Exploring counselling and in what settings it might be used? Exploring longer-term therapeutic relationships with psychotherapy

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Unit 1 Defining Counselling and Psychotherapy: The Necessity of Clinical Supervision

This unit is mandatory.

Introduction

Exploring counselling and in what settings it might be used? Exploring longer-term therapeutic relationships with psychotherapy

Welcome to the Advanced Counselling Diploma.

Counselling and psychotherapy is an art. The art of counselling and psychotherapy can be used creatively to help people who are in distress or struggling to understand difficulties, and looking to make major changes in their lives.

Throughout this course, you will learn about the different theories that underpin how counsellors help their clients. You will build on your knowledge of previous courses and/or previous work experiences. You will learn more about the importance of boundaries within the counselling setting, and how the law applies to counselling (within the UK). In addition to the content in this course, much of what you will learn as a counsellor will be within the counselling room, working directly with clients.

You will find a list of recommended reading at the end of some of the units. These titles are suggested to help improve your theoretical understanding and how you can relate it to your client work.

Throughout this course, you will see that we have used the terms ‘therapist’ and ‘counsellor’. Both words are interchangeable, but both words essentially have the same meaning for the purposes of this course.

Unit 1

Learning Outcomes

By the end of this unit, the learner will be able to distinguish between Counselling and Psychotherapy, short-term and long-term therapeutic relationships. In addition, the learner will be able to demonstrate how he/she can use supervision for the benefit of therapeutic work.

The learner will explore the necessity of clinical supervision and challenge ways in which it differs from management meetings? The learner will develop an insight into giving and receiving feedback.

Other Requirements

It is advisable at this level of your training that you will have already a student placement with an agency; such as the Terrence Higgins Trust, Place2Be, Cruse Bereavement Care or Victim Support, to name but a few. Perhaps you will already be seeing clients and participating in regular clinical supervision. This is important as you will be applying the theory you learn directly during sessions with clients. During your client work and the subsequent supervision, you will also learn about practical ways of working with your clients so that you can help them address conscious and unconscious needs, which can then produce changes in emotional and cognitive processes and behaviours.

If you are not already seeing a therapist, personal counselling for yourself is advisable; in fact, many agencies insist you undertake personal counselling as part of the agreement you will sign with them before starting your placement. A counsellor or psychotherapist needs a good understanding of themselves and their psychological ‘make-up’, so that they are aware when they are reacting on a personal level and to ‘stuff’ that belongs to the client rather than belonging to the counsellor. This is what Freud called countertransference. We will look at self-awareness later in the course. For this reason, it is important that anyone training as a counsellor or psychotherapist undergoes an extensive period of therapy themselves. This is vital so that as a trainee you have a place to talk over difficult thoughts and feelings of a personal nature. It is important that the therapist does not act out thoughts and feelings with a client in the therapy room. It is also crucial that you have had personal experience of what it is like to be in therapy - to be the client sitting in front of the counsellor, opening up about personal and private thoughts, feelings and situations and reflecting on these in detail.

The 100 hours voluntary placement is not complusory to complete and gain certification of this course. However, in order to become accreditied with the ACCPH, members will need to complete the required  hours and for these to be recorded and suportted through monthly supervision.

As a trainee therapist, it is vital that you work with an experienced and accredited supervisor. As a minimum, you should have no less than 1.5 hrs of supervision (one-to-one) per month for a light caseload. The more clients you are seeing, the more supervision you should have. If you want to work towards accreditation after your training, then you are advised to look at the membership organisation’s rules on supervision and counselling hours. The number of monthly supervision hours you need for each client to claim these counselling hours as part of your accreditation will be determined by the rules of the membership organisation you join. 

Keeping Evidence

When using your client work as evidence to meet criteria for your coursework, you need to change or anonymise the names of your clients. This is to protect their confidentiality.

 You need to keep a record of any hours and supervision you engage in throughout this course. This is in case you want to use it to achieve acceditation during this course; also in the future, if you want to apply to be a member of one of the membership organisations.

Supervision and Self-Reflection All counsellors and psychotherapists, as well as supervisors, need to have regular and ongoing formal supervision to cover their clinical work. The considerable demands that therapeutic work places on therapists make it imperative for counsellors to have an ‘outlet’ for their professional work. Without supervision, there is a risk that the therapist may become over-involved with a client he or she is counselling.

