Dialectical Behavior (DBT) Therapists in Kutztown, PA

Photo of Cheryl Wilson-Smith - Advanced Counseling and Research Services, LPC, LMHC-FL, CCMHC, CCTP, CT, Licensed Professional Counselor
Advanced Counseling and Research Services
Licensed Professional Counselor, LPC, LMHC-FL, CCMHC, CCTP, CT
Verified Verified
2 Endorsed
Kutztown, PA 19530
, LPC CAADC CCTP C- DBT.
Advanced Counseling and Research Services provides a comprehensive array of professional counseling services to the greater Lancaster community. In general terms, these clinical services help clients address problematic issues in their lives that are impacting on their daily lives. Throughout the counseling experience, the counselor and client work collaboratively to address problems presented by the client. The overall purpose of counseling can be summarized in the following objectives: To identify the problematic issues facing each individual client seeking counseling. To identify secondary issues contributing to problem.
, LPC CAADC CCTP C- DBT.
Advanced Counseling and Research Services provides a comprehensive array of professional counseling services to the greater Lancaster community. In general terms, these clinical services help clients address problematic issues in their lives that are impacting on their daily lives. Throughout the counseling experience, the counselor and client work collaboratively to address problems presented by the client. The overall purpose of counseling can be summarized in the following objectives: To identify the problematic issues facing each individual client seeking counseling. To identify secondary issues contributing to problem.
(717) 964-8581 View (717) 964-8581
Photo of Lynne A Williams, PhD, Psychologist
Lynne A Williams
Psychologist, PhD
Verified Verified
Kutztown, PA 19530
My experiences living in and working with people from multiple cultures and faith backgrounds help me to tailor therapy to your unique needs and goals. My professional experiences range from marriage and parenting issues, mood and anxiety disorders, delinquency, veterans' issues, career selection, bereavement, trauma recovery, family violence, adoption & infertility issues, relationship problems, cross-cultural adjustment, chronic illness and pain, and the challenges of living with ADHD and other learning difficulties.
My experiences living in and working with people from multiple cultures and faith backgrounds help me to tailor therapy to your unique needs and goals. My professional experiences range from marriage and parenting issues, mood and anxiety disorders, delinquency, veterans' issues, career selection, bereavement, trauma recovery, family violence, adoption & infertility issues, relationship problems, cross-cultural adjustment, chronic illness and pain, and the challenges of living with ADHD and other learning difficulties.
(484) 734-2746 View (484) 734-2746
Photo of Jess Adam, LPC, Licensed Professional Counselor
Jess Adam
Licensed Professional Counselor, LPC
Verified Verified
1 Endorsed
Kutztown, PA 19530  (Online Only)
What would it feel like to be unconditionally supported, the way you support others? What would change if you had someone that walked alongside you, offering skills, safety, and a healthy dose of humor along the way? If you’re curious about the answers to these questions, I invite you to schedule a consultation to see if we might be a good fit - especially if you are a caregiver yourself. I specialize in "supporting the supporters". Whether you are a parent, caring for a family member, or otherwise in a caregiving role - I understand the deep exhaustion that can come from all you give to others.
What would it feel like to be unconditionally supported, the way you support others? What would change if you had someone that walked alongside you, offering skills, safety, and a healthy dose of humor along the way? If you’re curious about the answers to these questions, I invite you to schedule a consultation to see if we might be a good fit - especially if you are a caregiver yourself. I specialize in "supporting the supporters". Whether you are a parent, caring for a family member, or otherwise in a caregiving role - I understand the deep exhaustion that can come from all you give to others.
(610) 795-5309 View (610) 795-5309
Photo of Suzanne Hastie, BC-DMT , NCC, LPC, Licensed Professional Counselor
Suzanne Hastie
Licensed Professional Counselor, BC-DMT , NCC, LPC
Verified Verified
Kutztown, PA 19530
Are you feeling stressed or struggling emotionally? Are you going through significant life transitions? Experiencing losses? Feeling unhappy with yourself or in your relationships? Is your child or adolescent facing challenges? There is no doubt about it, we can find ourselves in difficult places as we journey through life. Most all of us have to face and go through tough times. As a seasoned therapist who has been practicing for more than 25 years, I know that life can throw us curveballs.
Are you feeling stressed or struggling emotionally? Are you going through significant life transitions? Experiencing losses? Feeling unhappy with yourself or in your relationships? Is your child or adolescent facing challenges? There is no doubt about it, we can find ourselves in difficult places as we journey through life. Most all of us have to face and go through tough times. As a seasoned therapist who has been practicing for more than 25 years, I know that life can throw us curveballs.
(484) 427-5874 View (484) 427-5874
Photo of Trisha Gillott, MA, Pre-Licensed Professional
Trisha Gillott
Pre-Licensed Professional, MA
Verified Verified
Kutztown, PA 19530  (Online Only)
Through my practice, You First Counseling, I help motivated individuals work through anxiety, perfectionism, grief, gender dysphoria, relational issues, trauma symptoms, and more. But to work on those things, I'm finding that people need space to fully (for at least one hour) put themselves first; to know that their time is theirs, and to have someone help hold their struggles.
Through my practice, You First Counseling, I help motivated individuals work through anxiety, perfectionism, grief, gender dysphoria, relational issues, trauma symptoms, and more. But to work on those things, I'm finding that people need space to fully (for at least one hour) put themselves first; to know that their time is theirs, and to have someone help hold their struggles.
(484) 759-9554 View (484) 759-9554
Photo of Lissa Elliott St. Clair, MS, LPC, CTRTC, Licensed Professional Counselor
Lissa Elliott St. Clair
Licensed Professional Counselor, MS, LPC, CTRTC
Verified Verified
Kutztown, PA 19530
Have you been telling yourself it's time to call someone because you're feeling tense, anxious, or overwhelmed? Struggling to cope with a traumatic experience or painful past? Feeling numb & disconnected from your body? Or feel like you're on an emotional rollercoaster ride? If so, please call me and you can decide if I'm the one you're ready to call.
Have you been telling yourself it's time to call someone because you're feeling tense, anxious, or overwhelmed? Struggling to cope with a traumatic experience or painful past? Feeling numb & disconnected from your body? Or feel like you're on an emotional rollercoaster ride? If so, please call me and you can decide if I'm the one you're ready to call.
(484) 346-0627 View (484) 346-0627

