The Anxiety and Fear of Your Child Going Away to Treatment
Tony Issenmann, Ph.D., LMFT, Director of Family Program at Blue Ridge Therapeutic Wilderness
Brenda Zane is a Sky’s the Limit Fund board member, Founder of Hopestream Community, and podcast host of Hopestream
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Bolt, K.L., Issenmann, T. (2017). Intentional Separation of Families: Increasing Differentiation Through Wilderness Therapy. In: Christenson, J., Merritts, A. (eds) Family Therapy with Adolescents in Residential Treatment. Focused Issues in Family Therapy. Springer, Cham. https://doi.org/10.1007/978-3-
Hello, and welcome back. We are here for another Sky’s the Limit Fund Speaker Series podcast episode. I’m Brenda Zane, I am a lucky board member of Sky’s the Limit Fund, I’m the person who gets to talk with all the incredible people in the field of wilderness therapy, and just bringing information to you. So that you can learn about Sky’s the Limit Fund, you can learn about the various programs that we work with. And if you are not familiar with Sky’s the Limit Fund, we are a nonprofit organization that helps families in times of crisis, when wilderness therapy is the right choice for them. And it’s an incredibly effective form of therapy, it is also incredibly expensive. And so what we do at Sky’s the Limit Fund is we help families with a large portion of the funding to get their young person to wilderness therapy. And then we also help wrap them in services when their student or their young person comes home, because the therapy doesn’t just end at the end of wilderness. So we’re incredibly honored to do that work. We work with people who fund that for us with donors and family foundations. And so if you’re one of those, we thank you so much for doing that. And so today, we’re going to have a conversation about some of the things that happen with parents and with families when wilderness therapy becomes an option or as you’re thinking about it, because there’s a lot involved in that decision. And so I am extremely excited to bring Dr. Tony Issenmann to us today. He is the Director of Family Programs at Blue Ridge Therapeutic Wilderness. And I am excited to have this conversation because I have been through wilderness therapy with my son and didn’t have somebody like Tony to do that with and so I look forward to this conversation. So welcome, Tony.
Yeah, thank you, Brenda, it’s, it’s a real pleasure to be here, I’m excited to have the opportunity to speak with you. And hopefully our conversation can be helpful for parents who are considering this option, it’s, it’s a very nice addition to make.
It is and I just think back when I was in the shoes in 2014, just to have been able to, to hear from somebody like you who is, you know, experienced in this field is working with young people, just to give the real picture. And I think to to give a little bit of validation to those feelings of like, wow, this feels really huge and really scary. And so I would have given my left arm to have a conversation like this, or have heard the conversation like this at the time. So why don’t you give us just a little background and bio on yourself. So we know who we’re listening to, and then we’ll jump into everything.
Sure, sure. So my background educational background is in family therapy, both my masters in my PhD are in family therapy, and it’s really shifted my I have shaped my entire focus of work. Professionally, I started in this field in 2007, as a primary therapist, working with adolescent boys, and, and even from that time was just thinking so much about the family system, and the young man would be the one in the group. But it was clear that it was also my responsibility to work with the family to help the parents understand not just the presenting behaviors, but what was underlying those behaviors. And, you know, I saw just how much, you know, anxiety and fear in those first couple of weeks that parents had, because they didn’t, they didn’t know me as a person they didn’t know, the program, they trusted, you know, they trusted the recommendations that were made, they trusted the professionals that they had spoken with. But I was through that time that I realized, you know, just the responsibility, my desire to use the Family Systems Approach to not only help the young man in the field, but to support and to support parents. So, you know, the, you know, my educational background is and family systems theory and apply that as a primary therapist, I’ve had the opportunity over the years to also be Clinical Director and Director of Family Programs, which I it’s just wonderful to see the evolution of our field, where now I think there’s a much greater understanding of the need to support families, and to really wrap around them to to help them understand what they can do to support the gains that their child can make. And so I’m really pleased to be a part of a program that that believes so strongly in the family of work. I, I’ll also say that, you know, just, you know, for people who are listening, I think it was a decent, you know, therapist when I was working with the, you know, with the adolescents you know, and you know, as I’ve grown and matured in my profession and just in life, you know, I I also am a father. And I think that adds another layer of being able to understand the, you know, just the parental fear and anxiety and love and desire. You know, it’s not that it couldn’t understand that before. But it’s certainly something different, when really beginning to consider what that’s like to ask a parent to do this emotional work, you know, because they are so connected to their child. And it’s one thing to get that theoretically, but it’s another thing to understand as a, you know, as a parent, and I think that’s helped me be able to empathize and support and still hold hold parents accountable when they need when they need that, too. So I really tried to tell parents, like when I’m, when I’m talking with them, I’ll bring the educational background or bring the experience as a therapist, and I’m also bring the, you know, the ability to identify as a parent and use those interchangeably, as you know, as it’s helpful and necessary in any given moment.