Counselling and psychotherapy, at their core, are based on the idea of being self-reflective. Self-reflection helps to build self-awareness. By taking some time to think about yourself - and by asking yourself the important questions that come up through your client work and what you are learning during this course - you can gain a better understanding of your emotions, strengths, weaknesses and driving forces. When writing your assignments at the end of each unit, you will find you will gain the most from your experiences by self-reflection, and by looking at how you can apply the theory to yourself.

By the end of this course, you will have a thorough understanding of and be capable of:

  • Working ethically and safely with clients;
  • Developing your awareness of the client-counselling relationship;
  • Working with diversity and difference;
  • Identifying and focussing on the needs of your clients and working reflectively as a counsellor. 

“Love your enemies, for they tell you your faults.” – Benjamin Franklin

“Your vision will become clear only when you can look into your own heart. Who looks outside, dreams; who looks inside, awakes.”

– Carl Jung

“Know yourself.” – Delphic maxim at Delphi

Within each unit, you will see a series of reflective questions. You do not need to submit the answers to these reflective questions; instead they are an opportunity for you to think more about, and how best to apply, the information you are reading. As part of your learning, it is important keep a reflective journal. This will be a place where you can undertake reflection on your learning, your personal and professional development. You can use this reflective journal to demonstrate you have met certain criteria.

Reflection: Why else might it be important as a counsellor to be self-reflective?

“All clients come to counselling because they want to change something. Recent research has demonstrated that counselling works when the client instigates change supported by a particular kind of therapeutic environment in which the counsellor utilises not just their theoretical understandings and skills, but also [utilises] themselves and the counselling relationship, together with an ethical and reflective approach to their work.” (Ballantine Dykes, Postings, Kopp & Crouch: 2017, p.5)

Defining Counselling and Psychotherapy

Counselling gives people the opportunity to talk about their thoughts and feelings with a specially trained professional.

It is user-focussed and gives people, regardless of their background, the chance to think about their choices and the behaviour that is causing them a problem. Most importantly, counselling can potentially help people to make positive changes in their lives.

Counselling or psychotherapy can be a private arrangement between a client and a counsellor. Within organisations such as the NHS, it is used to help people foster good health and wellbeing.

Clients who seek counselling are looking to resolve difficult and distressing events in their lives. This could be anything from a job loss or bereavement, to underlying feelings of dissatisfaction with life.

Increasingly, many people feel they have no one to talk with about difficulties because family members are not living close by, there is a lack of closeness within the family unit, or there has been a breakdown in communication with family members. Often clients are reluctant to talk with friends as they do not want to burden them with their problems. Talking with a professional who is independent, and who is not emotionally involved, is what many clients are looking for.

Counselling and psychotherapy are both formal relationships between a professional therapist and a client. However, counselling can also take place with couples, with family members or with other groups, such as colleagues or those sharing similar experiences.

Counselling can happen in a variety of settings, including within schools, colleges and universities, GP surgeries and hospitals, in the workplace, addiction agencies and support groups, or privately on an individual basis.

Other Professions Using Counselling Skills

Many professions, including teachers, nurses and religious ministers, might use counselling skills within their daily work, particularly as they often help people dealing with very difficult issues. In these circumstances, the application of these skills would be different from traditional counselling as it would be more a listening situation rather than a therapy situation.

A helpline advisor using counselling skills can demonstrate to a helpline caller that they have a deep understanding, and are truly listening to what is being said.

If the therapist is working within an organisation, it is likely that the client will have already been assessed by a more experienced counsellor or psychotherapist. This means that when the client comes into counselling they have already had an initial counselling assessment session. During this assessment, the experienced counsellor will ensure that the counselling service is appropriate for this client. If the client is presenting with issues beyond the remit of the counselling service, it is likely the assessing counsellor will refer the client elsewhere; to an organisation or person who are better suited to help them.

What Qualities Does a Counsellor Need?

Counsellors and psychotherapists should have a natural empathy for others, which is the ability to understand and share the feelings of another person. Empathy is different from sympathy, which is feelings of pity or sorrow for another’s misfortune.

