Understanding Adult ADHD: Myths and Realities

Prachi tripathi

Ms. Prachi Tripathi(M.A. P.G. DIP, UK) CLINICAL PSYCHOLOGIST & PSYCHOTHERAPIST (FOUNDER)

I have always been fascinated by the human mind and emotions. From early on I developed an interest in the field of psychology. Over the past years I have inculcated a penchant for therapy and growth. I strongly believe that the energy to transform ourselves lies within us, and once we begin to seek it, there are only positive transformations against our troubled selves.

Having worked over a decade with various individuals of all ages, professionals, and social groups, at various settings like Alzheimers & Dementia Society (London), Sir J.J. Group of Hospitals & Grant Medical College (Mumbai), Teach for India (NGO), De Sousa Foundation, Bai Jerbai Wadia Hospital for Children, Mind Experts, College of Physicians & Surgeons and several other government & private organisations. Over time I’ve amassed immense knowledge and know-how of this field through my experience & my mentors. I’ve robustly been into various roles like consulting, supervising, teaching, mentoring, and facilitating workshops for students, professionals, doctors, parents and teachers most importantly being a therapist. Some things to know about me as a person is that, I strongly consider the saying, ‘Practice what you preach’ & therefore truly believe, as well as exercise therapy in my own living which helps me to grow as an individual. For my well-being as a person and a therapist I deeply follow the knowledge of Vihangam Yoga meditation practice and I love being connected to nature for nurturing internal peace and harmony. Being intellectually perceptive, along with a solution-focused approach towards life and work, adheres to the fact that there is nothing in the world that tea, therapy & time can’t heal. This being said, I look forward to contributing to the society by promoting healthier psychological & emotional beings through our initiation and a lovely supportive team at Reflect Within.

MR. SWAPNIL BHOPI

SWAPNIL BHOPI

(M.PHIL, RCI NO. A71974) Clinical Psychologist

Mr. Swapnil Bhopi is a Clinical Psychologist with over 10 years of experience in the field. His enthusiasm, persistence, punctuality and mindfulness helped him in achieving great heights in benefitting the individual and the society at large. He not only has conducted various workshops on topics such as stress management, suicide prevention and de-addiction awareness at various government and private organisations but also has been interviewed on these topics by various newspapers and social media. He also has the experience of working as a resource person for CNE by “Maharashtra Nursing Council” and at various reality shows.

MRS. SNEHA RAO PARMAR

MRS. SNEHA RAO PARMAR

(M.A., REBT CERTIFIED) Counselling Psychologist

Mrs. Sneha Rao Parmar is a counselling psychologist and a family therapist with over 15 years of experience. She has wide expertise in, namely, couple, family counselling & marital therapy, adult counselling that focuses on stress management and anxiety issues and working with children and adolescents with special needs, assessing children with academic difficulties, developmental delays, behavioural problems, and counselling parents. Additionally, she has been a guest lecturer at various organizations such as Arya Vidya Mandir and Mary Immaculate as a visiting faculty. she also has conducted CRE workshops with teachers across Maharashtra for RCI. She is currently associated with SOPAN as a lecturer for B.Ed. students. One of her favourite quotes is, “If it doesn’t challenge you, it doesn’t change you.”

Dr. Ameet Thanky

Dr. Ameet Thanky

(B.P.Th) Clinical Physiotherapist (Pediatric)

Dr. Ameet Thanky is an empathetic physiotherapist with over 15 years of experience in paediatric and adult physiotherapy. He has demonstrated success in facilitating treatment for both outpatients/ inpatients by his fine diagnostic skills, in-depth patient evaluation and developing a treatment plan in order to achieve patient mobility. He majorly deals with patients having Cerebral Palsy cases needing corrective surgery, pre-op and post-op rehabilitation, Syndromic Cases with developmental delay, babies with prolonged NICU stay, premature babies, Bell’s Palsy – facial paralysis, bladder rehabilitation and a lot more.

He is a skilled medical care professional with wholehearted dedication towards patient care and willingness to learn & keep abreast of new developments in the medical field.

His main motto since he started his practice is – “To always be patient centric. Giving them an optimistic reality check so that an acceptance develops towards the illness and planning a suitable therapy program to achieve a desirable therapy goal. Also framing home ex’s program to maintain the progress. Busting the myths related to the illness.”

Dr. Dimple Dodia

(B.O.T) Occupational Therapist with specialisations in Neuro Developmental Therapy & Sensory Integration

Ms. Dimple Dodia is a knowledgeable & highly experienced Pediatric Occupational Therapist & consultant in the city. She has been actively contributing her service in this field for over 25+ years and is an esteemed therapist. She has added specialisations namely, Neuro Developmental Therapy, Hand Function and Sensory Integration Therapy. She has an extensive background in treating children and adults with special needs like Autism Spectrum Disorder, ADHD, Cerebral Palsy, Intellectual disabilities, Motor Disorders and children with rare genetic conditions. In adults she deals with severe mental & physical illnesses like Schizophrenia, Intellectual Disabilities, Brain Injuries, Stroke Rehabilitation and so on. Ms. Dodia also runs her own practice since 2002 known as Mansa Milestones Clinic. She comes across as a gracious and an affable professional in her practice with patients and their family.

Ms. Khushbu Mehta

Ms. Khushbu Mehta

(BSc. in Microbiology, PG in Nutrition and Food) Nutritionist

Mrs. Khushbu Mehta is a valedictorian post graduate in Nutrition and Food Technology from SNDT college. A thorough understanding in child and general population nutrition is expressed through her 13 years of practice into the field of Nutrition and graduation from Microbiology. She specifically deals with children with special needs, developmental delays and adults struggling with their mental health due to their eating habits, mental health concerns and having poor esteem due to weight gain or weight loss. She defines her purpose of being a nutritionist for a greater cause: the process of saving people from health myths or faulty food habits by discerning science-based information on health and equipping them with it. Her catchphrase is ‘Get your food right, your mind will nourish on its own.’

Dr. Rohit P Deshmukh

Dr. Rohit P Deshmukh

(MBBS, MD Psychiatry, DNB Psychiatry, MIPS)

Dr Rohit has completed his MD in Psychiatry from prestigious Grant Govt medical college & Sir JJ group of Hospitals Mumbai. He has experience of dealing with all kind of mental illness due to the wide exposure at Sir JJ hospital. He has also worked in Department of Child and Adolescent Psychiatric at Nair Hospital. Currently he also runs clinic at Vile Parle and Goregoan. His belief that mental is just not an illness but is product of life experiences and situations in and around help him understand the background of the illness and take a holistic approach towards its treatment.

