Art Therapy in San Marcos, TX
![Photo of Teresa J. Connell, LPC-S, ATR-BC, NCC, Licensed Professional Counselor](https://photos.psychologytoday.com/4cc314f7-c43d-473d-b905-4c3f05c3ebea/1/320x400.jpeg)
Teresa J. Connell
Licensed Professional Counselor, LPC-S, ATR-BC, NCC
Verified Verified
1 Endorsed
San Marcos, TX 78666 (Online Only)
Neurodiverse/HSP Ally, Art Therapy, CBT, Mindfulness.
Accepting clients who are looking for freedom and peace within their life stories. Together we can problem-solve some coping strategies for overwhelm, depression, and anxiety. We'll discover what is in the way, dig deep into the here and now, or look for the patterns from the past. You decide where to go, and I will follow. In our time, you'll focus on taking small achievable steps that foster change and I’ll keep you accountable and motivated.
Neurodiverse/HSP Ally, Art Therapy, CBT, Mindfulness.
Accepting clients who are looking for freedom and peace within their life stories. Together we can problem-solve some coping strategies for overwhelm, depression, and anxiety. We'll discover what is in the way, dig deep into the here and now, or look for the patterns from the past. You decide where to go, and I will follow. In our time, you'll focus on taking small achievable steps that foster change and I’ll keep you accountable and motivated.
![Photo of Elizabeth Barnard, MA, LPC, RPT, Licensed Professional Counselor](https://photos.psychologytoday.com/49264b8c-46cd-11ea-a6ad-06142c356176/2/320x400.jpeg)
Elizabeth Barnard
Licensed Professional Counselor, MA, LPC, RPT
Verified Verified
1 Endorsed
San Marcos, TX 78666
Along with traditional talk therapy, I also offer a variety of modalities including games, art, sand tray, and music.
It’s hard to be vulnerable. Especially with someone you don’t know. I work hard to establish a therapeutic relationship built on trust. I provide a holistic approach exploring all parts of a person’s past and current circumstances so that the process can help in giving insight for healing and growth.
Along with traditional talk therapy, I also offer a variety of modalities including games, art, sand tray, and music.
It’s hard to be vulnerable. Especially with someone you don’t know. I work hard to establish a therapeutic relationship built on trust. I provide a holistic approach exploring all parts of a person’s past and current circumstances so that the process can help in giving insight for healing and growth.
![Photo of Kathleen Loisel, MA, LPC-S, BSN, RYT-200](https://photos.psychologytoday.com/82dcd0f7-8f91-445b-85ed-7650ca253303/2/320x400.jpeg)
Kathleen Loisel
MA, LPC-S, BSN, RYT-200
Verified Verified
San Marcos, TX 78666
Waitlist for new clients
These include art, sandtray, writing, music and yoga therapy.
In my experience, I've found that people come to therapy when they are in a crisis situation or encounter something that seems too overwhelming to face on their own. I approach my work in a collaborative way that promotes self-awareness, understanding, support and discovery, promoting safety and understanding. By focusing strengths, I hope to assist my clients in finding healthy ways to cope with stressors, achieve desired changes, better understand how they relate to others and the world, develop personal potential and empower in a gentle, purposeful manner.
These include art, sandtray, writing, music and yoga therapy.
In my experience, I've found that people come to therapy when they are in a crisis situation or encounter something that seems too overwhelming to face on their own. I approach my work in a collaborative way that promotes self-awareness, understanding, support and discovery, promoting safety and understanding. By focusing strengths, I hope to assist my clients in finding healthy ways to cope with stressors, achieve desired changes, better understand how they relate to others and the world, develop personal potential and empower in a gentle, purposeful manner.
![Photo of Alice M Seitzer, LCSW, LCDC, Clinical Social Work/Therapist](https://photos.psychologytoday.com/cdca81bf-bbee-4d09-9347-07bac1f48f18/3/320x400.jpeg)
Alice M Seitzer
Clinical Social Work/Therapist, LCSW, LCDC
Verified Verified
1 Endorsed
San Marcos, TX 78666
People and their stories have always inspired and humbled me. Helping others to walk through their shadows and experience the light is a true gift. Earlier in my life I went through some difficult experiences. The wilderness, music, art, and movement helped me to feel and learn to move through those hardships. My connection with the natural world has revealed my inner potential and helped me to heal from traumas. I am dedicated to incorporating my knowledge of therapy, relationship to the natural world, yoga and expressive arts for each person I work with. I believe in feeling all of the human emotions with balance and intention.
