The variety and versatility of Online Counselling


Hi, and welcome to this week’s blog post on the advantages of online counselling.

We are living in a day and age of high tech. It keeps changing and being “smarter” and more accessible and affordable to all of us.

I remember when the internet started. I was a teenager and it was exciting to meet people on the other side of the world, even keep up with music from over the Atlantic!

I never felt that those friendships I built online were very different from my face-to-face, local friendships.

Maybe that’s why I feel that online counselling makes sense, and is no different than face-to-face counselling in many aspects.

Of course, there are some things that I’ve needed to do to work online – further training, and thinking about some obvious differences, like less non-verbal cues to work with, but adjustments can be made and I’m pleased to say I’ve helped lots of clients through online counselling, and hope to continue to do so.


What do you think of when I say “online counselling”?

Maybe you think video calls.

That would be my first guess if I didn’t know about the other ways of working online!

There are many ways to work online with your therapist.

The way that works for you, and possibly the online therapist you choose to work with, will depend on your personality, lifestyle, available free time to attend sessions, and other aspects of your life that might get in the way of accessing face-to-face or synchronous (“live”) sessions.

Let’s go through a few creative ways in which you can look after your mental health through online counselling…


A live video call means you schedule a time with your chosen therapist, and try to meet regularly (usually every week), at the same time and using the same secure platform.

I use Zoom and Instahelp for private clients, but there are other safe platforms that keep your conversations encrypted and completely confidential.

If you prefer to see your counsellor, almost in the same way you would if you went to their physical office, then this might be the best way to work on your current situation.


Live audio calls happen in a similar way as described above, except you’d only be hearing each other’s voices.

This can be done using the same platforms, but with video turned off, or using the telephone.

If it’s easier for you to speak without being seen, then this might be the best way for you to have therapy.

Sometimes, internet connections might fail, and turning video off might be the only solution so the session can continue. These are things to discuss with your therapist – they would probably bring this up – in case technology fails and you have to adjust to using audio or telephone, or rescheduling.

Completing further training in the differences between seeing and not seeing my clients has really helped me when working with audio calls.


In this type of counselling, you and your therapist are using the same chat room, and are messaging back and forth, at the same time.

This would be for an agreed period of time – 20min, 40min, and hour.

If you’re a millenial or really enjoy using text-based communications in your daily life, then text-based messaging might be the best option for you right now.

Usually, therapists that offer this type of service can offer the other ways of working alongside text-based counselling.

Working online is so versatile!


I’ve used this type of therapy before, and it’s really helped me.

I didn’t feel I was missing out on anything, in fact, because I’m a fast typist and love to write anyway, I could get a lot out in one go.

My therapist was very good at catching what I was writing and replying sensitively and in a timely way. I felt really held by her, even when I’d only ever seen a photo of her and her text responses.

The great way about asynchronous messaging is that you can do it at anytime from anywhere.

Of course, you will have to wait for your therapist to log on and read your message, but you’ll usually have a good idea of what times they work and when you are most likely to expect a reply.


This is similar to text-based counselling, except you are going to be using email for this.

I would use a password protected word document to exchange your messages with your therapist, so nobody can open it except you two.

The responses would happen in a similar way to asynchronous messaging, as you can send emails at any time from anywhere, and wait for your therapist to reply at agreed times.


As you can see, online counselling opens up lots of possibilities for people to access good therapy, in a way that works for them.

Distance is not an issue any longer, and neither are some of the other barriers that might stop us from getting in touch with a counsellor – shame, fear, time, “what will people think”, amongst other things.


If you’d like to catch up on past posts, click the links below:

Accessibility

No Commute, Free resources

Anonymity

Confidentiality and Risk

Guest post: Would chronic illness benefit from online counselling? – By Olivia Djoudadi


See you next week!


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Would chronic illness benefit from online counselling? – By Olivia Djoudadi

Hi and welcome to this blog post collab with Olivia Djoudadi.

I’ve had a couple of collaborations through the years from people living with chronic illnesses or therapists that work with these.

You can read these here:

Self Care When Living With a Chronic Illness

Living with a Chronic Illness and Working as a Therapist

In this post, Olivia answers the question of whether online counselling can help people with chronic illness.

I think you know my answer will be a resounding “yes!”