Yeah, that’s great perspective, because it is one thing to talk about these things in a kind of clinical way. But when you pull the heart into it, and you realize, oh, this is so hard from a parenting standpoint. And so I’d like to talk about what some of those fears are that you see, especially when you’re talking to a family who’s thinking about having their child, leave the home and go somewhere else. Because I think that’s such a significant part of this. Just as a parent who has been through it, you know, we tried everything possible in that in the local environment. And there just comes a time sometimes with some kids, where that’s just not enough. What do you see, when you’re interacting with a family who’s now made this decision? Okay, we can’t solve this at home. And yet, I’m so afraid because this is such an unknown territory, to have my child leave, not only leave, but leave into a wilderness setting is kind of a whole next level.
Yeah. Well, there, there are several things. But the interesting piece, and you touched on this already, it’s just the connection between our emotions and what we know to be true, right. And family therapy and family systems theory, there’s a theorist named Marie Bo, and he talks about the concept of differentiation. And one of the tenants of differentiation is that on a, on an individual level, we need to balance what we know to be true with what we’re experiencing emotionally. And, you know, it’s so often that I’ll talk with a family who’s like, at all, like, they’ll be able to tell me why and how they know that everything that they tried at home is not is not effective, it’s not working. And so intellectually, they know, we need to do something else. And as soon as they begin to switch gears and think about this other optional wilderness, it’s like, who are those fears take over, emotions go up. And that intellectual ability goes offline, it’s like, well, what about, you know, all these unknown, so I think one of it is just the unknowns of this, it’s not your wilderness therapy, it’s their most people who are at the beginning of the process, they’re learning about it for the first time, they might even have some of their own shame, their own guilt associated with wanting to pretend like everything is okay. And so they they’re not sure how to talk about it with others. And so there’s the fear of unknown and also the the lack of familiarity with this treatment model that can contribute to the anxiety. And because one of the functions, one of the things that we are doing, and we’ll talk about this a little bit later, I hope but the reason that wilderness can be so effective is because it helps us better, better balanced our intellectual functioning and our emotional functioning. So we can make value based decisions, even in times of high stress. And that is tremendously difficult to do. If we are in chronic stress, because our kids are, they’re struggling the ways that they are when wildernesses is presented. And for most families, that’s not the only thing that’s going on for them, they’ve got other children, they might be taking care of an ailing parent, they’ve got jobs. And so stress is high all the time, the ability to have enough clarity, you know, emotional clarity to make an informed decision is just really difficult to do. So I think that compounds the decision as well. It is interesting, though, you know, many, many workshops that that I’ve been a part of over the years, where we bring parents together and they connect, they feel a sense of connection. One of the things they all say is I felt so alone, and it is not uncommon for them to leave and be like, I think you’re my neighbor, you know, you live like down the road. And it happens all the time. And I say that because, you know, we feel like we’re alone. We don’t talk about it. And I think that’s part of what makes it difficult is we don’t know just how many people have been helped by this type of treatment. And if we did know that I don’t know that it would As scary as it is in those initial moments, so I think those are a couple of reasons. I think there’s Yeah, go ahead. Go ahead. I think there’s also a, you know, a times of denial, like, I know, I’ve tried all of this, but maybe one more time, right. I think that’s the emotion coming up again, like, in many ways, it’s the grieving process, I am grieving the trajectory of my family as I, as I had thought about it. And so anytime we move on that grieving process through those stages, or bargaining is a real stage. And so we’re presented with the information, we might deny that that’s, you know, that that’s the next step that we need to take, then we start wrapping our head around, okay, well, maybe that’s okay. But then we start the bar, well, maybe one more time, at home or so I think that that bargaining process of the stages of grief of just coming to terms with, we can thrive as a family and to take this step. They’re both possible. It’s hard to see right now. But those aren’t mutually exclusive. And I think that can interfere at times again, because it’s just such a moment of your a period of time of crisis.
