I absolutely have some sound sensitivities.

Camera angles during online therapy in Colorado- starts at 15:43

Now we’re going to do a little bit of playing with the camera, which is going to be fun. Because my cat’s wandering across the keyboard. Oh, there he goes. So part of what ends up also messing with us on Zoom is camera placement. You have those people who, especially when they’re on their phones, are like this close. Or sometimes if they’re not paying attention, they end up with it like wandering over here, then over here. Then you end up, this is my favorite view to like talk to people at is when they’re like holding their phone and they’re not seeing it. Which is hard on some platforms because you can’t necessarily see some of those things.

My camera is angled up here which sort of distorts my face and I end up with this sort of large forehead thing. My favorite also is the I’m on my laptop and so my camera’s down here. I had one client who for a really long time would kind of talk to me from here and I’d see sort of this. So all of those things they’re challenging. This is my other favorite one is the people who wander around their house with their camera or they’re walking around. I had one standing desk that was not a great standing desk, let’s be real. And as I would type it would do this and so that’s another one. Or when people have it on their lap and it’s kind of doing this anytime the computer keyboard, like any time their laptop moves.

You’re too close

Those are all things that depending on the person can be more or less distracting. For some of us, those things are really hard because physiologically I don’t talk to people this close. And so for me, you’re inside my bubble and if you were that close to me, like we have a problem. Which is part of why I end up moving my computer back. I have my screen back much further, because I don’t talk to people that close. For those things of like the background moving, I have visual sensitivities. And so that, I’m just super distracted. I’m looking at the things from the background.

When you have it distorted where like it’s the massive forehead and lower chin, our brain goes “Humans don’t look like that. Like wait, what?” And it’s trying to make sense of those things. My favorite is the up the nose angle and then you end up like staring up their nose. Cause you’re like “wow I can see all of your nose hairs” or like getting distracted by those little details. Because our brains pay attention to whatever’s new. They pay attention to whatever’s different. And if it doesn’t fit into a box of the way that the world’s supposed to be, we get a little anxious. So it takes more work when we’re doing this.

Losing cues

For me, we lose a lot of the other cues. I request that my clients sit so that I can see their upper body all the way down to the waist. So that I don’t lose quite as much of the upper body stuff. However, the challenge with that is then I lose a lot of facial expressions.

For me, I’m a somatic therapist so I miss a lot of cues. Like I had one client who anytime she would talk about a particular thing her foot would start kicking. It would give me information. Another client, anytime she’d talk about anything stressful she’d stick her hands under her thighs. We started talking about those pieces, like “who do you want to kick? What are you stopping yourself from doing that you’re putting your hands under your legs?” So it’s just tough, when we’re missing those things.

My favorite with a client that I’ve done only online with, she started shortly after the pandemic began. I stood up to walk over to the door to close it and she goes, “oh my gosh, you have a whole body! I’ve never seen your whole body.” Which just creates this kind of weird dynamic like where we kind of want to know what people look like or how they’re moving. And we miss those things. I miss how somebody looks when they walk into the room. I miss those little cues and so that is definitely one of the challenges of this. You know it just gets tough.

I can’t see what you’re looking at during online therapy in Denver, CO- starts at 19:59

So one of the other things that’s challenging with this is that you can’t see what I’m looking at. So for lots of clients they don’t feel like I’m paying as much attention to them. They feel like I’m distracted. I have all of these lovely little fidget toys on the desk and people don’t know if like I’m looking at one of those in my hand. Sometimes I drop them and so I end up having to sort of narrate what I’m doing a little bit more. Like, I stand up and I close the blinds. People don’t know that. Sometimes my dogs and cats are down here off to my side and people don’t know that. Or I have their pet beds over here on the side.

People don’t know that that’s what I’m doing or I’m adjusting my air cleaner and so there’s all these pieces. Or I’m having to like fight with the cat or something, my cat’s dinking across the front. We don’t necessarily know what people are getting distracted by. Where if we’re in the office together and you look down over to the side, I can see what you’re looking at.