More Therapists Nearby

Photo of Brenna Fehr, LPC, CCTPII, CGP, Licensed Professional Counselor
Brenna Fehr
Licensed Professional Counselor, LPC, CCTPII, CGP
Verified Verified
7 Endorsed
Fleetwood, PA 19522
My background in Cognitive Behavioral Therapy (CBT), and Dialectic Behavioral Therapy ( DBT) can help with symptoms of depression and anxiety.
Healing does not always look pretty, well put-together and wrapped in a bow. Often, true healing can be messy, hard, tearful and exhausting. If you have made your way here, I imagine you are currently in the process of healing and looking for some support. Whether you are on the journey of healing from any level of trauma, fertility issues, postpartum struggles or general curves that life has thrown you, I am happy to and capable of assisting you along the way. I enjoy working with individuals who are motivated to help themselves, open to change and willing to have deep conversations about their troubles.
My background in Cognitive Behavioral Therapy (CBT), and Dialectic Behavioral Therapy ( DBT) can help with symptoms of depression and anxiety.
Healing does not always look pretty, well put-together and wrapped in a bow. Often, true healing can be messy, hard, tearful and exhausting. If you have made your way here, I imagine you are currently in the process of healing and looking for some support. Whether you are on the journey of healing from any level of trauma, fertility issues, postpartum struggles or general curves that life has thrown you, I am happy to and capable of assisting you along the way. I enjoy working with individuals who are motivated to help themselves, open to change and willing to have deep conversations about their troubles.
(484) 214-2498 View (484) 214-2498
Photo of Elizabeth Becks, LPC, PMH-C, Licensed Professional Counselor
Elizabeth Becks
Licensed Professional Counselor, LPC, PMH-C
Verified Verified
1 Endorsed
Allentown, PA 18106  (Online Only)
I utilize aspects of Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral therapy ( DBT), as well as principles of Mindfulness.
My goal is to provide a space to share without shame, and to process and learn skills to manage life more effectively.
I utilize aspects of Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral therapy ( DBT), as well as principles of Mindfulness.
My goal is to provide a space to share without shame, and to process and learn skills to manage life more effectively.
(844) 696-4631 View (844) 696-4631
Photo of Lorraine Ann LaPorte, LCSW, Clinical Social Work/Therapist
Lorraine Ann LaPorte
Clinical Social Work/Therapist, LCSW
Verified Verified
Allentown, PA 18106  (Online Only)
I primarily utilize Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy ( DBT) techniques and tools, as well as Motivational Interviewing.
I’m a Licensed Clinical Social Worker in Pennsylvania with a focus on developing practical skills to assist clients with their mental health needs through a compassionate, supportive and empowering approach. As an LCSW, I’m committed to hearing, understanding, and validating the goals you want to achieve.
I primarily utilize Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy ( DBT) techniques and tools, as well as Motivational Interviewing.
I’m a Licensed Clinical Social Worker in Pennsylvania with a focus on developing practical skills to assist clients with their mental health needs through a compassionate, supportive and empowering approach. As an LCSW, I’m committed to hearing, understanding, and validating the goals you want to achieve.
(856) 856-3521 View (856) 856-3521
Photo of Courtney Pursell, LPC, NCC, C-DBT, CCTP, Licensed Professional Counselor
Courtney Pursell
Licensed Professional Counselor, LPC, NCC, C-DBT, CCTP
Verified Verified
Fogelsville, PA 18051
My approach combines Dialectical Behavioral Therapy ( DBT) and psychoeducation to help you develop practical skills for emotional regulation and trauma recovery.
Struggling with overwhelming emotions or constant anxiety? Are you finding it hard to break free from negative thinking patterns & triggers? I’m here to help. As a Licensed Professional Counselor and Certified Clinical Trauma Professional, I specialize in treating Anxiety, Depression, Bipolar Disorder, and Borderline Personality Disorder. My goal is to support you in managing your thoughts & feelings, reducing distress, and achieving a sense of inner calm and happiness. I understand that navigating life’s challenges can feel daunting, especially if you’re unsure where to start.
My approach combines Dialectical Behavioral Therapy ( DBT) and psychoeducation to help you develop practical skills for emotional regulation and trauma recovery.
Struggling with overwhelming emotions or constant anxiety? Are you finding it hard to break free from negative thinking patterns & triggers? I’m here to help. As a Licensed Professional Counselor and Certified Clinical Trauma Professional, I specialize in treating Anxiety, Depression, Bipolar Disorder, and Borderline Personality Disorder. My goal is to support you in managing your thoughts & feelings, reducing distress, and achieving a sense of inner calm and happiness. I understand that navigating life’s challenges can feel daunting, especially if you’re unsure where to start.
