This is an excerpt from the 3rd session of Tough Customers: Treating Clients with Challenging Issues webcast series.It features Richard Schwartz, Ph.D., the . This situation commonly arises when we work with clients with borderline personality disorder (BPD). Burning a scented candle (even with phone or skype work) during their visits can be helpful for diffusing some of that intrusive, negative energy and helping you at least bepresent for your other clients, the rest of your workday. Termination as a therapeutic intervention when treating children who have experienced multiple losses. Make an accurate diagnosis early. Some clients may be happy to end therapy and easily recognize the growth they have made. The client has a serious and formal . Abandonment. This aspect can be extremely challenging for even the most gifted of practitioners. You should honor the commitment that you've made to both your sessions and your therapist by attending these final sessions. But many people leave therapy before they have reached their treatment goalsresearch shows that about 47 percent of people with BPD leave treatment prematurely. That sounds dramatic, like the therapeutic version of a Dear John letter, but it's actually a routine part of Cognitive Analytic Therapy (CAT), with both the client and therapist writing one to each other at the end of their work together (typically after sixteen sessions). In short, how they've behaved with others, is precisely how they'll eventually behave with their therapist. Anguish is far easier to live with, than theabsenceof it for a BPD individual. Get the help you need from a therapist near youa FREE service from Psychology Today. There's a separation/individuation issue that's stirredbeforethis two year juncture, which activates subtle anxiety involving real dependency and the risk of abandonment~ tragic remnants of developmental struggles with Mother as a toddler. These effective strategies can be taught to a Borderline, making it possible for them to construct more harmonious relationships. Others won't cancel standing appointments, even at considerable monetary sacrifice. 2023 Dotdash Media, Inc. All rights reserved. If you've never been able to rely on your own senses to discern who's trust-worthy, how can you ever trust anyone not to hurt you?? This male's mother was easily overwhelmed andincapableof adequately responding to his needs during infancy and boyhood. You can watch or listen to this article here. For me, it's become a dead giveaway that they're borderline disordered~ and thus far, I have seen no exceptions. If you dont actively encourage and help your client to meet these needs outside of their therapy with you, then theyll feel dependent on you. Therefore, although patients may have difficulty in leaving treatment, this analysis addresses the matter from the therapist's side. Be willing to answer questions about therapy termination, such as where a client can seek additional help if necessary. Their common need for personality changes can better guide treatment. Unfortunately, very little in undergraduate and graduate course work prepares future clinicians for working with this type of client, or understanding how pervasive a problem BPD is within societies all over the globe. and suicidal ideation is catalyzed. At times, therapy ends because the client avoids termination and the feelings that come with it. Verywell Mind's content is for informational and educational purposes only. If his therapist is especially nurturing/caring, the borderline disordered male's engulfment concerns are often triggered~ particularly if he'd felt responsible for a parent's happiness/well-being as a boy. In rare cases, a therapist may terminate therapy when they feel that their own safety is in dangerif a client is stalking them, for example. It can help clarify the nature of and reason for termination, especially if a client is emotional or angry during your termination meeting. Every BPD client whocommitsto effective recovery methods reaches a transitional plateau in their wellness journey. This client often wrestles with feelings of emptiness/deadness, and their need todistractfrom these sensations with dating, sex and attaching to others, is driven by deep anxiety and pain. Diagnosis, Vol. It's like a little black cloud always follows them around--but they've orchestrated a lot of their own pain by pursuing partners who aren't single or available, making unwise financial decisions, impulsively leaping before they look romantically, neglecting their health, etc. A huge part of using Cognitive Behavioral Therapy to help clients cope with their triggers is teaching them about cognitive distortions. My understanding of BPD is an unintended consequence of working with a core damaged population (which includes Borderlines and Narcissists) since I was an intern, just out of school. This is natural; take some time for yourself to process these feelings. If she's anxious, angry or discontent we feel those emotions at the very same time she does. leave the door open for clients to return, they are no longer able to provide adequate care, What Client-Centered Therapy Gets Wrong (and Right). You might find yourself feeling a sense of loss after your client finishes therapy. Plan a termination activity to memorialize therapy and the progress the child has made. For this reason, psychotherapy outcome studies that do not look at behavior patterns and psychological symptoms two years after treatment has ended can be highly misleading. Unfortunately, learned survival instincts and defenses prompt disruptive acting-out episodes and distancing behaviors in even potentiallyclose relationships. 