“To be a counsellor, you need to be:

  • Able to work and communicate with people from all backgrounds;
  • Warm, open and empathetic, able to gain people’s trust and help them feel relaxed;
  • Patient, tolerant and sensitive with an impartial, non-judgmental attitude;
  • Trustworthy and discreet, with a good sense of personal integrity and ethics; and
  • Resilient and self-aware with the ability to examine your own thoughts and values and understand your limitations”

(Student pages - www.bacp.co.uk/student/become.php)

The counsellor or psychotherapist will meet with the client for a series of formal meetings where the client will talk about their concerns, thoughts and feelings. Counselling not only involves the counsellor actively listening to what is being said by the client, but also to what is not being said. They help the client see matters from a different perspective. Later in this course, we shall look in depth at the different ways of defining and strengthening the counselling relationship with clients. Most importantly, the counsellor will be able to develop and maintain a good working relationship with clients.

A counsellor can be best described as holding a mirror to the client so the client can see his or her reflection - both the ‘good’ and the ‘bad’. Behaviour and thoughts are challenged to help the client see their issues more clearly or in a different way.

The counsellor will actively listen using skills such as asking open questions; reflecting on what is being said, and what is happening in the counselling room. As well as talking, the therapy could use a range of methods including art, music, drama and movement. In its purest form, talking therapy only will be used.

Reflection: Can you think of times when it might be best for a counsellor to refer a client onto another ‘expert’, rather than offering them counselling?

The counsellor is not there to talk about him or herself. Neither are they there to offer the client advice, or give their personal opinion on any subject or on difficulties the client is experiencing. The client is encouraged to find their own solution to their problems, or to be better able to live with the difficulties. On many occasions, problems do not have simple solutions.

“All worthwhile helping frameworks, models, or processes ultimately help clients ask and answer for themselves four fundamental questions:

  • What is going on? What are the problems, issues, concerns, or undeveloped opportunities I should be working on?
  • What do I need or want? What do I want my life to look like? What changes would make me happier?
  • What do I have to do to get what I need or want? What plan will get me to where I want to go?
  • How do I get results? How do I turn planning and goal setting into solutions, results, outcomes, or accomplishments? How do I get going and keep going?” (Egan, 2002, p.25)

The counsellor is not going to agree with everything the client says; He/she is not a friend and is not there to have a weekly, friendly chat about things. Counselling involves work that can be painful, difficult and emotional. It also gives the client responsibility and empowerment.

All therapists have a unique relationship with their clients. Therefore, the counsellor has some important responsibilities to themselves, clients and their profession:

  • Self-awareness, empathy, active listening skills and responsibility to establish and maintain a relationship of trust and respect with the client. Encouraging the client to talk about issues they might find they cannot normally share with others.
  • Helping the client to make decisions and choices regarding possible ways forward.
  • Accepting, without bias, the issues raised by the client.
  • Agreeing to a counselling contract to determine what will be covered during the sessions (including confidentiality issues).
  • Starting and finishing client sessions on time and keeping the boundaries of the professional working relationship with the client.
  • Ongoing training, which is important to keep skills up-to-date.
  • To have regular supervision. Professional supervision is essential to help counsellors work through any difficulties they experience during their client work. This is a requirement for all practising members of membership organisations.
  • To keep up-to-date on any changes in the law that might affect the way you work with your clients. Confidentiality is the most fundamental ethical and legal obligation owed by counsellors to their clients.
  • Keeping client notes up-to-date.
  • Referring clients to other sources of help where appropriate.
  • To have professional indemnity insurance.
  • Owing to the nature of the relationship, the therapeutic relationship between the counsellor and the client is, understandably, unbalanced in terms of power. By telling the therapist personal, intimate and sometimes secret material, the client gives the therapist power. This power is then used by the therapist to help the client empower him/herself. At the heart of any therapeutic relationship must be trust. The client must be able to trust his/her counsellor.

Counselling can be short-term, which might typically involve six to twelve sessions with each session normally lasting 50 minutes in duration – invariably at the same time each week. Counselling can happen face-to-face, over the telephone, by text message or online, using platforms such as Skype or email. The sessions would take place in a private place that is ‘safe’ for the client, where the sessions cannot be overheard.

Counselling on the NHS is generally short-term and focussed on a certain issue with measurable outcomes. Cognitive behavioural therapy (or CBT as it is known) is often popular for short-term work. You will find more information on CBT further on in this course.