Over to you, Olivia


When first diagnosed with a chronic condition it can be quite a shock for some people.

It may need medications, a newer type focus on the foods people eat and a shift on how life is lived.

This isn’t always realised until later as obvious affects on the person or family take time to realise.

Lets take a look at a fairly common condition like diabetes; the statistics show 63% of people with it may have either anxiety or depression.

That statistic can have quite an affect on how someone with diabetes looks after their medical care needs.

One might feel a doctor is the person that deals with the medical needs however psychotherapy or counselling can really help as well.


Dealing with a chronic illness and going out even to weekly therapy appointments can take its toll however there are options such as online counselling.

You can see your therapist online by either email, IM or video sessions.

Some therapists work online because they also have a chronic condition just like you.

Some conditions may be painful or cause a lot of fatigue making getting out to counselling much harder.

Research on the person you may see to see if they have worked with chronic illness before as that can help with trust.


How many medical conditions are there in the population of the UK? Do all conditions need therapy?

In the UK according to chronicconditions.co.uk over 15 million people in the UK live with a chronic condition yet not all need emotional support.

Some may have family support or don’t go through shock that accompanies some conditions.

Not every illness is obvious so people may assume that someone is completely fine when they actually have a condition that raises their likelihood of say a medical crisis.

If medication is not used then people can get incredibly unwell or even die and that can have quite a big effect on one’s mental wellbeing.

They may go through denial, anger, bargaining, depression and acceptance; some reading may realise that these are actually the 5 points to the Kübler-Ross grief model.

People may lean towards one of those or have a mixture of all or as one clinician noted as a Munchian Scream which is a painting depicting a screaming man by Edvard Munch.

It may seem like its awful to get any kind of condition but the truth is that many people cope very well living with a diagnosis.

So, one may ask why that is the case.


According to Harvard Medical School dealing with a chronic condition can improve by:

  • Beware of depression or anxiety. These can occur when someone is newly diagnosed or when they have lived with a condition for a long time and see the ongoing effects on self or family.
  • Build a team. This can be medical as well as psychological to help keep you at your best, keep in mind to include yourself as part of the team.
  • Coordinate your care. You may need to be cared for by a number of medical staff and access to each other’s notes may not always happen. You may need to highlight what has changed so your doctor is aware. Yes, they may have the notes from other departments but a five-minute appointment with a GP may not have realised changes.
  • Get a prescription for information. It can help to know what side effects medication may cause so you know what is normal. Use information from a site that has a medical reputation so you don’t get scared by other information then discuss with your doctor what is your normal on that medication. It can be useful to discuss in therapy how to handle these changes or the effect it has on you or others.
  • Make a healthy investment in yourself. Treatment for almost any chronic condition involves changes to lifestyle. A doctor may ask you to eat healthier, stop smoking or drinking, exercise more or seek counselling if you are having trouble coping. As well as taking care of your medical needs it may help to have selfcare times such as walking in the park or having tea with a friend, some people find support groups helpful.
  • Make it a family affair. When learning about your own condition it can be helpful to include family members as they may need to assist at times even if it’s to pick up a prescription or adjust to a healthier way of eating meals. Some maybe quite active and others maybe distressed so talking with a therapist may help them as well as the person with the condition.
  • Make your doctor a partner in care. When you leave the doctor’s office you are the one who needs to track changes such as symptoms or medical input. You may also need to assist the doctor by saying your finding it hard to cope.
  • Manage your medications. One may need an adjusted eating plan, pills, injections or medical devices so one can function well. Knowing about the drugs you take can be helpful as they may cause other noticeable issues such as tiredness and that’s important for your medical team to know.
  • Reach out. Medical input can be really helpful but so can therapy and support groups so it may help to seek online or face to face counselling.

I’ve learned quite a lot from reading this post by Olivia.

If you’d like to contact her for therapy sessions, or read more of her great blog posts, do follow her blog at this site.


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Hoarding Intervention: Step 1: Get yourself prepared


Hi, welcome to this week’s blog post on hoarding. Our next topic is about staging an intervention and we will be breaking it down into 4 steps.

This post is dedicated to the relatives and friends of hoarders, which are usually the ones that are aware of the problem, sometimes a long time before the hoarder realises what they’re doing.


