Dialectical Behavior (DBT) Therapists in Johnson County, IA
Rachel Valentine
Counselor, MA, MEd, CCSP, T-LMHC, NCC
Verified Verified
1 Endorsed
Iowa City, IA 52240
I use a variety of counseling methods that focus on strengths and positive change, including Motivational Interviewing (MI), Solution-Focused Therapy (SFBT), Cognitive Behavioral Therapy (CBT), and Dialectical Behavior Therapy ( DBT).
I offer therapy to adults, helping with challenges like academic struggles, career goals, anxiety, depression, trauma, and identity issues. I have worked with people dealing with various conditions like ADHD, BPD, and more. I believe in a holistic approach to counseling, which means focusing on all aspects of your well-being, including mental, emotional, and physical health, and helping you find purpose and fulfillment. I specialize in wellness, career counseling, identity development, and mindfulness. As a former collegiate athlete, I also have sports performance expertise.
I use a variety of counseling methods that focus on strengths and positive change, including Motivational Interviewing (MI), Solution-Focused Therapy (SFBT), Cognitive Behavioral Therapy (CBT), and Dialectical Behavior Therapy ( DBT).
I offer therapy to adults, helping with challenges like academic struggles, career goals, anxiety, depression, trauma, and identity issues. I have worked with people dealing with various conditions like ADHD, BPD, and more. I believe in a holistic approach to counseling, which means focusing on all aspects of your well-being, including mental, emotional, and physical health, and helping you find purpose and fulfillment. I specialize in wellness, career counseling, identity development, and mindfulness. As a former collegiate athlete, I also have sports performance expertise.
Meadowlark Psychiatric Services
Clinical Social Work/Therapist, LISW
Verified Verified
1 Endorsed
North Liberty, IA 52317
I have experience working with groups and individuals, and my approach incorporates the relational model, acceptance and commitment therapy, cognitive behavioral therapy, and dialectical behavior therapy.
My hope for you as my client, is that you move toward caring for yourself, and creating a life that is in line with your values. My therapeutic approach is collaborative, client-focused, and goal-oriented. I use a strengths-based approach to therapy, and believe in taking a practical approach to problem-solving. I primarily work with individual adults and couples. I look forward to supporting you as you go through this journey!
I have experience working with groups and individuals, and my approach incorporates the relational model, acceptance and commitment therapy, cognitive behavioral therapy, and dialectical behavior therapy.
My hope for you as my client, is that you move toward caring for yourself, and creating a life that is in line with your values. My therapeutic approach is collaborative, client-focused, and goal-oriented. I use a strengths-based approach to therapy, and believe in taking a practical approach to problem-solving. I primarily work with individual adults and couples. I look forward to supporting you as you go through this journey!
Ascent Therapy Group
Clinical Social Work/Therapist, LISW, RPT
Verified Verified
1 Endorsed
Coralville, IA 52241
Our providers can offer a variety of specialty services, including play therapy, CBT, ACT (Acceptance and Commitment Therapy), trauma-focused work, EMDR, DBT, and more.
At Ascent Therapy Group we believe in the human ability to rise, grow, and blossom. Ascent means to rise through the air. A seedling rising is a symbol of growth, hope and possibility. Even when conditions are undesirable, the ability of a seed to sprout, grow and evolve over time represents our belief in you. At Ascent Therapy Group, we value connecting with you in a way that offers warmth, safety, and healing. We believe connection is an energy exchange; it has the power to deepen the moment, inspire change, and cultivate natural strengths.
Our providers can offer a variety of specialty services, including play therapy, CBT, ACT (Acceptance and Commitment Therapy), trauma-focused work, EMDR, DBT, and more.
At Ascent Therapy Group we believe in the human ability to rise, grow, and blossom. Ascent means to rise through the air. A seedling rising is a symbol of growth, hope and possibility. Even when conditions are undesirable, the ability of a seed to sprout, grow and evolve over time represents our belief in you. At Ascent Therapy Group, we value connecting with you in a way that offers warmth, safety, and healing. We believe connection is an energy exchange; it has the power to deepen the moment, inspire change, and cultivate natural strengths.
I specialize in treating OCD and anxiety disorders, using Exposure and Response Prevention (ERP) integrated with ACT, CBT, and DBT strategies to help clients manage intrusive thoughts, reduce compulsions, and reclaim their lives.
