FOLLOW ME

Showing posts with label Dog Training. Show all posts
Showing posts with label Dog Training. Show all posts

Monday, 13 January 2014

Anxiety in Dogs - Treatments, Remedies - What Works, Might Work, Dosen’t Work



My German Shepherd x Malamute 'Jordie'
In this article...
  1. Loving Dog Owners - the Vulnerable Consumer Trained to Trust not to Question…
  2. A question that I am often asked - ‘Are you familiar with the Thundershirt?
  3. Understanding Limitations
  4. Setting Expectations
  5. Commercially Available Products - Can They, Do They Really Help
  6. Remedying Root Cause v.s the Band Aid Approach

Dogs acquire chronic anxiety for many reasons and with different outcomes. Anxiety may exhibit as localized to a specific situation or may be exhibited in multiple situations. Here are a few examples - 
There are a lot of products marketed to 'solve' anxiety but do they really work, and if the products don't work what does solve anxiety...

1.0 Loving Dog Owners - the Vulnerable Consumer  

Trained to Trust not to Question…

In the pet-care industry there are so many products that are promoted as being the ‘solution’. But what if that product is not the solution? What if the person pushing the product is not truly educated in the limitations of the product? What if you purchase the product and it does not meet your expectations?

Products marketed for 'reducing' or 'solving' anxiety include a wide range of applications - for example:
The 'Thundershirt' a garment that apply pressure to your dog's body;
Pheromone and herbal spray collars, and;
Veterinarian prescribed drugs such as Reconcile.

At best you may be disappointed.

At worst, failure of that product to meet its advertised goal can seriously and adversely impact on yours’ and your dog’s psychological and  physical well being, and can even cause death.

In the case of a chronic issue such as anxiety, a strategic and comprehensive approach that addresses immediate symptoms and root cause creates a recipe for success.

However when a single product is promoted as a ‘proven solution’ to a complex condition you should be suspicious and you should question the validity of the claim. This is so even if the product is recommended by your favourite pet store employee, your trainer/behaviourist or your veterinarian. 

I have seen much damage done to dogs and their people when trust was assigned without question.

Some products have only negative value - meaning that due to the nature of the product only an adverse result can be and will be realized. 

Other products may contribute great value when used in the context that they are really intended for or may be applied to a new situation with success as part of an overall strategy to address the situation.

Lastly - some products that are designed to and actually do provide helpful support to ameliorate a temporary condition do not provide the same quality of result when applied to a chronic condition. Regardless of a not-so-perfect outcome the manufacturer may decide to aggressively market the product becasue it is a good business decision when the priority is to make money. If the product finds a niche it can become very popular - but popular does not necessarily equate with appropriate, good or safe.

Sometimes a product migrates from its intended use as a means to address an emergency situation, into mainstream use for ‘treating’ a chronic condition. When a product has attributes that can be used in emergency, temporary and chronic conditions, multi-application is truly justified. When use is not justified but pushed for the sole gain of the company, the consumer may be ill served.


2.0 A Question that I am Often Asked...
‘Karen are you Familiar with the Thundershirt?’

When it comes to the topic of anxiety and dogs, people often ask me ‘Are you familiar with the Thundershirt’.

I cringe every time I see the product for sale in a pet store with the product packaging promoting it as the, to quote “proven solution for dog anxiety”.

I cringe when I hear sales people - who know little to nothing about dog and human behaviour advising customers to purchase the product to resolve the issue of anxiety. Resolve? Wait a minute, you must mean aid in the resolution of? Surly you don't mean actually resolve? The disturbing thing is that I do know that the person having the conversation thinks that the product can actually resolve the problem.

I cringe when I have people - now desperate and coming to me as a last ditch effort to save their dog, retell their experience with using that or another product. How did they and their dog end-up in such a desperate state? Because product manufacturers, sales people, trainers and behavourists that don’t understand the cause and effect behind the development of unhealthy behaviours, nor the real solutions required to right the condition push the Thundershirt as a remedy.

While the Thundershirt may have some value in some circumstances to ameliorate some or a single symptom of anxiety it is not the panacea for cure that is evoked by the product’s labeling as a "proven solution for dog anxiety”.
My Beagle x Fox Hound 'Willow'
3.0 Understanding Limitations

The Thundershirt works on the theory that by applying pressure around the majority of the body a feeling of comfort will be triggered in the being wearing the shirt. An intervention that has been found to have varying degrees of success when dealing with a human that is in a state of psychological distress. While this may work for some individuals it has little to no effect on other individuals.