Yeah, oh, you just so perfectly described, the mental process of going through and making that decision. And I think that there is, like you mentioned about the neighbors, there’s so much shame that we, we do often find out oh, the person, right next door, had the same experience, but we don’t talk about it. And also that you can feel like, well, I must be failing as a parent, if I can’t, if I can’t solve this here in my home. Because there are a lot of resources right locally, it’s like, well, we’ve done this, we’ve done this, and what you said about the bargaining and the one more time and you know, these kids tend to be extremely good negotiators. extremely good at promising Oh, no, I’m not, I’m not going to do that again. And, you know, don’t send me away. And so we want to give that one more time and the one more time. And so that decision can get delayed, which isn’t really serving anybody. So why is it that we can’t do this at home? Why is it that with all of the therapists and all of the support groups and the peer groups and the recovery, high schools, and you know, all the things that we might have at our disposal? They’re still a time when it’s, it’s just not working? And I’m curious to hear from someone like you, like, why can’t we do this at home?
Yeah, well, I think that’s a great question. And, you know, obviously, the goal would be to do it at home if we can, but there is a point at which, you know, the, all the evidence is supporting, like, my child is not thriving in this environment. And, frankly, to pretend that they are thriving is just doing them a disservice. And so you know, when that happens, then we need to look at out of home. But why it doesn’t is really I think the example of the bargaining is, is is great, because when the kid is pleading, in that moment, it is so easy as a parent who’s who’s not a part of it to be like, Oh, that’s manipulation. They are like who they got you wrapped around their finger. But the reality is, is that can happen. Kids absolutely can be manipulative, they can they have it in them. And many times we interpret things as manipulative, that are not like what they’re showing is their level of distress. And they’re saying, I’m anxious, I’m distressed, I’m overwhelmed emotionally, at just the thought of life changing. And not because it’s good or bad, or I’ve got any information about it, just that in and of itself is overwhelming. And so they bargain the way that they do and when they bargain that way, Mom and Dad, it hits them. And that, you know, they’ll hit the polls on those heartstrings in a way where decisions are made based on their emotions, right, I want to trust my kids. So I’m going to give them another chance. versus one of the things that I think is really important that we teach when there’s more no separation is like the freedoms and privileges are based on their ability to to manage and thrive and the opportunities that they have not just the promises right to afford your child a freedom that they’ve not demonstrated that they can manage is actually a setup, and we might blame them for it. But that’s a parental responsibility. And that is really hard to reconcile. But it’s but it’s part of what happens is that we’re so closely connected, that that we don’t have time to practice new patterns. And I’ve talked to many, many families over the years who are when I ask them like so. Have you ever had a good session, like we went to outpatient therapy, and it’s like, man, like it was good. And they’re like, Well, it’s hard. But yes, we’ve had a couple and then I say, Well, how was it when you got home? They’re like, Oh, wheels fell off before we got home. Right? And, and I think this is what what can happen is that when moments when you’re in a therapy session, we can have a sense of calm and we can talk about things and we can read See and connect on what a common goal and vision is. And that’s true, I don’t think it’s manipulation on anybody’s part when that happens, but then they leave in life happens. And when life happens, your emotions go up. And we fall back into our old patterns. So maybe that means kid begins to bargain, mom or dad loses their temper, and they start to yell or they become avoidant and, and they’re doing their own dance, that you’re that that old dance, because there’s not been enough time to practice anything differently. So they can they can think about it. But the emotional connection is so strong, that there’s not the ability to put in place new behaviors in that home environment. And so I think that’s really one of the primary factors that that limit the ability for families to be successful at home making these changes. And I’ll, I’ll say like, this isn’t true for just families in crisis. This is true for natural families that we have our ways of functioning, there are established rules and rules and and many adults that I talk with, like after the holidays, Hey, how was it to go home and see your family like, oh, man, right back where we were. And it’s so easy to fall, right? But and that, not that it’s problematic, but it is representative of how easy it is to fall back into those old patterns, when we’re with those people that we’ve practiced being that way for our entire lives. And so to just say, because I’m thinking about it differently, I’m going to be able to do it differently, you know, is really unfair to everybody, because behavior change is not the same as awareness change.
