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Ivan Pavlov was a Russian physiologist best known in psychology for his discovery of classical conditioning. During his studies on the digestive systems of dogs, Pavlov noted that the animals salivated naturally upon the presentation of food.

However, he also noted that the animals began to salivate whenever they saw the white lab coat of an experimental assistant. It was through this observation that Pavlov discovered that by associating the presentation of food with the lab assistant, a conditioned response occurred. Pavlov was also able to demonstrate classical conditioning in his subjects by associating food with sound of a tone.

Learn more about Ivan Pavlov and his contributions to the field of psychology.

Overview

Pavlov discovered classical conditioning in the 1890s and published his results in 1897. The discovery had a reverberating influence on psychology. Pavlov’s discovery had a major influence on other thinkers including John B. Watson and contributed significantly to the development of the school of thought known as behaviorism.

Take a closer look at Ivan Pavlov’s life and career in this brief biography.

Early Life

Ivan Petrovich Pavlov was born on September 14, 1849, in the village of Ryazan, Russia, where his father was the village priest. His earliest studies were focused on theology, but reading Charles Darwin’s On the Origin of the Species had a powerful influence on his future interests.

He soon abandoned his religious studies and devoted himself to the study of science. In 1870, he began studying the natural sciences at St. Petersburg University.

Career

Pavlov’s primary interests were the study of physiology and natural sciences. He was a founder of the Russian Physiological Society and also served as its first president, a position he held for 19 years. 

“Science demands from a man all his life. If you had two lives that would not be enough for you. Be passionate in your work and in your searching,“ Pavlov once suggested.

So, how did his work in physiology lead to his discovery of classical conditioning?

Ivan Pavlov’s Discovery of Classical Conditioning

While researching the digestive function of dogs, he noted his subjects would salivate when they saw the person who was delivering food. In a series of well-known experiments, he presented a variety of stimuli before the presentation of food, eventually finding that, after repeated association, a dog would salivate to the presence of a stimulus other than food.

Pavlov received considerable acclaim for his work, including a 1901 appointment to the Russian Academy of Sciences and the 1904 Nobel Prize in Physiology. The Soviet government also offered substantial support for Pavlov’s work, and the Soviet Union soon became a leading center of physiology research.

He died on February 27, 1936.

Ivan Pavlov’s Contributions to Psychology

Many outside of psychology may be surprised to learn that Pavlov was not a psychologist at all. Not only was he not a psychologist; he reportedly was skeptical of the emerging field of psychology altogether.

However, his work had a major influence on the field, particularly on the development of behaviorism. His discovery and research on reflexes influenced the growing behaviorist movement, and his work was often cited in John B. Watson’s writings.

Other researchers utilized Pavlov’s work in the study of conditioning as a form of learning. His research also demonstrated techniques of studying reactions to the environment in an objective scientific method.

Select Publications

One of Pavlov’s earliest publications was his 1897 text The Work of the Digestive Glands, which centered on his physiology research.

Later works that focused on his discovery of classical conditioning include his 1927 book Conditioned Reflexes: An Investigation of the Physiological Activity of the Cerebral Cortex and Lectures on Conditioned Reflexes: Twenty-five Years of Objective Study of the High Nervous Activity (Behavior) of Animals which was published one year later.

Trauma shock is any sudden, terrible experience that disrupts your well-being and overwhelms you. A traumatic experience can shock your system, causing you to go into a state of dissociation, where your body and mind feel disconnected and nothing feels real.

Your brain resorts to this adaptive defense mechanism when trying to cope with stressful or overwhelming events that it cannot prevent or escape. Shock helps reduce your awareness of your physical or emotional pain by dulling your senses, making you numb, and reducing your conscious cognizance of the event.

Symptoms of Traumatic Shock

Trauma can cause a wide range of physical and emotional symptoms. However, every individual reacts to it differently.

Physical Symptoms

These are some of the physical symptoms that may accompany traumatic shock:

• Chills
• Dizziness
• Shakiness
• Lightheadedness
• Unconsciousness 
• Nausea
• Vomiting
• Stomach pain
• Rapid heartbeat
• Headache
• Muscle tension
• Elevated blood pressure
• Rapid, shallow breathing

Emotional Symptoms

These are some of the emotional symptoms that may accompany traumatic shock:

• Fear
• Panic
• Denial
• Anxiety
• Anger
• Irritability
• Helplessness
• Brain fog
• Confusion
• Disorientation 
• Numbness 
• Withdrawal 
• Emotional outbursts
• Inability to concentrate
• Difficulty making decisions
• Decreased awareness of surroundings
• A feeling of being unsafe

Afterward, it’s not uncommon for the person to be preoccupied with the event, forget it entirely, or have flashbacks or nightmares of it.