(484) 218-4272 View (484) 218-4272
Photo of Arti Maharaj, LPC, Counselor
Arti Maharaj
Counselor, LPC
Verified Verified
2 Endorsed
Allentown, PA 18106  (Online Only)
I employ evidence-based treatments such as CBT, DBT, ACT, and EMDR, and other therapeutic modalities to ensure a comprehensive and tailored approach to your mental well-being.
Greetings! In this practice, I provide a warm, non-judgmental therapeutic space dedicated to offering support. I believe in a client-led approach, empowering you to find your voice. Progress is celebrated in the small steps that accumulate into significant strides throughout the treatment journey. I offer individual, couples, and family therapy to everyone, specializing in providing support to the minority population and thriving in working with intercultural couples and families.
I employ evidence-based treatments such as CBT, DBT, ACT, and EMDR, and other therapeutic modalities to ensure a comprehensive and tailored approach to your mental well-being.
Greetings! In this practice, I provide a warm, non-judgmental therapeutic space dedicated to offering support. I believe in a client-led approach, empowering you to find your voice. Progress is celebrated in the small steps that accumulate into significant strides throughout the treatment journey. I offer individual, couples, and family therapy to everyone, specializing in providing support to the minority population and thriving in working with intercultural couples and families.
(610) 233-1584 View (610) 233-1584
Photo of Sophie Hans, LSW, Clinical Social Work/Therapist
Sophie Hans
Clinical Social Work/Therapist, LSW
Verified Verified
Fogelsville, PA 18051
I use CBT, DBT, and Solution Focused work, using mindfulness, breathing techniques, visualization, and goal setting to help clients reach their short and long-term goals.
My ideal client is someone who comes to therapy in a time of need. They might be experiencing anxiety due to life changes and transitions or they might be experiencing symptoms of anxiety for the first time and be concerne as to where the anxiety came from. The client might be processing loss or grief from a loved one or past friendships and or relationships. My ideal client will have needs such as needing to identify coping skills to get through life stressors, assistance with reaching goals. As a therapist I would be able to provide the client with a objective perspective to bounce their ideas and situations off of.
I use CBT, DBT, and Solution Focused work, using mindfulness, breathing techniques, visualization, and goal setting to help clients reach their short and long-term goals.
My ideal client is someone who comes to therapy in a time of need. They might be experiencing anxiety due to life changes and transitions or they might be experiencing symptoms of anxiety for the first time and be concerne as to where the anxiety came from. The client might be processing loss or grief from a loved one or past friendships and or relationships. My ideal client will have needs such as needing to identify coping skills to get through life stressors, assistance with reaching goals. As a therapist I would be able to provide the client with a objective perspective to bounce their ideas and situations off of.
(267) 309-2843 View (267) 309-2843
Photo of Sophie Hans, LSW, Clinical Social Work/Therapist
Sophie Hans
Clinical Social Work/Therapist, LSW
Verified Verified
Fogelsville, PA 18051
I use CBT, DBT, and Solution Focused work, using mindfulness, breathing techniques, visualization, and goal setting to help clients reach their short and long-term goals.
My ideal client is someone who comes to therapy in a time of need. They might be experiencing anxiety due to life changes and transitions or they might be experiencing symptoms of anxiety for the first time and be concerned as to where the anxiety came from. The client might be processing loss or grief from a loved one or past friendships and or relationships. My ideal client will have needs such as needing to identify coping skills to get through life stressors, assistance with reaching goals. As a therapist I would be able to provide the client with a objective perspective to bounce their ideas and situations off of.
I use CBT, DBT, and Solution Focused work, using mindfulness, breathing techniques, visualization, and goal setting to help clients reach their short and long-term goals.
My ideal client is someone who comes to therapy in a time of need. They might be experiencing anxiety due to life changes and transitions or they might be experiencing symptoms of anxiety for the first time and be concerned as to where the anxiety came from. The client might be processing loss or grief from a loved one or past friendships and or relationships. My ideal client will have needs such as needing to identify coping skills to get through life stressors, assistance with reaching goals. As a therapist I would be able to provide the client with a objective perspective to bounce their ideas and situations off of.