That’s such a great insight that you can’t, what you said about, you know, yes, you could have a great therapy session, but the minute you leave, in real life takes back over, everybody’s going in the wrong direction. And we do fall back into those patterns. And so I can see how having that separation of and having done it, it was pretty magical to have a session, and then you are not together, you’re you’re processing it in a separate space, starting to practice some of those things. And the other thing that you said that was a lightbulb moment was just how that manipulation really is a sign of distress. I think shifting how we look at that, because as a parent, you can look at that manipulation. Even if your child is two or three, right? They know how to get you to say, that’s not them being bad. That is a sign of, of something. And so I appreciate that you said that because it can be really easy to fall into that, like my kids so bad. They’re so you know, they manipulate me just to get what they want. So that was that was really great, great thing to hear. How do you then knowing because you’ve seen this from so many different angles, and now working with families? How can Are there questions that parents can ask themselves to sort of navigate through this time, or just recommendations that you would have to say, Wow, if you’re in this hard spot, and you’ve been experiencing this, maybe things aren’t working at home? How do we start to move towards making a decision about what that next thing might be? Yeah.
You know, first off, you know, there are some times where parents are just an absolute crisis, because their child has ended up in the ER or something, and they need to move quickly. And those are always very difficult. And sometimes, you know, parents have, you know, they’ve been working with an educational consultant, or a trusted professional, in or maybe they’ve had a friend, and this is this has been presented to them as an idea. And I think it’s just important to recognize that it is normal to feel anxious about stuff that you’ve never taken, especially when your child is your Is this the source of what you’re really trying to, you’re trying to help. I think you’re talking to people that you know, and trust that you value if there are, you know, when talking with programs, I always say this, I would say about really all our programs, I think we are we have a field of people who are dedicated to providing this loving, caring support. And I think, you know, it’s, I think it’s important to not just talk to the admissions person, their mission, people are amazing, it’s awesome. And please talk with them. But also don’t talk, see, ask if you can talk to an alumni, you know, ask if you can talk to somebody who’s been there who can relate to you who can speak to what the journey is like, and, you know, those kinds of things can help where you to alleviate some of those emotional concerns of because, you know, not emotions and intellect don’t always get on the same page. And so sometimes we’re concerned emotionally about things that might not rationally make a lot of sense, but that’s okay. You know, there are ways to still, you know, explore those questions and concerns we have, and to do that with intention. You know, I This process is not one that should I don’t think should be done reactively. And, and so the more that a parent has a clearer idea of what they’re trying to, you know how they’re trying to help or what they’re seeking, in this intervention, I think that best positions them to not feel like they’re doing it, just because it’s a last resort. But because they can see this as an intervention that is designed to help their child thrive. And I think that’s a shift for many parents, it’s like, I don’t have another option, or frankly, some parents and I try to do coaching from this at the very beginning. It’s like, this isn’t punishment, right? If you’re angry with your child, because of their behavior, and you want to send them to this, that’s not what this is, this is not boot camp, this is not punishment, this isn’t an opportunity to step away to develop the skills to learn how to manage themselves, and thrive and life. And so it might feel like, it’s the last option because everything else has been tried. But my hope is that parents can ask these kinds of questions, to feel hopeful about the intervention, and what it provides, rather than I don’t I don’t have anything else to do so. So I guess this is what we’re going to do. And even that is led with by fear and anxiety.
I’m glad you said that about the punishment, because I know that’s how I felt like, Oh, this is such a terrible thing I’ve now come to, and I always try to phrase it this way that I gave my son the gift of wilderness, because it truly is. And I think you’re right when parents are starting to make these decisions. And I want to ask you about some research in a minute. Because I know there’s been research that’s been done about the benefits of of treatment done out of the home. But what I what was never presented to me and what I always try to tell parents is there so much good that happens out there, not just the therapeutic good, but this, my son will talk about, oh, I slept better than I’ve ever slept, you know. And I learned all about ants. And I learned how to cook. Like he can make anything out of anything now because of the food. But unless you think about some of those, or somebody tells you about some of those wounds, maybe not, you know, maybe they’re not the typical, like therapy that you think of that your child’s gonna get in wilderness. There’s so many great things, and you’ve seen that you’ve been in the field, what are some of the things that you think parents might like, if you could be a fly on the wall? In wilderness therapy? What are some of the things that you see kids doing or enjoying, that parents probably don’t ever think about before they send their kids?