The first step which we will be focusing on is getting yourself prepared for an intervention as a family member or friend of the hoarder.

Do please take the time out to learn more about hoarding, what it is, the possible consequences that hoarding can have on the person and how hoarding can be used as a coping mechanism for an underlying issue. Please read our previous blog posts, we cover all of those topics.  


Betterhelp mentions that TV shows about hoarding may spread awareness about the disorder, but many experts say these shows paint an incorrect picture about hoarding and how to help a person who hoards.

Don’t get us wrong. Awareness is great, but these shows only show a part of the process.

We imagine that there’s a lot of psychological and other support for the hoarder and the family behind the scenes.

Look for credible sources like the charity Mind. https://www.mind.org.uk/ and other websites.

You can also contact Stacey directly for more on how we work together to provide both practical and psychological support for you and your loved one.


Betterhelp also advise not to enable the hoarders behaviour.

While taking items against a person’s will is not helpful, adding to their clutter by buying or giving them things or taking them on shopping trips is just as bad.


Let’s be honest, nobody likes their stuff taken away without their permission. This is no exception, no matter how hard it is to watch what it’s doing to them.

Take it step by step. You’ll all get there!

Avoid adding to the clutter by showing your love in other ways and spending time doing activities not related to consumption.


Engaging in activities that have nothing to do with buying or adding to their stuff will deepen your relationship, allowing the upcoming intervention to be received in a better light, as you’ll be a trusted individual in the life of your hoarding loved one.


According to the Anxiety and Depression Association of America (ADAA) at a prearranged time, family members should approach the hoarder to talk about the effect of clutter on their lives and explain that help and support are available.

This is something we’ll be talking about in the next posts.

For now, let’s focus on preparing you for the day of the intervention.


Perhaps for now, just meeting as a group and practising with each other how you are going to approach the person and rehearsing what you are going to say and how will be helpful.


We understand that this intervention will be a big step for everyone involved, and we’re not sure how your hoarding loved one will respond yet.

Managing that anxiety with lots of preparation and possibly input from professionals such as Stacey and Karin will help.


Every step you take, whether they’re aware of it or not, is you showing them you care.

You are showing them in subtle ways that you care and they can receive help if they are open to it.


If you are living in a similar situation or know anybody that is, please do not hesitate to contact us today so that we can provide you with the support that is needed.


Declutter & donate your unwanted items to Shelter.

You can make a difference to improving someone’s life.

Contact Stacey for more info!


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Confidentiality in Online Counselling


Hi, and welcome to this week’s post on online counselling.

Natalia and I are both passionate about offering alternatives to face to face counselling. Her platform, Chat2Us, aims to grow its list of counsellors available for you to choose from, including myself.

I also work in private practice, and the focus of my practice is now going towards offering online counselling through different mediums – live or asynchronous messaging, Zoom video call, Zoom/Telephone voice call, and soon also email.

If you’d like to know more about Chat2Us or my private practice online services, click on the hyperlinks or message us to find out more.


In this week’s post, we’ll be talking about confidentiality.

When we talk about personal matters, confidentiality is a must.

This rule applies to online counselling too. Especially online counselling, with all the safety issues that might compromise the content of our sessions.

Before we start offering online counselling therapists need to make sure we can provide a safe and confidential online space.

We do this by using very high-end protocols.

These days, where technology offers unlimited options, finding the best way to provide safety and confidentiality should be straight forward.

Let’s go through the most known options.


Skype

It’s easy to use. Many of us use it to keep in touch with friends and family. with a handset, microphone and speaker we are ready to go.

I (Karin) still use Skype for some sessions, but am aiming to move everyone over to Zoom.

There is a major issue with Skype, that is enough to warrant moving to a more GDPR/HIPPA compliant platform, like Zoom or VSee (there are many others that are good to!)

The Issue: Skype is encrypted, but once you’ve signed the terms and conditions, you give up the rights to your sessions’ content.

Zoom

An alternative to Skype, but safer as it’s encrypted and your content is secure.

It’s great for one-to-one meetings, which have unlimited time, so it’s great for individual counselling sessions.

If you have a group meeting, the free version only allows 40 minutes per meeting.


Another great thing about zoom is that it can be used to record video conferences, present webinars and share your screen to show a powerpoint presentation and others (This is something that Karin has been doing alongside counselling and supervision!)