The Thundershirt was developed for use in slaughter houses with an end-goal of ‘comforting’ animals (i.e. cattle, horses) as they did their final walk to the slaughter room floor.

The Thundershirt was designed to treat a symptom in an emergency situation experienced by an individual animal once in his/her life span.

It is very important to understand that the act of applying pressure to the body does not alter the root cause of the distress - which is the fact that the animal is about to be slaughtered. If that animal were to experience the stressful situation on a daily basis the ravages of stress on the mind and body would not be completely of even partially eliminated in all or even in some of the animals.

The application of pressure to the body does not teach a being how to cope with the situation - the pressure simply triggers an auto-response by body and brain to relax to one degree or another in some individuals.

The Thundershirt was not designed for use as a remedy for a chronic condition experienced by an individual animal, nor was it designed to foster a permanent resolution of the root cause of the anxiety.

4.0 Setting Expectations

Understanding the logical reality of a product such as the Thundershirt means that you, the consumer and loving pet owner can set some reasonable expectations around the use of the product.

The company’s marketing strategy includes the following statements…
  • “The Thundershirt is the best solution for dog anxieties caused by thunderstorm, travel separation and more”
  • “Proven solution for dog anxiety”, and;
  • “Over 80% of dogs show improvement”.
So what do these claims really mean? I would say that the phrasing and words used in these claims should be scrutinized for their many permutations. "Over 80% of dogs show improvement" - does that mean that the issue of anxiety was resolved? I don't think so - in which case the product is not a solution. How do they define 80%? Do they get feedback from every customer that has ever purchased a Thundershirt? I don’t think so. Do they define the percentile from recording the results experienced by the dogs in the companies' ‘Training Center’? Do they define the percentile based on a group of dogs that they tested the product on during development of the product?

The statement also does not define what type of improvement was achieved - minor improvement? Major improvement? What percentage of dogs experienced what type of improvement?

These claims by the company are, in my opinion a good marketing strategy but a very unfair means of selling the product as the words used can create an expectation in the dog owner that the product may not be capable of delivering.

The claims all come down to symantics. 

How do you define ‘solution’?

Do you define a solution in the context of a big picture? Meaning that a solution provides a complete remedy to a condition? Or does ‘solution’ pertain to modifying an element of a condition? To attain ‘improvement’ in your dog so you just put the shirt on your dog and walk away, or do you need to sign up for the company’s training program or work with an affiliated trainer?

The answer to those questions requires contemplation, thought, comparison on the consumers part. Quite frankly when you are desperate for a solution you don’t always have the circumspection to read the fine print or compare and interpret the manufacturer’s use of a term (i.e. ‘solution’ or a phrase i.e. ‘over 80% of dogs show improvement’) against your understanding/interpretation of a term or phrase. You are more likely to buy into the desire to believe in the marketing and / or ‘advice’ being provided to you.

I have had many client’s that tried the Thundershirt first – for both separation anxiety, thunder anxiety, travel anxiety - to no avail which is why they end up coming to me to resolve the problem. Prior to trying the Thundershirt most of them have been to one or more trainers and behavourists who attempted to resolve the anxiety and some also recommended the thundershirt to the owner - which is why they tried to use it.  The trainers failed to remedy the anxiety because they did not understand the dog or the dog’s human companions. The same trainers and behavourists try other interventions such as pheromone and herbal spray collars, Bach remedies etc. Obviously if the approach had worked the people would not have had to seek me out and engage me to truly resolve the anxiety.



5.0 Commercially Available Products - Can They, Do They Really Help?

5.1 The Thundershirt

I think it would be fair to say that in some cases the Thundershirt is able to and may provide temporary relief of one or more of the symptoms of anxiety and if used consistently overtime the Thundershirt may change a dog’s association with events that lead to anxiety. Note the word some and may.

I would say that the Thundershirt - when it does work may do so in one or two of the following ways, depending n the circumstances:
One - via applying pressure to the body as discussed further above and;
Two - via a placebo effect.