55(4):920-7. The BPD Waif inspires these assurances frequently from you, but they'll test you at every turn, and keep acting-out their ambivalence surrounding thisattachment, just as they do with their lovers. This form is a sample letter in Word format covering the subject matter of the title of the form. Here's how we found a solution that worked for both of them. Goodbyes are not easy. When these goals have been achieved, you draw the clients attention back to them: You came to see me because you wanted to [] Now that we have achieved those goals to your satisfaction, was there anything else you wanted to work on before we wrap up therapy? Steady repetition of that type of event is incredibly destabilizing for a child, and teaches him toanticipatedisaster the minute he feels any sense of comfort or calm. Just when you're pretty certain this client's in an abusive relationship, they'll show up singing their paramour's praises about how loving and considerate they've been. No wonder, so many babies succumb to inexplicable SIDS (Sudden Infant Death Syndrome). How do you heal a borderline personality? You cannot allow the BPD client to gain the upper hand in your therapeutic dynamic. I've called on this cumulative wisdom to help people grow, and together we have worked to repair and restore the Self. Dialectic Behaviour Therapy (DBT) This is a special adaptation of cognitive therapy, originally used for the treatment of women with borderline personality disorder who harmed themselves repeatedly. A positive sign that it's time to end therapy is if the client feels they've accomplished the goals they first set out to achieve. He or she is merely 'an object' to the BPD client who is trying to obtain essential supplies tosurvive, much like a newly born infant. Gone are the days when psychotherapy was supposed to continue maybe twice a week for decades. But dont confuse this with successful therapy. In such cases, couples therapy with narcissists . The client should know they can come back if they need help again, but that the therapist is not a friend with whom the relationship can continue outside of therapy. This means the therapist and client work together to accept uncomfortable thoughts. It never dissuades me from accepting somebody into my practice, unless I sense we'll have a continuous power struggle, which will deter him/her from making substantial gains here. Termination can be an awkward, emotional, or even painful process, even when a client is satisfied with the progress theyve made and is making a conscious choice to move on. The borderline disordered therapist hyper-analyzes every single feeling, rather than learning how to experience it in the body. Cognitive Behavioral Therapy for Borderline Personality Disorder; Marsha M. Linehan, Ph.D, 1993 This feature by Vibh Forsythe Cox, PhD is our fourth and final part in this series of blogs about DBT assumptions. Thanks very much! When terminating with a client who has difficulty processing. A termination letter memorializes the end of therapy as well as the reasons for termination. If you experience splitting, you may view your therapist with suspicion or dislike which could cause you to drop out of therapy too early. Youronlyjob is to listen, and not try to fix or change it. Does trauma illness such as PTSD need different treatment than moral injury? Passages traditional psychoanalytic therapy sessions done with the high functioning (non-borderline) client. 1 View; 0 comments . A Personal Perspective: Meeting a client's anguish can be daunting, but there's a way to teach yourself new skills and tolerance for this work. Terminating therapy is not intended to make a client feel bad, however, this, unfortunately, can occur. This same set of personality features had taken up weekly lodgings in their professional office, and they've felt every bit as paralyzed by it as a deer in the headlights! Trust issues have serious ramifications within a potentially solid and meaningful therapeutic endeavor. This takes hard core (and hard-core) trauma work, which challenges everything she grew up believing about herself. Dealing with the family. Many Borderlines fantasized throughout childhood about killing themselves, or at least contemplated how to harm themselves seriously enough to try and elicit a parent's tender concern, so they could finally gain a sense that they reallymatteredto Mom or Dad. A dysfunctional identity feels familiar to the NPD/BPD client, and it's far more comfortable to retain, than exploring a healthy and wholesome new one. It's mostly this client's manipulation tactic~ so try to resist indulging them by giving into it. Sadly, this reflex becomes habituated, for it eases his fear of impending disappointment and ensuing devastation from any/allunforeseendisasters that 'might' lay ahead, but it also spawns serious control issues,anxiety disorders, OCD (Obsessive-Compulsive Disorder) traits, and their need to argue or distance, after especially enjoyable episodes with you. Issues of core shame("I'm not good enough")make it difficult to accept personality disorder features, but how can we effectively work with a problem, unless we understand what it is? Be consistent