There are lots of other applications out there that could offer the encryption required to secure the confidentiality, but we won’t go into all of them here.


As a provider of a mental health service, such as online counselling, confidentiality is an ethical concern (Read BACP’s guidance here).

The fundamental intent is to protect a client’s right to privacy by ensuring that matters disclosed to a professional are not relayed to others without the informed consent of the client.

Of course, there are exceptions as to where confidentiality could be broken or not applied (risk to self or others for example).

This is easier to establish with face-to-face clients, but is also necessary to establish the boundaries with online clients.

Sometimes, we might not have the information necessary to call emergency services and direct them to the client’s premises.

We might even be in different countries!


Some online services don’t take more than email and client’s name.

Online therapists might have an online counselling clause that states the limitations of how they can support their clients, providing information on services that might be able to support them in case of crisis or additional support.

Keeping ourselves safe as therapists is important. It keeps clients safe as a direct consequence. Which is a great thing!


Online counselling should offer the same frame of security, confidentiality and trust as face-to-face counselling.

And more.

There are so many more things to take into account regarding confidentiality and client safety when working online.

By providing anonymity to the client, the disclosure of emotional content and thoughts could be easier, but this disinhibition effect might mean the client might be opening up to a lot more than they would face-to-face, and in a very short period of time, with the potential risk increasing.


Before starting any online sessions with a new client, therapists should check that the client is a good candidate for online counselling at this point in time.

This means checking for risk, which is important because we won’t have as many details from the client if they want to keep their anonymity.

This limits our chance to keep them safe from a distance.

We might need to refer on to someone in their local area.


As you can see from this post, we back up our claims that online counselling is a great alternative to face-to-face counselling, but there are limitations to the work we can do when it comes to assessing risk and considering confidentiality issues.

Hopefully our options for platforms and ethical suggestions will help you with your search for an online counsellor; for therapists, we hope this gives you more insights into how the counselling therapy world works.

Make sure you sign up to this blog to get updates when we post a new blog about this topic, as well as catch up with previous posts.


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Hoarding as a coping mechanism


Hi, and welcome to our series on Hoarding – practical and psychological support.

In this week’s blog post we will be looking at other mental health problems which were mentioned here: possible causes (and consequences) for hoarding.


Mental health issues aren’t straighforward to spot, and neither is it straightforward to pinpoint their causes, consequences, or what might have triggered particular behaviours or conditions.

Dealing with the topic of hoarding is a sensitive issue, as it’s not just about “the stuff.”

It’s about the trauma, the life story, the way the individual is dealing with their past and current life issues, and how thing might have gotten out of hand and overwhelming for them and their loved ones.


The mental health charity Mind mentions that a person might start hoarding due to another mental health problem, for example:

In these situations, hoarding is usually seen as a symptom and acts as a coping mechanism and is not the main or “precipitating” issue.

Note: Diagnosing is good in some cases, but we work with the individual as a whole. A diagnosis is helpful to frame the work somewhat, but the main issues discussed in the therapeutic work are the issues the client brings. The client leads the work, and this means we are addressing the aspects of hoarding and their current life situation that need to be worked through.


According to Jo Cooke of Hoarding Disorders UK

“Hoarding is a coping mechanism.

There can be a number of reasons, but it’s about filling a void, an emptiness, with stuff.

Bereavement is one of the biggest triggers.

It acts as a sort of nest, a security blanket, a form of emotional insulation.

You can’t just put a skip outside someone’s house and tell them to get rid of stuff.

You need to work in a sensitive way, because it’s very much anxiety-based.”


Dr. Jessica Grisham (University of New South Wales) has found that the link between hoarding behaviour and traumatic events – such as losing a spouse or child – is especially important to consider in individuals exhibiting a late onset of hoarding symptoms.

This is especially important if those symptoms first appeared at the time of the event or shortly thereafter.

It’s also important to note that people react to different events at different paces, so there might be a delayed reaction to a life event that might mean the link to hoarding might not always be as clear as mentioned above.

Still, looking at the immediate aftermath of a life event will still help us start to pin-point a possible cause.


Accumulating “stuff” fills the emotional hole left by the trauma and allows individuals to avoid dealing with the pain.