You might be carrying patterns that feel heavy—intrusive thoughts, anxiety, depression, or substance use—and wondering why it’s so hard to break free. Maybe you’ve already done a lot of thinking, a lot of trying, and still feel stuck. It’s exhausting to live with pain that no one else can see, especially when you’re working so hard just to get through the day.
Often, people come to me wanting relief, but also wanting something more: clarity, connection, and a way to feel more like themselves again. They’re not looking for quick fixes. They want honest support, effective tools, and a space where their story can be held with care and
I specialize in treating OCD and anxiety disorders, using Exposure and Response Prevention (ERP) integrated with ACT, CBT, and DBT strategies to help clients manage intrusive thoughts, reduce compulsions, and reclaim their lives.
You might be carrying patterns that feel heavy—intrusive thoughts, anxiety, depression, or substance use—and wondering why it’s so hard to break free. Maybe you’ve already done a lot of thinking, a lot of trying, and still feel stuck. It’s exhausting to live with pain that no one else can see, especially when you’re working so hard just to get through the day.
Often, people come to me wanting relief, but also wanting something more: clarity, connection, and a way to feel more like themselves again. They’re not looking for quick fixes. They want honest support, effective tools, and a space where their story can be held with care and
Erica Reschly
Clinical Social Work/Therapist, LISW, PhD
Verified Verified
1 Endorsed
Iowa City, IA 52240
Waitlist for new clients
I skillfully weave Internal Family Systems (IFS), mindfulness, Acceptance and Commitment Therapy (ACT), Dialectical Behavior Therapy ( DBT) and Motivational Interviewing to support you in moving towards your goals and the life you want.
With specialized training and extensive experience, I am passionate about working with adults facing ADHD, LGBTQ+ issues, relational trauma, PTSD, as well as depression and anxiety. I provide an open, compassionate environment to support you in your healing journey. I provide guidance that allows you to align with your own strength, wisdom and inner resources.
I skillfully weave Internal Family Systems (IFS), mindfulness, Acceptance and Commitment Therapy (ACT), Dialectical Behavior Therapy ( DBT) and Motivational Interviewing to support you in moving towards your goals and the life you want.
With specialized training and extensive experience, I am passionate about working with adults facing ADHD, LGBTQ+ issues, relational trauma, PTSD, as well as depression and anxiety. I provide an open, compassionate environment to support you in your healing journey. I provide guidance that allows you to align with your own strength, wisdom and inner resources.
Kimberly Anderson
Clinical Social Work/Therapist, LISW
Verified Verified
1 Endorsed
Coralville, IA 52241
As a clinician for over 20 years, I embrace an integrative approach to healing. I have extensive experience working with families and individuals across the life span around a host of issues. I am a certified trauma-focused cognitive behavioral therapist with a strengths-based, 'person in environment' perspective. I utilize EMDR, ACT, cognitive-behavioral, IFS, dialectical-behavioral and psycho-dynamic approaches to therapy. I also have additional training in Expressive Arts techniques.
As a clinician for over 20 years, I embrace an integrative approach to healing. I have extensive experience working with families and individuals across the life span around a host of issues. I am a certified trauma-focused cognitive behavioral therapist with a strengths-based, 'person in environment' perspective. I utilize EMDR, ACT, cognitive-behavioral, IFS, dialectical-behavioral and psycho-dynamic approaches to therapy. I also have additional training in Expressive Arts techniques.
Currently accepting new clients! Tayler (she/her/hers) is a licensed master social worker. Through a trauma-informed lens, Tayler incorporates aspects from various therapeutic approaches including: dialectical behavioral therapy ( DBT), motivational interviewing, cognitive behavioral therapy (CBT), and somatic processing. Tayler strives to provide a safe, compassionate and empowering environment to collaborate with clients to process life stressors and achieve their goals.
Currently accepting new clients! Tayler (she/her/hers) is a licensed master social worker. Through a trauma-informed lens, Tayler incorporates aspects from various therapeutic approaches including: dialectical behavioral therapy ( DBT), motivational interviewing, cognitive behavioral therapy (CBT), and somatic processing. Tayler strives to provide a safe, compassionate and empowering environment to collaborate with clients to process life stressors and achieve their goals.