What Causes Traumatic Shock?

While anything that significantly disrupts your emotional equilibrium can be considered a traumatic event, these are some examples of events that can cause traumatic shock:

Types of Traumatic Shock

Traumatic shock can be categorized into different types, depending on how it affects the brain and body.

Dissociative Shock

Traumatic events can sometimes cause a person to go into shock and disconnect from either themselves or the people around them. People who experience dissociative shock may feel disconnected from reality, suffer memory loss, or develop dissociative disorders.

Medical Trauma

Certain physical injuries or illnesses can be traumatic for the body and cause the person to go into a state of shock. These are the different types of shock, medically speaking:

• Hypovolemic shock is marked by severe blood and fluid loss, which can make it difficult for the heart to pump blood and in turn, cause vital organs to stop functioning.
• Distributive shock is characterized by abnormalities in the blood vessels that distribute blood around the body, which can lead to low blood pressure.
• Cardiogenic shock, often caused by a heart attack, occurs when the heart isn’t able to pump blood to the rest of the body. It is also known as cardiac shock.
• Neurogenic shock is caused by spinal cord injuries that can damage the nervous system and interfere with blood flow.

While these types of shock are medical conditions, they can also affect us emotionally and vice versa because the body and mind are interlinked. 

For instance, someone who has been shot at or been in a car accident may have severe blood loss and go into hypovolemic shock; however, they may also sustain severe emotional trauma. Similarly, someone who receives devastating news or experiences a trauma may have a heart attack and go into cardiac shock.

Diagnosing Traumatic Shock

The healthcare professional will assess your condition and symptoms, perform any tests or exams required, diagnose your condition and its severity, refer you to a specialist if needed, and chart out a treatment plan for you.

Depending on your symptoms and the amount of time it has been since the traumatic event, you may be diagnosed with:

• Acute stress disorder (ASD): ASD is a mental health condition that can occur in the first month after a traumatic event.
• Post-traumatic stress disorder PTSD): PTSD is a mental health condition where the symptoms of trauma persist for months after the traumatic event.
• Dissociative disorders: These are a group of disorders characterized by a feeling of dissociated from reality.

How Is Emotional Trauma Treated?

The emotional effects of trauma are best treated by healthcare providers who specialize in trauma-informed care, which takes a different approach from other types of mental healthcare. Trauma-informed care recognizes the need for healthcare providers to understand the person’s life experiences to deliver effective care.

Treatment for emotional trauma may involve:

• Medication to alleviate symptoms
• Trauma-focused therapy to help you process the painful events and develop coping strategies

Depending on the circumstances, treatment may be administered on an inpatient, outpatient, or partial hospitalization basis.

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Coping With Traumatic Shock

These are some coping strategies that can help you if you are dealing with a traumatic event that has shocked you:

• Seek social support: Reach out to loved ones you feel safe and comfortable with. While you might be tempted to withdraw, having the support of loved ones is essential as you recover.
• Practice self-care: Prioritize your physical and emotional needs. Do things that provide comfort. Get regular sleep, watch a favorite show, take baths, read a book, or anything else that helps you feel cared for.
• Give yourself time: Understand that healing from trauma takes time. Don’t set unrealistic expectations for yourself or compare yourself to others.
• Seek help and treatment if you need it: Remember that there are trained professionals who can help you and that recovery is possible.

Keep in Mind

A traumatic event can send you into a state of shock, particularly if it takes you by surprise and you are unable to process it. Traumatic shock is a defense mechanism that helps protect your brain and body. 

Traumatic shock can be accompanied by a range of physical and emotional symptoms, such as numbness, confusion, disassociation, dizziness, and rapid heartbeat. It is usually short-lived, but can feel a lot longer.

If you are struggling to deal with the trauma, you can seek help from a licensed healthcare professional, who can help you process it and equip you with the skills you need to cope.