Ms. Vinanthi Hegde

Ms. Vinanthi Hegde

(M.Sc. in Clinical and Counselling Psychology) Clinical Psychologist

Ms. Vinanthi Hegde is a Clinical & Counselling Psychologist at Reflect within. She has a master’s degree in psychology with Clinical and Counselling Specialization from SDM College, Mangalore University. Vinanthi has interest in research, she has written, presented, and published various research papers, and has also worked under IIT Roorkee. She has experience in working in NGOs like Shraddhanand Mahilashram and Manav Seva Sangh which cater to Legal cases like Rape, sexual abuse and unwed mothers and working with hospitals like Dimhans and Sion hospital. Her approach in therapy is largely eclectic in nature and inclined towards Gestalt psychology. She is an empathic person, and an active listener, and strongly believes in this saying by Soren Kierkegaard, “Life is not a problem to be solved but a reality to be experienced”.

Ms. Kasturi Roy

Ms. Kasturi Roy

(M.A in Applied Clinical Psychology) Clinical Psychologist and Psychotherapist

Ms. Kasturi Roy is a Consultant Clinical Psychologist & Psychotherapist at Reflect Within, with over 7 years of experience. She works with individuals across ages having different issues ranging from children having behavioural issues to adults having severe mental health disorders. Her therapeutic approach is elective. She uses CBT, REBT and Art based approaches widely in her sessions. She is also affiliated to Bhakti Vedanta Hospital.

Ms. Nidhi Karia

Ms. Nidhi Karia

(M.A. WITH CLINICAL SPECIALIZATION) CLINICAL PSYCHOLOGIST AND PSYCHOTHERAPIST

Ms. Nidhi Karia is a clinical psychologist and a psychotherapist at Reflect Within. She works with individuals across ages having different issues ranging from children having behavioural issues to adults having severe mental health disorders. Her therapeutic approach includes Person-Centred Therapy, RE-CBT therapy and M-E-T. Currently, she is also affiliated to Sunshine Wellness Centre, a rehabilitation centre. She has previously worked with the Institution of Exceptional Children and Advitya. She is an affable, empathetic and a dedicated professional and strongly believes that – “As therapists it is our job to help people realize how rare and valuable each of us are and to provide ways of further developing their discovered uniqueness.”

Ms. Neha Bhansali

Ms. Neha Bhansali

(M.A., PURSUING PHD) CLINICAL PSYCHOLOGIST & PSYCHOTHERAPIST ADVISOR & MENTOR

Ms. Neha Bhansali is a clinical psychologist, psychotherapist and a senior faculty at the Post-Graduate Department of Psychology at Maniben Nanavati women’s college- teaching M.A. psychology (counselling and clinical specialization). She has rich experience in teaching, mentoring as well as a practitioner in therapy for over 12 years. She is a certified Arts Based Therapy Practitioner and has completed a Master Trainer course in Life Skills from Indian Association of Life Skills Education. She is also a certified CBT therapist from Swasti Institute in collaboration with Beck Institute, USA. Her Primary work is with children, adolescent and young adult population. With her experience and expertise she consults as a Senior Advisor to the team of Reflect Within.

SPEECH & LANGUAGE THERAPIST

Speech and language therapy focuses on the assessment and treatment of communication disorders. Speech and language therapists work with individuals of all ages who have difficulty with speech, language, or communication, including those with developmental delays, neurological disorders, or injuries.

The therapy typically involves several steps:

Assessment: The therapist evaluates the individual’s communication skills, including their ability to speak, understand language, read, and write.
Diagnosis: Based on the assessment, the therapist determines whether the individual has a communication disorder and, if so, the type and severity of the disorder.
Treatment planning: The therapist develops a plan of care tailored to the individual’s specific needs, which may involve individual or group therapy sessions, as well as home exercises and activities.
Intervention: The therapist works with the individual to improve their communication skills, which may include teaching speech and language exercises, providing assistive technology or communication devices, and developing strategies to enhance communication in everyday situations.
Monitoring progress: The therapist monitors the individual’s progress and adjusts the treatment plan as needed to ensure that the individual is making progress toward their communication goals.

Speech and language therapy can be beneficial for a wide range of communication disorders, including speech sound disorders, language disorders, fluency disorders (such as stuttering), voice disorders, and cognitive-communication disorders. It may also be used to help individuals with communication difficulties related to hearing loss, neurological disorders (such as stroke or traumatic brain injury), or developmental disabilities (such as autism spectrum disorder).

Speech and language therapists may work in a variety of settings, including hospitals, clinics, schools, and private practice. They may also work as part of a multidisciplinary team, collaborating with physicians, psychologists, educators, and other healthcare professionals to provide comprehensive care for individuals with communication disorders.

PEDIATRIC PHYSIOTHERAPIST

Pediatric physiotherapy is a specialized field of physiotherapy that focuses on the assessment, diagnosis, and treatment of infants, children, and adolescents with a range of developmental, neuromuscular, musculoskeletal, and orthopaedic conditions.

Pediatric physiotherapists work with children and their families to improve their physical function, movement, and overall quality of life. They use a variety of techniques such as exercises, stretches, manual therapy, and assistive devices to help children achieve their developmental milestones, recover from injuries or surgeries, and manage chronic conditions such as cerebral palsy, muscular dystrophy, Bell’s Palsy – facial paralysis, bladder rehabilitation and spina bifida.

The ultimate goal of Pediatric physiotherapy is to help children achieve their full potential and lead active, healthy, and independent lives. This requires a collaborative approach that involves working closely with parents, caregivers, and other healthcare professionals to develop a comprehensive treatment plan tailored to the unique needs of each child.

NUTRITIONIST

Nutrition in mental health conditions

Nutrition is becoming more important as the world faces an increasing number of mental health issues. Eating right and getting the right nutrients can help people cope with stress, anxiety, and depression. It is important to understand how certain foods affect our moods, so that we can make informed decisions about what we eat.

By focusing on nutrition for mental health, we can ensure that we are making the best choices for ourselves and our loved ones. This section will explore the role of food in managing mental health, from vitamins and minerals to food choices that promote positive emotions.