A Graceful Space, LLC
Clinical Social Work/Therapist, MSW, LISW
Verified Verified
1 Endorsed
Iowa City, IA 52240
A comprehensive mix of TFCBT, EFIT, CBT, DBT, Strengths-Based Therapy and Motivational Interviewing are utilized to stabilize symptoms, regulate emotions and achieve therapeutic goals.
Are you struggling with depression and anxiety? Do you find yourself overwhelmed with emotions, like the weight of the world is on top of your shoulders? You don't have to carry these burdens alone. At A Graceful Space, I thrive on giving grace and holding space in a peaceful, nonjudgmental environment. By utilizing evidence-based, trauma-informed care, my goal is to walk alongside you while you process through past and present stressors, in order to reach your life worth living goals.
A comprehensive mix of TFCBT, EFIT, CBT, DBT, Strengths-Based Therapy and Motivational Interviewing are utilized to stabilize symptoms, regulate emotions and achieve therapeutic goals.
Are you struggling with depression and anxiety? Do you find yourself overwhelmed with emotions, like the weight of the world is on top of your shoulders? You don't have to carry these burdens alone. At A Graceful Space, I thrive on giving grace and holding space in a peaceful, nonjudgmental environment. By utilizing evidence-based, trauma-informed care, my goal is to walk alongside you while you process through past and present stressors, in order to reach your life worth living goals.
I specialize in eating disorder therapy (CBT, FBT, and RO- DBT), family therapy (ESFT - Ecosystemic Structural Family Therapy), and am highly skilled and trained in DBT.
Hello and welcome! I am currently taking new clients. Are you or someone you love struggling with the day-to-day? Are you feeling lost, stuck, or disconnected? Have you had a life event that you're struggling to cope with? Are you interested in learning more about how to become the best version of yourself? Are you or someone you love struggling with disordered eating or an eating disorder? Are you a member of the LGBTQ+ community and are needing a safe space to just simply be your true authentic self? I see children, adolescents, young adults, and families who are looking for someone to travel along the journey of therapy with.
I specialize in eating disorder therapy (CBT, FBT, and RO- DBT), family therapy (ESFT - Ecosystemic Structural Family Therapy), and am highly skilled and trained in DBT.
Hello and welcome! I am currently taking new clients. Are you or someone you love struggling with the day-to-day? Are you feeling lost, stuck, or disconnected? Have you had a life event that you're struggling to cope with? Are you interested in learning more about how to become the best version of yourself? Are you or someone you love struggling with disordered eating or an eating disorder? Are you a member of the LGBTQ+ community and are needing a safe space to just simply be your true authentic self? I see children, adolescents, young adults, and families who are looking for someone to travel along the journey of therapy with.
Claire utilizes a combination of ACT, DBT, CBT, and MI to support your healing journey
Now providing Ketamine Assisted Psychotherapy. KAP treats long term depression and PTSD with a new approach. Reach out for more details.
Do you feel an undercurrent of uneasiness most or all of the day? Do you need a space to work through your anger and frustration? You are not alone in feeling this way. In these tumultuous times, it's understandable to feel on edge, depressed or uncertain. You deserve an affirming, supportive, and empowering therapist to help you sort through these intense emotions and create strategies to manage the stress and fear that come with living in a world that often feels hostile or unsafe.
Claire utilizes a combination of ACT, DBT, CBT, and MI to support your healing journey
Now providing Ketamine Assisted Psychotherapy. KAP treats long term depression and PTSD with a new approach. Reach out for more details.
Do you feel an undercurrent of uneasiness most or all of the day? Do you need a space to work through your anger and frustration? You are not alone in feeling this way. In these tumultuous times, it's understandable to feel on edge, depressed or uncertain. You deserve an affirming, supportive, and empowering therapist to help you sort through these intense emotions and create strategies to manage the stress and fear that come with living in a world that often feels hostile or unsafe.
I specialize in providing Parent Child Interaction Therapy (PCIT), Project ImPACT, Cognitive Behavior Therapy (CBT), Acceptance And Commitment Therapy (ACT), and Dialectical Behavior Therapy ( DBT).
I work with children, teens, young adults, and adults with anxiety, depression, ADHD, developmental disorders (including autism), and stress related to relationships and transitions. I have significant experience working with children and their caregivers to help children who struggle with anxiety, transitions, and struggles in different situations. I enjoy helping parents have strategies to best help their children. I have a MSW degree from the University of Iowa. Prior to going into private practice I worked at the Center or Disabilities & Development at the University of Iowa Hospital for 9 years.