Children in foster care are facing tremendous hardships. The simple act of leaving home is a traumatic experience, but this is just the beginning for children entering the welfare system. Many have been removed from their home due to abuse or neglect. Many are forced to adapt to constantly changing environments, as they are bounced from home to home. Some are returned to their biological family after a short-term placement, only to be reentered back into the system. 

Living in foster care is challenging, no matter the situation, and this experience can have a negative impact on a children’s mental and behavioral health.

While the goal of foster care is to provide children with a safe and nurturing temporary home until they can be reunited with their biological family or given permanent placement, the reality is that more than 20,000 foster care children age out of the system on an annual basis before this happens.

The Effects of Early Childhood Trauma

In many foster care cases, children are removed from their biological home due to maltreatment, abuse, or neglect, which means the child has likely experienced physical, emotional, or psychological trauma.

Even if a child is taken out of their home for other reasons—a parent is sent to prison, both parents have died, a parent is battling a substance use disorder—they are still dealing with a traumatic event that can have serious mental health implications. 

“In foster care, children are often moved around a lot and have to interact with multiple people in their journey. With instability comes loss, and loss is always part of foster care starting with the removal or separation of the child from their first family,” says Ebony E. White, PhD, LPC, NCC, ACS. Children endure a constant ‘starting over’ process in the system, which can cause problems with attachment and detachment, impacting the child’s ability to form and maintain healthy relationships. 

Without support or the proper treatment, children in foster care may have a hard time processing, understanding, and recovering from their circumstances, and this can cause physical, mental, and emotional symptoms that can extend into adulthood.

Mental Health Disorders Associated With Foster Care 

Foster care children are among the most vulnerable in the world, so it’s no surprise that the majority face mental and behavioral health problems. When you’re taken out of your home by a stranger and placed in a new home or congregate setting with more strangers, you’re bound to experience anger, confusion, fear, and distrust. 

When placed into another home, many children in foster care ask the following questions, according to John DeGarmo, EdD, founder of The Foster Care Institute: Why am I here? Did I do something wrong? Do my parents not love me anymore? How long will I be here?

Common mental health disorders seen among foster care youth include:

It’s also common for foster care children to experience comorbid disorders and engage in high-risk behaviors such as violence, substance use, and delinquency.

They also face significant emotional difficulties, such as a lack of self-worth and the need to be in control, which can make it hard to establish healthy, loving relationships. 

Barriers Facing Long-Term Foster Care Youth

While some children are reunited with their biological family or adopted into a new family, many others age out of foster care and find themselves without the support they need to live independently. Youth leaving foster care, also called care leavers, suffer more with mental health and behavioral problems than non-fostered youth and are more likely to be incarcerated.

The transition to adulthood—and independent living—for foster care youth is extremely difficult, as many experience low levels of support, which leads to an increased risk of social exclusion, homelessness, unemployment, low education, financial difficulties and behavioral problems. This is especially true of LGBTQ+ youth, youth of color, and youth diagnosed with mental illnesses. 

In order to aid in this transition, we need to provide foster care youth with educational assistance, job training, housing placement, and financial support, as their biggest concerns often revolve around social drivers like housing, finances, employment, and access to health care.

Providing Mental and Behavioral Health Care and Support

Studies suggest that among the 40% of youth in foster care, up to about 80% exhibit a serious behavioral or mental health problem requiring intervention. The problem is that many mental health issues go unaddressed and untreated, and far too often, the children are blamed for their behavior rather than offered support and care. 

“Children need to have structure, boundaries, consistency, affection, and attention,” Dr. Ebony White explains.

Simply living in foster care, for any period of time, puts a child at a high risk of developing medical, behavioral, and/or emotional difficulties.

Children in foster care don’t always get their basic human needs met. A child may be experiencing homelessness, housing instability, food insecurity, financial hardship, maltreatment, or neglect, which prevents them from addressing and meeting other human needs like connectedness, intimacy, love, independence, and self-actualization. 

“It is important that children in foster care receive professional therapy and counseling services,” says Dr. DeGarmo. “Along with this, foster parents need to ensure that their child in care and in their home are provided security, safety, consistency, and feelings of being loved unconditionally. Foster parents must also be patient, understanding, compassionate, and non-judgmental in order for the child to heal and thrive.”