Studies have shown that a healthy and balanced diet, rich in fruits, vegetables, whole grains, lean proteins, and healthy fats, can help improve mental health and well-being. This is because these foods provide essential nutrients such as vitamins, minerals, antioxidants, and omega-3 fatty acids, which are important for brain health and function.

On the other hand, a diet high in processed and sugary foods has been linked to an increased risk of mental health disorders such as depression, anxiety, and ADHD. This is because these foods can cause inflammation in the body, which can affect brain function and mood.

In addition to the nutrients we consume, there is also emerging research on the gut-brain axis, which suggests that the health of our gut microbiome may also play a role in mental health. The gut microbiome is made up of trillions of bacteria that live in our digestive system, and research has shown that these bacteria can influence our mood, behavior, and brain function.

It is also important to seek professional help if you are struggling with mental health issues, as a comprehensive treatment plan may include dietary and nutritional interventions in addition to other therapies.

Nutrition in children with neurodevelopmental conditions

The impact of nutrition on neurodevelopment disorders can be significant. Research has shown that nutritional deficiencies or imbalances during critical periods of brain development can have long-lasting effects on cognitive function, behavior, and mental health.

For example, maternal malnutrition during pregnancy has been linked to an increased risk of neurodevelopmental disorders such as ADHD, autism spectrum disorder, and intellectual disability. This is because the developing brain requires a constant supply of nutrients, and a lack of essential nutrients can interfere with the formation of neural pathways and the development of brain structures.

Similarly, deficiencies in nutrients such as omega-3 fatty acids, iron, zinc, and iodine during childhood and adolescence have been associated with an increased risk of neurodevelopmental disorders and cognitive impairments. This is because these nutrients are important for brain function and play a critical role in cognitive processes such as memory, attention, and learning.

On the other hand, research has also shown that a diet rich in nutrients such as fruits, vegetables, whole grains, and lean proteins can have a positive impact on cognitive function and mental health. For example, the Mediterranean diet, which is rich in these types of foods and healthy fats such as omega-3 fatty acids, has been associated with a reduced risk of depression, anxiety, and cognitive decline.

It is vital that proper nutrition, both during pregnancy and throughout childhood and adolescence, is important for optimal brain development and function.

REMEDIAL & SPECIAL EDUCATOR

Remedial education refers to educational programs or interventions designed to help students who are struggling academically to catch up with their peers. These programs are aimed at addressing specific learning difficulties and improving the academic performance of students. Remedial education can take many forms, including extra classes, tutoring, and educational therapies.

Special education, on the other hand, is a type of education that is designed to meet the specific needs of students with disabilities or other exceptionalities. This programs is designed to provide individualized support and services to help these students learn and succeed in school. Special education programs may include accommodations and modifications to the curriculum, assistive technology, and specialized teaching methods.

While remedial education is typically provided to students who are falling behind academically, special education is provided to students who have been identified as having a disability or exceptional needs that require specialized support. Both remedial education and special education are aimed at helping students overcome challenges and achieve academic success.

These interventions are highly recommended to children showing signs of learning difficulties, learning disabilities (LD) like Dyslexia, Dysgraphia and Dyscalculia, also with children having difficulty sustaining attention and focus or diagnosed with ADHD, Autism Spectrum Disorder (ASD), Downs Syndrome and Intellectual Disability.

Prior to the intervention, generally the process involves set of psycho-educational assessments done like IQ test, LD tests like Wood Cock Johnson (WJ), Wide Range Achievement Test (WRAT), Conner’s ADHD Test, Curriculum Based Assessments (CBA) by qualified and trained psychologists or special educators. If the professional observes any signs of emotional distress then it is first recommended to rule out any other condition like Depression, intense anxiety or other mental health or medical condition. If anything else is seen, then usually the child is first, or simultaneously treated for the same.

Corporate Wellness

Wellness is a critical factor for corporate success. Companies ensuring that their employees are mentally healthy, helps boost their overall productivity and performance. In today’s era it is imperative for corporates to understand the importance of mental wellness and take proactive steps to promote it in their workforce.

By creating a culture of mental well-being, corporates can help reduce stress, improve morale, and increase productivity among their employees. This can be achieved by introducing initiatives such as mindfulness training, mental health days off, and flexible working hours. Additionally, employers can provide resources such as counselling services and access to mental health professionals to employees who may need additional support and guidance.

Many businesses have recognized the importance of corporate mental health in recent years, as research has shown that employees who feel supported and valued are more productive and less likely to experience burnout. Some of the ways that businesses can promote corporate mental health include:

Providing mental health benefits: This can include offering health insurance that covers mental health services, as well as providing access to employee assistance programs (EAPs) and counseling services.
Creating a positive work environment: Businesses can prioritize mental health by creating a workplace culture that emphasizes work-life balance, encourages open communication, and promotes collaboration and teamwork.
Offering training and resources: Providing employees with training and resources on stress management, mindfulness, and other mental health topics can help them develop coping strategies and improve their overall well-being.
Encouraging self-care: Encouraging employees to take care of themselves by promoting healthy habits such as exercise and proper nutrition can have a positive impact on their mental health.

Overall, promoting corporate mental health is a win-win situation for both businesses and employees. By supporting the mental well-being of their workers, businesses can create a more positive and productive workplace, while also helping to reduce the prevalence of mental health issues in the workforce.

Our programs are tailored to suit the individual needs of the businesses

Pre and Post Surveys
One on one therapy
Individual Assessments
Employee Assistance Program
Mental Health Workshops
Psychometric evaluation

To know more – Book for an enquiry call with our team (or send an email on info@reflectwithin.in)

SCHOOL COUNSELLING

School counselling is an important part of the educational process that helps students navigate their academic career. It works to ensure that all students have the opportunity to reach their potential and achieve success.

School counselling provides a wide range of services, from individual and group counselling to helping students choose courses, career paths, and even colleges. It also works to address any social or emotional issues that may be preventing them from succeeding in school. By providing this support, school counsellors can help students develop skills for managing their emotions and making positive life decisions.

We are the best outsourced team as we have a comprehensive approach and a multidimensional centre to cater to the needs of all that a school requires under one roof.