I specialize in providing Parent Child Interaction Therapy (PCIT), Project ImPACT, Cognitive Behavior Therapy (CBT), Acceptance And Commitment Therapy (ACT), and Dialectical Behavior Therapy ( DBT).
I work with children, teens, young adults, and adults with anxiety, depression, ADHD, developmental disorders (including autism), and stress related to relationships and transitions. I have significant experience working with children and their caregivers to help children who struggle with anxiety, transitions, and struggles in different situations. I enjoy helping parents have strategies to best help their children. I have a MSW degree from the University of Iowa. Prior to going into private practice I worked at the Center or Disabilities & Development at the University of Iowa Hospital for 9 years.
Meet Our Dialectical Behavior (DBT) Therapists
I utilize evidence-based interventions rooted in cognitive-behavioral, dialectical behavioral, and solution-focused therapy while also considering your unique worldview!
I believe that from a young age, we find ways to navigate and survive the world around us. However, sometimes the tools we’ve developed in the past no longer serve us in our current situation and can lead to distress. By gaining a better understanding of ourselves and embracing our strengths, we’re better equipped to develop adequate and effective skills to navigate both internal and external challenges that come our way! I have experience working in settings that have allowed me to meet and work with people with different challenges, backgrounds, and experiences!
I utilize evidence-based interventions rooted in cognitive-behavioral, dialectical behavioral, and solution-focused therapy while also considering your unique worldview!
I believe that from a young age, we find ways to navigate and survive the world around us. However, sometimes the tools we’ve developed in the past no longer serve us in our current situation and can lead to distress. By gaining a better understanding of ourselves and embracing our strengths, we’re better equipped to develop adequate and effective skills to navigate both internal and external challenges that come our way! I have experience working in settings that have allowed me to meet and work with people with different challenges, backgrounds, and experiences!
I have training in several evidence-based practice counseling modalities, including EMDR, Dialectical Behavior Therapy ( DBT), Cognitive Behavioral Therapy (CBT), Cognitive Processing Therapy, Mindfulness, and Motivational Interviewing.
I am currently accepting clients for both EMDR and general therapy. I am offering telehealth sessions, with flexible scheduling options.
As a Licensed Mental Health Counselor with several years of diverse experience in the field, I am well positioned to help support and guide you towards meeting your mental health goals. My clinical work in community mental health has allowed me to gain an immense amount of clinical experience with a vast array of mental health conditions, with a particular focus being Post-traumatic Stress Disorder. You are in the ideal place to get the mental health care that you deserve.
I have training in several evidence-based practice counseling modalities, including EMDR, Dialectical Behavior Therapy ( DBT), Cognitive Behavioral Therapy (CBT), Cognitive Processing Therapy, Mindfulness, and Motivational Interviewing.
I am currently accepting clients for both EMDR and general therapy. I am offering telehealth sessions, with flexible scheduling options.
As a Licensed Mental Health Counselor with several years of diverse experience in the field, I am well positioned to help support and guide you towards meeting your mental health goals. My clinical work in community mental health has allowed me to gain an immense amount of clinical experience with a vast array of mental health conditions, with a particular focus being Post-traumatic Stress Disorder. You are in the ideal place to get the mental health care that you deserve.
I combine traditional therapeutic approaches (cognitive-behavioral therapy, rational-emotive behavior therapy, dialectical behavior therapy) with alternative approaches (brainspotting, pain reprocessing therapy, trauma-informed yoga).
Trauma happens when stressful experiences deplete our physical, mental, or emotional resources. Unresolved traumas can persist as anxiety, depression, substance abuse, physical pain or illness, and other distressing symptoms that wreak havoc on our daily lives. I do not believe that we "get over" our traumas, but rather that we find a way through them. As your therapist, I will walk beside you as you navigate your trauma journey and regain ownership over your personal story.
I combine traditional therapeutic approaches (cognitive-behavioral therapy, rational-emotive behavior therapy, dialectical behavior therapy) with alternative approaches (brainspotting, pain reprocessing therapy, trauma-informed yoga).
