How Does One Identify an Experience as a Trauma?

By Matt E. Jaremko and Beth Fehlbaum

Our title might sound somewhat nonsensical. Of course, if you have experienced a trauma, you will know it. However, admitting that you have experienced trauma may not be as straightforward as you might think.
Folks can tend to underplay the extent to which they deserve care and attention. It’s almost as if these reluctant victims think, “Oh, I’ll be all right. Let someone else use the help and support.” Additionally, some victims might underplay the extent of trauma experienced because it could keep them from having to face ugly stuff. Sadly, there are those among us who have been trained well to follow rules that delay or avoid self-care. Under defining or failing to admit traumatic experience(s) could hold one back from getting needed help.

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It was not uncommon in Matt’s years as a clinical psychologist to hear a client conclude that he/she had never really figured such and such event in the past had been traumatic. But after examining such under-defined life experiences in juxtaposition with the symptoms they had been having for years, these folks came to realize: “Yeah, that event was truly traumatic, and I wish I had started working at recovering from it much sooner.”

The criteria mental health professionals use to diagnose disorders (DSM V) states that a traumatic event is any occurrence that involves actual or threatened death, serious injury or other threat to one’s personal integrity. In our forthcoming book, Trauma Recovery: Sessions With Dr. Matt, we present fictional accounts of the lives of seven victims with the following traumatic histories: childhood sexual abuse, attempted rape, being in an explosion in combat, being in a mobile home destroyed by a tornado, driving while in a motor vehicle accident in which the passenger is killed, and being a first responder to a multi-fatality terrorist shooting in a church.


Rates of Trauma in Modern Life

Most folks would agree that the experiences depicted in our book are life-changing traumas. A recent scientific research article described a survey that asked a carefully selected representative sample of over 3000 respondents if they had experienced trauma in their lives, (Kilpatrick, et a., 2013). 87% said they had!

In order of most-to-least common, the study listed the actual traumatic event and the percent of respondents who reported it: Physical or sexual assault (53.1%), Death of family/close friend due to violence/accident/disaster (51.8%), Disaster (50.5%), Accident/Fire (48.3%), Witnessed physical/sexual assault (33.2%), Threat or injury to family or close friend due to violence/accident/disaster (32.4%), Witnessed dead bodies/parts unexpectedly (22.6%), Exposure to hazardous chemicals (16.7%), Work exposure (11.5%), Combat or warzone exposure (7.8%).

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These are startling numbers because they conclude that almost everyone is exposed to traumatic events. But if that is the case, why are we all not walking around like thunder-struck basket cases? The answer may lie in a concept known as “objective” trauma versus “subjective” trauma.


Objective Versus Subjective Trauma

If we asked a 100 people whether they thought being raped at gunpoint was traumatic, all would say, “Yes!” But if we asked the same 100 people whether experiencing the divorce of their parents at age 12 was traumatic, we might get an affirmative answer less than 100 times. Be that as it may, it could well be that at least some of the children of divorced parents consider the family disruption to be traumatic. In one case (brutal rape), the definition of trauma is based on the set of objective facts that surround the event, but in the other (divorce), the definition of trauma is subjective to the person experiencing it.

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Trauma must be defined by the experience of the survivor. Two people could undergo the same event and one person might be traumatized while the other person remained relatively unscathed. It is not wise, for example, to determine an event as not traumatic because no one was physically injured. Perceptions of an event can vary greatly from one individual to the next. It is impossible to assume that the meaning of an event that is distressing for one person will be same for another person.

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The same goes for “objectively lesser” traumatic events, such as the divorce mentioned above or psychological abuse from a spouse. Using a subjective definition, many events perhaps people consider not to be traumatic should, in fact, be considered traumatic to some people.

Divorce has been mentioned: how about financial ruin and bankruptcy? After the market crash in the 1930’s, suicides were all too common among those who lost their fortunes. Speaking of the 1930’s Great Depression, prolonged unemployment and poverty probably caused trauma to many families. In a similar vein, countless individuals and their families facing major medical issues such as cancer are being exposed to traumatic events.