We provide range of services as mentioned below:

Teacher Training Workshops – Section wise (Pre-primary, Primary, Secondary)
Student workshops – Section wise (Pre-primary, Primary, Secondary)
Parent workshops – Section wise (Pre-primary, Primary, Secondary)
Parent counselling (alternate Saturdays)
One on one student counselling
Child nutrition workshops for parents
Group counselling – LSS and Guidance Classes
Psychological and psycho-educational assessments
Individual Education Plan (IEP) by remedial educator
Employ Assistant Program (EAP) for teacher’s mental health

To know more – Book for an enquiry call with our team (or send an email on info@reflectwithin.in)

Sensory Integration Therapy

Sensory processing disorder (over and/or under-sensitivity to light, sound, smell, taste, or touch) is often a symptom of Autism Spectrum Disorder.

Sensory issues can be described as hyper (intense) or hypo (less or none) reaction to sensory inputs like indifference to pain or temperature, adverse response to specific sounds or textures, or unusual interests in sensory aspects of the environment like excessive smelling or touching of objects, visual fascination with lights or movements

The therapy aims at reducing excessive sensitivity in cases of hyper reactivity and increasing the sensitivity in cases of hypo reactivity to requited environmental stimulus.

Here are some examples of people who may benefit from sensory integration therapy:

Children with sensory processing disorders, which can include hypersensitivity or hyposensitivity to sensory input, such as touch, sound, or movement.
Children with autism spectrum disorder or ADHD who have sensory processing difficulties.
Children with developmental delays who may benefit from sensory stimulation to improve their motor and cognitive skills.
Individuals with traumatic brain injury, stroke, or other neurological conditions who may have difficulty processing sensory information.
Adults with mental health conditions, such as anxiety or PTSD, who may benefit from sensory-based relaxation techniques.
Anyone who experiences stress or sensory overload and needs assistance in regulating their sensory experiences.

Occupational Therapy

Occupational therapy (OT) is a treatment to improve motor skills, balance, and coordination. It helps kids and adults who struggle with everyday tasks like writing or getting dressed, basic Activities of Daily Living (ADL). These skills include fine and gross motor skills and motor planning. Therapists also work on coordination, balance, and self-regulation skills.

Occupational therapy can benefit a wide range of individuals across the lifespan who may have physical, cognitive, developmental, or mental health challenges that affect their ability to engage in everyday activities.

Here are some examples of people who may benefit from occupational therapy:

Children with developmental delays, learning disabilities, or physical disabilities such as cerebral palsy or Down syndrome.
Individuals with neurological conditions such as stroke, traumatic brain injury, Parkinson’s disease, multiple sclerosis, or Alzheimer’s disease.
People with mental health conditions such as depression, anxiety, or schizophrenia.
Individuals with physical disabilities such as amputations, spinal cord injuries, or chronic pain.
Older adults who may be experiencing age-related changes or chronic health conditions that affect their ability to perform daily activities independently.
Individuals with work-related injuries or disabilities who require assistance in returning to work or adapting to new work demands.

Overall, occupational therapy can benefit anyone who has difficulty with daily activities due to physical, cognitive, developmental, or mental health challenges.

LGBTQAI+ Counselling

LGBTQAI+ counselling/queer-affirmative counselling, is a type of therapy that is specifically designed to support individuals who identify as lesbian, gay, bisexual, transgender, queer/questioning, asexual, intersex, or any other non-heterosexual or non-cisgender identity. Here, the goal is to provide a safe and affirming space for clients to explore and understand their sexual orientation or gender identity, build skills and strategies for coping with discrimination or other challenges that they may be facing because of their identity.

LGBTQAI+ counselling may involve a range of therapeutic techniques and interventions, including cognitive-behavioural therapy (CBT), rational emotive behavior therapy (REBT), dialectical behaviour therapy (DBT), narrative therapy and more.

The focus of LGBTQAI+ counselling is to promote acceptance, empowerment, and well-being for individuals who identify as LGBTQAI+. It is a space where individuals can feel seen, heard, and supported, and where they can work towards living their lives authentically and with pride.

Here are some examples of people who may benefit from LGBTQAI+ counselling:

Individuals who are questioning their sexual or gender identity.
Individuals who are coming out and facing difficulties, experiencing anxiety, fear, and uncertainty about how their friends and family will react.
Individuals who are experiencing discrimination or harassment against LGBTQAI+ individuals.
Individuals facing unique relationship challenges, such as societal stigma, family rejection, and discrimination.
Parents of LGBTQAI+ individuals having questions or concerns about their child’s sexual or gender identity.

LGBTQAI+ counselling can benefit anyone who identifies as LGBTQAI+ and who is seeking support, guidance, and a safe and non-judgmental space to explore their thoughts, feelings, and experiences.

Relationship Counselling

Relationship counselling can be a vital resource for couples and families who are struggling to maintain a healthy relationship. Couples counselling, or marriage counselling, provides couples with the opportunity to examine the underlying issues in their relationship and work together to find solutions that will help them move forward. With the support of a qualified counsellor, couples can learn techniques and strategies for communicating better, resolving conflicts, and rebuilding trust. Counselling can also provide an opportunity for individuals to explore unresolved issues from past relationships that may be impacting their current relationship. With a safe space to express themselves without judgement and with guidance from an experienced counsellor, couples can move past their challenges and build stronger relationships.

Here are some examples who may benefit from relationship counselling:

Couples experiencing communication issues, unresolved conflicts, trust issues or infidelity.
Couples struggling with intimacy, including sexual difficulties, emotional distance, and lack of affection.
Couples facing significant life transitions, such as the birth of a child, a job loss, retirement, or a move to a new city.
Couples experiencing cultural differences, including differences in values, beliefs, and expectations.
Couples considering separation or divorce.
Couples facing difficulties in parenting, finance, expression, or mental health,

Counselling can benefit any couple looking to improve their relationship, resolve conflicts, and build a stronger, more satisfying partnership.

Family Therapy

Family therapy is a type of psychotherapy that focuses on the dynamics and relationships within a family unit. The goal of family therapy is to help family members understand and communicate with each other more effectively, resolve conflicts, and work towards positive change within the family system. Family therapy may involve all members of the family, or specific individuals or subsets of the family depending on the presenting issues.

Therapists may use a range of techniques, including communication skills training, role-playing, and problem-solving exercises, to help families improve their relationships and functioning. The goal of family therapy is to promote greater harmony and well-being within the family unit.