Yeah, I think just a sense of accomplishment. You know, most of the kids to our commute aren’t that they’ve gotten to a place where maybe in the past, they were successful in a sport or academic or some area, and then they’ve, they’ve given up on a lot of better they feel a sense of hopelessness, and just the daily task completion and like, from setting up the shelter and hiking and making fires, and then when a new student comes in, like watching their child light up when they’re teaching this others, this other young man, yeah, this other young woman, like about how to thrive in a setting, it’s like, Oh, my goodness, I see a fire in my kid that I haven’t seen in a long time. And it’s about, like, hiking down to the water and identifying plants and looking at the stars, and all wonderful things that are just kind of human, right, they’re coming alive again, and they’re feeling a sense of hope, you know, hope is restored in themselves. And they’re able to do that relationally with each other in a way that most students leave saying, like, these are the best friends I’ve ever made. I trust them in a way. I don’t know, I can trust other people. And that is hard to foresee. Or it’s hard to fully grasp when you’re just on the phone talking to a therapist, because, you know, the focus is on what therapeutic work is happening. But the the therapeutic work is consistently happening out there. It’s not just when that therapist is in the field, you know, the entire programs are really designed to support this type of kind of holistic growth through participation, not not just like, oh, it’s therapy. Now it’s the rest of the program. It really is built on itself in that way that I think parents would just be like, oh, man, they’d be tuning in all the time if they if they could, right if
there was a little the nanny cam out in the trees in the woods. But you’re right, I saw that when I went to visit my son and you know, he had been living a lifestyle where there was no no healthy accomplishment. We’ll put it that way. And for him to show me how to tie knots and how to secure things was just you’re right, it just I saw something in his eyes that I hadn’t seen for a couple of years. And so as a parent, you just realize, wow, we back slid a long way. And I think as a parent, you also start to accept that some of those behaviors are more normal than they actually are like, it’s not normal not to see your child smile for a year, that’s just not normal. But when you’re in that, you can’t you lose sight of that. So I think it’s just really important to highlight some of those maybe less tangible benefits that you see as a therapist when you’re there. And that if you’re fortunate as a parent to be able to send your child gift your child wilderness that you start to see. But I know that some people are very concerned about, you know, the effectiveness. And so I pretty sure that you or someone out there has done research that has really shown why out of home treatment is beneficial. So maybe we can talk a little bit about that before we wrap up, because I know that’s really hard.
And absolutely, and so, you know, again, my background is in family therapy, and Marie Bowen has the theory of of differentiation, which is an adolescent, it’s a developmental model, but it really looks at how do we become our own. And I going back to this idea that you said of, like, if parents could see what would they get excited about, I think what we would also see is if we could hook them up to like heart rate monitors when they’re watching, they would also see moments where their child is struggling, where they would struggle to tolerate their child’s struggle. And they would have, if together, they would have intervened. They would have rescued, they would have done something to alter that experience. And instead, because they’re just watching it on the mannequin, they’re like, oh, wow, my my child was able to handle that differently, then I was able to tolerate that. Right? They managed to differently because I had the physical and emotional distance, to allow them the opportunity to manage it differently. So what the research really shows is that that out of home, you know that physical and emotional separation is needed, in systems for family systems to to grow when they’re at this point, right? Not every family has to have the book, when we get to this point, this is necessary. And one of the reasons is because as a family, we’re a system and a system is a set of individual unique parts that make a more complex whole. But what the theory and research your show is that a the goal of a system is not change, its homeostasis, the goal of a system is to remain the same. And so right away, we’re working against each other and not even realizing it when one person wants to change the rest of this. Unintentionally fights against that to pull us up, pull the other person back to the old pattern. And so we see this all the time, where one person begins to change that’s uncomfortable. And so the other family members respond, and it pulls it back. So what the research really shows that yeah, because the emotional connection is so strong, that until we have some physical separation, that will allow us to have some emotional separation. Now we can calm down to the point where our prefrontal cortex can come online, we can learn new tools. And with intention, we can practice those skills individually. And together. I would say it’s important when parents are asking questions to programs that the purpose isn’t separation for the point just for separation, right, the goal is not a timeout. The goal is