Therapists in Kern County, CA

Photo of John R Navejas, Marriage & Family Therapist Associate in Kern County, CA
John R Navejas
Marriage & Family Therapist Associate, MS, AMFT
Verified Verified
1 Endorsed
Bakersfield, CA 93309
John Navejas is registered as an Associate Marriage and Family Therapist providing services in both substance abuse and mental health treatment modalities. John’s career experience began while volunteering with the Homeless Collaborative. John has worked with many populations including adolescents and adults experiencing anxiety, depression, substance abuse, anger, relationship issues, and identifying/controlling emotions and thoughts. He has led groups such as Anger Replacement Training, Strengthening Families, CBT interventions for substance abuse and created the first trauma informed yoga group at a juvenile detention facility.
John Navejas is registered as an Associate Marriage and Family Therapist providing services in both substance abuse and mental health treatment modalities. John’s career experience began while volunteering with the Homeless Collaborative. John has worked with many populations including adolescents and adults experiencing anxiety, depression, substance abuse, anger, relationship issues, and identifying/controlling emotions and thoughts. He has led groups such as Anger Replacement Training, Strengthening Families, CBT interventions for substance abuse and created the first trauma informed yoga group at a juvenile detention facility.
(661) 233-9744 View (661) 233-9744
Photo of Omar De La Cruz, Marriage & Family Therapist in Kern County, CA
Omar De La Cruz
Marriage & Family Therapist, LMFT
Verified Verified
Bakersfield, CA 93306
Hi! My name is Omar de la Cruz, and I am a licensed marriage and family therapist. I have an extensive amount of experiencing working with individuals having difficulties with substance use and mental health. I have worked with children, youth, and adults experiencing difficulties in different areas, such as anxiety, depression, substance use, relationship difficulties, and trauma. My goal is to meet clients where they are at and through my expertise be able to work on the therapeutic goals that individuals have.
Hi! My name is Omar de la Cruz, and I am a licensed marriage and family therapist. I have an extensive amount of experiencing working with individuals having difficulties with substance use and mental health. I have worked with children, youth, and adults experiencing difficulties in different areas, such as anxiety, depression, substance use, relationship difficulties, and trauma. My goal is to meet clients where they are at and through my expertise be able to work on the therapeutic goals that individuals have.
(661) 370-2857 View (661) 370-2857
Photo of Maxwell Sleep-Frankel, Clinical Social Work/Therapist in Kern County, CA
Maxwell Sleep-Frankel
Clinical Social Work/Therapist, LCSW
Verified Verified
Bakersfield, CA 93305
My name is Max Sleep-Frankel, a Licensed Clinical Social Worker (LCSW); I am also certified as a Clinical Trauma Professional (CCTP) and a Grief Informed Professional (CGP). I have extensive experience working with older adults and adults with disabilities as they navigate the many life transitions that beset them during this time period. My approach to therapy is to serve as a guide to accomplishing your personal goals and living a more enriched life.
My name is Max Sleep-Frankel, a Licensed Clinical Social Worker (LCSW); I am also certified as a Clinical Trauma Professional (CCTP) and a Grief Informed Professional (CGP). I have extensive experience working with older adults and adults with disabilities as they navigate the many life transitions that beset them during this time period. My approach to therapy is to serve as a guide to accomplishing your personal goals and living a more enriched life.
(805) 510-7694 View (805) 510-7694
Photo of Michael Buck, Clinical Social Work/Therapist in Kern County, CA
Michael Buck
Clinical Social Work/Therapist, LCSW
Verified Verified
Ridgecrest, CA 93555
Hello, My name is Michael Buck and I'm a Licensed Clinical Social Worker in the State of California. Even though my experiences include multiple modalities in Behavioral Health covering all age groups, my passion lies in the area of Substance Use Services/Recovery. I utilize a Cognitive Behavioral Perspective to support individual's journeys and I come with 25 plus years in this field. My communication style can vary depending on the individual, delivered without judgment, while being supportive through active listening. I've been told that my style is calm and comfortable.
Hello, My name is Michael Buck and I'm a Licensed Clinical Social Worker in the State of California. Even though my experiences include multiple modalities in Behavioral Health covering all age groups, my passion lies in the area of Substance Use Services/Recovery. I utilize a Cognitive Behavioral Perspective to support individual's journeys and I come with 25 plus years in this field. My communication style can vary depending on the individual, delivered without judgment, while being supportive through active listening. I've been told that my style is calm and comfortable.
(949) 787-1233 View (949) 787-1233
Photo of Angel Herrera-Castaneda, Marriage & Family Therapist in Kern County, CA
Angel Herrera-Castaneda
Marriage & Family Therapist, LMFT
Verified Verified
Bakersfield, CA 93301  (Online Only)
I am a bilingual licensed child and family therapist raised in Southern California with 8+ years of experience working with kids, parents, and families. I specialize in anxiety, ADHD, aggressive behaviors, and trauma. I also love video games, which makes it often easy for me to connect with teens.
I am a bilingual licensed child and family therapist raised in Southern California with 8+ years of experience working with kids, parents, and families. I specialize in anxiety, ADHD, aggressive behaviors, and trauma. I also love video games, which makes it often easy for me to connect with teens.
(213) 558-4348 View (213) 558-4348
Photo of Joe Mutow, Licensed Professional Clinical Counselor in Kern County, CA
Joe Mutow
Licensed Professional Clinical Counselor, LPCC
Verified Verified
Bakersfield, CA 93312
I have provided therapy for individuals (children K-12 and adults), families, groups, and couple sessions for over ten years. My modality is Cognitive Behavioral which means we believe it is not the event itself but how we perceive and react to the circumstance that may cause a problem. We will explore different possibilities through our session and discover what may serve us the best in pursuing happiness.
I have provided therapy for individuals (children K-12 and adults), families, groups, and couple sessions for over ten years. My modality is Cognitive Behavioral which means we believe it is not the event itself but how we perceive and react to the circumstance that may cause a problem. We will explore different possibilities through our session and discover what may serve us the best in pursuing happiness.
(818) 715-6005 View (818) 715-6005
Photo of Patrick Griffiths, Marriage & Family Therapist in Kern County, CA
Patrick Griffiths
Marriage & Family Therapist, LMFT
Verified Verified
Bakersfield, CA 93306
My name is Patrick Griffiths. I am currently licensed as a Marriage and Family Therapist (LMFT) and Professional Clinical Counselor (LPCC). I provide telehealth services to anyone living in California. My approach to therapy is that I am your guide on this journey. My focused area of practice is providing services to individuals, couples, and families. I have 18 years of experience as a therapist, working with a variety of clients. The clients I typically see struggle with symptoms of depression, anxiety, low self-worth, difficulty controlling impulses, lack of purpose and meaning, and job and/or family stress.
My name is Patrick Griffiths. I am currently licensed as a Marriage and Family Therapist (LMFT) and Professional Clinical Counselor (LPCC). I provide telehealth services to anyone living in California. My approach to therapy is that I am your guide on this journey. My focused area of practice is providing services to individuals, couples, and families. I have 18 years of experience as a therapist, working with a variety of clients. The clients I typically see struggle with symptoms of depression, anxiety, low self-worth, difficulty controlling impulses, lack of purpose and meaning, and job and/or family stress.
(323) 827-7570 View (323) 827-7570