People and their stories have always inspired and humbled me. Helping others to walk through their shadows and experience the light is a true gift. Earlier in my life I went through some difficult experiences. The wilderness, music, art, and movement helped me to feel and learn to move through those hardships. My connection with the natural world has revealed my inner potential and helped me to heal from traumas. I am dedicated to incorporating my knowledge of therapy, relationship to the natural world, yoga and expressive arts for each person I work with. I believe in feeling all of the human emotions with balance and intention.
![Photo of Leslie C. Simmons, LCSW, RYT-200, RCYT, Clinical Social Work/Therapist](https://photos.psychologytoday.com/507185e9-3ae1-4e5f-99f4-58a3a96f4236/3/320x400.png)
Leslie C. Simmons
Clinical Social Work/Therapist, LCSW, RYT-200, RCYT
Verified Verified
San Marcos, TX 78666
I have been a member of The NASW, ACA, American Art Therapy Association, Phi Alpha National Honor Society, The Texas-New Mexico Hospice Organization, Member, The Student Health Advisory Council-HISD.
Accepting New Clients- Life gets prickly! I can help you get unstuck! I am an inclusive, compassionate & creative therapist who puts the client first. I enjoy working w/ teens, college-age & women struggling w/ anxiety, depression, trauma, complex relationships, college/educational challenges, career transitions, grief/loss, eating disorders, chronic illness or suicide loss. I am a trans-affirming & proud ally who works closely w/ lgbtqi & queer communities. Note: I am an out-of-pocket provider and don't accept insurance except out-of-network. I offer reduced rates for college students & a certain number of sliding scale clients.
I have been a member of The NASW, ACA, American Art Therapy Association, Phi Alpha National Honor Society, The Texas-New Mexico Hospice Organization, Member, The Student Health Advisory Council-HISD.
Accepting New Clients- Life gets prickly! I can help you get unstuck! I am an inclusive, compassionate & creative therapist who puts the client first. I enjoy working w/ teens, college-age & women struggling w/ anxiety, depression, trauma, complex relationships, college/educational challenges, career transitions, grief/loss, eating disorders, chronic illness or suicide loss. I am a trans-affirming & proud ally who works closely w/ lgbtqi & queer communities. Note: I am an out-of-pocket provider and don't accept insurance except out-of-network. I offer reduced rates for college students & a certain number of sliding scale clients.
![Photo of Amanda Arriola, LPC, RPT, AAC, Licensed Professional Counselor](https://photos.psychologytoday.com/3997acc9-ab14-4a24-9984-ed0ece444c9b/3/320x400.jpeg)
Amanda Arriola
Licensed Professional Counselor, LPC, RPT, AAC
Verified Verified
1 Endorsed
San Marcos, TX 78666
I have a passion for working with children and have worked with kiddos of all ages as a public school teacher and a counselor since 2011. I love incorporating play, art therapy techniques, and animal assisted interventions in my sessions. I strive to create a trusting relationship with each child and their family and create a safe and fun space for processing feelings. I believe that each client has innate strengths and abilities that can help them work toward therapeutic goals. I provide play therapy, individual counseling and canine assisted counseling for children, adolescents and teens ages 3-18.
I have a passion for working with children and have worked with kiddos of all ages as a public school teacher and a counselor since 2011. I love incorporating play, art therapy techniques, and animal assisted interventions in my sessions. I strive to create a trusting relationship with each child and their family and create a safe and fun space for processing feelings. I believe that each client has innate strengths and abilities that can help them work toward therapeutic goals. I provide play therapy, individual counseling and canine assisted counseling for children, adolescents and teens ages 3-18.
![Photo of Katie Lacenere, MSS, LCSW, CET1, Clinical Social Work/Therapist](https://photos.psychologytoday.com/a9eeefd1-05a1-4f74-a4a5-df563607def4/1/320x400.png)
Katie Lacenere
Clinical Social Work/Therapist, MSS, LCSW, CET1
Verified Verified
San Marcos, TX 78666 (Online Only)
Have you already tried traditional talk therapy in the past? Has it been somewhat helpful, but now you're searching for other therapy modalities that can help you heal the root-cause of your issues? I’m a Licensed Clinical Social Worker (LCSW), Reiki Master, Certified Experiential Therapist, and Founder of Divine Light Sanctuary. I currently offer virtual therapy sessions for clients throughout the state of Texas. I’m also a highly sensitive person (HSP), oracle card reader, and spiritual guide. I believe that healing from trauma is about co-creating change that YOU choose.
