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Stress on the Job: Self-Care Resources for Counselors.

For the past 25 years, counseling and psychology professional literature has examined the issues of stress on the job. Research and discussion initially identified burnout resulting from job stress as an important area for treatment and prevention. In the last decade, the focus has shifted from burnout to secondary traumatic stress due to the recognition of the specific challenges of working with traumatized individuals. Whether we are addressing the impact of working with others in general or those who have been traumatized, research agrees that we have a responsibility to maintain our own health and wellness as counselors (Iliffe & Steed, 2000; Miller, 1998; Savicki & Cooley, 1982; Sexton, 1999; Sherman, 1996).

The challenge lies in the fact that wellness is a concept that we as counselors often focus on more readily for our clients than ourselves. Counselors who are trained to care for others often overlook the need for personal self-care and do not apply to themselves the techniques prescribed for their clients. Therefore, this manuscript offers numerous resources for self-care that can be helpful in maintaining wellness. Following the advice Hippocrates might have made, "Counselor heal thyself," we recommend that counselors prescribe self-care for themselves. We provide recommended resources to do so below.

In the 1970s, the study of burnout in the counseling profession resulted in definitions of burnout, several instruments for its measure (Arthur, 1990), and recommendations for burnout prevention. Burnout has been defined as "to fail, wear out or become exhausted by making excessive demands on energy, strength, or resources" (Freudenberger, 1974, p.159). The Maslach Burnout Inventory assesses three symptom areas: emotional exhaustion, depersonalization of clients, and lack of feelings of personal accomplishment (Savicki & Cooley, 1982). Recommendations for dealing with burnout in the counseling profession included personal therapy, ample free private time (Watkins, 1983), stress-reduction techniques, development of an attitude of detached concern, and clarification of expectations and beliefs about counseling (Savicki & Cooley, 1982).

Common themes exist in the symptoms of burnout and secondary traumatic stress (STS). Both may result in depression, insomnia, loss of intimacy with friends and family, and both are cumulative (Arvay & Uhlemann, 1996). The key difference lies in the cause of the symptoms. STS is the direct result of hearing emotionally shocking material from clients, while burnout can result from work with any client group (Iliffe & Steed, 2000).

Secondary traumatic stress is defined as an outcome or risk that is related to engaging empathetically with another's traumatic material (Stamm, 1995). Symptoms, which are nearly identical to PTSD symptoms, include:

* Reexperiencing the traumatic events in recollections or dreams

* Avoidance or numbing of reminders of the event such as efforts to avoid thoughts, feelings and activities related to the situation, diminished affect, and loss of interest in significant activities

* Persistent arousal such as having difficulty sleeping and concentrating, hypervigilance, and exaggerated startle response

STS symptoms arise after being confronted with an event that involved death, injury, or extreme threat resulting in intense feelings of fear or helplessness. When symptoms last less than one month, they are considered normal reactions to crisis situations (Figley, 1995,1998). However, Figley (1995) suggests this cluster of symptoms becomes classified as a disorder, STSD, when experienced for more than 30 days following exposure to the traumatic event.

Counselors in community agencies, private practice, and schools work with clients of all ages who have directly experienced trauma. These include experiences such as sexual assault, domestic violence, violent crime, war, traumatic "natural" catastrophes (e.g., tornadoes and floods), and vicariously experienced trauma through a loved one's traumatic experience. Research suggests that in 1998, 8,116,000 people ages 12 and older in the U.S. were victims of violent crime, and 333,000 of those were victims of sexual assault or rape (Rennison, 1999). Approximately 984,000 children were victims of abuse and neglect in 1997 (U. S. Department of Health and Human Services, 1999), and countless others have experienced trauma due to a natural catastrophe. One study of 250 mental health counselors found that 42% of the clients in their current caseload reported a history of child sexual abuse (Follette, Polusny, & Milbeck, 1994).

Treating traumatized clients involves assisting the individual to manage PTSD symptoms, helping her or him to tell the story of the traumatic events, and providing a safe place for feelings of helplessness, anger, and fear to be released. This can result in secondary traumatic stress (STS) or secondary traumatic stress disorder (STSD) in the counselor. Since STS symptoms are considered a normal reaction when working with clients' traumatic material, many counselors will at a minimum experience STS and may experience extended symptoms in STSD.