And so there’s this challenge with video of needing to look at you more so that you know that I’m paying attention. When I talked to one person I mentioned that and they were like “I know you pay attention, like I know you.” And so I think for them it brought them more peace to just assume that like I was in fact paying attention even if I was looking at something else.

More communication helps with online counseling in Colorado- starts at 21:23

So with any of this, a lot of it involves a lot more communication with the other person. Speaking up more if the internet’s not working. Speaking up more if the sound is off, if somebody’s backlit and you can’t see them. All those things are more challenging.

Staring at yourself during online therapy in Colorado- starts at 21:40

So one of the other things of course that comes up a lot for a lot of people is the fact that you’re staring at yourself and lots of people get distracted by looking at their own face. For some people, if your video is mirrored, a lot of us are used to seeing ourselves in mirrors and so when we look at things like pictures or we look at things like videos, all of a sudden it’s weird because things like my scars, they’re on the opposite side of the screen from what I’m used to them being at. And some stuff like that can be really challenging when we’re staring at ourself. Or people get self-conscious in all sorts of ways.

I’ve been joking that like with these videos, of course I’m comfortable doing them at this point, right. Like I’ve been talking to people on video for 28-30 hours a week, sometimes a little bit less, since the pandemic began. Like, I’m used to staring at myself when I’m talking, and so I think that really has desensitized me.

So for some people with certain platforms you can’t change that. It also can be challenging depending on the platform. Mine gets really frustrating because you can’t move the video, the one that I’m using currently, you can’t move the video of yourself. You can’t turn it off so that you can’t see it anymore. You can’t move it so that it’s in a different place where it doesn’t block the person’s face.

That’s really challenging for some of my clients depending on the device that they’re using. And so I’ve heard some people like putting sticky notes over their own picture so that they’re not distracted by them. So it’s just one of the parts that’s more difficult.

Why I do online counseling instead of in person counseling in Denver, CO during the pandemic- starts at 23:00

Seeing your face

So there’s a lot of why online counseling is bad, why Zoom fatigue is bad. For me, the reason I have chosen to do online counseling instead of in person counseling is that I still get to see your whole face. I went to a doctor in mid-August and saw them again just last week and they couldn’t place who I was and I think that part of that placement was the fact that they couldn’t see this much of my face. So they had to either remember me from my mask or from this much of my eyes. As soon as we started talking, they were like “oh, that’s who you are.”

But it’s so much harder when we don’t get to see this part of people’s faces and so even though I lose all of these other cues and all of these other things are more challenging. It’s so important to me to get to see people’s faces. It just really helps me to feel more connected to them.

Less anxiety

Also I’m not freaking out when you’re talking about the things that you’ve been out doing or who you’ve seen or who around you is getting tested for COVID or who near you has the flu. Prior to the pandemic, I got sick all the time and so now, like I’m not worried if somebody has a sneeze, like any of that stuff. And so it allows me to really focus on the other person and that person isn’t worrying as much about what I’m doing.

They’re not worried as much about what I’m spending my time on, who I’ve seen, what I’ve done, how many other sick people have been in my office that day. And so it allows us to be much more present during the session when we’re present with what the other person is sharing and not distracted by our own anxieties.

Technology issues in online counseling in Colorado- starts at 24:38

For lots of people they get super anxious about the technology issues and all those things. For me, I don’t feel like the technology issues take any more time from the sessions than if somebody’s running late because of traffic or they have to go to the bathroom before they come in, or any of those things. And so really if you look it’s just a different thing that kind of takes a chunk out of our time.

For those of you who are private paying for sessions, obviously, we always have the ability to switch to a phone call. If you’re using insurance it’s much more limited as far as our options and so it does feel a bit more disruptive if somebody’s internet goes out or things like that. However so far, really in a pandemic, that’s super rare and we’ve been able to manage it.

Like even last week, somebody’s internet wasn’t working and 15 minutes into the session they were able to get it up and running and so we missed maybe five minutes of their session because I was able to be flexible on time. So it’s really not as disruptive as people feel like it is when they first start talking about it.