(856) 807-5458 View (856) 807-5458
Photo of Courtney Pursell, LPC, NCC, C-DBT, Licensed Professional Counselor
Courtney Pursell
Licensed Professional Counselor, LPC, NCC, C-DBT
Verified Verified
Fogelsville, PA 18051
My approach combines Dialectical Behavioral Therapy ( DBT) and psychoeducation to help you develop practical skills for emotional regulation and trauma recovery.
Struggling with overwhelming emotions or constant anxiety? Are you finding it hard to break free from negative thinking patterns & triggers? I’m here to help. As a Licensed Professional Counselor and Certified Clinical Trauma Professional, I specialize in treating Anxiety, Depression, Bipolar Disorder, and Borderline Personality Disorder. My goal is to support you in managing your thoughts & feelings, reducing distress, and achieving a sense of inner calm and happiness. I understand that navigating life’s challenges can feel daunting, especially if you’re unsure where to start.
My approach combines Dialectical Behavioral Therapy ( DBT) and psychoeducation to help you develop practical skills for emotional regulation and trauma recovery.
Struggling with overwhelming emotions or constant anxiety? Are you finding it hard to break free from negative thinking patterns & triggers? I’m here to help. As a Licensed Professional Counselor and Certified Clinical Trauma Professional, I specialize in treating Anxiety, Depression, Bipolar Disorder, and Borderline Personality Disorder. My goal is to support you in managing your thoughts & feelings, reducing distress, and achieving a sense of inner calm and happiness. I understand that navigating life’s challenges can feel daunting, especially if you’re unsure where to start.
(484) 989-7147 View (484) 989-7147
Photo of Valentine Croft, LPC, CCTP, Licensed Professional Counselor
Valentine Croft
Licensed Professional Counselor, LPC, CCTP
Verified Verified
1 Endorsed
Fogelsville, PA 18051  (Online Only)
Techniques I use are CBT, DBT and mindfulness.
I have worked with many people struggling with depression, anxiety, low self-esteem, low self worth, rumination, difficulty finding meaning and purpose in life. Perhaps due to current overwhelming situations, past traumas or living far away from home and having difficulty acclimating. I am passionate about helping people gain a better understanding between surviving and thriving, gaining a better understanding of their strengths and resiliencies, finding and implementing healthy coping skills, goals and confidence needed to move forward.
Techniques I use are CBT, DBT and mindfulness.
I have worked with many people struggling with depression, anxiety, low self-esteem, low self worth, rumination, difficulty finding meaning and purpose in life. Perhaps due to current overwhelming situations, past traumas or living far away from home and having difficulty acclimating. I am passionate about helping people gain a better understanding between surviving and thriving, gaining a better understanding of their strengths and resiliencies, finding and implementing healthy coping skills, goals and confidence needed to move forward.
(610) 978-6621 View (610) 978-6621
Photo of Diana Cofsky, LPC, Licensed Professional Counselor
Diana Cofsky
Licensed Professional Counselor, LPC
Verified Verified
Fogelsville, PA 18051
My approach to therapy is client centered, using a variety of modalities including CBT, DBT and family systems therapy.
I am a licensed professional counselor that has been working in behavioral health for over 20 years. I am a lifelong resident of South Jersey and obtained my Bachelors and Masters degrees from La Salle University in Philadelphia. I have been fortunate to have backgrounds in both addiction and mental health at all levels of care, including inpatient residential, intensive outpatient and outpatient. My approach to therapy is client centered, using a variety of modalities including CBT, DBT and family systems therapy. I believe in the mind/body connection and offer guided imagery.
My approach to therapy is client centered, using a variety of modalities including CBT, DBT and family systems therapy.
I am a licensed professional counselor that has been working in behavioral health for over 20 years. I am a lifelong resident of South Jersey and obtained my Bachelors and Masters degrees from La Salle University in Philadelphia. I have been fortunate to have backgrounds in both addiction and mental health at all levels of care, including inpatient residential, intensive outpatient and outpatient. My approach to therapy is client centered, using a variety of modalities including CBT, DBT and family systems therapy. I believe in the mind/body connection and offer guided imagery.
(267) 309-2843 View (267) 309-2843