Reflection: What might be the benefits to working with a client online instead of face-to-face?

Many counsellors specialise and help clients with particular problems, such as addiction or bereavement. Counsellors can work in different ways with clients, such as by applying ‘theoretical approaches’, which can be humanistic, psychodynamic or behavioural therapies

Additionally, counsellors and psychotherapists often train in one mode of therapy. However, many counsellors will apply different techniques when they feel it would be of benefit to the client to help with specific issues. You could see this as having a ‘box of tools’ to use when a job might need a certain type of tool to help a client. As each client is unique and brings different things into the counselling room, it stands to reason that a unique way of working is required for working with each client.

If you look on YouTube, you will find many videos recorded by counsellors showing you how to set out a counselling contract with a client, and demonstrating core counselling skills.

Membership Organisations

In the UK, the main professional organisations for counsellors and psychotherapists is the British Association for Counselling and Psychotherapy (BACP) (www. bacp.co.uk); the UK Council for Psychotherapy (UKCP) is the main professional organisation for psychotherapists (www.psychotherapy.org.uk) and there is also the membership organisation Accredited Counsellors, Coaches, Psychotherapists and Hypnotherapists (ACCPH) (www.accph.org.uk).

These organisations exist to promote and maintain high standards in the practice of psychotherapy and counselling for the benefit of the public throughout the UK.

The Responsibilities of the Client

The role of the client is to commit to the counselling sessions with the aim of helping themselves to develop insight into their situation. The counselling process allows the client to take charge of their own personal growth and development.

Both counselling and psychotherapy are confidential relationships where trust and understanding are built between the client and the counsellor. The sessions are always person-focussed.

Defining Counselling and Psychotherapy

Generally, counselling happens over a shorter period of time and deals with less complex issues; while psychotherapy happens over a longer period of time and deals with issues that have deeper roots and are often recurring difficulties. A psychotherapist will have a longer period of training than a counsellor.

Someone who trains as a psychotherapist might, however, decide to call themselves a counsellor. Generally, a practitioner offering short-term treatment is known as a counsellor. An individual with two or more years of advanced training might choose to be known as a psychotherapist. There is also an idea that the title of ‘counsellor’ sounds less intrusive, and less grand, and so maybe more accessible than the name ‘psychotherapist’ suggests.

In summary, counselling:

  • Helps the client to take steps to resolve any issues.
  • Is short-term and promotes a change of behaviour.

On the other hand, psychotherapy:

  • Helps the client understand their feelings, thoughts and actions more clearly.
  • Can help the client with psychological problems that have happened over long periods of time.
  • Is a long-term treatment that helps the client to identify the root causes of their problems and difficulties.

Clinical supervision is imperative in the counselling profession for all therapists regardless of their experience - in fact it is vital for anyone helping clients. For the beginner and the more advanced/experienced counsellor, supervision can help with ‘diagnosis’ when the counsellor is working with a client who is presenting with an issue unfamiliar to the therapist. It can help identify issues that the therapist is struggling to make sense of, explore dilemmas and give the counsellor a chance to seek advice on trying new techniques within the counselling room. In short, supervision is a learning situation for therapists.

The British Association for Counselling and Psychotherapy’s ‘Ethical Framework for the Counselling Professions’ says:

“Supervision is essential to how practitioners sustain good practice throughout their working life. Supervision provides practitioners with regular and ongoing opportunities to reflect in depth about all aspects of their practice in order to work as effectively, safely and ethically as possible. Supervision also sustains the personal resourcefulness required to undertake the work.”

(BACP (2018), BACP Ethical Framework)

Reflection: What other reasons might there be for a counsellor to have supervision

In Unit 5, you will find the British Association for Counselling and Psychotherapy’s Ethical Framework in its entirety. 

A supervisor is an experienced therapist with many years of training within the counselling arena. They will also have a qualification that means they can practice as a supervisor. A supervisor will also have someone who will supervise their work, as a supervisor.

Just like counselling or psychotherapy, supervision will take place on a regular basis for a counselling hour of 50 minutes each time, probably on the same day and time each month. Supervision can happen individually or within groups. It can also be face-to-face, by telephone or online via platforms such as Skype or email.

There are many different styles of supervision but good supervision gives the supervisee the chance within which to react, comment on the work within the therapy room, explore challenges, feel feelings and share feedback within a confidential setting.