Have you already tried traditional talk therapy in the past? Has it been somewhat helpful, but now you're searching for other therapy modalities that can help you heal the root-cause of your issues? I’m a Licensed Clinical Social Worker (LCSW), Reiki Master, Certified Experiential Therapist, and Founder of Divine Light Sanctuary. I currently offer virtual therapy sessions for clients throughout the state of Texas. I’m also a highly sensitive person (HSP), oracle card reader, and spiritual guide. I believe that healing from trauma is about co-creating change that YOU choose.
![Photo of Jon Lasser, PhD, Psychologist](https://photos.psychologytoday.com/a802d12b-97d8-48b4-9c86-db3366f103f3/3/320x400.jpeg)
I'm a licensed psychologist who specializes in working with children, adolescents, emerging adults and families. Helping clients learn how to be successful in life makes my work rewarding. I have experience working as a psychologist in public school settings and can support goals for home and school.
I'm a licensed psychologist who specializes in working with children, adolescents, emerging adults and families. Helping clients learn how to be successful in life makes my work rewarding. I have experience working as a psychologist in public school settings and can support goals for home and school.
![Photo of Sally Fletcher, MA](https://photos.psychologytoday.com/a98df9ba-10ef-48fd-9337-6620af68bb48/1/320x400.jpeg)
You care so much about your child. They are your top priority. You may be at your wits end or nervous about what is going on with your child. You would do anything to see them happier and thriving in all areas of life. I've helped many families with behavioral, social, and emotional concerns. I help build coping, self esteem, and resilience skills. I believe in involving the parents and helping them learn new strategies because this will bring more lasting results for the child/teen. I finished my Bachelors in Counseling in 2000 and Graduate degree in Counseling in 2013. I have worked helping children for 19 years.
You care so much about your child. They are your top priority. You may be at your wits end or nervous about what is going on with your child. You would do anything to see them happier and thriving in all areas of life. I've helped many families with behavioral, social, and emotional concerns. I help build coping, self esteem, and resilience skills. I believe in involving the parents and helping them learn new strategies because this will bring more lasting results for the child/teen. I finished my Bachelors in Counseling in 2000 and Graduate degree in Counseling in 2013. I have worked helping children for 19 years.
Susan Harris
Marriage & Family Therapist, MS, MA, LMFT
Verified Verified
1 Endorsed
San Marcos, TX 78666
Most Marriage and Family Therapists study systems. Even if an individual comes alone to a counseling session, they bring many influences. My role is to help you find your unique path amid the many voices, and become your best self. I have observed that almost everyone has had a time where they wondered if they have all the necessary life tools to move in a positive direction. Utilizing a safe environment, individual creativity and resources, I have seen people truly Become.
Most Marriage and Family Therapists study systems. Even if an individual comes alone to a counseling session, they bring many influences. My role is to help you find your unique path amid the many voices, and become your best self. I have observed that almost everyone has had a time where they wondered if they have all the necessary life tools to move in a positive direction. Utilizing a safe environment, individual creativity and resources, I have seen people truly Become.
![Photo of Emily Sousa, LPC, CEC](https://photos.psychologytoday.com/357df75f-a675-4783-8a49-2545215a37fa/1/320x400.jpeg)
Many of us are taught to disregard the messages our bodies and emotions carry, initiating a distrusting and confusing relationship with ourselves and others. My work often focuses on giving you the tools and felt experience to release trauma from your nervous system, create inner safety, connect to agency, establish healthy boundaries, and re-connect to your intuition. Together we’ll work to (re)discover your relationship with your true inner voice. Through this connection and awareness, you can learn to trust yourselves and navigate through life’s obstacles and challenges with flexibility and resilience.