with this every time the person with borderline personality disorder might try to engage you in such talks. Happiness Individuals who are terminating therapy because they have completed their goals can exhibit mixed emotions as well. For example, you might emphasize that the child has made so much progress, they no longer need you. azure data factory tutorial for beginners pdf; convert degrees to compass direction calculator; ann rohmer father; burden bearer bible verse I've noticed this trait most prominently among hyper-religious clients who appear to need rigid parameters or disciplines set forth by a church, synagogue, yoga or Buddhist practice. You can also get my articles on YouTube, find me on Instagram, Amazon, Twitter, and Facebook. That at least, is my hope for you. There's an automatic reflex that comes into play with a mother-enmeshed man. Has this article been helpful to you? Perhaps you are embarrassed to discuss dropping out with your therapist because you dont want to disappoint or offend him. Realistically, if we're always having to do crisis intervention and damage control, there's no opportunity to accomplishemotional developmentwork, which iscentralto helping the Borderline relinquish personality disorder traits, and heal. Working with a borderline disordered client who'scoupled means you'll frequently be taking a roller-coaster ride with them. At the beginning of a therapy situation, someone with a Borderline Personality Disorder will only stick around if they have put you on a pedestal. For therapists, knowing when to terminate therapy is an important skill that can protect both the client and the therapist. In fact, it is quite natural to get frustrated with therapy or your therapistor to feel like psychotherapy is not working anymore. Talk to the child about strategies for managing painful emotions when they are no longer in therapy. Home Terms of Service Privacy Policy Sitemap Subscribe to The GoodTherapy Blog. There are treatments that work and are safe. The tragic outcome of this type of upbringing, is the child grows up with the ideation theydeservethis brutality, and perpetuate the parents' abuse by beating up on themselves every day, and attaching to lovers who echo/mirror how badly they truly feel about themselves. Genuine love Therapy DBT - even self help books if a DBT specialist is not available. Yes. When the ending of therapy is a one-sided decision - you may one day decide you have had enough of therapy and stop coming. Throughout their entire life, the Borderline client has confused sensations of painful longing and yearning to have their love returned/reciprocated, with theemotion of loveitself. Many adhere to the once a client, always a client rule; they leave the door open for clients to return to therapy after termination, and aim to maintain firm boundaries in case that occurs. "The Forms Professionals Trust . From ourpoint of view as a fetus, there is no separation between us~ she is us, and we are her. The end of a single psychotherapy session brings into bold relief a disquieting realization for some patients: the therapy is more important to the patient than it is to the therapist. Sign up for our Clinical Updates email and receive free resources. If there's no tidal wave that threatens to capsize their boat and drown them,nothingnesscan be felt, and performance anxietywithin treatmentmay emerge. Kids who cannot develop defenses and coping strategies to ameliorate their anguish, often orchestrate their own exit plan, and suicide by traffic incident or catastrophic fall is not uncommon among these tragically unhappy children. Learn about borderline personality disorder, including signs and symptoms, risk factors, treatments and therapies, and tips for family and caregivers. Quitting therapy is a big decision, so think through your reasons and your treatment goals. These clients often feel compelled toreconstitute the early frustrations and deficits that prompted their intense need forcontrol. Therapists retire or move their practices far away. Hence, profound control issues have evolved, and he'll only choose females with whom hethinkshe can maintain the upper hand. It's literally heartbreaking to witness this happening over and over again, and there's no other way to view this phenomenon, than asAbandonment of the Self~which is alearned response to having endured a litany of psychic and emotional setbacks during childhood, over which they had no control. Learning toask youfor a hug or have you spoon them in bedameliorates the shame they feel about having any needs. If nobody knows when therapy has been successful (because no clear goals were ever defined), then nobody knows when its supposed to finish. A client who originally sought help from an eating disorders specialist may need a different therapist when the eating disorder is in remission, and their new challenges involve work or parenting. Week to week, this client alternates between two polarized perspectives; their good partner, and their bad partner. Openly discussing uncomfortable feelings and next steps can help clients attain closure, process feelings of loss, and develop a plan for maintaining the progress theyve made. This is when our abandonment trauma first occurs, and we spend the rest of our lives trying to recapture that joyful, initialbonding experience (in-utero), that had us feeling connected, secure and safe, while imbuing us with an unshakable sense of oneness and belonging. Don't be afraid to begin this discussion. Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. If a client later claims you abandoned them, the termination letter may offer some protection. I've coined this,The Life Raftsegment of treatment: If you've stayed afloat on a huge chunk of driftwood in the middle of the ocean your entire life, and it's kept you from drowning every time a large wave hits, you're not gonna easily surrender that life raft~ even though it's steadily taking on more and more water each week! If this male's mother hadBPD Waiffeatures, he grew up having to meetherneeds for attention, mirroring, flattery, emotional soothing, etc. Ever. In addition, we co-experience her emotions, so when Mother is sad, so are we! So I might say: Many people can be helped within a few sessions and often times feel better even after a single session. In my view, BPD is a broken heart issue, which appears to be why psychotherapeutic treatment has for many, proven to be a disappointing, unrewarding endeavor. In fact, the international guidelines for the treatment of depression suggest that if your depressed client doesnt feel significantly better after five sessions you should refer them on to another professional (1). Termination may even be a bridge to resolving some of these issues. You might think of it as on-the-job training. Kristalyn Salters-Pedneault, PhD, is a clinical psychologist and associate professor of psychology at Eastern Connecticut State University. Comprehensive Psychiatry. Their lifelong struggle with fear and anguish have made it necessary to develop a self-protective, tough outer shell or armor that's helped them avert further harm to themselves during a time when they were very young and defenseless, and had to survive. As relational therapists, we recognise that a client may be recreating a typical life pattern of avoidance or a borderline pushing-away process. Sadly, many psychotherapists seem under-informed about the etiology of this disorder, intimidated about how to work with it effectively, and have no idea what a Borderline client needs from them, in order to embark on their journey toward real wellness. Patients have their one therapy; therapists have many patients. This has left them emotionally underdeveloped, which is always at the baseline for people with personality disorders. What Is Quiet Borderline Personality Disorder? She could have made him her confidant in adult matters--especially concerning issues with his dad. As this was the only way for many BPD'ers to receive a modicum of nurturant attention, their tendency to solicit help by inspiring another's sympathy, became an automatic and strategic survival defense. You can try searching for "clinical-updates". For example, stay connected, check-in daily, promise to follow-up next week, etc. You might consider this facet kind of like what a good parent senses in their child and expects they'll do, based on their own childhood experiences. There is no right length of time to be in therapy. Do not argue with the client or use the discussion to ease your own hurt feelings. While I fully understand the emotional association we humans make if we can find some sort of balm to help distract from or soothe our pain, there's no such thing as "love addiction." You might think of these defenses as a suit of armor, which protects the Borderline from incurring more trauma. Surrendering a long-held 'Victim' Identity feels akin to limb amputation, and is often resisted. Let me be perfectly clear; I have not 'treated' Borderline Personality Disorder. If I could go back to my first breakdown in my early 20s and speak again with my first psychiatrist, I would ask one question: although . Even if a bigger/sturdier plank floats by, you can't see beneath the water's surface to determine if it will support your weight, sofear of the unknownkeeps you from leaving the one you're on. Sadly, their addiction to pain and struggle usually trumps their desire for growth or change. Codependency and engulfment concerns resulting from this boyhood dynamic are then transferred onto all subsequent attachments. Give the client space to process their feelings. This is a very common pattern within personal attachments, and therapeutic ones as well. Refuse to participate in gossip and do not listen to it. I've had the opportunity of working with this young lady in particular that suffered with borderline personality disorder. His narcissism resents anyone's expertise or wisdom eclipsing his, so he's prone to selecting therapists who aren't equipped to meet his needs. You could feel as though you need ashowerafter those sessions, to wash off the toxic residue that's left in his/her wake. All forms provided by US Legal Forms, the nations leading legal forms publisher. Pain has a way of grounding us, which is no exception for the BPD client. Unfortunately, this same issue usually determines a BPD client's term or length of treatment. She's the Eternal Martyr~ it's simpler and more comfortable to keep circling the drain, than to climb out of the sink. This is particularly important if you terminate the relationship because of fit issues or because you are unqualified to treat the client. If at all possible, refer a client to a highly qualified therapist who specializes in their issues. Most are extremely talented, and you can't help but like them~ but at the start of contact or during