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Has Social Media Killed Kindness and Compassion?


In the times we’re living in, it seems that narcissism – extreme focus on the self over and above others – is the accepted way to be. Everywhere we go, we see people taking selfies and then uploading these images immediately to the ever-growing band of “followers”, or those we might call worshippers. People whose every waking breath is dedicated to waiting for the next piece of trivia fed to them by their idols.


Praise is heaped on those who build up massive numbers of adoring fans, even to the point where we now call these people “social influencers”. Apparently, social influencers now have the capacity to instantly shape social opinions and determine the success, or failure, of brands, products, businesses, even reputations. They are even being engaged by companies, at huge sums of money, to simply take a selfie showing themselves somehow associated with a product – and no doubt they are laughing all the way to the bank.


Whatever has happened to social conscience, compassion, kindness and respect?


As a neuropsychotherapist, I worry about the pervasive influence of the media on our brains, and then on our society more broadly. Most “social influencers” are in their twenties and thus running on brains that still haven’t fully come online – the last part of the brain to fully mature and become operational is the frontal cortex, the area directly behind the forehead. These parts of the brain drive those human experiences we refer to as meaningful – compassion, insight, wisdom, kindness, respect, perspective.


In particular, myelination (the maturing of brain cells) of areas deep beneath the frontal area, known as the pre-frontal cortex, is not often completed until our late twenties. Unfortunately, due to the slowing down of neural pruning during this phase of development – that is, the discarding of unnecessary or faulty cells – this is the stage of development when the most severe pathologies can begin to emerge. These include psychoses (like schizophrenia) and serious personality disorders like psychopathy and narcissism.


So the world we have created, with unfettered social media, is inadvertently providing boundless fuel for those vulnerable people most at risk during a stage of development when they are least able to tell the difference between reality and pathological fantasy. When enough of these people get together, it’s easy to start to believe that mental disorder is in fact “normal”. By normalising the abnormal, there is a huge risk to our society.

As real social influencers – adults and parents – what can we do?

Some are despairing that it’s too late to turn the tide. Well, unfortunately that has to be a cop-out. We are all still stuck here on this planet with nowhere else to go (despite Elon’s great promises!). Therefore it’s time that those of us who have nurtured our brains to full maturity band together to set the standards for what is “normal”. Some are referring to the current “toxic triangle” – destructive pathological leaders, susceptible followers, and conducive environments.


We can start by examining our environments – are we creating environments that provide opportunities for kindness, compassion, respect, and reflection? In our homes, do we engage in balanced debate that promotes deeper and more critical thinking from a variety of viewpoints or perspectives? In our community, are we supporting and promoting groups whose sole purpose is to unconditionally give back for the greater good of all?


We can then start to examine those we follow with a bit more critical reflection. How do our leaders show that they are acting for the benefit of something higher than themselves? If self-interest appears to be the primary drive, perhaps it’s time to un-follow them. Perhaps it’s time we looked at the background behind the selfies.


Dr Kate Lemerle, Psychologist

Chrysalis Counselling & Coaching, Norfolk Island

WEB: www.chrysaliswellnessservices.com

TEL: 52112 or email drkate@iinet.net.au

Please 'contact us' for more information.

Diagnosing Mental Disorders: Time to Lift Our Game


Getting an accurate diagnosis for problems of the mind still lags well behind the science of diagnosing problems of the body, or physical conditions. All too often, I hear that a diagnostic “label” has been given to a client on the barest of symptoms and commonly without any use of diagnostic procedures.

I don’t believe anyone would be happy with being told they “probably have liver cancer” on the sole basis of reporting abdominal pain. At the very least, we’d expect a series of questions about symptoms including pain, energy levels, appetite, digestive changes and much more. Then we’d expect to have medical tests – standardised procedures with a solid evidence base - such as an ultrasound, blood tests, even a biopsy before we accept a definitive diagnosis. We’d consider this normal before starting any form of treatment.

However, when it comes to conditions of the mind, we seem willing to accept something far less rigorous, and plunge ourselves into treatment regimes, including medications, without even asking about options.

As an example, it’s sadly still common to have a client referred with a diagnosis of, say, Bipolar Disorder on the basis of a brief clinical interview. The patient may have reported periods of low mood, hopelessness, irritability or outbursts of anger that fluctuate with periods of feeling energetic, sleeping less than usual, or having a burst of grand ideas. Depending on the mood state at the time – either low or high – they may be prescribed either antidepressants or a mood stabiliser without much, if any, other diagnostic investigation.

