Photo of Rachel J Guadamuz, Counselor in Vancouver, WA
Rachel J Guadamuz
Counselor, MA, LMHCA, LPCA
Verified Verified
4 Endorsed
Vancouver, WA 98661  (Online Only)
I strongly believe that reflecting on life's past and present relationships provides insight to help us explore current and future relationships, experiences, and self. I specialize in working with fellow Christians as they navigate relationship challenges, leadership pressures, anxiety, depression, spiritual abuse, grief, and life transitions.
I strongly believe that reflecting on life's past and present relationships provides insight to help us explore current and future relationships, experiences, and self. I specialize in working with fellow Christians as they navigate relationship challenges, leadership pressures, anxiety, depression, spiritual abuse, grief, and life transitions.
(360) 339-8647 View (360) 339-8647
Photo of Loraine G Madian, Counselor in Vancouver, WA
Loraine G Madian
Counselor, MA, LMHC
Verified Verified
Vancouver, WA 98660
I help to reduce stress and facilitate healing of trauma, depression, anxiety, grief, and life adjustment issues.
At Bluebird Counseling, I enjoy working with individuals, families, and youth. My areas of expertise are Mindfulness Practice, Cognitive Behavioral Therapy, Neural Therapies (LifeSpan Integration and EMDR- Eye Movement Desentization Reprocessing) and Gestalt - In the moment awareness.
I help to reduce stress and facilitate healing of trauma, depression, anxiety, grief, and life adjustment issues.
At Bluebird Counseling, I enjoy working with individuals, families, and youth. My areas of expertise are Mindfulness Practice, Cognitive Behavioral Therapy, Neural Therapies (LifeSpan Integration and EMDR- Eye Movement Desentization Reprocessing) and Gestalt - In the moment awareness.
(541) 516-1297 View (541) 516-1297
Photo of Courtney Smith, Licensed Professional Counselor in Vancouver, WA
Courtney Smith
Licensed Professional Counselor, MEd, LMHC, LPC, RPT
Verified Verified
2 Endorsed
Vancouver, WA 98684
Always feeling inadequate from your drive to be perfect? Perfectionism comes with feeling uneasy when making mistakes, high expectations, self-criticism, and good enough is unacceptable. Thinking that being perfect will lead to a happier life usually lends to finding an unfulfilled life. Growth transpires when you let go of holding yourself to the unattainable standards. I specialize in helping clients starting at age 8 to adult struggling with perfectionism, anxiety, Autism spectrum disorder, ADHD, spirituality development, behavioral issues, LGBTQIA support, and relationship issues.
Always feeling inadequate from your drive to be perfect? Perfectionism comes with feeling uneasy when making mistakes, high expectations, self-criticism, and good enough is unacceptable. Thinking that being perfect will lead to a happier life usually lends to finding an unfulfilled life. Growth transpires when you let go of holding yourself to the unattainable standards. I specialize in helping clients starting at age 8 to adult struggling with perfectionism, anxiety, Autism spectrum disorder, ADHD, spirituality development, behavioral issues, LGBTQIA support, and relationship issues.
(360) 230-5632 View (360) 230-5632
Photo of Richard Golosinskiy, Counselor in Vancouver, WA
Richard Golosinskiy
Counselor, LMHCA, MA, NCC
Verified Verified
Vancouver, WA 98684
Depression, worry, anxiety, and fear can be crippling experiences. If you feel overwhelmed by these phenomena, I want to help you overcome these barriers. I believe that reflecting on life’s past and present relationships can offer insight into helping you redefine current and future relationships, experiences, and self. Re-evaluating beliefs and held attitudes can help you achieve your goals, create new experiences, and make informed choices that forge a more satisfying and fulfilling life. The digital age snuck in on us and provided with no room to breathe. As your therapist, I hope to help you work through this and gain clarity.
Depression, worry, anxiety, and fear can be crippling experiences. If you feel overwhelmed by these phenomena, I want to help you overcome these barriers. I believe that reflecting on life’s past and present relationships can offer insight into helping you redefine current and future relationships, experiences, and self. Re-evaluating beliefs and held attitudes can help you achieve your goals, create new experiences, and make informed choices that forge a more satisfying and fulfilling life. The digital age snuck in on us and provided with no room to breathe. As your therapist, I hope to help you work through this and gain clarity.