In the past several years, literature has suggested the need for counselors to address this potentially debilitating result of working with traumatized clients. Recommendations have focused on coping strategies or secondary prevention (i.e., early identification and treatment) of traumatic stress more frequently than primary prevention (i.e., preventing the disorder from occurring). In the literature, counselors and psychologists have been reminded to maintain supervision and a personal support system (Perlman, 1999), utilize debriefing, monitor caseload for numbers of PTSD client, and focus on clients resilience and strengths (Iliffe & Steed, 2000). Engaging in creative endeavors, rest, and physical and social activities has also been recommended (Pearlman, 1995). When used for prevention or wellness, such methods can assist counselors in maintaining their psychological and physical health while treating traumatized individuals. Self-care techniques can reduce the likelihood of secondary traumatic stress symptoms developing into STSD.

We believe that implementing preventive self-care strategies for counseling practitioners is vital to maintaining effective practice. Wellness or holistic health concepts fit our primary prevention perspective. Wellness from a holistic perspective can be defined in six domains: social, emotional, cognitive, physical, spiritual, and vocational (adapted from Wegscheider-Cruse, 1989). In our work, we find these six domains to be a convenient way to address self-care as practitioners.

The following list of books includes current, excellent self-care guides addressing each of the six domains of wellness. We selected these resources based on their usability and representativeness of a wide range of wellness resources. Some are classic texts, in print for decades; others are recent releases. This list is not intended to be exhaustive but represents some of the best self-care resources available today.

RESOURCES

Social

Bower, S., & Bower, G. (1991). Asserting yourself: A practical guide for positive change. Reading, MA: Addison-Wesley.

This user-friendly book provides an action-oriented approach for developing assertiveness. Step by step, the authors outline several self-assessment techniques and interventions for improving self-esteem, assertiveness, and coping skills. Many worksheets and exercises are offered throughout the text to enhance reader learning. Asserting Yourself is an excellent resource for those who want to improve their interpersonal skills and ability to confront stress and anxiety.

Halberstam, J. (1994). Everyday ethics: Inspired solutions to real-life dilemmas. New York: Penguin.

This easy-to-read book discusses personal relationships and values in the context of morality and ethics. The author, a philosopher by training, encourages the reader to develop a "moral imagination" and to apply ethical principles to ordinary daily dilemmas. Solutions to common relationship quandaries are offered and a moral, problem-solving framework is presented. This is a good resource for those who want to strengthen their values and improve their relationships through critical self-examination.

McGoldrick, M. (1998). You can go home again: Reconnecting with your family. New York: Norton.

This book discusses the importance of family relationships and their relevance to our often busy lives. Writing from a family systems perspective, the author encourages readers to become "researchers" and to explore their family history in great detail. To illuminate the process, family histories and genograms of several famous personalities are presented. The last chapter describes the reconnecting process and offers several tips for successful renegotiation of family relationships. This engaging text can help counselors guard against work-related stress and trauma by improving social ties with loved ones.

Pachter, B., & Magee, S. (2000). The power of positive confrontation: The skills you need to know to handle conflicts at work, home, and in life. New York: Marlowe.

This book outlines the process of positive confrontation and discusses skills necessary for success in handling difficult social situations. The author discusses the many aspects of confrontation, including both verbal and nonverbal behavior, and provides a step-by-step process for successful conflict resolution. Examples of some common confrontational situations are also provided. The Power of Positive Confrontation is a new and excellent resource for counselors who want to improve their assertiveness skills.

Rosenberg, M. (1999). Nonviolent communication: A language of compassion. Del Mar, CA: PuddleDancer Press.

In this book, the author describes the model of Nonviolent Communication, a form of communication that occurs when individuals convey their needs in a compassionate manner. In practice, nonviolent communication can deepen relationships, enhance counseling, and improve functioning in organizations. Through various exercises and examples, readers are encouraged to make accurate observations, express their feelings and needs, and communicate requests with empathy. Nonviolent communication may aid counselors in combating work-related stress by enhancing self-care and the ability to effectively communicate needs to others.

Emotional

Gladding, S. (1998). Counseling as an art: The creative arts in counseling (2nd ed.). Alexandria, VA: American Counseling Association.