Trauma happens when stressful experiences deplete our physical, mental, or emotional resources. Unresolved traumas can persist as anxiety, depression, substance abuse, physical pain or illness, and other distressing symptoms that wreak havoc on our daily lives. I do not believe that we "get over" our traumas, but rather that we find a way through them. As your therapist, I will walk beside you as you navigate your trauma journey and regain ownership over your personal story.
Sarah Cupp
Clinical Social Work/Therapist, LISW
Verified Verified
1 Endorsed
Iowa City, IA 52240
Waitlist for new clients
I have done my own healing through yoga, meditation, DBT and brainspotting.
I enjoy working with adults who are committed to therapy and want to gain insight, live more harmonious lives, and heal. I am passionate about assisting clients to heal old attachment wounds and further develop their interpersonal skills to better get along with others and connect wholeheartedly. Many of my clients have anxiety, situational depression, emotional reactivity, trauma, or feel stuck and unsure about how to cope and change current patterns. I promise to show you respect and compassion within a safe and judgment-free environment.
I have done my own healing through yoga, meditation, DBT and brainspotting.
I enjoy working with adults who are committed to therapy and want to gain insight, live more harmonious lives, and heal. I am passionate about assisting clients to heal old attachment wounds and further develop their interpersonal skills to better get along with others and connect wholeheartedly. Many of my clients have anxiety, situational depression, emotional reactivity, trauma, or feel stuck and unsure about how to cope and change current patterns. I promise to show you respect and compassion within a safe and judgment-free environment.
Lindsey Piper
Clinical Social Work/Therapist, MA, LISW
Verified Verified
3 Endorsed
Iowa City, IA 52240
Waitlist for new clients
I am trained in EMDR therapy, brainspotting, DBT, and use other modalities including mindfulness.
While I am on a waitlist for new clients, I have immediate openings for gender affirming care letters. I can offer this service free of charge for those who can't afford it. Poet Anne Sexton wrote, "That the worst of anyone Can be, finally, An accident of hope." If you're here, you probably feel at your worst. Maybe a traumatic event has left you feeling broken and lost. Perhaps what you've been doing to cope just isn't working anymore, or is doing more harm than good. Whatever your reasons, I'm glad you're thinking about therapy. This process can be scary and takes hard work, and I welcome anyone courageous enough to seek out hope.
I am trained in EMDR therapy, brainspotting, DBT, and use other modalities including mindfulness.
While I am on a waitlist for new clients, I have immediate openings for gender affirming care letters. I can offer this service free of charge for those who can't afford it. Poet Anne Sexton wrote, "That the worst of anyone Can be, finally, An accident of hope." If you're here, you probably feel at your worst. Maybe a traumatic event has left you feeling broken and lost. Perhaps what you've been doing to cope just isn't working anymore, or is doing more harm than good. Whatever your reasons, I'm glad you're thinking about therapy. This process can be scary and takes hard work, and I welcome anyone courageous enough to seek out hope.
My approach is trauma-informed, utilizing CBT, DBT, and EMDR.
Do you struggle with anxiety, depression, or trauma that affects your day-to-day life? In my practice, I start by understanding where you are now and the unique challenges you are facing. Together, we will create a personalized plan to help you move forward in the direction you want to go. I am committed to offering a safe and supportive environment, with both in-person and virtual appointments available on a confidential platform. Whether you're seeking to overcome obstacles, build coping skills, or simply need someone to talk to, I am here to support you every step of the way.
My approach is trauma-informed, utilizing CBT, DBT, and EMDR.
Do you struggle with anxiety, depression, or trauma that affects your day-to-day life? In my practice, I start by understanding where you are now and the unique challenges you are facing. Together, we will create a personalized plan to help you move forward in the direction you want to go. I am committed to offering a safe and supportive environment, with both in-person and virtual appointments available on a confidential platform. Whether you're seeking to overcome obstacles, build coping skills, or simply need someone to talk to, I am here to support you every step of the way.
Pete Campie
Marriage & Family Therapist, LMFT, C-DBT
Verified Verified
3 Endorsed
Coralville, IA 52241
I use a blend of narrative, experiential, emotionally-focused and DBT approaches, but I'm not here to make you fit into my system.