It is my belief that the Thundershirt can have a placebo effect on some humans which then transfers to the dog. This is what I mean - the thought of using the Thundershirt calms the human because he/she thinks it will work. One of the fundaments of repairing anxiety in a dog is the ability to communicate a state of calm to the dog. By being that thing first you want your dog to be you set the example and provide the direction. I teach my client’s (the human client’s) how to achieve calm as in so doing they provide pure, logical direction to their dog to calm. For the most part dogs do exactly what their human’s communicate - the problem is that humans have become hasty and ineffectual communicators.

In a mild case of anxiety the Thundershirt may provide some positive impact on reducing symptoms. How much this product can achieve varies depending on the genetic and psychological make-up of those involved, dog and human, on the plan of treatment and on the knowledge and skill of the person - if any that teaches the dog’s owner how to implement a plan of treatment. Is the product going to be used alone or as part of a larger strategy?

5.2 Specialty Spray and Scent Collars, Bach flower essences, Rescue Remedies, etc.

Once again, I think it would be fair to say that in some cases these products may have some positive effect on mitigating some symptoms of anxiety in some dogs BUT these products will not normally cure the anxiety.

Once, again - how much these products can achieve varies depending on the genetic and psychological make-up of those involved, dog and human, on the plan of treatment and on the knowledge and skill of the person - if any that teaches the dog’s owner how to implement a plan of treatment. Is the product going to be used alone or as part of a larger strategy?


5.3 Veterinarian Prescribed Conventional Prescription Drugs

These pharmaceutical products cause me the greatest concern of all. While products such as the Thundershirt and speciality collars may simple not create a looked for result that may lead to added frusteration on the owners part - pharmaceuticals can do immediate and long-term damage to the health of a dog. Products such as Reconcile - (Prozac renamed for use by allopathic veterinarians) can and do cause mild to serious to lethal harm. And when used long-term are known to cause an enlarged heart, seizures and an early death. You can read about Reconcile here. This is not a product that I ever recommend and if I am going to work with a client whose dog is on the drug I ask them to get the dog off of the drug prior to a session.

There are many natural nutraceuticals and herbs that can be used on a temporary and permanent basis along with a properly designed diet which will BETTER support the reduction of anxiety than any conventional drug. These natural items can also do double duty by supporting over-all health and the immune system. These natural items will NOT have the serious adverse consequences that conventional drugs impose on the dog. 

There are many listed and unlisted ingredients in most pet foods that can - on their own, create anxiety in a dog. Another reason why I approach all matters in a comprehensive, holistic manner rather than relying on stop-gap measures that were never designed to use on a long-term basis and will not result in actual remedy.

In an emergency situation and when used for a very short time when access to alternative knowledge is not available, the use of conventional drugs may in some cases have some value, however the side effects of the drug may far out-way benefit. 

It is interesting to note that Reconcile - in addition to exposing the dog to adverse and serious side effects also has side effects that create the same symptoms that the drug is supposed to 'treat' - anxiety. 

Once again, I think it would be fair to say that in some cases conventional drugs may have some positive effect on mitigating some symptoms of anxiety in some dogs BUT these products will not cure the anxiety and the side effects of using the drug may have far worse consequences than the actual issue the drug is supposed to 'treat'.


6.0 Remedying Root Cause v.s the Band Aid Approach

In my opinion based on years of working with dogs and people - the real remedy to anxiety is comprised of multiple elements - you can read about those many facets here and how they interconnect and when accomplished properly result in a remedy for anxiety.

While there are commonalities amongst most cases of anxiety, including separation anxiety, there are also unique variables that exist in any single given case. These unique variables are a direct reflection of the reality that each person and each dog is a unique individual. When one or all of these key contributors is not understood and/or not addressed the root cause is not resolved. The issue remains.

Although I work with dogs and their humans who are experiencing truly extreme anxiety - the dog is chewing his/her way through metal crates, drywall, doors, electrical wire and sustaining severe physical damage (and yes I do mean both dog is anxious and dog’s human is anxious). I have never had a need to use products such as the Thundershirt, special spray collars etc. I am fortunate in that I have (and have the knowledge, understanding and skills to perceive root causes and effect solutions by working with the actual psychology and physiology of a dog and his/her human. This allows me to perceive what triggers behaviour (good and bad, human and canine), identify and apply methods that resolve the issue, which I then teach to the dog’s person.