Although the purpose of this book is to improve counseling services for clients, much of its content can be included in counselors' self-care plans. In separate chapters, the therapeutic uses of music, dance and movement, imagery, visual arts, literature and writing, drama and psychodrama, and play and humor are considered. Additionally, several creative exercises are incorporated at the end of each chapter. In this case, counselors may do well to heed their own advice and explore the benefits of the creative arts in dealing with personal and professional strain.

Kleinke, C. (1998). Coping with life challenges (2nd ed.). Pacific Grove, CA: Brooks/Cole.

The author effectively synthesizes years of scientific research on coping into one practical manual. Numerous self-assessment and coping strategies are provided throughout the well-organized text as they relate to a variety of life challenges. Chapter topics include coping with anger, anxiety, pain, injury, and trauma. Counselors will find this exceptional resource to be useful both personally and in their work with clients.

McKay, G., & Dinkmeyer, D. (1994). How you feel is up to you: The power of emotional choice. San Luis Obispo, CA: Impact Publishers.

This practical text characterizes the power of emotion and its relationship to our thoughts and physical sensations. The authors provide several self-assessment exercises and instruments for recognizing the role of emotion in our daily lives and the process of emotional choice. Also included are four applied chapters in which strategies for gaining control over emotions are presented. Counselors will likely find the chapters on stress and anxiety particularly relevant in their efforts to prevent secondary traumatic stress.

Wegscheider-Cruse, S. (1987). Learning to love yourself: Finding your self-worth. Deerfield Beach, FL: Health Communications.

Contained in these chapters are several strategies for enhancing a strong sense of self-worth. Often with poignant examples, the author illustrates some of the processes that can lead to low self-esteem, emotional pain, and addiction. Counselors may find Chapter 3: New Perspectives on Old Feelings particularly relevant to their self-care following work with traumatized clients.

Weisinger, H. (1985). Dr. Weisinger's anger work-out book. New York: Quill.

This well-organized guide provides 22 anger work-outs intended to improve anger control skills and overall well-being. Each work-out consists of three components: an explanation of purpose, information regarding how the intervention is carried out, and a worksheet to help the reader take action. Dr. Weisinger's anger work-outs are designed to create solutions to problems through action-oriented change rather than intellectual insight. Not only is this an excellent professional resource for working with clients, but it can also assist counselors in managing their own anger and related emotions.

Cognitive

Fritz, R. (1991). Creating: A guide to the creative process. New York: Fawcett Columbine.

As described by the author, this book is about "helping you create what you want to create," be it a work of art or a close relationship. The guiding principles of the creative process are outlined and their applicability to all areas of life is discussed. Additionally, numerous exercises are presented to facilitate learning and creative growth. The suggestions offered in Creating can assist counselors in managing work-related stress by increasing life satisfaction and encouraging personal success.

Gawain, S. (1998). Creative visualization (3rd ed.). Novato, CA: New World Library.

This book describes the technique of creative visualization, a method of creating the life you want through the use of imagination. The process of creative visualization is introduced and practical methods for making it a part of daily life are offered. Several specific meditations and affirmations are also provided. Creative visualization is one method for enhancing mental vitality and counselors may find it useful in combating the detrimental effects of the helping role.

Gelb, M. (1998). How to think like Leonardo da Vinci: Seven steps to genius every day. New York: Delacorte.

Using the life and accomplishments of Leonardo da Vinci as a guide, the author describes a practical approach for fostering personal enrichment and creativity. Seven "Da Vincian" principles are presented and are accompanied by various associated growth-oriented exercises. As well, a complete list of suggested readings accompanies each Da Vincian principle. A, very extraordinary and thought-provoking book.

Levine, S. (1991). Guided meditations, explorations and healings. New York: Doubleday.

Loving Kindness Meditation, a process of sharpening concentration and liberating consciousness, is described in this book. Throughout the text, the reader is guided through several meditation exercises designed to increase awareness and foster "mental strength". As described by Levine, other uses of Loving Kindness Meditation include combating fear, doubt, and negative self-judgment. A beautifully written text, Guided Meditations is thought provoking and inspirational. Counselors should find it invaluable in their quest to enhance personal growth.