The loss of a loved one is one of the most painful experiences we’ll have in life. Bereavement refers to the state of having experienced the loss of a loved one. It most often refers to the time after a loss when emotions are at their most profound. This time is marked by intense grief and tremendous sorrow.

The term is sometimes used synonymously with grief and mourning. How people experience this time of grief can vary from one person to the next.

While bereavement is usually associated with death, it can also occur after other significant losses. The end of an important relationship or a major change in a person’s health, for example, can also lead to feelings of bereavement.

Symptoms of Bereavement

People may experience a wide range of symptoms during bereavement, including:

• Shock: The unexpected loss of a loved one can trigger physical and emotional symptoms that are triggered by the body’s stress response.
• Numbness: You may feel detached, isolated, and disinterested in anything around you.
• Guilt: You may feel guilty that you survived when someone else did not, or you may feel guilty about unresolved issues in your relationship with your loved one.
• Sadness: Intense sadness about the loss of your loved one is normal and expected.
• Crying: It’s normal to shed more tears than you normally do during this period of bereavement.
• Depression: The sadness brought on by a loss can also result in feelings of depression.
• Anger: You may also experience feelings of anger about the loss or even feel angry at your loved one for dying.
• Changes in appetite: You might eat less or more than usual.
• Difficulty sleeping: You may struggle to sleep or sleep much more than usual.
• Trouble concentrating: Bereavement can affect your ability to focus.

How Is Bereavement Diagnosed?

Bereavement is a normal response to loss and is in and of itself not a diagnosable condition recognized by the fifth edition of the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5-TR). However, it may sometimes play a part in the onset of other conditions, such as depression or anxiety.

“[The] DSM-5 recognizes that bereavement does not immunize the patient against major depression, and often precipitates it. Indeed, grief and depression—despite some overlapping symptoms, like sadness, sleep disturbance, and decreased appetite—are distinct constructs, and one does not preclude the other,” explained psychiatrist Ronald Pies in an article published in the journal Innovations in Clinical Neuroscience.

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What Causes Bereavement?

Bereavement is a response to loss. The circumstances that surround the loss, as well as the closeness of the relationship, can play a role in how intense the grief is that people experience. Some types of losses that can cause bereavement include:

• The death of a loved one: The loss of a family member or close friend can be one of the most difficult losses a person will face. In many cases, people must also cope with many different types of decisions related to the loss including making funeral arrangements and dealing with finances as they grapple with intense feelings of grief and sadness. 
• Anticipatory grief: This type of bereavement may occur when a loved one is dying. While the person is not gone yet, loved ones may still experience feelings of grief including sadness and anger as they prepare for the loss of their loved one.
• The loss of a beloved pet: Losing an animal companion can also trigger a period of bereavement. It can be a difficult transition and many people may struggle with feelings of deep sadness.
• Miscarriage: The loss of a pregnancy can also lead to feelings of grief and a period of bereavement. 
• A loss due to suicide: When someone dies by suicide, loved ones may be left struggling with feelings of shock and guilt. Because suicide is sometimes accompanied by stigma, those who are grieving may feel particularly isolated and unsupported.
• A change in health status: The onset of a chronic illness or a sudden change in a person’s health status can also lead to feelings of bereavement. People may experience feelings of fear, anger, anxiety, regret, and mourning as they face the new challenges presented by their condition.

It can occur when the loss is ambiguous, when there is a social stigma attached to the loss, or when a person’s relationship with the person who has died is not recognized or valued by others.

Types of Bereavement

Everyone experiences bereavement and grief differently. However, it often follows a predictable pattern that is often characterized as a normal response to loss. In other cases, people may experience more persistent symptoms that continue to interfere with their ability to function normally for a longer period of time.

Normal Bereavement

Feelings of grief and bereavement typically occur in a series of five stages:

• Denial: This stage is characterized by feelings of numbness, shock, and disbelief. People may refuse to accept the reality of the loss.
• Anger: During this stage, people may feel angry about the loss. These feelings may be directed at other people, at themselves, or even toward the individual who has died.
• Bargaining: This phase is often marked by appealing to a higher power for relief or a way to change the outcome. 
• Depression: During this stage, people tend to experience great sadness and feelings of depression. They often turn inward and withdraw socially.
• Acceptance: In the final stage of the bereavement process, people reach a point where they can accept the reality of the loss.