And the rub is that inappropriately prescribed medications for mental health problems can have a range of side effects that in themselves set off a cascade of physical and psychological changes that can be problematic, as well as masking the original symptoms, making it even harder to get to the core of the real problems (if any).

Diagnosing mental health disorders – problems of the brain and the mind – is a complex process that cannot be done properly in a single brief clinical interview.

Detailed History-Taking

A detailed history of the patient’s physical, emotional, cognitive, social and cultural experiences looking for potential triggers in each group is absolutely basic. Finding out how that person typically responds to life events helps us formulate an idea of the influence of personality, whilst getting a detailed life history of parents and grand-parents helps uncover patterns that may have a genetic basis. Understanding how their cultural background and belief systems shape the way they think and feel – or even interpret physical changes in the body – is absolutely necessary to determine whether the person is unwell.

Using Validated Psychological Tests

To help us put symptoms into perspective, psychologists have a wide range of tests we use to measure how far out of the normal range are a patient’s symptoms. At the very least, the DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure is a quick-and-easy self-report profile of psychopathology based on the internationally defined criteria for all mental health disorders. Depending on the information emerging from this screening tool, patients may then complete several of the Level 2 Cross-Cutting Symptom Measures which focus in on more specific clusters of symptoms that might indicate conditions like Depression, Sleep Disorders, Mania, Substance Abuse and others.

Each of these allows the clinician to drill down to gain a deeper understanding of the patient’s mental health condition.

Investigating Severity

Then we want objective data about the severity of symptoms, and factors influencing severity, along with personality factors such as negative affect, detachment, or antagonism. These measures give us important details that help narrow down the range of possible pathologies or disorders, and the complex interactions between states (how we feel or experience ourselves and the world moment-to-moment) and traits (general patterns to our responses to experiences). Most importantly, we could use the Early Development and Home Background (EDHB) Form to investigate early-life experiences such as trauma or broken attachments that we know shape the development of the brain, and hence the mind.

Other Possible Influences

Finally, the Cultural Formulation Interview (CFI) helps the clinician find out more about the presenting clinical problem from the point of view of the person within their social network (i.e., family, friends, or others involved in the current problem). It also includes the problem’s meaning (what the person believes about their symptoms), potential sources of help they have used or might use (like herbal medicines or religious activities), and expectations about the value of services they might use for recovery.

So the next time you hear of someone being diagnosed with depression just because they told the doctor they were feeling sad or can’t sleep, or any other mental health condition without having had a comprehensive diagnostic assessment, please recommend that they seek advice from a practitioner specifically trained in drilling down to get an accurate diagnosis. And who can then follow that up with a treatment plan that tackles the real problem, not just relieves symptoms.

Dr Kate Lemerle, Psychologist

Chrysalis Counselling & Coaching, Norfolk Island

WEB: www.chrysaliswellnessservices.com

TEL: 52112 or email drkate@iinet.net.au

Please 'contact us' for more information.

Norfolk Island Fitness and Health News


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How Much Do You Know About Dementia?


About 47 million people worldwide are living with dementia, and a new diagnosis is made every 3 seconds according to the World Alzheimer Report 2015. 
Last year, the World Health Organization (WHO) released a Global Action Plan on Dementia urging all nations to run public health campaigns to raise awareness about dementia, and to put in place strategies to foster a “dementia-inclusive society” by 2025.


For public health strategies like this to be effective, we need to know what people already understand about dementia. We need to know the people with facts versus fiction, who seeks early diagnosis and which groups don’t have access to early intervention and treatment services. Community surveys help us uncover general community attitudes to dementia and help policy makers plan where to direct funding for prevention through to palliative care services.

A recent systematic review (a search of the data from a large collection of research studies in Europe, the US, Eastern Asia and Australia) found the following beliefs about dementia:

48% of people believe that dementia is not preventable;
42% of people believe they can act to reduce their own risk;
71% of people believe alcohol consumption increases the risk;
56% of people believe stress increases the risk;
37% did not believe that there are medications available to prevent or reduce the risk of dementia;
75% believe vitamins are available to prevent or reduce risk for dementia;
61% believe that risk for dementia is reduced with mental activity;
41% believe risk can be reduced with physical activity;
37% believe eating a healthy diet reduces risk;
13% believe risk can be reduced with social activity.