In a recently published book entitled Supernormal, Meg Jay brilliantly proposes that most people experience serious adversity in their lives, both as children and as adults. One might think of these life adversities as “traumas inside the home.” They include alcohol/drug abuse by parents or siblings, neglect by parents, overbearing parental expectations, suicide of a family member, even major arguments and disagreements over political issues. These days, there is even serious mention of such a thing as President Trump Stress Disorder! I guess that would be ptsd (without caps!)

Thus, trauma takes many forms, and there are vast differences among people who experience the same trauma. So, in order to define trauma, it is best to examine the similarities and patterns of responses across the variety of stressors and victims who experience them.


Dimensions of Trauma’s Strength

There are several dimensions that have been shown to make traumatic events more or less intense. These dimensions might be considered when attempting to determine whether one’s life has been disrupted by trauma.

The effects of trauma are more likely to be worse if any of these factors are true: the trauma was caused by a human; it was experienced repeatedly; it has the quality of any of the following: unpredictable, multifaceted, sadistic, undergone in childhood, perpetrated by a caregiver, and a lack of support or negative consequences from disclosure.

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When it is another human that caused events leading to trauma, rather than a natural disaster, for example; the average reaction across victims will be worse. The recent mass shooting at a Texas church will no doubt lead to worse trauma reactions than the floods caused by the hurricane in the same state a few months before. But, once again, any one individual in either catastrophe could have a larger or smaller reaction to either of these tragedies.

The sexual assault victim who has been raped more than once will no doubt have more trauma to process than would someone who has been victimized one time. Incest victims who have been violated many times are typically more devastated than a child who had a single episode of being molested.

Repeated exposure to trauma clearly makes things worse. The effects of repeated trauma will be especially ‘hidden’ if what is repeated has been generally accepted to be ‘mild’ by the social group(s) in which it takes place. A youngster verbally abused (e.g. being called ‘stupid’) repeatedly might have an unrecognized trauma, until effects accumulate to form the symptoms of PTSD discussed below.

Being unable to predict when extreme stress is going to happen is often a predictor of whether PTSD will be severe. Consider refugees who must leave home due to war. Such folks might be in camps for unknown lengths of time with no control over even the most basic human factors. PTSD is more likely to be severe in such individuals.

In a similar vein, if events are so devastating as to consist of several distinct traumas, the stress reaction following them will be more intense. An individual in a motor vehicle accident is no doubt traumatized, but even worse so when a family member dies in the same accident. It should also be noted the age at which the trauma happens is important, with children more vulnerable to the development of post-traumatic reactions. Thus, a kidnapped child whose parent is killed trying to save him or her will be in for a long and difficult recovery process. Related to age is adversity or trauma caused by being raised by abusive or neglectful parents, and being around an abusive sibling all one’s life can cause enough cumulative stress that the effects are traumatic.

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Finally, it should be noted that the reactions of people in the victim’s support system can add to the intensity of post-trauma reactions. Let’s say someone who was supposed to be trustworthy, for example, a stepparent, sexually abused a child, but when the abuse was disclosed, the biological parent was unsupportive or even dismissive. Such events predict intense PTSD symptoms with a very difficult course of recovery.

In summary, any event that combines the actual or perceived existence of two or more of the above dimensions will most likely lead to more intense PTSD and should be recognized as such so that appropriate treatment planning can begin.


The Symptoms of PTSD

Following an analysis of the nature of the stressful events, it is important to list and examine the symptoms being displayed by the victim. For PTSD, such a symptom list will contain 5 categories: re-experiencing the event, excessive effort to avoid anything to do with the event, negative emotions (anxiety, fear, anger, guilt, shame), social and occupational self-defeating activity, missing purpose and/or enthusiasm or meaning in life.

If these symptoms are observable, then a PTSD reaction is taking place, even if an “objective” assessment indicates otherwise. Becoming stuck in PTSD is so destructive to life, it should be identified and remediated as soon as possible. “Over-diagnosing” this condition harms little, but much is gained by catching it in a timely manner.