Sark (1992). Inspiration sandwich: Stories to inspire our creative freedom. Berkley, CA: Celestial Arts.

This book is unlike any other on the list. Through several stories, suggestions (e.g. "invite someone dangerous over for tea"), and very personal accounts, the author dares the reader to try new and foreign things. Additionally, several unique quotes and inspirational thoughts offered throughout the text encourage the reader to examine life from a different perspective. Designed to inspire creativity, with Inspiration Sandwich Sark certainly persuades by example.

Physical

Balch, J. F., & Balch, P. A. 0997). Prescription for nutritional healing (2nd ed.). Garden City Park, NY: Avery.

This self-help guide by a physician and a nutritional consultant provides readers with reliable information regarding alternative healing/health practices. Part One describes the role of diet, vitamins, minerals, herbs, and other nutritional supplements in health. In Part Two, 190 disorders are described, and key nutrients with suggested doses, herbs, recommendations and considerations for healing are outlined. Part Three describes remedies recommended in the text such as chelation therapy, fasting, glandular therapy, and juicing. This book is useful both for counselors considering alternative methods of health care for the first time and those familiar with alternative healing methods.

Davis, M., Eshelman, E. R., & McKay, M. (1999). The relaxation and stress reduction workbook (4th ed.). Oakland, CA: New Harbinger.

This classic stress management text includes discussion of the physiological stress reactions, and physical, cognitive and behavioral methods for managing stress. Methods outlined include progressive relaxation, breathing exercises, biofeedback, self-hypnosis, thought stopping, nutrition, and exercise. Each method includes description and instructions for use, symptom effectiveness, contraindications, if any, and a guide to the amount of practice necessary for mastery. Counselors should find the techniques in this text helpful in ameliorating physical symptoms of burnout and STS.

Gach, M. R. (1990). Acupressure's potent points. New York: Bantam.

This guide to self-care for common ailments through the use of acupressure is clearly written and well illustrated. Acupressure is a healing technique based on ancient Chinese medicine that uses the body's natural self-curative abilities. General guidelines for use and acupressure techniques are included for more than 20 common ailments such as asthma, colds and flu, insomnia, pain, and stomachaches. Counselors who exhibit stress somaticlly (e.g., through headaches or backaches) may find this text especially useful.

Hittleman, R. (1998). Yoga 28 day exercise plan (Reissue ed.). New York: Bantam.

This classic text on yoga practice outlines the principles of Hatha yoga, and presents step-by-step descriptions and photographic depictions of yoga positions. The practice of yoga is designed to gradually increase one's strength and flexibility through repeated practice of poses. Thoughts for the day are included to provide an introduction to the philosophy of Hatha yoga. While the book is designed to take readers through a 28-day cycle, there are additional practice routines that could provide many months of deep physical relaxation for counselors.

Weil, A. (1998). Health and healing. Boston: Houghton Mifflin.

An internationally known expert on alternative medicine and health, Dr. Weil provides an overview of the alternative healing methods of homeopathy, holistic medicine, chiropractic, Chinese medicine, and others. This well-written text compares alternative and traditional methods of healing and stresses the mind-body connection in health and healing. Counselors will benefit through examination of their beliefs about health and expanding their awareness of alternative methods for healing.

Spiritual

Baldwin, C. (1990). Life's companion: Journal writing as a spiritual quest. New York: Bantam.

This book describes journal writing as a means toward gaining spiritual insight. Several questions, exercises, and quotations are offered throughout to facilitate the process of meaningful personal and spiritual exploration. Here, journal writing is considered a tool by which individuals can discover meaning in everyday life events. Life's Companion is a good resource for those who wish to improve spiritual aspects of their personal and professional lives through writing and self-examination.

Cohen, A. (1993). The dragon doesn't live here anymore: Laving fully, living freely. Somerset, NJ: Alan Cohen Publications.

The purpose of this book is to assist the reader in attaining spiritual growth and wisdom. Through numerous topic-focused essays and stories, the author illustrates the importance of a strong spiritual base to living a full and contented life. Some of the topics covered in the book include overcoming limitations, the mind, love, and the future. Well written, this book is recommended for counselors who wish to enhance spirituality in their personal and professional lives.

Harris, R. (2000). Twenty minute retreats: Revive your spirits in just minutes a day with simple self-led exercises. New York: Holt & Co.