Psychiatrist Elisabeth Kubler-Ross introduced this stage model in 1969 to describe the process of bereavement following the loss of a loved one. However, she later adapted these stages to apply to other types of grief as well.

Complicated Grief

Bereavement is painful and can be exhausting. While it isn’t something that people “get over,” the intensity of these feelings of grief usually lessen gradually over time. Some people, however, experience a more persistent form of bereavement that is known as complicated grief. 

This form of bereavement is characterized by intense feelings of sadness and pain that persist for a longer period of time. People who are experiencing complicated grief may experience symptoms such as:

• Hopelessness
• Preoccupation with death 
• Feelings of detachment
• Social withdrawal and isolation
• Loss of interest
• Loss of sense of self

While it is not recognized as an official diagnosis by the American Psychiatric Association’s diagnostic manual, medical experts have suggested that complicated grief is characterized by symptoms of persistent, acute grief that last six months or longer.

Prolonged Grief Disorder

To recognize that long-lasting forms of grief deserve a clinical diagnosis, the American Psychiatric Association added a new condition to the trauma- and stressor-related disorders chapter in the DSM-5-TR (fifth edition, text revision), published in 2022. This condition is called prolonged grief disorder (PGD).

There is some controversy surrounding the pathologizing of grief into some form of mental illness. Some in the mental health community don’t support labeling grief as a medical condition, but rather, would rather address the fact that there is no “normal” when it comes to grieving, and its severity exists on a continuum.

Others claim that making grief an official medical condition allows those who experience extreme forms of it to better access treatment—such as therapy and medication if needed—through their insurance carriers.

Treatment for Bereavement

The experience of bereavement is a natural and inevitable part of life, albeit an incredibly painful part. It often temporarily affects a person’s ability to function normally and can affect nearly every aspect of an individual’s life.

For people who are struggling to cope, professional help may be beneficial. Types of treatment include:

• Bereavement therapy: Also known as grief counseling, this is a type of treatment designed to help people who are coping with a loss. You may speak about the circumstances surrounding your loved one’s death as well as your emotions related to the loss.
• Cognitive behavioral therapy (CBT): CBT works by helping people identify and change the negative thoughts that affect their mental well-being. CBT helps people learn how to make plans for the future, set goals for their recovery, and cope with their feelings about the death of their loved ones.
• Grief-specific cognitive behavioral therapy: This type of therapy uses techniques similar to CBT, such as changing negative thought patterns. However, grief-specific cognitive behavioral therapy also teaches ways to develop a healthy attachment to your lost loved one in a way that doesn’t negatively affect your life. It may be especially helpful for those with prolonged grief disorder.
• Interpersonal psychotherapy (IPT): IPT is often used to treat depression; however, it has shown promising results to help address symptoms of bereavement, particularly those associated with complicated grief. IPT focuses on building up your relationships and encourages involvement in activities you enjoy as part of your healing.
• Complicated grief treatment (CGT): CGT combines elements of CBT and IPT. You will share the story of how you lost your loved one, work on building up healthy relationships, and set personal goals for yourself and your recovery.

Support groups can also be a helpful place to explore difficult emotions and find social support from people who have had similar experiences.

Coping During Bereavement

Some things that you can do when you are bereaved include:

• Showing yourself acceptance when you are dealing with strong or difficult emotions
• Talking about the loss with others
• Finding support from friends, family, and others
• Caring for yourself by getting enough rest, eating healthy meals, and staying physically active
• Celebrating and remembering your loved one

There are a number of different factors that can influence how people cope with bereavement. Access to support, maturity levels, experience with past losses, and the nature of the relationship can all affect how a person manages the loss.

Your own beliefs about death, religious upbringing, and cultural factors may also influence the bereavement and grieving process. A sudden, unexpected, or traumatic loss can also affect how people cope in the aftermath.

In such cases, consider seeking professional help. It can be a great way to get the extra support you need to cope with the loss and the emotions you are experiencing.

Psychoeducation is a therapy intervention that involves the therapist providing their client with information about their diagnosis, symptoms, or the method of treatment used. It is more than simply sharing information with the client; psychoeducation refers to a structured and specific method of providing knowledge.

The goal of psychoeducation is to help the client understand and cope with their diagnoses as well as improve treatment adherence, as clients who understand their treatment are better able to follow through on recommendations.

When Did Psychoeducation Become Important in Psychology?