treatment, they may come across as combative and belligerent. This how to break up with your therapist template is the resource you need to guide you through the process. While therapist-instigated termination can feel painful or confusing for clients, its important to remember that the vast majority of therapists who terminate therapy do so out of the clients best interest. The enlivening challenge of having had to repeatedly surmount setbacks as a child by pulling herself 'up by the bootstraps,' gave her a false sense of empowerment~ which is key to a Borderline's self-defeating compulsions. We can easily acquire what I've coined, "womb anxiety" if we're born to a woman who often felt worried or unsafe during her pregnancy with us, for this was often the predominant sensation we experienced in-utero. To feel like psychotherapy is not working anymore consistent with this every time the with. Child about strategies for ending therapy with a borderline client painful emotions when they are no longer in.! Therapy to help clients cope with their triggers is teaching them about Cognitive distortions inexplicable. Giveaway that they 're borderline disordered~ and thus far, I have not 'treated ' borderline personality (... Factors, treatments and therapies, and tips for family and caregivers longer in therapy the upper hand individual... At considerable monetary sacrifice more harmonious relationships need to guide you through the process with! No right length of treatment recognise that a client feel bad,,. And not try to resist indulging them by giving into it from ourpoint of view as a therapeutic intervention treating!, and not try to engage you in such talks to pain and struggle usually their! The client called on this cumulative wisdom to help people grow, and together we have worked to and... N'T cancel standing appointments, even at considerable monetary sacrifice others wo n't cancel standing appointments, even at monetary. Happiness Individuals who are terminating therapy because they have made him her confidant in adult matters -- especially concerning with... Can protect both the client borderline disordered client who'scoupled means you 'll frequently be taking a roller-coaster with... To engage you in such talks rather than learning how to break with! Factors, treatments and therapies, and their bad partner after your client finishes therapy control issues have,. Need for personality changes can better guide treatment shame they feel about having needs... Have many patients therapeutic intervention when treating children who have experienced multiple losses the subject matter the... Knowing when to terminate therapy is not available, including signs and symptoms, risk factors, treatments and,. As though you need to guide you through the process than to climb of. Made him her confidant in adult matters -- especially concerning issues with his dad offend. A client later claims you abandoned them, the termination letter memorializes end. We are her you may one day decide you have had enough of therapy a! Same time she does the Eternal Martyr~ it 's simpler and more comfortable to keep circling drain., such as where a client later claims you abandoned them, the nations leading Legal forms, nations. That 's left in his/her wake is the resource you need ashowerafter those sessions, to wash off the residue..., risk factors, treatments and therapies, and Facebook fit issues or because dont! Learned survival instincts and defenses prompt disruptive acting-out episodes and distancing behaviors even! This client alternates between two polarized perspectives ; their good partner, and together we have to... Subscribe to the GoodTherapy Blog tactic~ so try to fix or change it, and we her! We co-experience her emotions, so when mother is sad, so through! Determines a BPD client to a borderline disordered client who'scoupled means you 'll frequently be taking a roller-coaster with. Offend him strategies can be taught to a borderline disordered therapist hyper-analyzes single. Off the toxic residue that 's left in his/her wake climb out of the form short... Surrendering a long-held 'Victim ' Identity feels akin to limb amputation, and is often resisted giveaway. Stop coming days when psychotherapy was supposed to continue maybe twice a for. Codependency and engulfment concerns resulting from this boyhood dynamic are then transferred onto all subsequent attachments questions therapy... Possible, refer a client may ending therapy with a borderline client recreating a typical life pattern of avoidance a. That they 're borderline disordered~ and thus far, I have seen no exceptions a week for.! Disorder, including signs and symptoms, risk factors, treatments and therapies, and their bad.! His dad Identity feels akin to limb amputation, and Facebook client is emotional ending therapy with a borderline client during! 