Later removal of these items can trigger high levels of anxiety, especially if someone else gets rid of these items without the hoarder’s permission.

When discussing their behaviours, many hoarders describe the “rush” they experience when purchasing new items, especially if the item is free or on sale

They can also go to great lengths to justify purchases when questioned by friends or family members.

This reinforces the fact that hoarding as a coping mechanism is a complex issue that requires time and working through different aspects of the hoarding experience so that they are replaced with healthier habits.


It’s important to understand the things mentioned above are very sensitive and personal to each individual hoarder.

Removing items without the person’s permission are a breach of their autonomy – even if we believe their decisions to keep seemingly useless or value-less things aren’t the right ones.

Something I learned during my (Karin) time in care work, was that we can’t stop people from carrying out actions or making decisions just because they might not seem like the best for us, or just because we know the consequences will affect them negatively.

We all take risks every day in our lives. Some result in positive things, others we might regret or want to amend or take back somehow. But we still go ahead and test them out without anyone stopping us.


Hoarders deserve the same courtesy, even if it’s harming them – the work might take a long time, while the hoarder comes to terms with the reality in front of them, and the imminent dangers they might be putting themselves into by not having clear paths to leave the house, or a safe place to sleep or relax, or even do work.

Be patient, as you support your loved one through the hard process of coming up with better coping mechanisms than hoarding and it’s consequences.


If you are living in a similar situation or know anybody that is, please do not hesitate to contact us today so that we can provide you with the support that is needed.

Declutter & donate your unwanted items to Shelter.

You can make a difference to improving someone’s life.

Contact Stacey for more info! 


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Advantages of online counselling: Anonymity

Welcome to the 3rd post of our joint series with Natalia from Chat2Us.

On this post, we will continue with the advantages of online counselling, focusing on Anonymity.

What are the benefits of people feeling anonymous when speaking – or typing – about the things that worry them or that they’re struggling with at the moment?


We might feel comfortable talking to friends and family about our current situation.

We don’t need to be anonymous to do so. They know us better than anyone else!

But sometimes we get to the point where they might not be the best people to talk in depth to about the issues we are going through.

Maybe because we don’t want to worry them, or simply because, let’s face it, we all have problems we deal with on a daily basis.

There’s also the other aspect of not being able to get a neutral response to what we are telling our friends, by no fault of their own.

After all, they’re not our therapist!


This is why seeking the support of a counsellor will help you process your current situation in a way that is limited when talking to a friend.

By all means, use your support system to vent and get help. This is one of the first questions we ask clients when starting therapy.

A good support system in place will help you through the tougher times – and will be there to enjoy the happier ones too!


Now, let’s go back to the anonymity issue…

You might be lucky to feel comfortable in sharing your issues openly, and talking about how you deal with them, with people you know; but you may be like so many others who simply are not as comfortable.

This might be remedied to a greater or lesser extent by seeking one of the many forms of online therapy.

Text-based therapy would provide the most anonymity, and might be ideal for some of us, but others might still prefer to see someone that lives miles away from us, and speak to them via video link.

It’s all about what works best for you!


Choosing to seek therapy online might reduce the chances of you feeling socially stigmatised if you wanted to keep the fact that you’re attending therapy between you and your therapist, and maybe a handful of trusted friends or family.

Unfortunately the social stigma attached to therapy is still alive and well.

Bumping into a friend at the therapist’s waiting room and feeling like you might have to explain why you are there might be an inconvenience and make both of you feel awkward (or it might just be absolutely fine! – there are more and more people accepting the fact that attending therapy is good for us, for many reasons!)

This inconvenience can be solved with online counselling.

You will save your energy for self-care and focusing on the process of therapy you’ve started, saving yourself the potentiality of having to explain why you are going to a counsellor’s office.

Once the social stigma attached to it vanishes, it will eventually reduce the hesitation to seek assistance.

Natalia, Chat2Us

Through online counselling, you can keep your privacy protected and engage easier with your therapist from home, even in the comfort of your pyjamas.


If we look at the different age brackets of people that are seeking therapy, younger clients may prefer the online version as most of them are very good with IT and may embrace the efficiency and convenience of using their devices to look after their mental wellbeing. 