What do you believe about dementia?

The review also looked at people’s beliefs about available treatments for dementia. Results showed that:
42% believed a cure is available;
89% agreed that people should seek help for memory problems;
55% believe effective treatments exist but only 42% believe effective treatments exist to slow the progression of the disease;
82% of people believe treatments are available to improve the wellbeing of people with dementia.

How much do you know about treatment options for dementia?

Over the last ten years, the belief that dementia is a preventable disease has increased. Fewer people believe that there is a cure for dementia, while belief that effective treatments exist appears to have increased. However, belief that dementia is a normal part of ageing has remained relatively steady.

In a nutshell, this huge review found that the common misconceptions that dementia is a normal part of ageing and it’s not preventable are still very widespread, even among health professionals who diagnose and treat dementia. 

Knowledge about the importance of cognitive leisure activities has improved but still needs a lot more awareness in the community, along with raising awareness of the importance of formal educational attainment and reducing cardiovascular risk factors as preventative strategies. More people need to be aware of evidence that both medical and non-medical methods can delay functional and cognitive decline as we age.

So here are some evidence-based facts about ways to reduce your dementia risk:
People who are happily married (or in a secure long-term relationship) have a lower risk – the relative risk for lifelong singles is 1.42 and the relative risk for those who are widowed is 1.20. This is about being happily engaged in positive intimate relationships .
Nutritional interventions including dietary changes, medical food or nutraceutical supplements (e.g. fish oil, flax seeds) have shown moderate results for preventing the onset of dementia ;
A risk index (Lifestyle for Brain Health, LIBRA) based on 13 measured risk and protective factors can accurately predict future risk of dementia, for example, a one-point increase in LIBRA scores relates to a 19% higher risk for dementia. LIBRA provides a solid tool for “prescribing” changes to lifestyle-related risk factors that may reduce an individual’s risk of dementia in later life .


Dr Kate Lemerle, Psychologist
Chrysalis Counselling & Coaching, Norfolk Island
WEB: www.chrysaliswellnessservices.com 
TEL: 52112 or email drkate@iinet.net.au 

Please 'contact us' for more information.

What Makes Families Thrive?


With the recent opening of Norfolk Island’s new child and family support service, it’s timely to find out what we know about families that thrive. Surprisingly, apart from a raft of Google pages devoted to blogs telling people to spend more time together, tackle conflict positively, recognise each family member’s strengths, and follow the lead of good role models, there seems to be little evidence-based research that unpacks the ingredients of successful families.


The guru of couple’s therapy, John Gottman, who has devoted over 40 years studying couples, is one exception who has turned his sights on families. Gottman’s research was the first to use observational coding systems refined over many years to map out the critical elements or building blocks of successful couples. His scientific research with thousands of couples and families included observations, interviews, physiological, and questionnaire data. Some families were tracked for as long as 20 years to observe changes in how this social system works at different stages in the family life cycle.


Gottman’s research pinpointed the emotional climate between the parents as being a core indicator of thriving families. By this he means the strength of each adults’ ability to manage their own emotional states, and to be attuned to the emotional states of their family members. Put simply, this means having the capacity to look inwards whilst also being able to look outwards. It means being focused on the multitude of subtle changes in emotional states we have ourselves in response to things going on around us, and at the same time being able to observe and make sense of subtle changes in the emotional state of another person (or in the case of the family, several other persons).


In his books, Gottman is critical of much of the popular parenting literature as he claims the focus on “discipline” rather than “attachment” and “interaction” is flawed. For families to thrive, people have to (a) feel safe and connected to each other, and (b) attune their brains to each other, like master satellite dishes constantly on watch for changes in each other. More importantly, he suggests that we must also have the skills for smoothing out ripples in the emotional climate, bearing in mind that there’s no “one size fits all” method for getting disturbed emotions back into a state of stability.