To illustrate the idea of a “subjective” instance of PTSD, let’s consider a fictional case. Paula is a 20-year-old junior in college. While attending a college fraternity party, Paula and her dorm mate got mixed up in an unpleasant exchange with some males at the party. These males ‘cornered’ the women in an upstairs bedroom for more ‘private interplay’. The males started coming on very strongly, making suggestive overtures, and actually groping Paula’s dorm mate. Two of the males disrobed and began to expose themselves. Paula reacted by freezing up, quite unable to respond. Her roommate, however, kicked one of the boys in the exposed genitals and started screaming loudly. Another young woman came into the bedroom, and the episode was broken up before the situation got worse. (As if it wasn’t already bad enough).

After the event, some of the girls in Paula’s dorm had occasion to talk about the event and similar events. Much to Paula’s surprise, a number of the other women in her dorm had had experiences like hers, a number of times. They seemed almost “immune” to it. Paula’s roommate appeared to have no visible reactions after the event.

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For Paula, however, things were different. She stopped going out with her friends on weekends. Occasionally, she would wake from bad dreams in the middle of the night about being locked in a frat house with a half dozen naked drunk college males. She was anxious all the time but ashamed that she could not ‘shake it off’ like her roommate did. She even considered quitting school, since she found little meaning in a place where such evil things took place, but everyone acted like they were no big deal.

As we observe this situation, we see two young women at the same event with two highly different reactions. Paula needs help, and she needs it quickly. Unless she gets it, she runs a great risk of becoming stuck in a pattern of internal dialogue in which she thinks it’s not okay, or that it’s even silly or weak for her to react in the way her mind and body have done. The subjective aspects of her life before this trauma and her reactions after it have created a PTSD reaction just as real as any more ‘objectively’ horrible trauma. The victim, not anyone else, best defines trauma.

Paula’s story is a common example of how and why folks who have been traumatized do not seek treatment or avoid seeking more information about trauma recovery. In our forthcoming book, Trauma Recovery: Sessions With Dr. Matt, one of the characters, Felicia, has experienced a sexual assault much like described here with Paula. Felicia goes for years suffering PTSD symptoms, in part due to an ongoing internal dialogue with herself in which she told herself that she was weak and unworthy of having a normal life.

Let’s examine another example of “childhood adversity” that might not be considered as an objective trauma but results in all the PTSD symptoms. Growing up with a parent who is an active alcoholic is highly stressful. Adult Children of Alcoholics is a self-help recovery movement for such folks. People with this history have life experiences that include all of the dimensions of trauma’s strength discussed above, and many individuals who are adult children of alcoholics have all five of the symptoms of PTSD. However, many such folks would never equate themselves to a rape victim or an incest victim. Nonetheless, their subjective reactions amount to a life full of trauma.

Dr. Patricia Resick, a noted expert in treatment for assault-related trauma, has pointed out the role of becoming “stuck” in unhealthy emotions and beliefs that nothing came be done after victimization. Dr. Resick contends that much can be done to reclaim/rebuild life, and that such work can be basically quite effective once begun, but—to accomplish recovery, one must overcome the stuck points such as those illustrated in this article. Perhaps the first step in that process is being more ‘liberal’ in defining life events as traumatic.


Life Events Sometimes Not Considered as Traumatic

So, here are some examples of life events that tend to not be defined as trauma because folks have, for the reasons cited above, under-defined them or avoided examining these life events with the criteria of trauma in mind. If you have any of the five symptoms discussed above, maybe you should look more closely at this list to see if these events happened to you and might be the cause of your hard-to-account-for symptoms:

1. Repeated verbal abuse by a parent/caregiver

2. Date rape or otherwise unwanted sexual physical contact

3. Experiencing or witnessing domestic violence

4. Victimized by a crime, even a ‘white-collar’ crime where much was lost

5. Living with chemically dependent family members

6. Severe and sustained economic downturn

7. Divorce and separation from your children

You should especially consider the above as traumas if any of the dimensions that add to the strength of a trauma are involved: repeated, happened in childhood, caused by a human—especially a caregiver or trusted person, were intentional, and the reporting of them was discouraged or punished.