(360) 346-1476 x4 View (360) 346-1476 x4
Photo of Sharman Carpenter, Counselor in Vancouver, WA
Sharman Carpenter
Counselor, MS, NCC, LMHC
Verified Verified
Vancouver, WA 98665
I mostly work with clients with depression, anxiety, PTSD, and/or who have issues related to life transitions, loss of loved ones, relationship challenges, codependency, low self-esteem, life/work balance, career uncertainty, parenting, sexual orientation, discrimination, and trauma including abuse, rape and near death experiences.
My approach to counseling is personalized and collaborative, and is based in Relational-Cultural Theory which takes into account the effects of abuse, discrimination and marginalization on mental health. I believe that all humans have the tendency to grow, heal, and develop their full potential. I work to gain an accurate, accepting, understanding of each client’s reality so that the therapeutic relationship provides a safe, nonjudgmental environment to explore his or her thoughts and feelings about difficult life issues, with the goal of resolving issues, gaining self-acceptance and building relationships.
I mostly work with clients with depression, anxiety, PTSD, and/or who have issues related to life transitions, loss of loved ones, relationship challenges, codependency, low self-esteem, life/work balance, career uncertainty, parenting, sexual orientation, discrimination, and trauma including abuse, rape and near death experiences.
My approach to counseling is personalized and collaborative, and is based in Relational-Cultural Theory which takes into account the effects of abuse, discrimination and marginalization on mental health. I believe that all humans have the tendency to grow, heal, and develop their full potential. I work to gain an accurate, accepting, understanding of each client’s reality so that the therapeutic relationship provides a safe, nonjudgmental environment to explore his or her thoughts and feelings about difficult life issues, with the goal of resolving issues, gaining self-acceptance and building relationships.
(833) 997-2869 View (833) 997-2869
Photo of David A Sangster, Clinical Social Work/Therapist in Vancouver, WA
David A Sangster
Clinical Social Work/Therapist, LCSW
Verified Verified
Vancouver, WA 98661
From struggling to THRIVING. Become more fully "yourself." Enjoy relationship satisfaction. Strengthen connection to something bigger that is meaningful. Get relief from depression and anxiety (really!). Improve effectiveness at work. Feel more at home in your body, content. Mindful and present. LAUGH. Choosing a therapist that is both really good AND a great fit is important. There is a difference here you will experience from the get go. The office is in a 1930's Cape Cod style house...inviting & comfortable. With warmth and character. David is unusually relational and "real." Sessions are 60, 75 or 90 minutes rather than 50.
From struggling to THRIVING. Become more fully "yourself." Enjoy relationship satisfaction. Strengthen connection to something bigger that is meaningful. Get relief from depression and anxiety (really!). Improve effectiveness at work. Feel more at home in your body, content. Mindful and present. LAUGH. Choosing a therapist that is both really good AND a great fit is important. There is a difference here you will experience from the get go. The office is in a 1930's Cape Cod style house...inviting & comfortable. With warmth and character. David is unusually relational and "real." Sessions are 60, 75 or 90 minutes rather than 50.
(503) 444-8649 View (503) 444-8649
Photo of Mandy Miller, Counselor in Vancouver, WA
Mandy Miller
Counselor, MA, LMHC, LPC
Verified Verified
Vancouver, WA 98683  (Online Only)
I help clients work through many issues including depression, anxiety, family dynamics, relationship concerns, grief and loss, mood disorders, lifestyle transitions and self-exploration.
UPDATE: currently have availability for telehealth sessions! Limited open spots Mondays and Tuesdays! Seeking therapy can be an exciting, scary, and/or overwhelming decision. I am here to help make that decision a positive one of personal empowerment. With respect and compassion, I work to create a comfortable and safe environment in which we can develop a therapeutic alliance and share in the journey of personal growth. Helping each client work through specific life challenges, goals, and transitions is both a privilege and a passion for me and I welcome the opportunity to be a part of your journey!
I help clients work through many issues including depression, anxiety, family dynamics, relationship concerns, grief and loss, mood disorders, lifestyle transitions and self-exploration.