Online Therapists

Photo of Jared Peter Roehrig, Marriage & Family Therapist Associate in Kern County, CA
Jared Peter Roehrig
Marriage & Family Therapist Associate, AMFT, MA, MFA
Verified Verified
1 Endorsed
Santa Barbara, CA 93101
I use EMDR, art therapy, and imaginal/somatic work to help all sorts of folks work through anxiety, depression, and trauma.
I help people relate to self and others in healthier ways. Together we will discover new insights into your symptoms, your patterns, and the frustrations that keep you from embracing your creative life. I come from a background in education and creative writing and specialize in using the imagination to tap into your unique voice. I appreciate wherever you are coming from on this stage of your life journey, and will provide a non-judgmental place to explore it all. Building a new relationship with a therapist can be challenging. I treat therapy as a sacred space, where every part of you belongs. Let's explore together.
I use EMDR, art therapy, and imaginal/somatic work to help all sorts of folks work through anxiety, depression, and trauma.
I help people relate to self and others in healthier ways. Together we will discover new insights into your symptoms, your patterns, and the frustrations that keep you from embracing your creative life. I come from a background in education and creative writing and specialize in using the imagination to tap into your unique voice. I appreciate wherever you are coming from on this stage of your life journey, and will provide a non-judgmental place to explore it all. Building a new relationship with a therapist can be challenging. I treat therapy as a sacred space, where every part of you belongs. Let's explore together.
(805) 918-1549 View (805) 918-1549
Photo of Thomas Williams, Marriage & Family Therapist Associate in Kern County, CA
Thomas Williams
Marriage & Family Therapist Associate, MA, AMFT
Verified Verified
Chatsworth, CA 91311  (Online Only)
Waitlist for new clients
Through this solution-focused narrative lens, we can incorporate various modalities to support your growth, such as art, music, and movement.
My name is Thomas Williams and I am an Associate Marriage and Family Therapist. I have been working with a diverse population, such as children, adolescents, adults, couples, and families with a variety of needs; behavioral, emotional, social, relational, and psycho-educational.
Through this solution-focused narrative lens, we can incorporate various modalities to support your growth, such as art, music, and movement.
My name is Thomas Williams and I am an Associate Marriage and Family Therapist. I have been working with a diverse population, such as children, adolescents, adults, couples, and families with a variety of needs; behavioral, emotional, social, relational, and psycho-educational.
(650) 600-7742 View (650) 600-7742
Photo of Robin S Walker, Marriage & Family Therapist in Kern County, CA
Robin S Walker
Marriage & Family Therapist, MA, MFT
Verified Verified
If only you could just tell your kids what to do and watch them feel better! It seldom works out that way, though. To help a child, you have to "speak the language of youth" and find ways to help that aren't lectures or punishments. My office is half consulting room and half art studio. Your child is invited to express their emotions in whatever way suits them--colors, brushes, toys and, yes, a couch. I help kids and teens find their own answers and begin growing into the people they were meant to be.
If only you could just tell your kids what to do and watch them feel better! It seldom works out that way, though. To help a child, you have to "speak the language of youth" and find ways to help that aren't lectures or punishments. My office is half consulting room and half art studio. Your child is invited to express their emotions in whatever way suits them--colors, brushes, toys and, yes, a couch. I help kids and teens find their own answers and begin growing into the people they were meant to be.
(818) 347-1242 View (818) 347-1242
Photo of Jose Cabrera, Marriage & Family Therapist in Kern County, CA
Jose Cabrera
Marriage & Family Therapist, MFT, ATR-BC
Verified Verified
Los Angeles, CA 90025  (Online Only)
I also integrate art therapy to help when words are not enough.
I believe no two people are alike and my approach is eclectic, deriving from many different modalities to better serve my client's needs. My style integrates humanistic, mindfulness and problem solving. We all have the ability to heal from anything life throws our way and I'm here to assist in uncovering your healing potential. My way of looking at therapy is simple, people come to me because they're experiencing some kind of pain. I help them come to terms with what that pain is, where it's coming from and how to manage and heal it.
I also integrate art therapy to help when words are not enough.