Many of us are taught to disregard the messages our bodies and emotions carry, initiating a distrusting and confusing relationship with ourselves and others. My work often focuses on giving you the tools and felt experience to release trauma from your nervous system, create inner safety, connect to agency, establish healthy boundaries, and re-connect to your intuition. Together we’ll work to (re)discover your relationship with your true inner voice. Through this connection and awareness, you can learn to trust yourselves and navigate through life’s obstacles and challenges with flexibility and resilience.
![Photo of Meghan Burgess, LCSW, LCDC, Clinical Social Work/Therapist](https://photos.psychologytoday.com/7c1b4c8e-7029-46be-9e66-a1e3ec5fd9c2/3/320x400.jpeg)
Do you ever feel like you're living for other people? Are your relationships wearing you down? Do you find yourself in sabotage cycles that keep you stuck, in shame, and feeling as if you can't access a life that feels authentic to you? Do you feel like something is off in your life, but can't figure out what? If so, I am eager to meet you! I pride myself in working with people who, through experiencing deep pain and dissatisfaction in their life, feel ready to dig deep, gain clear insight on what's blocking them from their true desires in life, and start re-creating a life of authenticity, freedom, self-compassion, and confidence.
Do you ever feel like you're living for other people? Are your relationships wearing you down? Do you find yourself in sabotage cycles that keep you stuck, in shame, and feeling as if you can't access a life that feels authentic to you? Do you feel like something is off in your life, but can't figure out what? If so, I am eager to meet you! I pride myself in working with people who, through experiencing deep pain and dissatisfaction in their life, feel ready to dig deep, gain clear insight on what's blocking them from their true desires in life, and start re-creating a life of authenticity, freedom, self-compassion, and confidence.
![Photo of Amy Birchill Lavergne, MEd, LMFT-S, LPC-S, CTMH, CCATP, Marriage & Family Therapist](https://photos.psychologytoday.com/c64578d3-07ee-4d51-946d-c4c3ecd82bfa/2/320x400.jpeg)
Amy Birchill Lavergne
Marriage & Family Therapist, MEd, LMFT-S, LPC-S, CTMH, CCATP
Verified Verified
1 Endorsed
San Marcos, TX 78666
Have you decided to make positive changes in your life, relationship, family? Are you feeling stuck or overwhelmed? I can help. I believe that we all have strengths and my job is to help people achieve their goals by using their strengths. Everyone needs support at some point in their lives. Whether it's a loss - death or divorce, relationship distress, difficulty making a big decision, anxiety caused by a life transition, parenting a child experiencing behavioral challenges, no matter what the circumstance, it's okay to talk to someone who is trained to provide support and assistance.
Have you decided to make positive changes in your life, relationship, family? Are you feeling stuck or overwhelmed? I can help. I believe that we all have strengths and my job is to help people achieve their goals by using their strengths. Everyone needs support at some point in their lives. Whether it's a loss - death or divorce, relationship distress, difficulty making a big decision, anxiety caused by a life transition, parenting a child experiencing behavioral challenges, no matter what the circumstance, it's okay to talk to someone who is trained to provide support and assistance.
![Photo of Amy Donegan Bethel, MA, LMFT, LPC, Licensed Professional Counselor](https://photos.psychologytoday.com/8171c0d5-3487-46f6-8990-8a5df1ad379a/3/320x400.jpeg)
Amy Donegan Bethel
Licensed Professional Counselor, MA, LMFT, LPC
Verified Verified
San Marcos, TX 78666
Unavoidable tragedies occur. We make choices we regret. Opening up to a stranger in therapy can seem so unsettling that we wait until it is a last resort. But with a qualified therapist, we can cultivate something purposeful from even the most painful of experiences. While transforming our futures, we are transforming our past experiences. Therapy is magical, mystical, effective - and surprising. Dare to envision yourself in more hopeful circumstances, to discover what you want, and - to CREATE what you have never believed is possible. Let me help. Lean on my faith - until you find yours.
Unavoidable tragedies occur. We make choices we regret. Opening up to a stranger in therapy can seem so unsettling that we wait until it is a last resort. But with a qualified therapist, we can cultivate something purposeful from even the most painful of experiences. While transforming our futures, we are transforming our past experiences. Therapy is magical, mystical, effective - and surprising. Dare to envision yourself in more hopeful circumstances, to discover what you want, and - to CREATE what you have never believed is possible. Let me help. Lean on my faith - until you find yours.