Early psychotherapies did not emphasize client education. It was not considered important to educate the client about their diagnosis because the therapist is the expert, not the client. However, this view has become dated, as many therapists currently recognize the client’s expertise in their own life and experience.

Physicians began using psychoeducation to help clients understand their treatment and improve adherence in the early 1900s. In mental health, the researcher C M Anderson first introduced using psychoeducation with clients diagnosed with schizophrenia. The research looked at the impact of providing education to family members to improve treatment outcomes.

Although this research emphasized teaching family members rather than clients directly, this intervention marked a shift in treatment approaches by making the family members active participants in treatment.

Types of Psychoeducation

Depending on the type of treatment and specific goals, psychoeducation can take on different forms.

Psychoeducation can also mean teaching clients specific coping skills that they can use to manage their symptoms. When developing coping skills, clients can follow through and use skills most successfully if they understand why the skill might be helpful and how it works.

It’s easier for clients to stick to a plan or a regimen when they don’t feel as though what they are doing is arbitrary and they understand the why and the how of the recommendation.

A therapist can also provide psychoeducation to family members when appropriate. For example, if the client is a child, therapists often educate parents about appropriate discipline or how the child’s symptoms might interfere with their learning.

Parents might not recognize how their parenting style contribute to the child’s mental health or behavioral concerns, and psychoeducation can help them develop appropriate and effective skills.

Is Psychoeducation Effective?

Psychoeducation is an important component of treatment, as it has been found to improve treatment outcomes for a wide variety of diagnoses.

Although research is still emerging, psychoeducation has been linked to improved treatment compliance and outcomes for stress, depression, and anxiety. Furthermore, psychoeducation has been found to improve social skills and behavior management in people with Attention-Deficit/Hyperactivity Disorder (ADHD).

For clients with schizophrenia, a combination of mindfulness and psychoeducational interventions can reduce psychotic symptoms, improve insight and reality testing, and increase attention and emotion regulation.

Not only is psychoeducation an effective treatment on its own, research suggests that it is comparable to other evidence-based therapy interventions.

In fact, some research found that a psychoeducation control group was more effective in alleviating symptoms in individuals with bipolar disorder compared to cognitive-behavioral therapy.

How Psychoeducation Is Used in Therapy

When a provider diagnoses a client, they should also educate the client about their diagnosis, how the diagnosis accounts for the symptoms that brought them for treatment, and what their treatment options are.

Psychoeducation is often used as a component of motivational interviewing, a client-centered and evidence-based therapy intervention. In motivational interviewing, the therapist helps the client articulate their understanding of the problem and provides education about the possible consequences as well as how to make manageable, sustainable changes.

Motivational interviewing is collaborative and involves helping the client identify their level of willingness to change and what resources they have that can support these changes. It also emphasizes identifying specific, measurable, and attainable goals that fit with the client’s values.

Psychoeducation Empowers the Client

When a therapist uses psychoeducation with a client, they are not telling the client what they must do or even what they ought to do. Instead, psychoeducation involves giving the client accurate information about their diagnosis and treatment options. The client can use this information to make their own decision about how they will engage with their care.

Once the client has this information, they might not choose the treatment options that the therapist thinks are best. Instead of pushing the client to do what the therapist thinks is best, psychoeducation empowers the client to make their own decisions about how to move forward.

Impact of Psychoeducation

Clients who are armed with accurate information and knowledge are in a position to make decisions about their care, and clients who are empowered to make these decisions for themselves will be able to continue advocating for themselves even after therapy has ended.

Psychoeducation is not a one-time conversation. Clients might have more questions as new symptoms emerge or as their situation changes. The client should feel comfortable asking questions and feel that the therapist will provide them with accurate information in a non-judgmental environment.

Psychoeducation Limits Misinformation From Non-Reputable Sources

Educating clients about their diagnosis and treatment options can prevent them from finding incorrect or harmful information from disreputable sources.

After receiving a diagnosis, many people want to know more and understand, which can lead them to search the internet for information. It can be difficult to vet sources this way, and misinformation is rampant. Appropriate psychoeducation can prevent this.

Finally, psychoeducation can build the therapeutic relationship. Clients learn that they can trust their therapist to provide them with accurate information as well as listen to and address their concerns. This connection and trust are the foundation for progress in treatment.