Therapy is not necessarily a lengthy, expensive venture. Once you commit to one of several efficient and time-limited cognitive-behavioral treatments, you have a good chance of turning your life around. More information about types of treatment—including names of therapists—may be found at Dr. Resick’s website for understanding and treating trauma: cptforptsd.com

Our book, Trauma Recovery: Sessions with Dr. Matt, points out that 40% or more of people who have experienced trauma end up being stronger and better adjusted after the trauma is ‘processed.” This is called “post-traumatic growth.” In easy to understand language, we present the “the how and why” trauma victims get better, even stronger.


The First Step

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If you’re ready to move toward post-trauma growth, we propose that you can begin by taking the initial step toward recognizing your under defined trauma.

 

 

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Giving Thanks for the Opportunity to Share a Message of Hope and Resilience with Trauma Survivors

Something I’m thankful for: my writing partner and the book we wrote together. I’m sharing the cover with you. It’s the first time it’s been posted publicly.
My co-author, Matt, and I really like this cover because of the light coming into the group therapy circle: providing the light of hope in the face of the indescribable darkness that is being “stuck” in mental illness and desperation.

I think it was spring of 2016 that Matt Jaremko and I discussed writing a book to help trauma survivors. It took us a bit to find our writing groove in terms of both how we could best communicate what we wanted to say that would extend hope and model the power of resilience for traumatized people, AND for us to find the most efficient way for us to write together without becoming frustrated…we initially tried using Google Docs, and, never having co-written with anyone else, I didn’t realize we couldn’t be in the document at the same time. So I was working and Matt was, too, and the page was jumping all over the place…it was not fun. So we dispensed with that pretty quickly and moved to Word and Track Changes, which is the industry standard for working with editors.
Once we found our way to work together by exchanging the manuscript (“The book is now in your hands. I will not touch it until you send the manuscript back to me”), our book began to take shape in a meaningful, rewarding way. Matt and I have such a strong respect for each others’ strengths and abilities. He is, without a doubt, one of the two smartest, most compassionate and caring men I know, with the other being my husband, Daniel. Not coincidentally, these 2 men also comprised my primary support system when I was broken.

I rank our book, “Trauma Recovery: Sessions With Dr. Matt–Narratives of Hope and Resilience for Victims With PTSD,” as one of my “heart” books. What this means, for you non-writer types, is that this book is one of the most personally meaningful to me. It is defining. It IS to come full circle. While I love all 4 of the YA fiction novels I’ve written, 3 of them: Courage in Patience, Hope in Patience, and Truth in Patience, are the most precious to me because I wrote them while in recovery when I was working with Matt Jaremko, many years ago. They are the arc of Ashley, a teen girl who is entering recovery after being abused by her stepdad and neglected by her mom through deliberate indifference. Ashley’s biggest hurdle is facing the truth about her life–about her worth as a person, in spite of being discarded by the person who should have loved her most. She is removed from her stepdad & mom’s home & placed with her father, David, who she does not know at all.
Ashley is a frightened victim at the outset, a person beginning to realize her value in the middle, and a strong survivor capable of advocating for herself at the conclusion. That’s why the books are called Courage (1), Hope (2), and Truth (3). They are set in the small E. Texas town of Patience, and the girl’s therapist is Scott “Dr. Matt” Matthews. Guess who he’s modeled after?

When Matt and I decided to take 2 of my characters–Ashley and Dr. Matt– and place them in a group setting in order to facilitate the combination of fiction and teaching about resilience, we took Ashley, aged her from 15/16 to 19, and made her a member of Dr. Matt’s Thursday evening Therapy Group for Victims, Survivors, and Righteously Indignant Angry Folks. Then we imagined the other members:
Hunter, age 32, who woke on the ground in the dark after a rain-wrapped tornado destroyed his mobile home, critically injuring his toddler daughter;
Felicia, age 34, who, at age 14, was nearly raped by her brother’s friend; 20 years later, she is still haunted by it, but needs to come to realize an even darker truth about her youth;
Ben, age 20, who saw combat horrors in the Middle East and returned home a fundamentally different person;
Patty, age 47, who lost control of her car, with her husband being killed when they hit a semi-truck;
Jake, age 30, an Emergency Medical Technician (EMT) who responded to a hate crime-shooting at a local church’s Wednesday night prayer service. The son of a preacher, Jake lost his faith as a result of what he saw.
Darrell, age 35, who served time in prison for armed robbery. When he was released, he entered therapy to seek solutions for the frequent rages that overtook his decision-making abilities. Through his work with Dr. Matt, Darrell learned new ways of interacting with others. He joined the Black Lives Matter movement and discovered his passion for making a difference through teaching young African-Americans about non-violent protest.
Betty, age 40. Her family-of-origin abandoned her when she began coming to terms with the sexual abuse perpetrated on her from a young age. Betty worked with Dr. Matt and gradually found the strength to rebuild her life. She entered college as a non-traditional student and became a bilingual education teacher, where she puts her native Spanish to work.