I believe no two people are alike and my approach is eclectic, deriving from many different modalities to better serve my client's needs. My style integrates humanistic, mindfulness and problem solving. We all have the ability to heal from anything life throws our way and I'm here to assist in uncovering your healing potential. My way of looking at therapy is simple, people come to me because they're experiencing some kind of pain. I help them come to terms with what that pain is, where it's coming from and how to manage and heal it.
(424) 294-8979 View (424) 294-8979
Photo of Kevin Finn Therapy, Marriage & Family Therapist Associate in Kern County, CA
Kevin Finn Therapy
Marriage & Family Therapist Associate, AMFT, EMDR
Verified Verified
Los Angeles, CA 90039
I work with adults and children alike, and enjoy incorporating meditation, art, and play therapy.
I believe that we all have an innate healing power within us, and that developing a safe and caring relationship with a therapist can be a wonderful means toward enlivening this power. By going within, we can discover the agency to overcome any obstacle and can bring into being a renewed sense of hope, purpose, and a life of fulfillment. I come from a holistic, humanistic, and mindfulness/spiritually-oriented tradition who believe that a therapist is only as skilled as they are evolved, or self-actualized themselves. I specialize in trauma, dissociation, & complex post traumatic stress disorder.
I work with adults and children alike, and enjoy incorporating meditation, art, and play therapy.
I believe that we all have an innate healing power within us, and that developing a safe and caring relationship with a therapist can be a wonderful means toward enlivening this power. By going within, we can discover the agency to overcome any obstacle and can bring into being a renewed sense of hope, purpose, and a life of fulfillment. I come from a holistic, humanistic, and mindfulness/spiritually-oriented tradition who believe that a therapist is only as skilled as they are evolved, or self-actualized themselves. I specialize in trauma, dissociation, & complex post traumatic stress disorder.
(818) 862-4333 View (818) 862-4333
Photo of Muhammad Rahman & Associates, LCSW, Inc., Clinical Social Work/Therapist in Kern County, CA
Muhammad Rahman & Associates, LCSW, Inc.
Clinical Social Work/Therapist, MSW, LCSW
Verified Verified
Valencia, CA 91355
Here are few my favorite credos: "Know thyself", "Unexamined life is not worth living", "Justice is what love looks like in public, while tenderness is what love feels like in private," " Life is a long distance run," "Every dream is a portrait of the dreamer," And, "Art, like nature provides nourishment for the soul and mind.
Life is not about winning or being successful at the end- its about finding life's meaning, its about personal empowerment, our agency, freeing ourselves from fear. We are a rich mixture of archetypes, energies, and potentialities. We have inner conflicts. Instead of reaching resolutions - we often surrender to our impulses and addictions. With hard work, we may evolve our problem into a source of consciousness and growth. When our inner 'healer' is inspired, we struggle towards the unifying truth of the self. One sees, for a brief time, a glimpse of the true unity, beauty, harmony peace. and most importantly - meaning of life.
Here are few my favorite credos: "Know thyself", "Unexamined life is not worth living", "Justice is what love looks like in public, while tenderness is what love feels like in private," " Life is a long distance run," "Every dream is a portrait of the dreamer," And, "Art, like nature provides nourishment for the soul and mind.
Life is not about winning or being successful at the end- its about finding life's meaning, its about personal empowerment, our agency, freeing ourselves from fear. We are a rich mixture of archetypes, energies, and potentialities. We have inner conflicts. Instead of reaching resolutions - we often surrender to our impulses and addictions. With hard work, we may evolve our problem into a source of consciousness and growth. When our inner 'healer' is inspired, we struggle towards the unifying truth of the self. One sees, for a brief time, a glimpse of the true unity, beauty, harmony peace. and most importantly - meaning of life.
(661) 241-0994 View (661) 241-0994
Photo of Dave Hunter Fein, Marriage & Family Therapist Associate in Kern County, CA
Dave Hunter Fein
Marriage & Family Therapist Associate, AMFT
Not Verified Not Verified
Los Angeles, CA 90036
I am a registered Associate Marriage and Family Therapist (AMFT 117039 ), working under the supervision of Cristy Pareti, PsyD, LMFT. I earned my Master’s Degree in Clinical Psychology at Pepperdine University and received my Bachelors Degree from Emerson College. My Clinical experience includes working with individuals whom struggle with anxiety, depression, life skills, substance abuse, eating disorders, trauma and interpersonal relationship difficulties.My modality is a mixture of of many psychological techniques as well as creative skills. This includes a blend of existentialism, mindfulness, humor, art and behavioral skills.