The Focus of Supervision is the Therapy

Questions which you, the counsellor, might take to the supervisory session:

  • What is the reason for the client coming for therapy at this time?
  • What is the background (history, recent events) of the client?
  • What does the client see as the final outcome of the counselling sessions?
  • What does the counsellor see as the final outcome of the counselling sessions?
  • All the feelings that come up from the therapy (which may also appear in the relationship between supervisor and supervisee – this is called a parallel process).
  • Are there any theoretical and ethical issues to be considered?
  • Managing the boundaries of the therapy session.
  • How best to manage any risks?
  • The suitability of the therapist to work with the client (previous experience working with clients with similar experiences/history).
  • Any organisational issues (if the counsellor is working within an organisation)

Reflection: What ethical issue might you talk to your supervisor about during supervision? How can your client’s confidentiality be affected by talking about their sessions during group supervision?

The Function of Supervision

Brigid Proctor and Francesca Inskipp have written many titles and given many lectures on the subject of supervision. The authors have suggested a framework for supervision based on the division of tasks between counselling-supervision and management. The four functions of supervision are:

Formative (educative)

The supervisor is teacher, trainer and facilitator and enables the therapist to learn new skills.

Normative (managerial)

The supervisor challenges, is co-monitor and assessor, which means the therapist works safely, ethically and maintains standards.

Restorative (support)

The supervisor is in the role of colleague, counsellor and helps the counsellor to work confidently and with enjoyment.

Perspective

The role of the supervisor here is to have an overview of the whole counselling work as well as of the therapist’s work with others.

An experienced and effective supervisor will be able to work within these functions and apply these whenever necessary.

There might be times when it appears (as the counsellor talks within the supervision session about his/her work with the client) that things in the therapist’s personal or professional life could be affecting his/her counselling work. There is always a risk of an overlap between personal and professional issues for the therapist. Supervision is not a substitute for personal therapy, and therefore the supervisor would suggest the therapist goes into counselling or psychotherapy to resolve the issues that are overlapping and being raised during the sessions.

What are the Challenges for Supervisees

Many therapists are unable to choose their supervisors; perhaps because they work within an organisational setting, so the supervisor is chosen by the therapist’s linemanager.

For some supervisees, it may be difficult to work with a supervisor who works differently to you because their theoretical professional training and background is different to yours. The therapist might get supervision once a month as part of a group, which in itself can prove very challenging for some therapists. There might be limited times for each therapist to talk about their work, and some counsellors might hold back because they are in a group setting.

Different membership organisations have different demands when it comes to supervision. The level of training (of the supervisor) and the amount of supervision a counsellor might have each month differs from one membership organisation to another. When you are a member, it is best to check with your membership organisation to confirm you meet their supervision requirement.

There needs to be a distinction between the role of line management and supervisor. A line manager as a supervisor can lead to difficulties since a conflict of interest may arise between the needs of the organisation and those of the therapist. A professional taking on a dual role supervising and managing can potentially inhibit the free presentation of client material, particularly if there are concerns around such issues as confidentiality and/or employment security.

What might the supervisor ask the counsellor about their work?

  • What is the main focus of your work? Is it one-to-one, couples, families, groups?
  • Is the work with the client short-term or long-term work?
  • Where does the therapist see the client? In what setting? In an organisation? Privately?
  • Who is clinically responsible for your work?
  • What are your arrangements for psychiatric (or other) backup?
  • Are you (the therapist) currently in training to be a counsellor or psychotherapist?
  • Will the supervisor need to provide a written report on the work of the therapist?

The Importance of Supervision

All counsellors and psychotherapists, as well as supervisors, need to have regular and ongoing formal supervision to cover their clinical work. The considerable demands that therapeutic work places on therapists make it imperative for counsellors to have an ‘outlet’ for their professional work. Without supervision, there is a risk that the therapist may become over-involved with a client he/she is counselling.

Reflection: Explain why both casework and managerial supervision are important for a trainee and a qualified counsellor?

Without supervision, there is a danger the therapist could ignore something important or become confused as to what is happening therapeutically with a particular client. Supervision can help highlight what is potentially being missed. It is difficult and, at times, impossible to be objective about your own work. Supervision can help ensure that the counsellor is working self-reflectively. It can also enhance the therapist’s capacity to work with difference and diversity. Supervision can also help you carefully manage your case load.