My methods are based on leveraging a holistic strategy that addresses root cause and contributing factors including diet. These are all part of a kit of tools that can and should be used to create a successful resolution. The other tools I use and which I teach my client’s to use are tools that we all have within ourselves - which just happen to be the same tools that a dog has to use. These tools are also very portable as both the dog and the human carry the tools with them wherever they maybe. No fear of forgetting one of the tools behind. No need for treats, clickers, special shirts etc.

Some of the tools I use and teach my client’s to employ are -

  • The ability to perceive, understand and communicate using multiple senses - for this is how dogs communicate and should the dog’s person not learn in part to do the same the person will always be at a great disadvantage when seeking to provide support for their dog;
  • The development and deployment of self awareness, self discipline, patience, persistence, determination to lead by logical and true example;
  • The ability to read a dog’s face and body language,
  • The ability to learn from your dog.

These skills provide a remedy to canine anxiety and human anxiety they also create positive growth in the human and the dog. By making sure diet is also addressed a complete solution is provided.

I think it is safe to conclude that a Thundershirt or any other single product is no match for a real solution.

I think it is safe to conclude that no single product used in isolation of a larger strategy can be expected to remedy anxiety - the product may instead, simply help to create a band aid ‘solution’. And this may be better than no intervention.

Consumer beware and adjust your expectations to suit. If you are successful to any degree in your use of a product you will feel good about it rather than stressed. If you feel stressed your dog will too.




Additional Assistance

Additional Assistance - Holistic Health and Wellness Service
If you require additional support, and guidance - contact me to discuss your requirements. I will determine the appropriate course of action for your situation and I will let you know the applicable fees. I offer consultative services to clients around the world...
Diet, Nutrition Wellness Services
  • Unbiased Diet, Nutrition, Product Advice - information and payment here >>. 
  • Holistic Diet, Nutrition Wellness Plans - information and payment here >>.
Dog Obedience Training and Behavior Modification Services
  • In-Person sessions - information and payment here >>.
  • On-Line consultation and sessions - information and payment here >>.

Wednesday, 28 August 2013

Is It Possible that Training Our Dogs Is Really Wrong?






Yeap, this is me with some of the dogs in my dog pack

On one of the professional dog training and behaviour forums that I belong to, (today) one of the trainers posed the question ‘Is It Possible that Training Our Dogs Is Really Wrong?’ She then went on to note…'In recent years after having tried the training with rewards, hanging my dog when aggressive, electric collars, alpha rolls....tried it all. Could there be something else ...another way to approach working with dogs? What if PR is really Negative Reinforcement?' Well I have not used e-collars, etc. but my answer to her question (and I think you might find it very interesting) was as follows...

YES! Training our Dogs is Wrong!

My dogs Robbie and Sarah waiting for permission to start their
off-leash portion of the walk

And now you are thinking "What!? Karen are you crazy, you make your living training dogs!"

Well...hmm, actually I make my living working with dogs and training their people :>) 

Dogs require clear communication – it is the human that requires the training!

OK, so who is it that is really trained - me, or my dogs?

So Is it possible that training our dogs is really wrong?

The following was my response to that seemingly odd but intriguing question...

It is my very firm belief that it is not the dog that requires training if we are talking about day-to-day life skills living in a home and community with humans, other dogs and other animals. If that is the scenario you are referring to then it is my belief that it is the humans that require training.

If on the other hand you are referring to situations where the dog will be working on a specific task such as bomb sniffing, search and rescue, supporting a person that is physically or mentally challenged then yes the dog will need training specific to that specialized task. My comments below do not refer to this type of specialized training, but instead to the type of requirement I noted in my first paragraph.

A glimpse into my way of working with dogs and their people...and why looking to train your dog is the wrong approach for those dog owners wanting to provide their dog with the life skills required to be happy well adjusted dogs for normal day-to-day life...

I do not seek to train the dog, but instead I look to see and understand the dog and then mentor the dog based on its individual inherited and acquired traits. I communicate with the dog in a logical and respectful manner, coaching and mentoring that dog through various situations - while I train its humans to be more insightful, more aware, more self-disciplined communicators.

In order to train the human I must also see and understand the human.

I do not believe it is necessary to train a dog, it is simply necessary to communicate to that dog in a respectful, logical, insightful manner. It is the human that must be trained. A brief but more detailed explanation of how that works can be gleaned from these two articles – here and here.