More Tips to get the most out of online counseling in Denver, CO- starts at 25:40

Remember what it feels like to be with people

So things that maybe make this a little bit easier. For me, I remember what it feels like in my body to be in the same room with somebody, especially if it’s a client that I used to see in person. I remember how they move, how they typically do things. I remember what it feels like in my body just in general to be in the same room with somebody, so that’s part of what I’m focusing on.

They’re intending eye contact

Also, I’m really trying to keep in mind that when they’re looking at things, they’re intending eye contact. So if they’re looking off to the side, I know it’s because my picture’s off to the side and so I just think “oh, they’re looking me in the eye.” And so I really try to keep in mind that most of the time when someone is looking wherever they’re looking, that their intention is to make eye contact with me.

Give more feedback

It is way more important for us to ask questions and give each other feedback. I have one client who, the other day, my breathing was louder because I had to use a different headphone and so it had the boom mic right here and they were like “why is your breathing so loud?” Another time, we were talking, that same client, I have my notes off to the side and they were like “why do you keep looking to the right? Why do you keep doing that?”

I’m happy to answer those questions. If it is causing distress for the other person, I’m happy to answer questions about what I’m looking at or what’s going on. We all just have to be a little bit more understanding and it’s causing us to have to learn to communicate more, right? “Hey, your sound’s off. Hey, your video’s off. I need you to change this. Hey, I can’t see your face.”

Use names with multiple people

I’m recognizing that when I am doing family sessions or couple sessions where there’s more than one person, I have to use names a lot more. So I can’t just look at this person and say “hey, what do you think? Hey, what do you think?” They have no idea who’s on my screen in what order, especially with some of the things that mirror stuff and some of the ones that don’t. I have to be much better about using names instead of just using my eye gaze.

Time reminders

One of the other things that’s been challenging for some folks, depending on the device, is that in session I do things that sort of indicate we’re coming closer to the time. What I actually developed for one client who requested them is that I now have these signs so I don’t have to interrupt people and I can tell them that we have 5 minutes left, 10 minutes left, 15 minutes left so that I can help people keep track of time. So folks are able to request that or not.

Why online counseling in Denver, CO is great in spite of the challenges- starts at 28:00

So even though there’s all these challenges with Zoom and all these challenges with just being on the computer in general. A lot of this stuff applies to anybody who works on the computer all day. So it still is a way for all of us to stay safe, a way for us to stay connected. Even outside of pandemic world, I offered video sessions because if people were ill, if the roads were bad, or if it was just cold and people didn’t want to go out in the freezing cold. Now as I had to move my home significantly further away from my office it gives clients a lot more ability to continue to access services, even if I live far away from them.

You can pick an online therapist anywhere in Colorado

With my intentions to eventually move my practice to the mountains, like again, it’s gonna allow clients access to services. They can be in Grand Junction. Can be in Durango. They can be in Fort Collins and they can access the therapist that they feel is best for them. And so I really love the fact that this makes it more accessible for people. For my clients who have health issues, I had a client who had back surgery and she was able to return services faster. I have another client who had an injury, they didn’t have to miss any sessions. So I just really love how much this increases accessibility for folks, so it’s just really important to me.

So I wanted to give these tips about how to make Zoom better for you and whatever video chat platform. I keep saying Zoom even though I don’t use Zoom. Hopefully you all found this helpful. If you want to drop me an email just to give me your thoughts on this, point out other things that maybe I missed, or just share how maybe this is helpful for you or what else might be helpful for you in future blog posts. My email is tia@basstherapy.org. Thank you very much for taking the time to listen. I always appreciate when you share your time with me. Take care.

Interested in starting online counseling with me? Head here to learn more.

Portrait of person smiling at the camera in an open park near a walking trail. This is Tia Young, the founder of Badass Therapy. She offers ptsd treatment in denver, abuse counseling in colorado, therapy for attachment styles in denver, co, and more. Contact her for alternatives to traditional talk therapy and start healing!
Tia Young, M.A., LPC, has worked in the mental health field for over 20 years. Tia is passionate about somatic therapy, complex PTSD treatment, developmental trauma therapy, counseling for depression, and anxiety counseling.

Tia has started drinking healthy shakes as recommended by her functional medicine doctor, and pours chocolate syrup into them to make them taste better.

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