I am a registered Associate Marriage and Family Therapist (AMFT 117039 ), working under the supervision of Cristy Pareti, PsyD, LMFT. I earned my Master’s Degree in Clinical Psychology at Pepperdine University and received my Bachelors Degree from Emerson College. My Clinical experience includes working with individuals whom struggle with anxiety, depression, life skills, substance abuse, eating disorders, trauma and interpersonal relationship difficulties.My modality is a mixture of of many psychological techniques as well as creative skills. This includes a blend of existentialism, mindfulness, humor, art and behavioral skills.
(475) 234-0201 View (475) 234-0201
Photo of Allan Herem LMFT, Marriage & Family Therapist in Kern County, CA
Allan Herem LMFT
Marriage & Family Therapist, LMFT
Verified Verified
Victorville, CA 92392
Amid the ups and down and trials of life, it is easy to succumb to the, "If you think that the grass is greener on the other side" mentality. Well, it's time to water your grass. Although events can affect our lives, a true master of the art of living learns to weather the ups and downs and not allow circumstance to control our relationships, and more importantly, our own self-worth, dignity, and willingness to put one step in front of the other. Counseling is an avenue to help yourself achieve this control over your life. Please visit my website for more information regarding my services: allanheremlmft.site
Amid the ups and down and trials of life, it is easy to succumb to the, "If you think that the grass is greener on the other side" mentality. Well, it's time to water your grass. Although events can affect our lives, a true master of the art of living learns to weather the ups and downs and not allow circumstance to control our relationships, and more importantly, our own self-worth, dignity, and willingness to put one step in front of the other. Counseling is an avenue to help yourself achieve this control over your life. Please visit my website for more information regarding my services: allanheremlmft.site
(949) 612-2761 View (949) 612-2761
Photo of Stan Kim, Marriage & Family Therapist in Kern County, CA
Stan Kim
Marriage & Family Therapist, MBA, LMFT, ATR
Verified Verified
Los Angeles, CA 90025
Waitlist for new clients
With practice in many areas - MBA with corporate experience, Masters in Landscape Architecture, EMDR treatment for trauma, Registered Art Therapist, licensure as a Marital and Family Therapist, I am able to understand where most people come from and how to go about helping you find your way towards a healthy mental state.
I help clients find paths that nurture and grow parts of the self that can enhance one’s experience of life to be fulfilling and whole. People come to me wanting to find out why their life is not satisfying and what could be done to work towards that goal. Often times they are stuck in life situations that block creativity and paths to self defined success. Goals often include happiness, pain relief (physical, mental, spiritual, emotional), self-awareness, productivity, insight, improved socialization, healthy relationships (or finding one), meaning, and contentment with life.
With practice in many areas - MBA with corporate experience, Masters in Landscape Architecture, EMDR treatment for trauma, Registered Art Therapist, licensure as a Marital and Family Therapist, I am able to understand where most people come from and how to go about helping you find your way towards a healthy mental state.
I help clients find paths that nurture and grow parts of the self that can enhance one’s experience of life to be fulfilling and whole. People come to me wanting to find out why their life is not satisfying and what could be done to work towards that goal. Often times they are stuck in life situations that block creativity and paths to self defined success. Goals often include happiness, pain relief (physical, mental, spiritual, emotional), self-awareness, productivity, insight, improved socialization, healthy relationships (or finding one), meaning, and contentment with life.
(310) 312-8032 View (310) 312-8032
Photo of Gerardo Castro, Clinical Social Work/Therapist in Kern County, CA
Gerardo Castro
Clinical Social Work/Therapist, LCSW
Verified Verified
Visalia, CA 93277
I also offer art and play therapy for children and adolescents.
I provide a safe and comfortable environment so you can start your healing and feel better. I have seen clients improve with the right guidance, motivation, and applying more effective coping strategies. If you struggle to manage your emotions, have difficulty trusting others, experience poor self-control, un-healthy relationships, un-healthy partners, get anxious, have poor communication skills, feel stressed out, low self-esteem, depressed, feel stuck/in a fog, and dwell on the past, give me call so we could talk. I am bilingual, English and Spanish speaking, and accept mostly PPO insurances. I offer free phone consultations.