Another key element Gottman recognises is that there’s much more to re-stabilising emotional ripples than just words – saying “the right thing”. His work with communications experts like Paul Ekman and Wallace Friesen led to developing the Specific Affect Coding System (SPAFF) for observing emotional shifts between people in families. These are tied to behavioural patterns, the habits people develop over time which becomes a kind of short-hand communication system


Another body of work that helps us identify what makes families thrive is that of Stephen Covey. His book “The 7 Habits of Highly Effective Families” (1997) also took the focus off discipline and parenting. Instead, Covey emphasises “beginning with the end in mind”. That is, what is your vision for this family? He recommends looking beyond the front fence and developing a “flight plan” which is the end point at which you are aiming. Covey asks us to describe our family in 20 years’ time – how will it be operating?


Covey talks about being proactive – looking into the future and seeing possible road bumps, then putting in place plans to avoid or minimise them. He suggests learning to “hit the pause button” rather than instantly reacting and being able to respond thoughtfully rather than react uncontrollably. Part of being proactive is also depositing into the family’s emotional bank account.


Understanding is critical to successful families. By this, we mean not jumping to conclusions or making hasty judgements, but being able to listen with an open mind and heart, as well as being able to share openly your own views, needs or emotions. It’s about setting up an open flow of information between family members about they each tick.


Finally, Covey talks about celebrating differences rather than trying to clone every member of the family. Differences are what captivates our attention in the wild, and in our social systems it’s no different. Seeing and thinking differently give us the opportunity to critically review our own positions on thing. It is also a chance to see completely new and exciting ways to move on from an argument or stonewalling.


What Covey and Gottman have in common, apart from their guidelines being based on extensive research, is that they drill down into how families work based on good evidence which is now being supported by neuroscience. They also talk about good research showing that families can be coached to success in the same way we do with individuals and with work teams. Rather than waiting until the family is in trouble, both suggest learning techniques from coaching so that your family becomes a work or art, a dynamic living being that is constantly nourished to grow stronger and more resilient.


Dr Kate Lemerle, Psychologist

Chrysalis Counselling & Coaching, Norfolk Island

WEB: www.chrysaliswellnessservices.com

TEL: 52112 or email drkate@iinet.net.au


Please 'contact us' for more information.

Trying to Make Sense of the Unthinkable


Every now and then, things happen in our lives that are unthinkable. Our nice ordinary everyday routines are stopped in their tracks by a piece of news or an event that leaves us shocked to the core. We question whether it’s true, how it could be true, what made it happened. We try to come up with explanations to make sense of it, to put it into some form that eases our need for predictability. We feel compelled to find some reason for the unthinkable. And often we latch onto something that makes the unthinkable seem plausible, so we can then rest easy “knowing” why the unthinkable happened. All too often, we find that our first “explanation” is way off track…but only if we make the effort to dig down and find the real reasons.


The Birth of Brain Science: What Makes the Brain Tick?

The fact is, unfortunately, that many “causes” for human behaviour are still largely unknown. This is because “brain science” – the scientific study of how the brain operates – is still very much in its infancy when compared to our understanding of how other organs of the body work. This is despite evidence that early Egyptians knew about the importance of the brain. An ancient papyrus dating back to 1700 BC is the earliest known medical text discussing the brain, the meninges, the spinal cord and cerebrospinal fluid. It contains details of 7 medical cases that deal directly with the brain, and documents brain injuries that were described as untreatable. 

It wasn’t until 1929 that Hans Berger invented electroencephalography (the EEG, a device that measures electrical activity in the brain. In 1938 Isidor Rabi discovered nuclear magnetic resonance which led to the development of magnetic resonance imaging (MRI). In 1974 The first Positron Emission Tomography (PET) scanner was invented, providing visual information about brain activity. 

The last decade of the 20th century was declared the Decade of the Brain, and in 1992 functional magnetic resonance imaging (fMRI) was first used to map activity in the human brain. In 2009 the Human Connectome Project (HCP) was launched to build a "network map" of the structures and anatomical functions of the human brain. This is the first time in human history that an investment has been made into finding out how the brain works and to link this to other aspects of our behaviour such as the genome and biochemistry of the body – basically to explore that question: what drives people to do what they do?