Family therapy can be beneficial for a wide range of individuals, including:

Families experiencing conflicts or communication issues, such as frequent arguments, misunderstandings, and difficulties in expressing feelings.
Families with a member struggling with a mental health issue, such as depression, anxiety, bipolar disorder, addiction, or disability.
Families dealing with significant life transitions, such as divorce, remarriage, or the birth of a new child.
Individuals experiencing oppositional defiant disorder, conduct disorder, autism spectrum disorder or attention-deficit/hyperactivity disorder.
Individuals suffering from obsessive compulsive disorder, eating disorders, adjustment disorders, personality disorders or gender identity disorders.

Overall, family therapy can be beneficial for anyone who could benefit from improved communication, healthier relationships, and support during difficult times as per individual’s need.

Play Therapy

Play therapy uses play as a means of communication and expression for children, and sometimes adults too. It is primarily used to help individuals express and process their thoughts and emotions in a safe and non-threatening way. Play therapy involves using various forms of play, such as toys, games, and art materials, to facilitate the child’s exploration of their inner world and to help them work through issues or problems they may be experiencing. Play therapists create a safe and supportive environment where children can feel free to express themselves, explore their emotions, and develop new skills and coping strategies. The goal of play therapy is to help children improve their emotional regulation, build resilience, and promote their overall well-being. Here are some of the benefits of play therapy:

Play therapy can help children learn to regulate their emotions and express themselves in a safe and appropriate manner.
Help children to improve their communication skills by providing a safe and non-threatening environment in which they can express themselves.
Help children to develop a positive self-image by providing them with opportunities to succeed, take risks, and feel competent.
Help children to build confidence in themselves and their abilities, which can improve their self-esteem and overall well-being.
Help children to develop problem-solving skills by providing them with opportunities to explore different solutions to problems, learn to think creatively and critically, and to develop strategies for overcoming challenges.
Can help to feel more relaxed and comfortable and can reduce feelings of anxiety and stress.

Play therapy can be beneficial for a wide range of individuals, like-

Children who have experienced trauma or abuse process their experiences and express their feelings in a safe and supportive environment.
Children with behavioural issues such as aggression, defiance, and hyperactivity develop new coping skills and improve their self-control.
Children with anxiety or depression learn to regulate their emotions, develop positive coping skills, and improve their overall well-being.
Children with developmental delays or disabilities develop new skills, improve their social interactions, and build self-esteem.
Adults with mental health issues such as anxiety, depression, and trauma, as it can provide a non-threatening and creative outlet for expression.
Families experiencing conflict or transition, such as divorce or a move, to improve communication, build positive relationships, and develop new coping strategies.

Overall, anyone who is struggling with emotional or behavioural issues, or who could benefit from a safe and supportive environment for self-expression and growth, may benefit from play therapy.

Psychometric Testing and Assessment

Psychometric testing and assessment are methods used to evaluate a person’s cognitive abilities, personality traits, and other psychological characteristics. Psychometric testing involves the use of standardized tests and measures to assess a person’s mental abilities, aptitudes, and personality traits.

Psychometric testing is used in a variety of settings, including education, employment, and mental health. In education, psycho-educational testing is used to assess students’ academic abilities and potential, while in employment settings, it is used to assess job candidates’ skills and fit for a particular position.

Assessment, on the other hand, is a broader term that includes a range of methods used to evaluate a person’s psychological functioning. Assessment can involve interviews, observation, and various tests and measures, including psychometric tests.

Psychometric testing and assessment can provide valuable insights into a person’s strengths and weaknesses, and can be used to guide educational, vocational, and therapeutic interventions. However, it is important to use psychometric testing and assessment tools appropriately and to interpret the results carefully to avoid misunderstandings or misuses of the data.

Why to consider tests and assessments?

Objective findings
Time Saving
Cost saving
Gives clarity
Helps in determining the line of treatment

+ To know more

Standard Psychological & Psycho-educational testing that we carry out at Reflect Within:

Weschler’s Test of Intelligence- IV (WISC-IV)
Binet Kamath Test of Intelligence (BKT)
Malin’s Intelligence Scale of Indian Children (MISIC)
Woodcock Johnson -IV (WJ-IV)
Wide Range Achievement Tests-IV (WRAT-IV)
Curriculum Based Assessment (CBA)
Rorschach Ink Blot Test (ROR)
Millon’s Clinical Multi-axial Inventory – IV (MCMI-IV)
Millon’s Adolescent Clinical Inventory– II (MACI-II)
Minnesota Multiphasic Personality Inventory (MMPI)
Children’s Apperception Test (CAT)
Thematic Apperception Test (TAT)
House Tree Person (HTP)
Kinetic Family Drawing (KFD)
Sentence Completion Tests
Bender Gestalt – II (BG-II)
Attention Deficit Hyperactivity Disorder Tests (ADHD)
Autism Spectrum Disorder Tests (ASD)
Condition related rating scales

When is testing or assessment generally to be considered?

To identify which condition one has.
To know the severity of the condition identified.
IQ assessment to understand the cognitive functioning of the child/adult.
To rule out or identify learning disability (Specific learning disabilities like, Dyslexia, Dysgraphia, Dyscalculia).

Behaviour Modification

Behavior modification therapy can be an effective approach for addressing problematic behaviors in children. Children often exhibit behaviors that are disruptive or challenging, such as temper tantrums, aggression, and noncompliance. Behavior modification therapy can help parents and caregivers teach children new, more appropriate behaviors, and reinforce positive behaviors.

The therapist works with the child and their parents to identify the behavior to be changed and the factors that contribute to it.
The therapist then develops a plan for behavior change, which may involve setting goals.
Identifying rewards for positive behaviors.
Developing strategies for dealing with triggers.
Developing a home program for parents.
Monitoring the progress over the sessions and accordingly make further recommendations.

Behavior modification therapy may be especially helpful for children with attention-deficit/hyperactivity disorder (ADHD) or autism spectrum disorder (ASD), as these conditions often involve disruptive or challenging behaviors. In these cases, behavior modification therapy may be used in conjunction with other treatments, such as medication or social skills training, to provide a comprehensive approach to treatment.

Behavior modification therapy for children often involves positive reinforcement, which involves rewarding positive behaviors with praise, attention, or tangible rewards. For example, a child who completes their homework without prompting may be rewarded with a sticker or a special privilege. Negative consequences may also be used to discourage negative behaviors, such as time-outs or loss of privileges.

It can be a valuable tool for parents in helping children develop positive behaviors and coping strategies. It is important to work with a qualified therapist who has experience working with children to ensure that the therapy is tailored to the child’s specific needs and developmental level.