I also offer art and play therapy for children and adolescents.
I provide a safe and comfortable environment so you can start your healing and feel better. I have seen clients improve with the right guidance, motivation, and applying more effective coping strategies. If you struggle to manage your emotions, have difficulty trusting others, experience poor self-control, un-healthy relationships, un-healthy partners, get anxious, have poor communication skills, feel stressed out, low self-esteem, depressed, feel stuck/in a fog, and dwell on the past, give me call so we could talk. I am bilingual, English and Spanish speaking, and accept mostly PPO insurances. I offer free phone consultations.
(559) 529-6877 View (559) 529-6877
Photo of Jason Edward Bernardo, Marriage & Family Therapist in Kern County, CA
Jason Edward Bernardo
Marriage & Family Therapist, LMFT
Verified Verified
Jack of all trades, master of none: it includes person centered as its core, and has a good blend of elements from existential, CBT, experiential, object relations, gestalt, and sensorimotor with a dash of experiential art.
Greetings! My name is Jason Bernardo, LMFT142300 and would like to support you on your journey. It is possible for you to win at life alone, but I do not think it was meant for it to be that way. If you are ready to work through the naysayers with those around you and those within you, maybe I can help play a part in this period of your life.
Jack of all trades, master of none: it includes person centered as its core, and has a good blend of elements from existential, CBT, experiential, object relations, gestalt, and sensorimotor with a dash of experiential art.
Greetings! My name is Jason Bernardo, LMFT142300 and would like to support you on your journey. It is possible for you to win at life alone, but I do not think it was meant for it to be that way. If you are ready to work through the naysayers with those around you and those within you, maybe I can help play a part in this period of your life.
(323) 987-6760 View (323) 987-6760
Photo of Joshua Sandler, Clinical Social Work/Therapist in Kern County, CA
Joshua Sandler
Clinical Social Work/Therapist, MFA, MSW, LCSW
Verified Verified
2 Endorsed
Pasadena, CA 91101
I am trained in many modalities but most often employ trauma-informed, Humanistic, DBT, Gestalt, ERP, CBT, IFS, Art-based, and Psychodynamic approaches.
Do you want to dig deeper? Are you repeating behaviors or situations and wishing you could break the cycle? Are you or your partner struggling with mismatched communication, attachment, intimacy, vulnerability, desire, culture, or conflict resolution styles? Sometimes, we're not sure what causes our distress, but we can sense we're not reaching our potential for health, happiness, or success. And even when we know the cause, change can still feel impossible. That's where I come in. Without judgment, my job is to listen, help you understand root causes of your difficulties, and teach you practical tools to help change your life.
I am trained in many modalities but most often employ trauma-informed, Humanistic, DBT, Gestalt, ERP, CBT, IFS, Art-based, and Psychodynamic approaches.
Do you want to dig deeper? Are you repeating behaviors or situations and wishing you could break the cycle? Are you or your partner struggling with mismatched communication, attachment, intimacy, vulnerability, desire, culture, or conflict resolution styles? Sometimes, we're not sure what causes our distress, but we can sense we're not reaching our potential for health, happiness, or success. And even when we know the cause, change can still feel impossible. That's where I come in. Without judgment, my job is to listen, help you understand root causes of your difficulties, and teach you practical tools to help change your life.
(626) 507-7925 View (626) 507-7925
Photo of Michael G Bauer, Marriage & Family Therapist in Kern County, CA
Michael G Bauer
Marriage & Family Therapist, MA, LMFT, ATR
Verified Verified
3 Endorsed
Los Angeles, CA 90042  (Online Only)
Waitlist for new clients
My areas of focus are Cognitive Behavior Therapy, Art Therapy, Cognitive Behavior Art Therapy, and Mindfulness. I often work through a cognitive lens, helping us to make sense of our often confusing thoughts, feelings, and actions to bring about positive, helpful, and lasting change. I have a background in art and love working with creatives.
My areas of focus are Cognitive Behavior Therapy, Art Therapy, Cognitive Behavior Art Therapy, and Mindfulness. I often work through a cognitive lens, helping us to make sense of our often confusing thoughts, feelings, and actions to bring about positive, helpful, and lasting change. I have a background in art and love working with creatives.
(213) 318-4695 View (213) 318-4695