Brain “Fingerprints” and Human Behaviour

Recent evidence coming out of the project suggests that specific patterns or “fingerprints” of both structure and neural activity (the ways in which various types of brain cells operate) predict personal traits such as intelligence, personality, behaviour habits (for example, gambling) and even some mental illnesses. This is done by correlating patterns of brain activity with test scores on widely used psychological tests. One study has reported that scans explained more than 20% of the variability in an intelligence test based on verbal reasoning. However, as the HCP progresses, the complexity of the way the brain operates becomes more and more evident. The old model that suggested certain regions of the brain were the seat of certain human behaviours or experiences, such as Broca’s Area operating speech, have now largely been discarded. Recently, it was found that some brain cells communicate by biophotons (low visible light produced by biological systems).

Can We Understand Unthinkable Behaviour Using Brain Science?

So how do we make sense of unthinkable behaviour - doing things that most people would find utterly despicable like sex offending. The answer is, we simply don’t know, but what we do know is that “unthinkable” behaviours arise from malfunctions in the brain. Sometimes these are the result of injury or disease, like the case of a paediatrician whose unspeakable acts happened out of the blue and were found to be the result of an intracranial bone tumour that affected orbito-frontal cortex and hypothalamus. His behaviour never occurred again after surgery to remove the tumour . 
 
Recent studies have found that paedophiles show notable differences in certain brain areas like the anterior insular cortex, which is linked to nurturing responses, and these differences were not the same as brain activation patterns found in child sex offenders. About 40% of child sex offenders have been abused themselves, suggesting specific patterns of brain changes may be related to specific types of childhood trauma, and may provide the foundation for aberrant patterns of behaviour.

Whether understanding what drives people to commit unthinkable actions helps forgiveness is a personal process. For many, forgiveness of unthinkable behaviours will be impossible. However, we should all resist the urge to be quick to judge. Judgement can only come when we have all the facts and evidence before us, and sometimes those facts reveal back-end stories that put an entirely new slant on the question “Why?”


Dr Kate Lemerle, Psychologist
Chrysalis Counselling & Coaching, Norfolk Island
WEB: www.chrysaliswellnessservices.com 
TEL: 52112 or email drkate@iinet.net.au 

Please 'contact us' for more information.

Norfolk Island Fitness and Health News


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Raising Resilient Children: Nature, Nurture or Both?


It’s often assumed that protecting children from adversity is important for their long-term health and wellbeing. Research such as the Adverse Childhood Experiences (ACE) Study, one of the largest studies of childhood abuse and neglect and later-life health and wellbeing, showed that the more trauma a child has, the greater the risk for a swag of physical, mental and social problems across the lifespan.

It’s believed that this is the result of biological and neurological changes in the body and brain. These changes come about either due to a build-up of repeated stress or from sudden changes or an event at a critical period of development.  

Whilst this research explains a lot of adult behaviour and health outcomes, there are a couple of issues that are often overlooked:

  1. Not ALL children exposed to adversity go on to automatically develop problems in adulthood. In fact, between 60% and 90% of people report lifetime exposure to at least one potentially traumatic event, yet only a fraction of them develop PTSD or related disorders;
  2. Not enough attention has been paid to finding out what gives some children the edge to go on and thrive despite very severe childhood experiences. Ann Masten’s research almost thirty years ago showed that adversity itself doesn’t “cause” problems, it’s adversity plus other risk factors like problems in the family that together put kids at risk.

We all come hardwired differently to respond to toxic stress or tolerable stress, in the same way that each of us is unique in terms of appetite, pain sensitivity, sleep needs and so on. Elaine Aron’s best-seller “The Highly Sensitive Person” (1996) was ahead of its time in suggesting that some people are simply hard-wired to be more sensitive to shifts in the outside (or inside) world than others. The converse is also true – some people come hardwired to be resistant to the damaging effects of toxic stress.

Thirty years on, new research comparing the brains of people who’ve experienced trauma and gone on to develop PTSD with those who haven’t, is supporting this view - differences have been found in both structure and function in various areas of the brain associated with memory and emotional processing when we compare resilient and fragile people.

As an example, magnetoencephalography (MEG) – a technique that detects magnetic fields above the surface of the head produced by changes in electrical potential between the brain cells – has revealed a highly distinctive, unique “signature” of brain activity linked to PTSD. Major differences were found in the brain “signatures” for those who are high vs low in trait resilience. That is, the brains of resilient people differ significantly from those who go on to develop pathology after trauma, and these differences (especially changes in right-hemisphere activity) are probably inherited. In fact, recent studies in epigenetics are confirming this.