Whereas older clients may prefer to opt for face-to-face therapy, as they might not be too literate with computers (although many do surprise us and are very tech-savvy!).

There are alternatives to online therapy that would also work well for someone that’s not very tech-savvy.

For example, a phone call might be great to retain a degree of anonymity but still access good therapy, with similar benefits to online counselling.


Something to take into account with online therapy, and something that happens more in this type of therapy, is the dis-inhibition effect.

Face-to-face social interaction may get in the way of the client fully opening up in a counselling session.

Some factors that can interfere with the client’s involvement in the therapy process might be paying attention to the therapist’s, and their own, body language; they might also get distracted by room furniture and other aspects of the face-to-face set-up.

Some clients do get inhibited by these things.

Think about autistic clients, for example, where feeling like there is too much sensory stimulation, which might distract them or not allow them to focus on dealing with their emotions, as they might feel overwhelmed by everything else going on around them.

– Karin

Choosing online therapy can therefore allow the person to focus more on the therapy than the surrounding interference.

It will also allow them to talk about sensitive issues quicker and with more detail than they would in a different setting.


Both online and face-to-face therapy are equally effective, but the real question is this: where will you be able to work through your issues the best?

As we are talking about anonymity, the online option seems to keep any interfering factors in check, allowing you to focus on the things that you need to work through.


Finally, we hope that you have gathered from what we’ve said in this post, that online therapy allows for a greater openness for some clients.

The absence of face to face contact can also prompt clients to communicate more openly without concerns for a bias of race, gender, age, size or physical appearance.

This may lead to an increased level of honesty with themselves, and therefore greater and quicker self-disclosure.

This might not be the case for everyone, and we do advise that if you’re more comfortable with face-to-face counselling, then please do follow what’s best for you.


We offer both face to face and online counselling, but seeking to work more online as time goes on.


Until next week…


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Causes and Consequences of Hoarding

Hi, and welcome to this week’s blog post, which is a continuation of last week’s post (focusing on the individual).

In this post, we will focus on the possible causes (and consequences) for hoarding and understanding that everybody is different and there could be many reasons as to why the person is hoarding.


Different people will have different explanations for their own experiences and causes for hoarding and it is likely that there is a a combination of reasons.

These reasons are not clear-cut and they might be influencing one another, at different points of the individual’s life.


According to the Mental Health Charity Mind, the following could be the possible causes for hoarding (click on each of the links for more on those particular issues):


According to healthline:

“A person may begin to hoard because they believe an item that they have collected, or are considering collecting, may be valuable or useful at some point in time. They may also connect the item with a person or significant event that they don’t want to forget.”

This quote points towards the person’s reasons for hoarding, which might be something as reasonable as “I might need it later”, even though they don’t really ever use it.

Other times it might be the way a person grieves the loss of a loved one. Collecting items they might have liked or that they link to their loved one is a way to keep them a part of their lives.


Mind mention that, through working with a therapist in sessions, a person may be able to link the start of their hoarding to a stressful event or period in their life, such as:

  • being abused or attacked
  • breaking up with a partner
  • becoming very unwell
  • someone close to you dying
  • feeling extremely lonely.

For some people, experiences like these can also lead to an increase in existing hoarding, when hoarding has already begun.

Also, hoarding might have started with a trauma or another untreated mental health problem, but it might also bring up other mental health issues that will need to be addressed.

Some of these are:


In these situations, hoarding is usually seen as a symptom and acts as a coping mechanism and is not the main diagnosis.

As we mentioned above, it’s not as clear-cut as it seems.

Sometimes hoarding can be the symptom, other times it’s the mental health issue or traumatic event that take precedence.

Listening to the client’s story, paying attention to the triggers of hoarding AND of the mental health issues will help us deal with them in a timely fashion, addressing all the aspects of the individual’s life that need our support, in order to get the client back to living as healthy a life as possible.


With our collaboration, we will focus on understanding the person as an individual, getting to the root cause as to why they are hoarding, through in-depth therapeutic support, as well as providing thorough practical help in order to help to create a safer environment, both physically and mentally.

If you or your loved one need support, don’t hesitate to contact Stacey Sabido from Serenity for You, to start the process.


Declutter & donate your unwanted items to Shelter.

You can make a difference to improving someone’s life.

Contact Stacey for more info! 


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