UPDATE: currently have availability for telehealth sessions! Limited open spots Mondays and Tuesdays! Seeking therapy can be an exciting, scary, and/or overwhelming decision. I am here to help make that decision a positive one of personal empowerment. With respect and compassion, I work to create a comfortable and safe environment in which we can develop a therapeutic alliance and share in the journey of personal growth. Helping each client work through specific life challenges, goals, and transitions is both a privilege and a passion for me and I welcome the opportunity to be a part of your journey!
(360) 492-4933 View (360) 492-4933
Photo of Neha Christiaan, Counselor in Vancouver, WA
Neha Christiaan
Counselor, LMHC
Verified Verified
Vancouver, WA 98683
I have experience working with children (5+) along with their families, adults, and couples in a variety of settings, ranging from outpatient mental health in both community and private settings to day treatment programs for children and adolescents. My work focuses on the use of Collaborative Problem Solving as a therapeutic approach of communication and skills building. I enjoy working with clients struggling with communication, attachment, ADHD, anxiety, depression, trauma, and other mental health disorders, including those with comorbid diagnoses of Autism Spectrum Disorder, Developmental Delays, and Substance Use Disorders.
I have experience working with children (5+) along with their families, adults, and couples in a variety of settings, ranging from outpatient mental health in both community and private settings to day treatment programs for children and adolescents. My work focuses on the use of Collaborative Problem Solving as a therapeutic approach of communication and skills building. I enjoy working with clients struggling with communication, attachment, ADHD, anxiety, depression, trauma, and other mental health disorders, including those with comorbid diagnoses of Autism Spectrum Disorder, Developmental Delays, and Substance Use Disorders.
(360) 980-8087 View (360) 980-8087
Photo of Jake Jacob Hawbaker, Marriage & Family Therapist Associate in Vancouver, WA
Jake Jacob Hawbaker
Marriage & Family Therapist Associate, LMFTA
Verified Verified
1 Endorsed
Vancouver, WA 98684
I also have experience working with individuals dealing with grief, anxiety, depression, spiritual direction and many other life circumstances.
I believe we were created for relationships. Relationships can bring healing, wholeness and happiness. However, despite their powerful role in our life, they can be extremely difficult to manage and can cause us a lot of pain and stress. This is where I hope to be able to help you. I love working with individuals, couples and families to help them on the their road to finding peace and joy in their relationships. At Charis Counseling Associates you will find an accepting and understanding atmosphere where you can be open about the real struggles of life.
I also have experience working with individuals dealing with grief, anxiety, depression, spiritual direction and many other life circumstances.
I believe we were created for relationships. Relationships can bring healing, wholeness and happiness. However, despite their powerful role in our life, they can be extremely difficult to manage and can cause us a lot of pain and stress. This is where I hope to be able to help you. I love working with individuals, couples and families to help them on the their road to finding peace and joy in their relationships. At Charis Counseling Associates you will find an accepting and understanding atmosphere where you can be open about the real struggles of life.
(360) 329-9033 View (360) 329-9033
Photo of Daniella Bosman, Pre-Licensed Professional in Vancouver, WA
Daniella Bosman
Pre-Licensed Professional, BA
Verified Verified
1 Endorsed
Vancouver, WA 98682  (Online Only)
Welcome! I provide counseling for anyone 18+. I create an empathetic, supportive, and judgment-free space for those looking to process the stressors of life. I work with clients on a wide range of concerns, including anxiety, depression, burnout, and more. I have interest in working with survivors of trauma and abuse, those suffering from chronic pain or chronic illness, the LGBTQIA+ community, and those seeking inner child healing. As someone who has experienced many of these personally, I know the emotional weight they can carry.
Welcome! I provide counseling for anyone 18+. I create an empathetic, supportive, and judgment-free space for those looking to process the stressors of life. I work with clients on a wide range of concerns, including anxiety, depression, burnout, and more. I have interest in working with survivors of trauma and abuse, those suffering from chronic pain or chronic illness, the LGBTQIA+ community, and those seeking inner child healing. As someone who has experienced many of these personally, I know the emotional weight they can carry.
(425) 475-1908 View (425) 475-1908
Photo of Dr. Kristy Carangi, Counselor in Vancouver, WA
Dr. Kristy Carangi
Counselor, LMHCA, NCC
Verified Verified
Vancouver, WA 98660  (Online Only)
I see a wide range of clients, although I specialize in childhood trauma and CPTSD, relationships, anxiety, ADHD, and LGBTQ issues. I work with both couples and individuals, as well as children and adolescents. Therapy focus may include relationship conflict, anxiety control, satisfaction in both your personal life and work, focus and motivation, and building a sense of "feeling whole" or "complete." I've helped countless clients move from a place of feeling stuck and dissatisfied, to one of happiness and flourishing. I also offer specialized care to transgender and questioning clients, including transition-related counseling.