So What Should You Do Instead of Training Your Dog? 

Well as I see it, you should learn to be more like a dog! Or as Edward Hogland once said...

"In order to really enjoy a dog, one doesn't merely try to train him to be semi-human. The point of it is to open oneself to the possibility of becoming partly a dog."

That's my boy Robbie and yes, he is smiling and he is asking
'"Ok mom, what are we 'gonna do now?
"
In the discussion thread, another trainer noted that he believes our dogs are very in-tune to our emotions. Well not only do I believe this to be true, it is also a foundational concept of how I work with dogs and their people. 

Dogs have a full range of emotions and as such they do understand emotion - they also understand facial expression. 

Dogs are one of the few animals that have a similar muscular facial structure to humans – I can see all of the expressions on a dog’s face that a human can see on another human’s face. Understanding how to really read your dog’s face is just one of the keys to understanding your dog which is why it is something that I teach my clients. You can have a glimpse into the world of a dog’s facial expression here.

The same trainer then came back and asked me "I do have one question Karen. Are you saying you don't teach dog some like even...come?" My answer was of course I teach a dog to come :>) but is that training or is it just good communication? And how is that dog compelled to come? Because the dog wants to work with you and you have - in the past given the dog a truly logical reason to come, or becasue it must listen becasue we are the human :>)

When your wife or girlfriend asks you to follow her to a display in a store - do you oblige? Did she train you or are you acquiescing becasue you want to? Ya, I know you are going to say she trained you (grin) but how do you learn to come when your mother calls you when you are little?

How does a mother dog get her puppies to follow - is it training or is it communication delivered with nuances that make you want to cooperate? Or is it a combination of many things including respect for each other?

OK, so this is my dog Abby, and she is smiling with a glint of impishness,
she is happy and is asking if she can go charging off to play
with the other members of my dog pack
...
just in case you are curious - the answer to her question was...
Yes, off you go Abby'.
I gave her this direction with a gesture and a smile in my eyes and face
- no words were necessary :>)
A few trainers on the forum have had the lack of perspective in the past to say that what I do is 'voodoo' and 'wooo'. My response to them has always been to say how sad and how ridiculous, as their shallow comments come from a place of their own insecurity as it takes great self discipline, self awareness, self restraint and self control to work as I do. I have to be that thing first, that I would like the dog (and the people)  I am working with to be - I have to lead by exacting example.

What I do is based on a great sense of humility which allows me to see just how amazing, how intelligent dogs truly are, and how humans have much to learn from dogs.  I have learned from dogs and do so every time I work with a new dog. I do not have the inhibitor that says I am better than a dog, so a dog has nothing new to teach me. Should the human be truly intelligent they can liberate themselves from the constraint that a dog is just a dog.

What I do is based on pure logic which is not clouded by pre-conceived human concepts and resulting restraints driven by the notion that only a human may possess great intelligence. I have to have the courage to look beyond what our society, our culture teaches us from the time we are young.

Human intelligence is so often rendered less than it could be due to the emotional and judgmental nature of our species :>) 

A dog does not have to do as I say simply because I am a human and the dog is just a dog. I have to earn that dogs trust and respect.

When we allow ourselves to look beyond, it allows us to work more with what we have in ourselves so that we can rely less on man-made devices which simply cannot solve the root cause of our dog's problem - which is really our problem first as our dogs simply follow our lead. Having had the opportunity to work with many dogs and their people I know that a dog in distress is a gift to the human as that dog is there to teach the human how to overcome a personal constraint which they (the human) has never been able to grow beyond. The dog is a gift - the key is to help the human see what their dog is trying to teach them, and at the same time make sure that the experience is one of mutual benefit and growth.

What type of devices am I referring too? Well, for example..

E-collars, prong collars, ‘Easy-Walkers’, the ‘Halti’ and ‘Gentle leader’ etc. The ‘Easy-Walker’, ‘Halti’ and ‘Gentle leader’ can be no more gentle than a prong or e-collar. And yes, with that statement I am really going to tick some trainers and people off...but hey, reality is when I go to work with my clients I ask them, "so how would you feel if someone was digging into your shoulder joint, yanking your head sideways", uh huh - and then I show them how to work without those devices...to resolve the real issue, poor communication.