This resource provides more than 190 brief retreats designed to freshen the spirit and sharpen the mind. Harris utilizes awareness exercises, ritual, creative expression, psychotherapy techniques, body work, and energy work in the retreat exercises focusing on spiritual principles such as faith, forgiveness, intuition, joy, love, and patience as well as relaxation, self-acceptance, and self-care. This book could be an excellent guide for calming oneself between challenging sessions or used as a ritual to start the therapeutic day.

Moore, T. (1992). Care of the soul: A guide for cultivating depth and sacredness in everyday life. New York: Harper Collins.

The importance of spirituality and soulfulness in everyday life are discussed in this book. The author describes care for the soul as an appreciation of the mysteries of life, culture, and relationships. The importance of soul is outlined and methods for cultivating and improving spirituality are suggested throughout.

Nhat Hahn, T. (1993). The blooming of a lotus: Guided meditation exercises for healing and transformation. Boston, MA: Beacon.

In this book, guided mindfulness meditation is introduced and its uses are discussed. It is suggested that mindfulness meditation can provide relaxation, improve relationships, and foster self-awareness and healing. Some 34 guided meditation exercises are described in terms of their goals and techniques. Based on Buddhist principles, mindfulness meditation has long been used to strengthen and maintain spiritual life and can be used by counselors to relieve work-related tension.

Vocational

Boldt, L. G. (1998). Zen and the art of making a living (Rev. ed.). New York: Penguin.

This very large text provides an introduction to Zen thought and its application to the career development process. Boldt focuses on identifying satisfying work, locating or creating work, and methods for both. It is filled with illustrative quotes, worksheets, and guidelines. Throughout it combines spiritual concepts with career and work. A very thought-provoking and stimulating book for counselors in any stage of their career.

Bolles, R. N. (1990). The new quick job-hunting map. Berkley, CA: Ten Speed Press.

This little book, drawn from Bolles' (2000) annually published classic What Color Is Your Parachute?, provides a guide to career selection based on one's preferences and goals. The 80-page text is a self-guided exploration of one's preferred setting, rewards, outcomes, tools and work tasks. Working through the exercises and developing your own "Career Flower" is a powerful exercise in self-exploration. Counselors can benefit through verification of career choice and identification of life goals.

Canfield, J., & Miller, J. (1998). Heart at work: Stories and strategies for building self-esteem and reawakening the soul at work. New York: McGraw Hill.

This is a collection of inspirational stories related to the significance of self-esteem at work. Writers as varied as Kahlil Gibran, Art Buchwald, CEOs of corporations, and "anonymous" provide thoughtful essays and poems on self-esteem, caring, and the importance of acknowledgment of individual contributions in the workplace. A wonderful guide for managers and workers alike to keep close to the desk as a reference on developing healthy and supportive workplaces.

Hill, N., & Sartwell, M. (Ed.). (1997). Napoleon Hill's keys to success: The 17 principles of personal achievement. New York: Penguin Books.

Napoleon Hill was arguably one of the first writers of self-help and success guides. This new compilation of Napoleon Hill's writings outlines his recommendations for success in life and work based on interviews of successful American figures in the first part of the Twentieth Century (e.g., Henry Ford, Thomas Edison, Franklin Roosevelt). His motto, "Whatever your mind can conceive and believe, your mind can achieve" forms the basis of this step-by-step guide to success and fulfillment. Counselors will readily understand and find useful this cognitive-behavioral approach to change.

Sher, B. & Gottlieb, A. (1983). Wishcraft: How to get what you really want (Reissue ed.). New York: Ballantine.

This excellent guide to self-exploration and life planning continues to be a classic. It provides guidelines for exploration of self, identification of talents, goals, and roadblocks to success, and support and encouragement for the path of self-exploration and achievement. This book can be used to clarify life goals, develop a nurturing support system, and achieve some of our secret wishes.

CONCLUSION

In summary, counselors in all work settings are likely to encounter clients who have experienced some form of trauma. As some authors have suggested (Figley, 1995; Stamm, 1995), working with these traumatized clients may have negative consequences for counselor work and well-being., As a result of working with traumatized clients, counselors may experience symptoms of secondary traumatic stress or secondary traumatic stress disorder due to vicarious traumatization.