I see a wide range of clients, although I specialize in childhood trauma and CPTSD, relationships, anxiety, ADHD, and LGBTQ issues. I work with both couples and individuals, as well as children and adolescents. Therapy focus may include relationship conflict, anxiety control, satisfaction in both your personal life and work, focus and motivation, and building a sense of "feeling whole" or "complete." I've helped countless clients move from a place of feeling stuck and dissatisfied, to one of happiness and flourishing. I also offer specialized care to transgender and questioning clients, including transition-related counseling.
(206) 208-6954 View (206) 208-6954
Photo of Tina L Powell, Counselor in Vancouver, WA
Tina L Powell
Counselor, MA, MS, LMHC, NCC, DVTP
Verified Verified
Vancouver, WA 98663
Reflecting on my own counseling practice, I have discovered the overwhelming strength and healing power of human connectedness which is an essential cornerstone of my therapeutic counseling relationships. Life is a journey filled with both opportunities and challenges. When daily life and/or life transitions seem too overwhelming, the guidance and support provided from a trusted professional who is empathetic and objective can be informative, empowering, and restorative. I use cognitive-behavioral and psychodynamic interventions to help clients discover how conscious and unconscious thoughts impact emotions and behaviors. In addition, I draw from a variety of counseling theories to meet each client's individual needs.
Reflecting on my own counseling practice, I have discovered the overwhelming strength and healing power of human connectedness which is an essential cornerstone of my therapeutic counseling relationships. Life is a journey filled with both opportunities and challenges. When daily life and/or life transitions seem too overwhelming, the guidance and support provided from a trusted professional who is empathetic and objective can be informative, empowering, and restorative. I use cognitive-behavioral and psychodynamic interventions to help clients discover how conscious and unconscious thoughts impact emotions and behaviors. In addition, I draw from a variety of counseling theories to meet each client's individual needs.
(360) 614-2529 View (360) 614-2529
Photo of Refresh Therapy Inc in Vancouver, WA
Refresh Therapy Inc
LMFT, LMHC, LMHCA, LMFTA, LICSW
Verified Verified
Vancouver, WA 98685
We are a group of dynamic therapists, in multiple Washington state locations. Our goal was to create a place for you to settle in and tell your story. Everybody has one, and we want to hear yours. Counseling is a process that encourages you to examine your choices, your thoughts, your dreams, your barriers and your pain in an effort to create the positive change you are seeking in your life. We believe that successful counseling is a collaborative experience between you and your therapist; that finding the right fit is vital to that success.
We are a group of dynamic therapists, in multiple Washington state locations. Our goal was to create a place for you to settle in and tell your story. Everybody has one, and we want to hear yours. Counseling is a process that encourages you to examine your choices, your thoughts, your dreams, your barriers and your pain in an effort to create the positive change you are seeking in your life. We believe that successful counseling is a collaborative experience between you and your therapist; that finding the right fit is vital to that success.
(360) 972-3644 View (360) 972-3644
Photo of Joyner Hope Asbury, Counselor in Vancouver, WA
Joyner Hope Asbury
Counselor, MA, LMHC
Verified Verified
Vancouver, WA 98685
No matter what you have experienced or where you’ve come from, you will find that you feel heard, seen, and understood in counseling with me. You, your child, and your family are all unique, and I provide a space in which uniqueness is celebrated and identified to further emphasize your areas of strength. Sometimes life makes us feel buried and we may not know how to find our way out. However, each of us possesses an amazing potential for resilience, healing, and growth. I offer a compassionate and authentic space where we can identify life’s challenges and stressors together. You do not have to do this alone.
No matter what you have experienced or where you’ve come from, you will find that you feel heard, seen, and understood in counseling with me. You, your child, and your family are all unique, and I provide a space in which uniqueness is celebrated and identified to further emphasize your areas of strength. Sometimes life makes us feel buried and we may not know how to find our way out. However, each of us possesses an amazing potential for resilience, healing, and growth. I offer a compassionate and authentic space where we can identify life’s challenges and stressors together. You do not have to do this alone.