We wrapped our manuscript in July, began seeking a publisher in late summer, and by October–and this is remarkably fast to find a publishing “home”–we were offered a publishing contract with a “Mind-Body-Soul” imprint, Ayni Books, and our book will come out in late spring/early summer 2018. The book will have international distribution and be available in both print and e-book.

We began sharing the manuscript with others, asking for blurbs, and we were blown out of the water by what our readers said. Check ’em out.

We invite you to read the Prologue: The Internal Dialogue of a New Patient Being Sick and Tired of Being Afraid and Stuck.

I wrote this Prologue from the memory of where I was when I entered treatment to recover from Childhood Sexual Abuse. At that time, I was 38 years old, the mother of 3 teen girls, and I broke. I could no longer pretend that the stuff I’d gone through as a child and young adult, and in many ways continued to endure as an adult, were not killing me. The pretending was killing me. I was slowly killing myself through binge eating. Efforts to deal with the never-ending anxiety I lived with night and day were futile. Prior to working with Matt, I never stuck with therapy once I was nudged toward being authentic and honest with myself and others about how broken I was. I “clicked” with him and, after Daniel, Matt is the first man I ever truly trusted. Until that time, my understanding of men was that they would abuse me once I began to let my guard down.

This prologue is thoughts of the person prior to entering a therapist’s building when the choice at that time is either get better or die. These are exactly what it was like to be in my head at that time.
Facing the truth about one’s life is a soul-searing experience. For me, the journey to REAL, and WHOLE, was much like the process of birthing a child. It was exhausting, but without a doubt, learning to be resilient and authentic was the most gratifying experience of my life.
This is what we hope will be the result for those who read our book.

Please help us spread the word about our Facebook page. “Like”/”Follow” us, and you won’t miss out on the journey.

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Perseverence + Resilience + Patience = Hope for Recovery

The PTSD symptoms I had were so overwhelming that at times I thought I was losing my mind. I’m not even kidding–and if you ever meet my husband, or my children, who were teens at the time, ask them what Mama was like back then. I’m sure some of their stories would blow your hair back. I’ll never forget when I was in a really bad way and actually got behind my clothes in my closet, like I used to do when I was a child, to hide from my stepfather. My husband, Daniel, stepped in, leaned down, and said softly, “I seeeee youuuuuu…” but didn’t judge me harshly or make fun of me. It’s one of the reasons I love him more than words could ever adequately describe.

Trauma Recovery: Sessions With Dr. Matt helps people like me –like I was at that time–understand what happens when someone experiences trauma, and I love its message that sufferers are NOT crazy or weak: they are incredibly strong for continuing to put one foot in front of the other, even while enduring some very scary shit inside their heads. It’s compassionate, speaks to readers where they are–like Daniel that evening when I was a hot mess, and we let readers know, again and again, that HOPE is possible, and RECOVERY is possible, and we shine that all-important light when it’s so easy for survivors to get lost in the nooks & crannies of their minds. We strongly suggest that readers work with a therapist as they process their trauma, because recovery from PTSD is scary.