To combat the symptoms of burnout, STS, and STSD, we have offered a self-care prevention plan based on the wellness concepts. The wellness perspective encourages a balance in prevention and wellness practices and ensures against a self-care plan that is too dependent on one particular type of activity (e.g., exercise). While the 30 references offered here do not represent an exhaustive list, we feel that they are a good starting point for counselors who wish to engage in holistic prevention activities and lessen the likelihood that they will suffer from the debilitating symptoms of secondary traumatic stress disorder.

REFERENCES

Arthur, N. M. (1990). The assessment of burnout: A review of three inventories useful for research and counseling. Journal of Counseling and Development, 69,186-189.

Arvay, M. J., & Uhlemann, M. R. (1996). Counsellor stress in the field of trauma: A preliminary study. Canadian Journal of Counselling, 30,193-210.

Figley, C. R. (1995). Compassion fatigue: Toward a new understanding of the costs of caring. In B. H. Stamm (Ed.), Secondary traumatic stress: Self-care issues for clinicians, researchers, and educators (pp. 3-28). Lutherville, MD: Sidran Press.

Figley, C. R. (Ed.). (1998). Burnout in families: The systemic costs of caring. Boca Raton, FL: CRC Press.

Follette, V. M., Polusny, M. M., & Milbeck, K. (1994). Mental health and law enforcement professionals: Trauma history, psychological symptoms, and impact of providing services to child sexual abuse survivors. Professional Psychology: Research and Practice, 25, 275-282.

Freudenberger, H. J. (1974). Staff burnout. Journal of Social Issues, 30,159-165.

Iliffe, G., & Steed, L. G. (2000). Exploring the counselor's experience of working with perpetrators of domestic violence. Journal of Interpersonal Violence, 15, 393-412.

Miller, L. (1998). Our own medicine: Traumatized psychotherapists and the stresses of doing therapy. Psychotherapy, 35,137-146.

Pearlman, L. A. (1995). Self-care for trauma therapists: Ameliorating vicarious traumatization. In B. H. Stamm (Ed.), Secondary traumatic stress: Self-care issues for clinicians, researchers, and educators (pp. 51-64). Lutherville, MD: Sidran Press.

Perlman, S. D. (1999). The therapist's emotional survival: Dealing with the pain of exploring trauma. Northvale, NJ: Jason Aronson.

Rennison, C. M. (1999). Criminal victimization 1998 (Rev. 8/25/99). Retrieved January 3, 2000 from the World Wide Web http://www.ojp.usdoj.gov/bjs/pub/pdf/cv98.pdf

Savicki, V., & Cooley, E. J. (1982). Implications for burnout research and theory for counselor educators. Personnel and Guidance Journal, 60, 415-419.

Sexton, L. (1999). Vicarious traumatisation of counsellors and effects on their workplaces. British Journal of Guidance and Counseling, 27, 393-403.

Sherman, M. D. (1996). Distress and professional impairment due to mental health problems among psychotherapists. Clinical Psychology Review, 16, 299-315.

Stamm, B. H. (Ed.). (1995). Secondary traumatic stress: Self-care issues for clinicians, researchers, and educators. Lutherville, MD: Sidran Press.

U. S. Department of Health and Human Services, Administration on Children, Youth and Families. (1999). Child maltreatment 1997: Reports from the States to the National Child Abuse and Neglect Data System. Washington DC: U. S. Government Printing Office.

Watkins, C. E., Jr. (1983). Burnout in counseling practice: Some potential professional and personal hazards of becoming a counselor. Personnel and Guidance Journal, 61, 304-308.

Wegscheider-Cruse, S. (1989). Another chance: Hope and health for the alcoholic family. Palo Alto, CA: Science and Behavior Books.

Theresa M. O'Halloran, Ph.D., is an assistant professor and director of Training for the Counselor Education Doctoral Program at Western Michigan University, Kalamazoo. Email theresa.ohalloran@wmich.edu. Jeremy Linton is a doctoral candidate in Counselor Education at Western Michigan University, Kalamazoo. Email jeremy.linton@wmich.edu.
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Author:Linton, Jeremy M.
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Article Type:Brief Article
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Date:Oct 1, 2000
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