The research suggests that the brains of people who are more vulnerable to developing trauma-related problems are somehow stuck in a trauma-encoding state due to faults in their neural networks. They are more likely to link harmless stimuli with threat, and this keeps them in a higher state of arousal that leads to unhealthy patterns of responding such as avoidance.

The interesting question is, can we strengthen this positive inherited difference for people who are resistant to trauma, and can we repair the “faults” in those whose brains are not as hard-wired for resilience?

Well, we’re not yet able to screen everyone’s brains to identify faults. But we can invest in mental health promotion programs that give all our kids the tools they need to become more resilient people. “Raising Resilient Rascals” is a three-hour community workshop designed to help parents pick up the skills they need to help their kids cope positively with life when it goes pear-shaped. Other resources including a self-help program will be coming online soon. Give me a call or check out the website if you’d like more information.

Dr Kate Lemerle, Psychologist

Chrysalis Counselling & Coaching, Norfolk Island

WEB: www.chrysaliswellnessservices.com

TEL: 52112 or email drkate@iinet.net.au

Please 'contact us' for more information.

Raising Resilient Children: Can we teach grit?


One of the key building blocks for resilience is called “grit”. It’s not a quality we often talk about, although we do talk about similar qualities like perseverance and hope. Grit – defined as a commitment to keep going no matter how hard the going gets – is part of a cluster of qualities we call “growth mindset”. To have a growth mindset, we need resilience, the skills and personal traits to bounce back when things get tough.
 

Give it your all
Redo if necessary
Ignore giving up
Take time to do it righ

A “growth mindset” is the belief that your abilities can be improved through effort. That is, you can get better and hard work pays off. Having a fixed mindset makes us quit when we don’t do well at something immediately. If you don’t believe you can really improve, why keep trying?

Hope comes into it because having hope implies that you get a sense of something positive in the future – it’s worth making the effort because there will be good outcomes. It also implies the ability to keep going rather than giving up – this is perseverance. It depends on having the belief that you can make changes, you CAN do it.

In a study with 373 seventh graders, some were told that their IQ was changeable, while others were told their IQ was fixed at birth. The kids’ grades were tracked over the next two years. The study found that the grades of those kids who were told their intelligence can change continued to improve, but the grades of those told their IQ was fixed stayed stable. Belief in possibilities predicted higher effort and better outcomes. A surprising finding was that the group who were told their IQ could change behaved significantly less aggressively, were more prosocial (caring and respectful of others) and showed fewer conduct problems.


How do we help our children develop grit and become more resilient adults? Here are some tips for parents:
1. Praise your child for specific “wins” or qualities rather than global abilities. For example, rather than saying “You’re such a smart person”, say “I really admire the way you stuck at that homework and came through with a great mark this time!”. This draws the child’s attention to the outcome directly connected to the effort put in on this occasion.

2. Respond positively to failure. Rather than saying “That’s just bad luck” or “You should have tried harder”, try exploring with the child what they believe they could have done differently to get a different outcome. For example, ask what they would do next time in the same situation using the wisdom from this experience.

3. Help children set positive goals (not avoid punishment). Telling kids they just need to make more effort doesn’t help with learning. Instead, teach them how to map out the steps needed to get to the desired end point, and break these down into small manageable chunks – goals. Put mini-rewards in place for each accomplishment.

4. Help them transfer skills from one area of life to another. Find something your child does already that involves setting goals, practicing, working hard, and celebrating success. It might be playing in a sporting team, learning music, or simple things like learning anew computer game. Show them how their determination and commitment have taken them from a beginner to a winner, then talk about applying the same process to a new skill like managing homework or study.

5. Share your own stories of grit. Or draw attention to other people they admire who have had to work hard and overcome adversity to get to where they are today. Children are much more likely to adopt new behaviours if they are inspired and fantasise about achieving the same greatness of their idols, rather than being nagged by well-meaning parents.

If you want to find out more about grit, and test your own “grit score” or assess your children’s grit, visit Angela Duckworth’s website and take the quick online test at https://angeladuckworth.com/grit-scale/ 

Dr Kate Lemerle, Psychologist
Chrysalis Counselling & Coaching, Norfolk Island
WEB: www.chrysaliswellnessservices.com 
TEL: 52112 or email drkate@iinet.net.au 

Please 'contact us' for more information.



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