Nearly a decade ago, Matt taught me HOW to be resilient and HOW to persevere through those undoubtedly dark days. I wrote poems and essays and short stories and shared them only with Matt: there was no one else I could trust with–saddle with, really– what was coming out of my mind and landing on my keyboard and screen. At his suggestion that I try writing a novel, I imagined the trauma I had endured as having happened to someone else, stepped outside of myself, and began to tell 15 year old Ashley Nicole Asher’s story. With her being “born,” so was my life as a professional writer, although I didn’t know it at the time. All I was doing was following the advice of the man I had learned I could trust with my darkness, and he would be by my side, holding the light.
Trauma Recovery: Sessions With Dr. Matt is a unique amalgam of teaching about PTSD and giving insight into the recovery process and the storylines of 7 members of the Thursday Night Therapy Group. Matt E. Jaremko is the inspiration for the Dr. Matt character in my Patience books, and I patterned the experiences of the main character, Ashley, after my own. All these years later, Matt and I teamed up and took those 2 characters, aged Ashley up to 19, and placed Dr. Matt and Ashley in a group therapy setting. Along with Ashley, group members include a survivor of a tornado destroying his mobile home and gravely injuring his toddler daughter; a woman who was behind the wheel, reached for her phone to check a text, and slammed into a semi, killing her husband on impact; a first responder to a mass shooting at a church (timely, sadly); a soldier who was injured when an IED exploded outside his barracks, killing his best friend; an ex-con who is determined to rebuild his life and make a difference; and a survivor of an attempted rape by her brother’s best friend when she was 14–as well as family secrets she has yet to allow herself to process. She attempts to cope with her anguish by numbing herself with food. And, of course, there’s Dr. Matt, an experienced therapist nearing the end of his career and contemplating what’s next.

Please check out the Facebook page Matt created for  our book, and take a look at our website, Trauma Recovery: Sessions With Dr. Matt too! We also have a blog, Hope for Post-traumatic Growth.
I hope you’ll subscribe to our sites & give our FB page a “Like” so that you get the latest news on our book, which is set to release around late Spring/early Summer, 2018.

And-I hope you’ll read the posts Matt has entered on our FB page so far. He has a lot to say, and he is one of the 2 smartest men I know–the other being my husband, Daniel. I owe my life today to Matt and Daniel’s unwavering support, presence, and holding me accountable to not give up.
Trauma Recovery: Sessions With Dr. Matt is one special book, and it holds a hallowed place in my , alongside The Patience Trilogy.

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Trauma Recovery: Sessions With Dr. Matt will release in summer, 2018!

I am beyond thrilled to tell you that Trauma Recovery: Sessions With Dr. Matt, a creative non-fiction book written by Dr. Matt E. Jaremko and me, has found a publisher, Ayni Books. Our book should release in early summer, 2018.

The best way to describe it to you is to borrow from our book proposal:

“This book is a starting place for hurting people who are seeking healing, either on their own or in partnership with a therapist or other helping person. Dr. Matt E. Jaremko maximizes readers’ understanding of Post-Traumatic Stress Disorder (PTSD) by explaining its origins in easy-to-understand language and offering insight into the process of reclaiming a life from trauma. Beth Fehlbaum shares her insight from the perspective of a person who experienced trauma, was once scared to death about going into therapy, and is now recovered.

Most powerfully, Dr. Jaremko and Beth created characters: a psychologist, Scott “Dr. Matt” Matthews, and his ongoing therapy group, to illustrate how recovery can and does happen. The situations these characters survive; their struggles and triumphs of reclaiming their lives, and their potential for thriving are all realistic. We reassure people who are terrified of trying therapy by providing them with a “fly on the wall” perspective of observing the recovery process.”

Read more about Trauma Recovery: Sessions With Dr. Matt, here.


Those of you who have read (and have affection for) The Patience Trilogy (Courage, Hope, and Truth), likely recognize “Dr. Matt”’s name, and you will be pleased to know that Ashley is in Trauma Recovery: Sessions With Dr. Matt! She’s now 19 and about to leave for college. I hope you’re as pleased with Ash’s progress as I am.

Watch this space for the latest and greatest as we move forward in the publication of a book that Matt and I hope will have a far-reaching positive effect for traumatized individuals by providing a light in the darkness. In other words: hope.

I encourage you to subscribe to our blog site, “Hope for Post-Traumatic Growth,”  and check out our website, Trauma Recovery: Sessions With Dr. Matt, too!

Cheers!
Beth

Photo by Austin Schmid on Unsplash

P.S. If I could choose an image that conveys how I feel about our book having a release date, it would be this, accompanied by a “Woo-hoo!”

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