Photo of Christina Belknap, MSW, LCSW, Clinical Social Work/Therapist
Christina Belknap
Clinical Social Work/Therapist, MSW, LCSW
Verified Verified
Fogelsville, PA 18051
I have experience in many modalities, from CBT, DBT, EMDR, and somatic therapy approaches.
My ideal client aims to engage in an active partnership to build self-awareness and take action to make a change. I will give you feedback and challenge you, which is not everyone’s cup of tea! I work best with those suffering from anxiety, panic attacks, overwhelm, trauma, or emotional flooding. Many of my clients report that our work helped them shift from survival mode to a sense of thriving. I suggest homework; your progress is based on your willingness to practice. The ideal client for my strengths is someone who wants to learn and shift by discovering tangible skills and techniques they can use in their own lives.
I have experience in many modalities, from CBT, DBT, EMDR, and somatic therapy approaches.
My ideal client aims to engage in an active partnership to build self-awareness and take action to make a change. I will give you feedback and challenge you, which is not everyone’s cup of tea! I work best with those suffering from anxiety, panic attacks, overwhelm, trauma, or emotional flooding. Many of my clients report that our work helped them shift from survival mode to a sense of thriving. I suggest homework; your progress is based on your willingness to practice. The ideal client for my strengths is someone who wants to learn and shift by discovering tangible skills and techniques they can use in their own lives.
(267) 309-2843 View (267) 309-2843
Photo of Melissa DiTaranto, LPC, NCC, Licensed Professional Counselor
Melissa DiTaranto
Licensed Professional Counselor, LPC, NCC
Verified Verified
Breinigsville, PA 18031  (Online Only)
CBT, mindfulness, DBT, person-centered and trauma informed care).
I’m a licensed professional counselor with 9 years of experience supporting individuals with anxiety, depression and other mood disorders, trauma and stress related disorders, and who are struggling to manage and move through issues related to trauma, relationships, and life transitions.
CBT, mindfulness, DBT, person-centered and trauma informed care).
I’m a licensed professional counselor with 9 years of experience supporting individuals with anxiety, depression and other mood disorders, trauma and stress related disorders, and who are struggling to manage and move through issues related to trauma, relationships, and life transitions.
(610) 439-9846 View (610) 439-9846
Photo of Christina Belknap, MSW, LCSW, Clinical Social Work/Therapist
Christina Belknap
Clinical Social Work/Therapist, MSW, LCSW
Verified Verified
1 Endorsed
Fogelsville, PA 18051
I have experience in many modalities, from CBT, DBT, EMDR, and somatic therapy approaches.
My ideal client aims to engage in an active partnership to build self-awareness and take action to make a change. I will give you feedback and challenge you, which is not everyone’s cup of tea! I work best with those suffering from anxiety, panic attacks, overwhelm, trauma, or emotional flooding. Many of my clients report that our work helped them shift from survival mode to a sense of thriving. I suggest homework; your progress is based on your willingness to practice. The ideal client for my strengths is someone who wants to learn and shift by discovering tangible skills and techniques they can use in their own lives.
I have experience in many modalities, from CBT, DBT, EMDR, and somatic therapy approaches.
My ideal client aims to engage in an active partnership to build self-awareness and take action to make a change. I will give you feedback and challenge you, which is not everyone’s cup of tea! I work best with those suffering from anxiety, panic attacks, overwhelm, trauma, or emotional flooding. Many of my clients report that our work helped them shift from survival mode to a sense of thriving. I suggest homework; your progress is based on your willingness to practice. The ideal client for my strengths is someone who wants to learn and shift by discovering tangible skills and techniques they can use in their own lives.
(484) 416-8132 View (484) 416-8132
Photo of Richard Joseph Loeb, MA, Licensed Professional Counselor
Richard Joseph Loeb
Licensed Professional Counselor, MA
Verified Verified
Maxatawny, PA 19538
I provide a safe and ethical practice that embraces individuality. My capacities are teacher, mentor, guardian, cheer leader, back-board, and many others. I present in reality and genuinely so.. Change and grow are possible in most cases. Client / patent focus in a holistic, comprehensive manner.
I provide a safe and ethical practice that embraces individuality. My capacities are teacher, mentor, guardian, cheer leader, back-board, and many others. I present in reality and genuinely so.. Change and grow are possible in most cases. Client / patent focus in a holistic, comprehensive manner.
(610) 624-6627 View (610) 624-6627