I am never dismissive of the devices that my clients have used in the past but instead seek to offer them another perspective and a chance to move forward with better options. After all that is my job! When we set out for 'The Walk' I say please bring the tools that you are comfortable with (prong collar, easy walker, extensible leash, gentle leader, etc.)...but put it in your pocket (prong collar ouch :>). Then I say "bring it with and we will try my way first, if you feel uncomfortable, if I cant find a way to make this work for you, we will use your device" The device never gets used again. Why? Because the human learns to communicate properly with their dog!
  •  Despite the claims and advertising tactics of the manufacturer these devices
    • Are not in many cases ergonomically healthy for the dog;
      • The gentle walker works as a restraint as it digs into the soft tissue, muscle, ligaments and tendons of a dog’s shoulder joint;
      • The Halti or Gentle Leader puts pressure on the dog’s nose and neck and often on the dog’s eye sockets as well;
  • These devices simply allow the human to invasively, physically control the dog;
  • These devices do not solve the root cause of why it is necessary for the human to use the device;
  • These devices do not teach a human how to understand their dog better;
  • These devices do not teach the human how to become a better communicator;
  • And the same can be said for the use of treats.
Now before you get angry and hot under the collar...oops its too late for that...but wait...

Granted some of you might be thinking "this dog whisperer is just arrogant". 

Nope, I'm not, what I am doing is driving home the point that the human needs to be trained...

Are there ever applications when these devices do have a place?
 
Yes of course.

For instance, if a dog must quickly acquire an understanding of how to cope with a situation i.e. how to behave in a safe manner around industrial or farm equipment. When used properly an e-collar can be a positive aid. But this type of situation is very specialized and really does not fit into the parameters faced by the typical dog owner.

While many dog owners find themselves using these various devices, it is fair to say that they have little choice but to do so, if the trainer that they engaged to assist them had only a limited knowledge from with to work.

In my opinion...
It is far better for a dog to be subject to the use of one of these devices than for the dog to be euthanized because the owner had no control over the dog...

But...

It is one-thousand fold better for the root cause that drives the need for such devices to be solved rather than masked;

And that requires that the human be trained...

When we as a species, and as individuals allow ourselves to openly and truly see  what is possible, and what is truly before our eyes and what in reality presents to our other senses;

We are empowered to work as a dog does. 

This then allows us to be more like a dog - a being that is a truly an amazing communicator.

Yeap, Robbie and Sarah smiling again and asking again
- this time their question was "can you pick an apple from the tree for us?"
Which of course I did do, after all dogs are omnivores :>)



The following is an example I often use with my clients - the example explains how we have the opportunity to engage a dog to work with us or instead we can create a situation in which we force a dog to not want to work with us. It is all about patience and communication …

Let’s say you were at work and something went wrong…

Your boss says to you "YOU really messed that up" – he/she does not speak with any kindness or openness but instead with pure anger, ire, aggression. Are you going to want to work with your boss? Or are you thinking he is a jerk (to put it mildly).

Now let’s look at what happens if your boss reacts in a different manner…

Your boss says to you "that did not go so well, but hey - look, this is what WE are going to do instead" – he/she speaks with an open and positive energy that draws you in, compels you to be happy to work with him/her.

Your bosses’ approach, his energy and emotions have the power to either repel you or engage you – and so it is for a human when working with a dog. The instant you think ‘bad’ dog’ you have just fed your body language with your thoughts (your mind and your body) and closed your heart (your emotions, your spirit). Your dog reads all of this instantaneously – combine this with your tension and you have consistency and leadership…but not the kind you want! Here is an article that takes this theory into practice – I recommend reading it.


Pure logic, not based on training the dog, but instead based on training the human :>)

And now you can enjoy knowing your dog a little better, WOOF!



Additional Assistance

Additional Assistance - Holistic Health and Wellness Service
If you require additional support, and guidance - contact me to discuss your requirements. I will determine the appropriate course of action for your situation and I will let you know the applicable fees. I offer consultative services to clients around the world...
Diet, Nutrition Wellness Services
  • Unbiased Diet, Nutrition, Product Advice - information and payment here >>. 
  • Holistic Diet, Nutrition Wellness Plans - information and payment here >>.
Dog Obedience Training and Behavior Modification Services
  • In-Person sessions - information and payment here >>.
  • On-Line consultation and sessions - information and payment here >>.