It is critical that you look after yourself as a counsellor because it is a demanding role, which requires you to give yourself over fully to the client when they are in the therapy room with you. With your supervisor, you can discuss your capabilities and limits; talk about how your client work might be impacting on other aspects of your life, and how to best manage the demands of seeing clients whilst training and having other responsibilities. Your placement line manager (within your organisation) should also be helping you to evaluate your caseload to make sure it is manageable for you along with the other demands you might have. Your line-manager, supervisor and the senior counsellor who assesses clients before they come into the service will make sure you are not taking on clients with needs that are too complex for you to manage, particularly during early stages of your training.

These are the reasons why supervision is invaluable. A regular time with a trusted professional can allow for an ongoing therapeutic relationship that monitors the work of the therapists. In addition, good supervision can also be a time of training and self-development, skilfully learning to interweave and integrate theory and practice. Your supervisor is a catalyst for continued learning and self-monitoring. It is, however, important that therapists have other sources of help in between supervisory sessions, for example peer-to-peer support.

The contract covering your supervision will normally include:

  • Any practical arrangements, such as timings, any costs, etc.;
  • Confidentiality, privacy and its limits;
  • A cancellation policy;
  • How the supervisor monitors the work of the therapist;
  • How the supervisor reports any concerns about professional competence and fitness to practise;
  • The keeping of supervisor notes (who owns these, how they are stored, etc.); and
  • If the counsellor has any special needs (e.g. language, communication or mobility disabilities).

 

Feedback – Giving and Receiving Feedback

Giving feedback effectively and in a way that does not offend is an important skill. During this diploma course, you will no doubt have plenty of opportunity to develop the skill of giving feedback and the chance to receive feedback, too. It is likely there will be opportunities to give feedback to other counsellors who are part of your organisation or part of your supervision group.

Sandwich feedback is a method that consists of giving praise, followed by corrective and constructive feedback, followed by more praise. The sandwich feedback method means you start and finish on a positive, and so place any corrective feedback in the middle of two layers of praise.

Reflection: Reflect on a time when you gained valuable insight from some ‘negative’ feedback?

If you are giving feedback, there are a number of considerations:

  • The feedback should not be personal - it is not about someone’s personality.
  • The counsellor takes ownership of their feelings, rather than blaming the other person. So not “You make me angry when ...” but instead “I noticed that when you said ... I felt ...”.
  • Feedback needs to be as specific as possible.
  • It should be timely - there is no point telling someone how you felt weeks later
  • Certain times are not necessarily the best time to give feedback. Someone who is angry is unlikely to hear feedback regardless of how skilfully it is done. It might be an idea to give the feedback not now but as soon as is suitably possible.
  • Receiving feedback from others is an important part of developing selfawareness. Sometimes you will hear feedback that is not positive; how you deal with this feedback is important. One of the things you need to do as a counsellor or supervisee is to actively listen to hear the feedback being given. This is not a time to ask questions or argue your point.
  • Think about how the feedback relates to you and to your client work. How can it better inform the work you do with clients? It is likely that clients will also give you feedback and again, this is a time to use your active listening skills. 

In the next unit, we look at core counselling skills. What are the key skills used by therapists within the counselling room?

Bibliography

BACP, Student pages, www.bacp.co.uk/ student/become.php

BACP (2018) Ethical Framework for the Counselling Professions, https://www.bacp.co.uk/events-andresources/ethics-and-standards/ ethical-framework-for-the-counsellingprofessions/

Ballantine Dykes, F. Postings, T. Kopp, B. and Crouch, A. (2017), Counselling

Skills and Studies; 2nd edition, Sage Publications Ltd

Egan, (2002), The Skilled Helper, Brooks/Cole Thomson Learning

Further Reading

Counselling Skills and Studies, Fiona

Ballantine Dykes, Traci Postings, Barry

Kopp and Anthony Crouch, Sage Publications Ltd

Counselling Skills and Theory 4th

Edition, Margaret Hough, Hodder Education

Effective Supervision for the Helping

Professions, Michael Carroll, Sage Publications Ltd

Integrative Counselling Skills in Action,

Sue Culley and Tim Bond, Sage

Publications Ltd 


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