Hi, I'm Pete. Therapy can mean different things to different people depending on your perspective. From mine, I'm here to help you reach the goals you're shooting for, and I'm not here to waste your time or tell you things you already know. I'll give you everything I've got to help you get where you're going. Relationship in real trouble? Feeling like you can't figure out who you are or want to be? Sounds heavy. I help with heavy.
I use a blend of narrative, experiential, emotionally-focused and DBT approaches, but I'm not here to make you fit into my system.
Hi, I'm Pete. Therapy can mean different things to different people depending on your perspective. From mine, I'm here to help you reach the goals you're shooting for, and I'm not here to waste your time or tell you things you already know. I'll give you everything I've got to help you get where you're going. Relationship in real trouble? Feeling like you can't figure out who you are or want to be? Sounds heavy. I help with heavy.
I commonly draw from ACT, CBT, self-compassion, mindfulness, ERP and DBT.
I believe each individual holds unique strengths, values, and experiences. Harsh internal narratives and emotions can engulf you and make it hard to cope. Unresolved trauma can weigh on you and manifest as anxiety, depression and unhealthy coping strategies. Life can be overwhelming! Therapy can help you to develop a deeper understanding of yourself and build the skills to persevere through the inevitable challenges you face.
I commonly draw from ACT, CBT, self-compassion, mindfulness, ERP and DBT.
I believe each individual holds unique strengths, values, and experiences. Harsh internal narratives and emotions can engulf you and make it hard to cope. Unresolved trauma can weigh on you and manifest as anxiety, depression and unhealthy coping strategies. Life can be overwhelming! Therapy can help you to develop a deeper understanding of yourself and build the skills to persevere through the inevitable challenges you face.
Working within the framework of Dialectical Behavioral Therapy, Cognitive Behavioral Therapy, Mindfulness, and Internal Family Systems Therapy, we can move through depression, anxiety, and extreme experiences, into the life you seek.
The idea of therapy for many people can be scary in a lot of different ways. You may feel like it's an impossible step to take. Or maybe you feel a wall come up at the idea of possibly trusting a therapist. Whatever the case may be, I am here to respect and meet you where you are at. If you notice a mix of feelings or just feel ready to dive right in, that's welcome too; all parts of us are welcome here!
Working within the framework of Dialectical Behavioral Therapy, Cognitive Behavioral Therapy, Mindfulness, and Internal Family Systems Therapy, we can move through depression, anxiety, and extreme experiences, into the life you seek.
The idea of therapy for many people can be scary in a lot of different ways. You may feel like it's an impossible step to take. Or maybe you feel a wall come up at the idea of possibly trusting a therapist. Whatever the case may be, I am here to respect and meet you where you are at. If you notice a mix of feelings or just feel ready to dive right in, that's welcome too; all parts of us are welcome here!
See more therapy options for Johnson County
Dialectical Behavior (DBT) Therapists
Who is DBT for?
Dialectical Behavior Therapy (DBT) is designed for people who experience extreme emotional suffering because they lack the skills of emotion regulation and distress tolerance. The basic affliction can underlie a wide range of conditions, from borderline and other personality disorders to PTSD and treatment-resistant anxiety and depression. The therapy is helpful to those whose emotional reactivity is so intense it is disruptive to everyday functioning and leads to frequent crises.
Why do people need DBT?
The ability to regulate emotions is a core psychological skill that enables people to function in life and pay attention to the world outside themselves; it is consistently associated with well-being. DBT is designed to help people learn how to manage and regulate their emotions. Originally developed to treat people with borderline personality disorder whose extreme emotional suffering led to self-harming behavior and suicide attempts, the therapy is now applied to other conditions involving emotion dysregulation, particularly when other treatments have failed.
What happens in DBT?
Individuals meet weekly with their therapist to discuss their experiences relating to moods, behavior, and skills. Using checklists they maintain, they review emotional experiences and positive practices they engage in. The diaries help individuals discern what led up to a specific problem encountered, this is followed by discussion of the consequences of their actions. In addition, individuals may meet in class-like small groups to learn skills such as mindfulness, emotion regulation and distress tolerance.
How long does DBT last?
Because it is intended to establish long-lasting behavioral change among those with persistent problems, DBT is designed to last six months to a year. DBT includes both weekly sessions of individual therapy and weekly skills-training sessions conducted in small groups. Studies of DBT have documented improvement within a year of treatment, particularly in controlling self-harmful behavior; nevertheless, individuals may require therapy for several years.