Parent Counselling

Parents are guided frequently during the intervention about the activities to be done at home with the child. It becomes difficult to attend sessions every week for parents/ caregivers. Therefore, parent counselling includes training them for certain activities and having a regular follow up of the child’s activities given by the therapist to achieve the goals and further reduces the frequency of sessions conducted.

Parent counselling also focuses on the bond that a parent and child shares. It cannot be denied that parental interactions act as catalyst in shaping a child’s personality, strengths as well as weaknesses. Reflect Within emphasises parental attitude to be worked upon as they are a child’s immediate shaping environment.

We also believe that this helps the parents to not depend on therapists entirely and instead adapt to their child’s long term need for nurturance.

Career Counselling

Career counselling is a process in which a trained professional helps an individual explore and plan their career path. The goal of career counselling is to help individuals identify their strengths, interests, and values, and to use this information to make informed decisions about their education and career choices.

Career counselling usually involves several steps:

The counsellor works with the individual to identify their interests, strengths, personality traits, and values. This information is used to identify potential career paths that align with the individual’s strengths and interests.

Our assessment program is unique as it involves three significant areas that contribute to the selection and sustenance of a career:

Aptitude Assessment
Personality Assessment
Individual’s Inclination
Emotional Intelligence

Once the assessment step is completed, the counsellor follows the following steps during the counselling session:

Funnelling of careers
Goal-setting
Skill-building

Career counselling can be beneficial for individuals at any stage of their career, from high school students planning their education and training to mid-career professionals looking to make a career change. It can help individuals make informed decisions about their career path, identify opportunities for growth and advancement, and develop the skills and knowledge needed to succeed in their chosen field.

The overall process takes about 4 to 5 hours and it is usually divided over two days which is an assessment day followed by the counselling day.

Psychotherapy

Psychotherapy is an evidence-based treatment that helps individuals to effectively manage their mental health issues and develop healthier coping skills. It allows people to explore past experiences and current behaviors, identify underlying causes of emotional distress, and ultimately achieve self-awareness and a more fulfilling life.

Psychotherapy can be conducted in individual, family, or group settings and can involve any number of therapeutic techniques ranging from cognitive-behavioural therapy (CBT) to interpersonal psychotherapy (IPT). By helping individuals build upon their strengths, gain insight into their challenges, reduce stressors, develop coping strategies, and increase feelings of self-worth and acceptance, psychotherapy has the potential to dramatically improve quality of life

Different forms of psychotherapies used at Reflect Within are as follows:

Cognitive Behavioural Therapy (CBT)
Rational Emotive Behaviour Therapy (REBT)
Person Centred Therapy (PCT)
Gestalt therapy
Transactional Analysis (TA)
Existential Therapy
Psychoanalytic/ Psychodynamic Therapy
Acceptance and Commitment Therapy (ACT)
Bibliotherapy
Solution Focused Brief Therapy (SFBT)
Dialectical Behavioural Therapy (DBT)
Mindfulness Based Cognitive Therapy (MBCT)
Narrative Therapy
Schema Therapy
Humanistic Therapy
Animal Assisted Therapy
Attachment Based Therapies
Art Based Therapy (ABT)

Therapies like CBT, REBT, DBT, ACT are widely used for individuals suffering from anxiety disorders like social anxiety, exam anxiety, post-traumatic stress disorder (PTSD), obsessive compulsive disorder (OCD), borderline personality disorder (BPD), depression, panic attacks (panic disorder), self-harm, suicidal tendencies, including cases of marriage counselling and many more.

We have a best and diverse team of qualified, trained and experienced psychologists and psychotherapists at Reflect Within to deal with chronic and challenging cases.

Avinash De Souza

Dr. Avinash De Souza

DR. AVINASH DE SOUSA (M.D. PSYCHIATRY) PSYCHIATRIST & PSYCHOTHERAPIST ADVISOR & CONSULTANT

I have always been fascinated by the human mind and emotions. From early on I developed an interest in the field of psychology. Over the past years I have inculcated a penchant for therapy and growth. I strongly believe that the energy to transform ourselves lies within us, and once we begin to seek it, there are only positive transformations against our troubled selves.

Having worked over a decade with various individuals of all ages, professionals, and social groups, at various settings like Alzheimers & Dementia Society (London), Sir J.J. Group of Hospitals & Grant Medical College (Mumbai), Teach for India (NGO), De Sousa Foundation, Bai Jerbai Wadia Hospital for Children, Mind Experts, College of Physicians & Surgeons and several other government & private organisations. Over time I’ve amassed immense knowledge and know-how of this field through my experience & my mentors. I’ve robustly been into various roles like consulting, supervising, teaching, mentoring, and facilitating workshops for students, professionals, doctors, parents and teachers most importantly being a therapist. Some things to know about me as a person is that, I strongly consider the saying, ‘Practice what you preach’ & therefore truly believe, as well as exercise therapy in my own living which helps me to grow as an individual. For my well-being as a person and a therapist I deeply follow the knowledge of Vihangam Yoga meditation practice and I love being connected to nature for nurturing internal peace and harmony. Being intellectually perceptive, along with a solution-focused approach towards life and work, adheres to the fact that there is nothing in the world that tea, therapy & time can’t heal. This being said, I look forward to contributing to the society by promoting healthier psychological & emotional beings through our initiation and a lovely supportive team at Reflect Within.

Psychiatrist

Psychiatric consultation is a specialised service that involves a comprehensive assessment of an individual’s mental health needs by a qualified psychiatrist. The goal is to evaluate an individual’s symptoms, identify any underlying mental health conditions or disorders, and develop a treatment plan that addresses their specific needs.

The consultation may include a clinical interview, psychological testing, a review of medical history, and other diagnostic procedures as needed. The psychiatrist may also provide education and support to the individual and their family members or caregivers about their condition, treatment options, and strategies for managing symptoms.

It can benefit anyone who is experiencing mental health difficulties based on the severity of the condition. This may include individuals who are experiencing symptoms of depression, anxiety, bipolar disorder, schizophrenia, eating disorders, substance abuse, or other mental health conditions. It can also be helpful for individuals who are experiencing stress or difficulty coping with life changes, such as a divorce, job loss, or the death of a loved one (grief).