(360) 383-5968 View (360) 383-5968
Photo of Rachel Richards, Counselor in Vancouver, WA
Rachel Richards
Counselor, LMHC
Verified Verified
1 Endorsed
Vancouver, WA 98662  (Online Only)
Hi, I'm Rachel Richards, therapist and founder of Four Winds Therapy. At Four Winds we believe that humans have the ability to awaken their highest potential and that authentic individualized therapy and collaborative support can help one to recognize their true inner goodness. Therapy with Four Winds is client centered and we believe that therapy's focus can be whatever you'd like it to be. I am here to address your mental health needs with compassion and respect. I am trauma informed and culturally aware as well as respectful to people of all backgrounds and beliefs and I operate within counseling's strict ethical guidelines.
Hi, I'm Rachel Richards, therapist and founder of Four Winds Therapy. At Four Winds we believe that humans have the ability to awaken their highest potential and that authentic individualized therapy and collaborative support can help one to recognize their true inner goodness. Therapy with Four Winds is client centered and we believe that therapy's focus can be whatever you'd like it to be. I am here to address your mental health needs with compassion and respect. I am trauma informed and culturally aware as well as respectful to people of all backgrounds and beliefs and I operate within counseling's strict ethical guidelines.
(503) 836-8894 View (503) 836-8894
Photo of Dr. Donna J Winsor, Counselor in Vancouver, WA
Dr. Donna J Winsor
Counselor, PhD, LPC, LMHC
Verified Verified
Vancouver, WA 98664  (Online Only)
It can be very difficult to take the first step to seek counseling. My intent the moment you walk through the door is for you to feel safe, cared for, listened to, and above all, understood. I am not here to judge or condemn. We all have our stuff. Life gets messy. Life can be complicated. We all need help. I am a people person, which means you have value, simply because you are. I am empathetic, I listen, I am real, and I can help.
It can be very difficult to take the first step to seek counseling. My intent the moment you walk through the door is for you to feel safe, cared for, listened to, and above all, understood. I am not here to judge or condemn. We all have our stuff. Life gets messy. Life can be complicated. We all need help. I am a people person, which means you have value, simply because you are. I am empathetic, I listen, I am real, and I can help.
(602) 641-4062 View (602) 641-4062
Photo of Karyn Andriesen, Counselor in Vancouver, WA
Karyn Andriesen
Counselor, MA, LMHCA
Verified Verified
4 Endorsed
Vancouver, WA 98660  (Online Only)
Sometimes in life we all need a “companion on the journey,” someone to partner with us and help make sense of our experience, ease our pain, and support our goals. As a therapist, I am committed to providing a safe environment where individuals can identify their strengths, recognize unhelpful patterns, and live into their goals. Working from an integrative, client-centered approach, I seek to support individuals wherever they are on their journey and my approach is holistic, collaborative, and non-judgmental. I value cultural humility and look forward to working with people of all backgrounds, identities, and walks of life.
Sometimes in life we all need a “companion on the journey,” someone to partner with us and help make sense of our experience, ease our pain, and support our goals. As a therapist, I am committed to providing a safe environment where individuals can identify their strengths, recognize unhelpful patterns, and live into their goals. Working from an integrative, client-centered approach, I seek to support individuals wherever they are on their journey and my approach is holistic, collaborative, and non-judgmental. I value cultural humility and look forward to working with people of all backgrounds, identities, and walks of life.
(206) 752-3471 View (206) 752-3471
Photo of Michael A Miller LMHC , Counselor in Vancouver, WA
Michael A Miller LMHC
Counselor, L, M, H, C
Verified Verified
1 Endorsed
Vancouver, WA 98660
Accepting new clients for in-person or telehealth appointments. You don't need to know exactly why you are seeking counseling. Common topics addressed in counseling are issues with self-esteem, finding purpose and meaning in life, relationship concerns, stressful life circumstances, psychological education and/or symptom improvement. Whether you have goals or are needing to figure that out, I can be flexible and hopefully useful! I have 20 years of experience working with all ranges of presenting issues (intense psychosis to everyday stress) and can vary the approach to one that best suits your unique experience.