![Photo of Jaclyn Conte, MS, LMFT-S, Marriage & Family Therapist](https://photos.psychologytoday.com/08a17e9c-4f60-47ed-956d-d7f74ef85b20/3/320x400.jpeg)
Jaclyn Conte
Marriage & Family Therapist, MS, LMFT-S
Verified Verified
1 Endorsed
San Marcos, TX 78666 (Online Only)
Hi! I’m Jaclyn and I’m ready to offer you a fresh perspective on therapy. Using the most progressive, research-based techniques we’ll get you moving in the direction you want to go. Let’s find the patterns that are keeping you from achieving your relationship, career, and personal goals.
Hi! I’m Jaclyn and I’m ready to offer you a fresh perspective on therapy. Using the most progressive, research-based techniques we’ll get you moving in the direction you want to go. Let’s find the patterns that are keeping you from achieving your relationship, career, and personal goals.
![Photo of Sarah Picken, Clinical Social Work/Therapist](https://photos.psychologytoday.com/c8181bbe-5684-4080-bb1f-fe0eb366baa3/3/320x400.jpeg)
Whether it is your first time in therapy or a you are a lifelong therapy fan, I strive to make everyone feel comfortable and accepted in my (virtual) office. In therapy sessions, I am flexible to client’s needs both in their goals and how they want to get there. I have some clients who prefer to be more structured and practice certain skills while I have other clients who prefer to make the session feel more like a free-flowing conversation. Some issues that I speciailze in are PTSD, Anxiety, Depression, veteran's issues, and life adjustment issues.
Whether it is your first time in therapy or a you are a lifelong therapy fan, I strive to make everyone feel comfortable and accepted in my (virtual) office. In therapy sessions, I am flexible to client’s needs both in their goals and how they want to get there. I have some clients who prefer to be more structured and practice certain skills while I have other clients who prefer to make the session feel more like a free-flowing conversation. Some issues that I speciailze in are PTSD, Anxiety, Depression, veteran's issues, and life adjustment issues.
![Photo of Michele Brower, LPC-S, CCTP-II, Licensed Professional Counselor](https://photos.psychologytoday.com/83343f56-d1df-4453-beda-e26168690d91/3/320x400.jpeg)
Michele Brower
Licensed Professional Counselor, LPC-S, CCTP-II
Verified Verified
San Marcos, TX 78666 (Online Only)
Have you experienced trauma or attachment wounding? Are you in a constant state of fight or flight or dissociation and shut down? Does your nervous system feel like your enemy? Traumatic events affect people in very different ways. One thing is certain though; trauma is stored in your body and affects your mind, body, memory, mood, spirit, and relationships with yourself and with others. There is a way to befriend your nervous system, effectively heal your past wounds, cope with your current triggers, and discover your own personal post-traumatic growth and resiliency for the future.
Have you experienced trauma or attachment wounding? Are you in a constant state of fight or flight or dissociation and shut down? Does your nervous system feel like your enemy? Traumatic events affect people in very different ways. One thing is certain though; trauma is stored in your body and affects your mind, body, memory, mood, spirit, and relationships with yourself and with others. There is a way to befriend your nervous system, effectively heal your past wounds, cope with your current triggers, and discover your own personal post-traumatic growth and resiliency for the future.
More Therapists Nearby
![Photo of Dr. Maritza P Rodriguez, LPC-S, CCST, Licensed Professional Counselor](https://photos.psychologytoday.com/83675bc1-0604-4fbe-b37f-9b7bea98aac0/2/320x400.jpeg)
Dr. Maritza P Rodriguez
Licensed Professional Counselor, LPC-S, CCST
Verified Verified
Kyle, TX 78640
My philosophy begins inside the heart of my clients. As a former elementary teacher, I learned the valuable lesson that my kids will never care what I know or had to teach them until they knew I cared about them. This lesson is applicable in so many instances, and especially when I counsel. I enjoy getting to know every child that I work with. I want to know them as a person, and especially what they enjoy most. That is one reason why I am passionate about play therapy. This technique incorporates what children love most, which is often to play, and in doing so, they are more at ease to have meaningful conversations.
My philosophy begins inside the heart of my clients. As a former elementary teacher, I learned the valuable lesson that my kids will never care what I know or had to teach them until they knew I cared about them. This lesson is applicable in so many instances, and especially when I counsel. I enjoy getting to know every child that I work with. I want to know them as a person, and especially what they enjoy most. That is one reason why I am passionate about play therapy. This technique incorporates what children love most, which is often to play, and in doing so, they are more at ease to have meaningful conversations.