Art Therapy

How does art therapy work?

The process of making art allows people to express themselves. Art-making can take many forms, such as painting, collage, or sculpting. The therapist asks questions that the work elicits, such as how the person felt while creating their piece, or if any memories surfaced that they can discuss. The therapist will then work with the patient to process their experience, understand themselves better, and work toward change.

Does art therapy help with trauma?

Art therapy can be a valuable treatment option for those suffering from trauma. Traumatic experiences such as combat, rape, or childhood abuse can be so painful that articulating them can be too scary or painful; creating art allows people to express themselves without words, and tell their story in a different way. The physical nature of creating art can also help people feel rooted in the body, which may benefit those who feel disconnected from their body in the aftermath of trauma.

How long does art therapy last?

The duration of art therapy varies, but a common length for treatment is 10 to 15 weekly sessions. Some people may see improvement in just a few weeks, while others may choose to remain in therapy longer term. Patients should periodically discuss their goals with their therapist to make sure the two are aligned on process and progress.

What are the limitations of art therapy?

Art therapy is helpful for many people, but a limitation is that it doesn’t have as robust an evidence base as other forms of therapy, such as cognitive behavioral therapy or acceptance and commitment therapy. The evidence on art therapy is mixed; some research demonstrates its benefits, while other research suggests that it has little impact on patients.