Accepting new clients for in-person or telehealth appointments. You don't need to know exactly why you are seeking counseling. Common topics addressed in counseling are issues with self-esteem, finding purpose and meaning in life, relationship concerns, stressful life circumstances, psychological education and/or symptom improvement. Whether you have goals or are needing to figure that out, I can be flexible and hopefully useful! I have 20 years of experience working with all ranges of presenting issues (intense psychosis to everyday stress) and can vary the approach to one that best suits your unique experience.
(360) 523-7497 View (360) 523-7497
Ally Christian Counseling
Licensed Professional Counselor
Verified Verified
1 Endorsed
Vancouver, WA 98684
If you are looking for help in overcoming a mental, emotional, spiritual, or relational distress, you have come to the right place. Our team of highly trained and spiritually-minded specialists offer a variety of options for allying with you on your journey. Regardless of your background; who you are, what you've done, or what's been done to you, we desire to provide a safe space for you to process where you've been, where you are, and where you desire to go. We have witnessed many clients have tremendous success in achieving their goals and experiencing growth and healing through counseling.
If you are looking for help in overcoming a mental, emotional, spiritual, or relational distress, you have come to the right place. Our team of highly trained and spiritually-minded specialists offer a variety of options for allying with you on your journey. Regardless of your background; who you are, what you've done, or what's been done to you, we desire to provide a safe space for you to process where you've been, where you are, and where you desire to go. We have witnessed many clients have tremendous success in achieving their goals and experiencing growth and healing through counseling.
(360) 295-2988 View (360) 295-2988
Photo of Gail Jean Nicholson, Licensed Professional Counselor in Vancouver, WA
Gail Jean Nicholson
Licensed Professional Counselor, MA, LPC
Verified Verified
Vancouver, WA 98661
Passionate about working with individuals who want to explore and connect with a more authentic sense of self as a basis for defining their lives, work lives and roles in the larger community. I offer a blend of personal and career counseling to provide a holistic approach to career and life planning. My typical client is interested in finding direction and fulfillment, but is overwhelmed or discouraged. Focusing on personal issues or mental health concerns can reduce barriers to moving forward. We can work on defining purpose and direction, handling stress and tackling career exploration and job search.
Passionate about working with individuals who want to explore and connect with a more authentic sense of self as a basis for defining their lives, work lives and roles in the larger community. I offer a blend of personal and career counseling to provide a holistic approach to career and life planning. My typical client is interested in finding direction and fulfillment, but is overwhelmed or discouraged. Focusing on personal issues or mental health concerns can reduce barriers to moving forward. We can work on defining purpose and direction, handling stress and tackling career exploration and job search.
(503) 227-4250 View (503) 227-4250
Anxiety Therapists

What are the most common treatments for anxiety?

Talk therapy, particularly cognitive behavioral therapy, is the most common treatment for anxiety. Studies have shown it is equally effective as medication. Other popular forms of therapy are popular, depending on a patient’s experience. Exposure therapy, for instance, can be useful for people dealing with fears and phobias, or who have experienced traumatic events. Dialectical Behavioral Therapy may be useful for patients who need help with emotion regulation. Anxiolytic medications, like benzodiazepines, can also help with calming a person enough to focus on the skills they’ve learned, and physical exercise has been shown to help symptoms of anxiety across the board.

How long does therapy for anxiety take to work?

The amount of time needed to alleviate symptoms depends on the severity of a person’s condition. Some therapies may take 5-20 weekly sessions to show results. Anti-depressant medications typically take two to four weeks before a benefit is felt. Anti-anxiety medications are felt typically within 20-30 minutes. Medications are best used to offer a patient a better headspace in which to work on techniques learned in therapy. Exercise, improved sleep habits, and meditation are effective, but takes weeks or months to show results.

When should I seek treatment for anxiety?

Everyone feels anxious at times, but when anxiety causes disruption to your daily life, it may be time to seek help. Such disruption can be mental, physical, or both: having fear dominate your thoughts, avoiding situations or objects that bring on feelings of anxiety, or experiencing shortness of breath, sweating, dizziness, or panic attacks. When these symptoms are recurrent and distressing, it may be time to talk to someone.

How effective is treatment for anxiety?

Treatment for anxiety has been shown to be moderately to highly effective, according to a large body of psychology studies and analyses. For some people, treatment using CBT or exposure therapy alone is effective. Others respond best to a combination of medication and therapy.