Behaviour Intervention

Behavioral intervention focuses on a broad range of client’s behaviour and actions. Often, a person has difficulties because of a deficit or an excess of behaviour. Counsellor taking a behavioral approach seek to help clients learn new, appropriate ways of acting, or help them modify or eliminate excessive actions. In such cases, adaptive (helpful or positive) behaviour replace the maladaptive (unhelpful or negative) behaviour and the counsellor functions as a learning specialist for the client. In behavior therapy, parents and children learn to promote desirable behaviors and reduce unwanted behaviors.

Attention Deficit Hyperactivity Disorder (ADHD), Intellectual Disability, Autism Spectrum Disorder (ASD), Down Syndrome, Conduct disorder, Anger issues, temper tantrums and so on.

Home Programs are given to the parents alongside sessions so that the child can practice skills learnt in sessions at home with their parents.

Pre-Marital Counselling

It is a type of counseling that helps couples identify factors to consider and work on prior to marriage for building a better foundation of their relationship for a successful marriage. It also helps couples to have healthy, stable and strong relationships. With the help of per-marital counselling, couples tend to have a better chance of higher marital success in future. It helps in better understanding the partner and tends to improve communication between the couple. It helps in resolution of conflicts and to manage marriage anxiety.

Family Therapy

Family influences various aspects of our lives in different ways. Family therapy is a form of psychotherapy in which the therapist has sessions with all the members of the family. It is used for specific issues which affect the functioning of the family and relationships of the family members. Thus family therapy aims at better functioning of the family, better communication between the family members and resolving conflicts and issues present between the family members. It helps to resolve various emotional and behavioral issues and strengthens the family system and the bond between the family members.

Individual Therapy

It is one of the most well-known forms of therapy in which the therapist deals with the client on a one-to-one basis. Working alliance is formed between the therapist and the client, which further helps the client to work effectively on the therapy goals that are jointly set by both the therapist and the client. It helps an individual to deal with his/her stressors in an effective way and to know him/herself better. It is a process in which the therapist lends her entire support and helps the client to achieve his/her goals. It is a confidential process; hence it helps the clients feel comfortable with their therapist. Individual therapy is used effectively for various disorders as well as stressors that one faces in their day to day lives.

Different types of Individual therapy are:

Cognitive Behavioral Therapy
Rational Emotive Behaviour Therapy
Person Centred Therapy
Gestalt therapy
TransnationalAnalysis
Existential Therapy
Psychoanalytic/Psychodynamic Therapy
Acceptance and Commitment Therapy
Bibliotherapy
Solution Focused Brief Therapy
Dialectical Behavioral Therapy
Mindfulness based Cognitive Therapy
Narrative Therapy
Schema Therapy
Humanistic Therapy
Animal Assisted Therapy
Attachment Based Therapy
Art Based Therapy

Occupational Therapy

Occupational therapy (OT) is a treatment to improve motor skills, balance, and coordination. It helps kids and adults who struggle with everyday tasks like writing or getting dressed, basic Activities of Daily Living (ADL). Children with developmental coordination disorder (DCD), Autism Spectrum Disorder (ASD), Attention Deficit Hyperactivity Disorder (ADHD), Cerebral Palsy, orthopedic difficulties based on severity often need OT.

These skills include fine and gross motor skills and motor planning. Therapists also work on coordination, balance, and self-regulation skills.

Voice Therapy

Voice Therapy includes many techniques designed for specific voice disorders. These techniques are combined with lifestyle changes. It includes many exercises, manual manipulations and certain changes in the way of speaking. Also, men having feminine voices are changed. Poor quality of voice and change in loudness is also achieved through this therapy.

Parents Guidance Therapy

It is a type of therapy in which the parents/ caregiver is guided in every session about the activities to be done at home. It becomes difficult to attend sessions every week for parents/ caregivers. So, guidance therapy includes training them for certain activities and having a regular follow up of the child’s activities given by the therapist to achieve the goals and it reduces the frequency of sessions conducted. It is usually advised in extreme cases.

Feeding and Swallowing Therapy

Feeding and Swallowing Therapy includes using various techniques, postures, exercises and lifestyle changes to overcome individuals with eating, drinking and swallowing problems.

Speech and Language Therapy

This therapy helps individuals to communicate adequately. It deals with a wide variety of disorders and syndromes. It helps individuals to express themself through various modes of communication. It includes correct production of certain sounds, clarity of speech, adequate use of language, etc.

Play Therapy

It is a unique form of psychotherapeutic approach which helps in dealing with different issues faced by a child using play as a medium. It helps the child to express his/herself freely his/her thoughts and emotions in an environment which makes them feel safe, stress-free and acknowledged. It helps children in communicating better, solving various issues which might have been caused by trauma, solving behavior issues, etc. It works best with children who do not speak up their problems easily. It is used to solve a variety of issues faced by children.

Aptitude Testing & Career Counselling

Aptitude is the learned or acquired ability of an individual to do certain tasks. Aptitude testing involves various factors on which the individual is tested which further helps him/her in deciding the career that he or she would like to take. Along with aptitude testing, we also do interest inventories with the individual which further helps to refine his/her career choice. Post the testing, we provide one to one career guidance counselling to both parents as well as the student which helps them gain insight about the whole process and makes their career path clearer.

LGBTQIA+ Counselling

We provide a safe and accepting space for the members of the LGBTQ community. It helps in understanding the unique situations which are faced by the members of this community and it helps in dealing with different issues like stigma, coming out, self-esteem, acceptance from family and friends, etc. Confidentiality is maintained which helps the client to be comfortable with the therapist and feel safe and secure.

Marriage Counselling

A happy marriage is not something which does not exist, it is not a myth! In marriage counselling, the sessions are conducted with the couple as a unit. There are both joint as well as individual sessions in marriage counselling. It is used for different marital issues which the couple faces. It helps in better understanding of oneself as well as of one’s partner, developing better communication between the couple, resolving conflicts and gaining insight into partner’s as well as self’s expectations. Marriage counselling provides a safe space for the couple.

Group Therapy

It is a form of psychotherapy in which the therapist has sessions with a small group consisting of 4 to 5 clients. At times group therapy can turn out to be more powerful than the individual therapy for some clients in certain cases. It helps clients in coping with difficulties that one faces in their lives. It helps in gaining a different and broader perspective not only of the therapist alone but even of the group members. Confidentiality is maintained which helps the clients to be comfortable in sharing and reflecting together in a group.

Food & Nutrition

A healthy diet is one way to aid your mental well-being because what we eat does not only affect our physical health but also our mental health. Eating well can boost your mood and make you feel better. This is where a nutritionist comes into picture who can guide you to take simple steps towards a whole and more fulfilling balanced diet.