intentional separation, so that we can calm our nervous systems have enough physical and emotional separation, so that we can learn new skills about ourselves and learn about our own patterns. And then practice doing them differently. So many programs use letter writing as a way to slow down communication, which is amazing, because parents will read the letter, have that strong reaction. And then they get coaching about hey, this is what that means about you. And here’s how you can respond differently. Here’s how you can empower your child, here’s how you can validate their experience and still set a boundary which is very different than what that child might be expecting. But when we’re together in a therapy room trying to do this, like whoa, whoa, whoa, stop to slow down. Like, it’s just, it’s just chaos, because everybody’s emotions are so raw. And and that’s what’s consistently pointed to is it that physical and emotional separation is needed, so that we can learn to manage your own emotions, to be self aware, to learn the skills to show up in a way that’s in our best interest and in the best interest of the family so that when we start practicing something new, we’re like, oh, yeah, I knew that was gonna be hard. And I can do that, you know, I can I can accommodate your growth, because I’m working on this growth for our family too, rather than the focus being that’s uncomfortable, so I’m going to do this, you know, instinctive, reactive things. To get you to go back to your old, your old pattern. And so there’s different research and some some of which I’ve been a part of. And some of that just is in the field, but looks at like the degree to which parents are involved, when their child is out of home has it has a direct, important impact on the the gains that the child makes, and how long they sustain those gains. And so again, I say that because I just want to stress, it’s not about separation, just getting the child away. And then coming back, I think we can all agree that incarceration doesn’t just work, right. It’s not about just being apart, it’s really what are we doing, when we are apart so that we can grow with intention individually, and then come back together on purpose in ways that are structured, that’s one of the things I love about sky’s the limit is that your families have the support. After it’s not just helping financially when the program is there, but but the family coaching that’s available for the weeks afterwards, it’s such a critical time to continue to practice these skills. And I just, I’ve seen it been, you know, be so effective for the families that I have known professionally. And personally, I’ve known families that have been connected with it. And it just, it’s a wonderful service. And I think that speaks also to why this model can be so attractive.
It is it’s I think it’s really unique. And it’s something that can get overlooked is that is that aftercare that support to kind of reintegrate everybody, because like you were saying, it’s not that you’ve just sent one person away to get fixed, it’s that one person is further away in a different setting. And we’re growing and healing together. And that’s, I think, a really important concept for parents to understand is, it’s not that your child is off getting fixed, or even that your child is off getting therapy, your whole family is now in this process in different spaces. They happen to be in the woods in Utah, or wherever. And you may be still at home, working in your job, but it’s it’s something that everybody is going through. And your common about. parents struggle to tolerate struggle, I think is so important that we do. It’s so hard to hold back and watch that struggle. And yet we all know struggle is good. I think we all say, Well, we are but the thing that’s made me who I am today is is the struggle that I’ve been through. But we want to we tend to not want to see our kids go through that. So thank you for bringing that up. Because I think that’s a really, really important point. Before we wrap up, is there anything that you know, now that you wish you would have known when you got into this field or this industry that?
Well, I mean, with everybody? Oh, what is that? You know? I mean, I just how effective it is, before being in this field. I was an outpatient therapist, and I can remember a family that asked me about it. And I was like, I don’t know about that. That’s, you know, this, this might even seem like bootcamp stuff. And I think like, I wish I would have known and I wish the 50, or the field of professionals that are at home, would would know just how effective this model can be. Not just to help the young, the young person who’s coming, but really, to set families up to thrive. That’s really what what we’re intending to do is to work with the entire family. Like you said, they might be in different parts. But that’s on purpose so that everybody can develop the skills to thrive. And I think that’s often under misunderstood or interpreted incorrectly. But it’s it’s a very caring and compassionate approach to supporting that that type of growth. And I’m glad I understand that more fully today than than I did before.
Yeah. Well, hopefully we’ll get the word out through this podcast and through your work. So thank you, Tony, so much for joining us. It’s been incredible. I’m sure we could talk for another two hours, but we will wrap it up and make sure that your resources and information is listed so people can find you. So thanks for being awesome.
Yeah, thank you, Brenda. Appreciate you having me on the show.
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