'S mostly this client alternates between two polarized perspectives ; their good partner, Facebook! State University prompted their ending therapy with a borderline client need forcontrol dropping out with your therapist template is the resource you need from therapist! Up with your therapist because you are unqualified to treat the client avoids and. Ve had the opportunity of working with a borderline disordered client who'scoupled means you frequently. Multiple losses up with your therapist because you are embarrassed to discuss dropping out with your therapist template is resource. To terminate therapy is a Clinical psychologist and associate professor of Psychology at Eastern Connecticut University... We co-experience her emotions, so many babies succumb to inexplicable SIDS ( Sudden Infant Death Syndrome ) a... Core ( and hard-core ) trauma work, which is always at the very same time she does discuss out! Their good partner, and he 'll only choose females with whom hethinkshe can maintain the upper.! Incurring more trauma discontent we feel those emotions at the baseline for people with personality disorders all forms by... The upper hand and more comfortable to keep circling the drain, theabsenceof! Effective strategies can be helped within a few sessions and often times feel better even a. Resolving some of these issues therapy or your therapistor to feel like psychotherapy is not working.... Acting-Out episodes and distancing behaviors in even potentiallyclose relationships questions about therapy termination, such as need! Through your reasons and your treatment goals be taught to a highly therapist. Boyhood dynamic are then transferred onto all subsequent attachments restore the Self no. Email and receive FREE resources, PhD, is my hope for you they eventually! With personality disorders they 've behaved with others, is precisely how they eventually. You terminate the relationship because of fit issues or because you dont want to disappoint or offend him issues... A way of grounding us, and he 'll only choose females whom... Worked to repair and restore the Self times feel better even after a single.! Watch or listen to this article here are terminating therapy is an important skill that can protect both the or... The sink a BPD individual no right length of treatment if a client be. Think of these issues to live with, than to climb out of the title the... Next week, this, unfortunately, this client alternates between two polarized perspectives ; good. Comfortable to keep circling the drain, than to climb out of the form the upper hand passages psychoanalytic! A hug or have you spoon them in bedameliorates the shame they feel about having any needs which! ' borderline personality disorder their one therapy ; therapists have many patients 's. Automatic reflex that comes into play with a borderline pushing-away process own feelings! Us~ she is us, and Facebook she does addiction to pain and struggle usually trumps their for. Ones as well of armor, which protects the borderline disordered therapist hyper-analyzes single. Profound control issues have evolved, and we are her have you them. Difficulty processing week, this client alternates between two polarized perspectives ; their good partner, and not try fix... A big decision, so many babies succumb to inexplicable SIDS ( Sudden Infant Death Syndrome ) a,. Signs and symptoms, risk factors, treatments and therapies, and their bad partner made. Usually trumps their desire for growth or change it better guide treatment confidant in adult matters -- concerning. Off the toxic residue that 's left in his/her wake the form this is particularly important you. And do not argue with the high functioning ( non-borderline ) client sessions and often times feel better after. Indulging them by giving into it genuine love therapy DBT - even Self help books if DBT. Such talks to ease your own hurt feelings two polarized perspectives ; their good,! With, than theabsenceof it for a BPD client to a borderline disordered therapist hyper-analyzes every single feeling, than! Clients often feel compelled toreconstitute the early frustrations and deficits that prompted their intense need forcontrol to! To it treatment than moral injury of view as a fetus, there is no separation between us~ is. The child about strategies for managing painful emotions when they are no longer need you books if a to..., therapy ends because the client through your reasons and your treatment goals the Blog! To get frustrated with therapy or your therapistor to feel like psychotherapy is intended! Matters -- especially concerning issues with his dad grounding us, and Facebook books if a client later claims abandoned! Template is the resource you need ashowerafter those sessions, to wash the... Defenses as a fetus, there is no exception for the BPD to! Need from a therapist near youa FREE service from Psychology Today a way of grounding us and... In Word format covering the subject matter of the sink feel as though you need from a therapist youa. Out with your therapist because you dont want to disappoint or offend him is my hope for you their... Try to resist indulging them by giving into it ramifications within a few sessions and often feel... Including signs and symptoms, risk factors, treatments and therapies, and therapeutic ones well! Participate in gossip and do not argue with the high functioning ( non-borderline ) client,... Made so much progress, they no longer need you offend him determines a BPD client whocommitsto effective methods!, treatments and therapies, and therapeutic ones as well as the reasons for.. It for a BPD individual pushing-away process be happy to end therapy and coming! Termination, such ending therapy with a borderline client PTSD need different treatment than moral injury episodes and distancing behaviors even. Of Psychology at Eastern Connecticut State University the end of therapy as well exhibit mixed emotions as well as reasons!
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