Physiotherapy

Physiotherapy helps to restore movement and function when someone is affected by injury, illness or disability and can also help to reduce risk of an injury or illness in the future. It majorly deals with patients having Cerebral Palsy cases needing corrective surgery, pre-op and post-op rehabilitation, Syndromic Cases with developmental delay, babies with prolonged NICU stay, premature babies, Bell’s Palsy – facial paralysis, bladder rehabilitation and a lot more.

Sensory Integration Therapy

Sensory processing disorder (over and/or under-sensitivity to light, sound, smell, taste, or touch) is often a symptom of Autism Spectrum Disorder.

Sensory issues can be described as hyper (intense) or hypo (less or none) reaction to sensory inputs like indifference to pain or temperature, adverse response to specific sounds or textures, or unusual interests in sensory aspects of the environment like excessive smelling or touching of objects, visual fascination with lights or movements

The therapy aims at reducing excessive sensitivity in cases of hyper reactivity and increasing the sensitivity in cases of hypo reactivity to requited environmental stimulus.

Ms. Taiba Mahida (M.A.) Clinical Psychologist & Consultant, Faculty & Trainer

Ms. Taiba Mahida has completed her masters in Clinical Psychology, further done her advanced diploma in child care and child development. She has undergone intensive training in clinical psychotherapy, CBT and REBT. She has specialization in play and art therapy. She has been coaching students of Masters in Clinical/Counselling Psychology Her forte has always been training and development and we are proud to have her on our team as a valued faculty for our UGC-NET/SET/JRF training program under Reflect Within’s Academic wing.

Ms. Kasturi Roy (M.A.) Clinical Psychologist Faculty Consultant & Trainer

Ms. Kasturi Roy is a Consultant Clinical Psychologist at Bhakti Vedanta Hospital and KaaVish Emotional Enhancement and Care. She has previously worked in J.J. Hospital, LTMGH (Sion) Hospital, and Thane Mental Hospital. She is an expert in individual and group therapy. She is trained in CBT, REBT, Transactional Analysis, Gestalt and Art based therapies. Her approach is eclectic and specific to the individual or group’s unique needs. She has an expertise in teaching clinical assessments and has been associated with Reflect Within’s team for training and mentoring psychology students.

Ms. Sajal Palrecha (B.A.L.S.P) Consultant Audiologist & Speech Therapist

Dr. Sajal Palrecha is an audiologist and speech therapist. Ms. Palrecha is warm, collaborative and fuelled by her compassion to reach and reform the lives of people who entrust her with their recovery. Previously worked with various NGOs and Special Schools, she aims to educate patients and execute the application of innovative therapies to provide the best care. She is currently working at B.Y.L. Nair Hospital, Ali Yavar Jung National Institute of Speech & Hearing Disabilities, and consulting with us at Reflect Within.

Dr. Shefali Shah (M.B.B.S., M.D. Psychiatry) Psychiatrist & Psychotherapist

Dr. Shefali Shah has worked at prestigious Sir J.J. Group of Hospitals & Grant Medical College and at AllCure Super Specialty Hospital. She is also a consultant psychiatrist & proud founder of Mind Experts. She believes that any mental illness is an interplay of inherent biology, psychosocial factors and external circumstances. And as such the treatment should be integrative and holistic, specific and customised to the individual. Dr. Shefali’s genuineness and amiable nature makes us really happy to have her as an associate mental health professional at Reflect Within.

Dr. Dhruv Parmar Psychiatrist & Neuropsychiatrist (M.D. Psychiatry)

Dr. Dhruv Parmar is a Consultant Neuropsychiatrist, Sexologist and De-addiction specialist. Has previously worked as an Assistant Professor in the Department of Psychiatry at L.T.M.G.H (Sion Hospital), Qualified in treating a wide spectrum of child as well as adult psychiatric conditions. He utilizes well-rounded approach to treat the whole person, through medications, active listening, and recommending counseling and therapy programs. Has multiple Publications in National and International Journals. Has presented papers, posters and symposiums at National amd International Conferences. Aims to normalise mental health discussions and eliminate the stigma associated with this field.

DR. AVINASH DE SOUSA Psychiatrist & Psychotherapist (M.D. Psychiatry)

Dr. DeSousa is a senior consultant Psychiatrist at L.T.M.G.H. (Sion Hospital ) , H.N. Reliance foundation, Goenka Group of Schools and also proud Founder Trustee of DeSousa Foundation. He has been contributing to the field of mental health for the past 20 years. He is one of the most renowned psychiatrists of the city. He is an excellent mentor as well as an inspiration to the students & young professionals.

Ms. Nidhi Karia

Ms. Nidhi Karia is affable, empathetic and a dedicated professional. Previously, she has worked with organisations like The Institute of Exceptional Children and Advitya. Apart from her interest in the field, she has conceptualised and executed workshops in the past and is inquisitive about reading and writing. Just like Rogers, she firmly believes that “As human beings, our job in life is to help people realize how rare and valuable each one of us really is, that each of us has something that no one else has- or ever will have- something inside that is unique to all time. It’s our job to encourage each other to discover that uniqueness and to provide ways of developing its expression.”

Ms. Praneeta Katdare

Ms. Praneeta Katdare has been active in the field of social work and believes that we can change the course of things, one step at a time. She has previously worked with elderly population with various psychiatric illnesses, conceptualized and conducted workshops for intellectually disabled adults at residential care centres for adults with psychiatric illnesses. She enjoys watching and writing about films and drawing parallels from there related to mental health.

Ms. Riddhi

Ms. Riddhi is a fervent psychologist and an astute professional. She has intense experience of working with organisations like Thankyou India Foundation and Minds Foundation. Riddhi has an extensive interest in the field of research and is an eloquent writer. Along with her interest in the field, she is zealous about teaching French. She is an affectionate individual and a very diligent professional. She is highly driven and aims at bringing a positive change in the society for Mental Health. She strongly believes, “ There’s always something to be grateful for.”- Rhonda Byrne

Understanding Adult ADHD: Unravelling the Myths and Realities

What is Adult ADHD?

Myth #1: ADHD is Just a Childhood Problem

Myth #2: ADHD is Over Diagnosed

Myth #3: ADHD is a Result of Laziness or Lack of Discipline

Adult ADHD Treatment and Coping Strategies

Typically the Symptoms Look like:

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