Online Therapists
![Photo of Marjorie Nelch, Marjorie Nelch, MA, LMHC, LPC, Counselor](https://photos.psychologytoday.com/99c8ed06-dc87-400e-b20e-d1f7b0d6b759/2/320x400.jpeg)
Marjorie Nelch
Counselor, Marjorie Nelch, MA, LMHC, LPC
Verified Verified
3 Endorsed
Austin, TX 78741 (Online Only)
I use a mix of Person-Centered therapy, Interpersonal, Cognitive Behavioral, and Art/Music Therapy.
Do you struggle with distressing thoughts, feelings, or relationships? I view these problems as both present and past, meaning what we learn early in life may be unknowingly affecting the way we behave in the present. The counseling process can help to illuminate personal strengths, goals, and solutions to fit your unique story and personal desires.
I use a mix of Person-Centered therapy, Interpersonal, Cognitive Behavioral, and Art/Music Therapy.
Do you struggle with distressing thoughts, feelings, or relationships? I view these problems as both present and past, meaning what we learn early in life may be unknowingly affecting the way we behave in the present. The counseling process can help to illuminate personal strengths, goals, and solutions to fit your unique story and personal desires.
![Photo of Leslie Woodworth, MSW, LCSW, Clinical Social Work/Therapist](https://photos.psychologytoday.com/3ed5507c-46cd-11ea-a6ad-06142c356176/2/320x400.jpeg)
Leslie Woodworth
Clinical Social Work/Therapist, MSW, LCSW
Verified Verified
1 Endorsed
Austin, TX 78759
I use art therapy, have a dance background, and utilize my movement knowledge to inform me.
I have a loving, direct approach with clear communication, a relaxed, non-judgmental style creating ease in therapy, and an intuitive ability to connect and help others re-connect. I love working with people who seek to deepen themselves and have more intimate connection with their loved ones, whether that's a child, spouse, parent or other relationship. I want to know who you are, and am here to listen and to be with you exactly where you are in this process. I am here to meet you. Come. Let's explore together.
I use art therapy, have a dance background, and utilize my movement knowledge to inform me.
I have a loving, direct approach with clear communication, a relaxed, non-judgmental style creating ease in therapy, and an intuitive ability to connect and help others re-connect. I love working with people who seek to deepen themselves and have more intimate connection with their loved ones, whether that's a child, spouse, parent or other relationship. I want to know who you are, and am here to listen and to be with you exactly where you are in this process. I am here to meet you. Come. Let's explore together.
See more therapy options for San Marcos
Nearby Art Therapy Searches for San Marcos
- Austin
- Bee Cave
- Buda
- Cibolo
- Dripping Springs
- Garden Ridge
- Kyle
- New Braunfels
- Schertz
- Seguin
- West Lake Hills
- Wimberley
Art Therapy
How does art therapy work?
The process of making art allows people to express themselves. Art-making can take many forms, such as painting, collage, or sculpting. The therapist asks questions that the work elicits, such as how the person felt while creating their piece, or if any memories surfaced that they can discuss. The therapist will then work with the patient to process their experience, understand themselves better, and work toward change.
Does art therapy help with trauma?
Art therapy can be a valuable treatment option for those suffering from trauma. Traumatic experiences such as combat, rape, or childhood abuse can be so painful that articulating them can be too scary or painful; creating art allows people to express themselves without words, and tell their story in a different way. The physical nature of creating art can also help people feel rooted in the body, which may benefit those who feel disconnected from their body in the aftermath of trauma.
How long does art therapy last?
The duration of art therapy varies, but a common length for treatment is 10 to 15 weekly sessions. Some people may see improvement in just a few weeks, while others may choose to remain in therapy longer term. Patients should periodically discuss their goals with their therapist to make sure the two are aligned on process and progress.
What are the limitations of art therapy?
Art therapy is helpful for many people, but a limitation is that it doesn’t have as robust an evidence base as other forms of therapy, such as cognitive behavioral therapy or acceptance and commitment therapy. The evidence on art therapy is mixed; some research demonstrates its benefits, while other research suggests that it has little impact on patients.