See more therapy options for Kutztown

Dialectical Behavior (DBT) Therapists

Who is DBT for?

Dialectical Behavior Therapy (DBT) is designed for people who experience extreme emotional suffering because they lack the skills of emotion regulation and distress tolerance. The basic affliction can underlie a wide range of conditions, from borderline and other personality disorders to PTSD and treatment-resistant anxiety and depression. The therapy is helpful to those whose emotional reactivity is so intense it is disruptive to everyday functioning and leads to frequent crises.

Why do people need DBT?

The ability to regulate emotions is a core psychological skill that enables people to function in life and pay attention to the world outside themselves; it is consistently associated with well-being. DBT is designed to help people learn how to manage and regulate their emotions. Originally developed to treat people with borderline personality disorder whose extreme emotional suffering led to self-harming behavior and suicide attempts, the therapy is now applied to other conditions involving emotion dysregulation, particularly when other treatments have failed.

What happens in DBT?

Individuals meet weekly with their therapist to discuss their experiences relating to moods, behavior, and skills. Using checklists they maintain, they review emotional experiences and positive practices they engage in. The diaries help individuals discern what led up to a specific problem encountered, this is followed by discussion of the consequences of their actions. In addition, individuals may meet in class-like small groups to learn skills such as mindfulness, emotion regulation and distress tolerance.

How long does DBT last?

Because it is intended to establish long-lasting behavioral change among those with persistent problems, DBT is designed to last six months to a year. DBT includes both weekly sessions of individual therapy and weekly skills-training sessions conducted in small groups. Studies of DBT have documented improvement within a year of treatment, particularly in controlling self-harmful behavior; nevertheless, individuals may require therapy for several years.