This is part 2 of an article on the Waverley integrative framework in Counselling Practice. Part 1 was published in the previous edition of this journal, and it set out some of my personal background and motivation for creating and developing a higher education counselling programme which is validated by a university, underpinned by a Christian worldview, and supported by the use of the Waverley integrative framework. In this second part, the focus is more on the practical application of the Waverley integrative framework and the competent and ethical use of Christian faith interventions in clinical practice.
The Waverley integrative framework
In part 1 of this paper, I provide an account of the creation and development of a BA (Hons) programme underpinned by a Christian worldview and a critical evaluation of the Waverley integrative framework. I also explain that the curricula of the counselling programme ensures students are facilitated to critically evaluate the use of Christian faith interventions and to be able to assess when it is appropriate to make use of these. In this second part of the article, I therefore continue my explanation of the training provided by the programme, with the focus on the practical application of the Waverley integrative framework and the competent and ethical use of Christian faith interventions in clinical practice.
(It is important to highlight that the approach promoted in this article fully respects clients’ rights to hold their own faith beliefs [or none] and values. Graduates of the College are therefore equipped and qualified to work with clients of all faiths or none.)
The use of Christian faith interventions
As students consider the use of Christian faith interventions in counselling practice, it is important they are facilitated to make a decision as to whether Christian faith interventions should be implicitly or explicitly utilised in counselling. Their decision will be significantly influenced by the context in which they work; for example, whether the setting in which they work has specific regulations regarding the incorporation of a faith-based approach. It will also be dependent on the specific needs and individual wishes of their clients, with students keeping in mind the client’s right to autonomy and to be self-governing at all times (Chappelle, 2000; Leach et al, 2009; Schlosser & Safran, 2009; Worthington et al, 2009; Tan, 2011; Sbanotto et al, 2016). The following two sections explain implicit/explicit integration in slightly more depth.
In certain contexts, for example when working in a context that either prohibits the use of Christian faith interventions and/or in a context where a client does not hold a Christian faith and/or when a Christian client makes the choice not to explore faith concerns, it is important that students engage in what Tan describes as ‘implicit’ integration (2011:340) or what Gubi describes as a ‘covert’ approach (2011:65. See also Tjeltveit, 2013). With implicit/covert integration, the integration and use of Christian faith interventions would not be obvious to an observer, for example a Christian practitioner may or may not choose to silently pray for their client. Admittedly, implicit integration is not without a level of ethical complexity and it is therefore vital that when students undertake implicit integration, they reflect all the attributes of respect, care, compassion and inclusiveness that are linked with a number of key themes derived from the doctrine of imago Dei, that were set out and explained in part 1 of this paper.
Explicit/overt integration and what is meant by Christian faith Interventions
Tan describes an ‘explicit’ approach to integration (2011:66), or what Gubi describes as an ‘overt’ stance (2011:65), as one which includes the explicit and obvious use of a range of faith interventions in clinical practice. These are broad and can include:
Use of faith language, metaphors and analogies;
Taking a faith history of the client;
Use of spiritual relaxation and/or meditation;
Assisting a client to explore their faith and beliefs and concerns;
Use of prayer (client or therapist led);
Exploring issues of guilt and/or forgiveness;
Exploring issues related to meaning and purpose;
(Gingrich & Worthington, 2007; Gubi, 2007; Pargament & Saunders, 2007; Wade et al, 2007; Frazier & Hansen, 2009; Schlosser & Safran, 2009; Barnett & Johnson, 2011; Sbanotto et al, 2016; Captari et al, 2018).
The work I conducted with a client, ‘Jane’ (a pseudonym) illustrates both an implicit and explicit approach to integration. (All three case studies in this paper make use of pseudonyms and in addition, identifying details have been significantly changed in order to protect client confidentiality.)
Case study: Jane
Jane’s presenting problem was that having experienced a significant car accident the previous year, she felt unable to get into the driving seat of her car without re-experiencing traumatic and what she described as ‘terrible’ memories of the accident. I thought Jane might be a Christian because I had seen her at a distance at a local ecumenical event. Nevertheless, during the assessment session, when I asked whether there was anything that gave Jane meaning or comfort during times of stress, she gave no indication of a Christian faith, nor did she disclose any specific faith issues.
This indicated an implicit approach to integration would be of benefit and I duly spent time with Jane helping her process some of her trauma and in particular to assist her with some of her trauma related symptomology (e.g. flashbacks and avoidance strategies). After several months, Jane felt sufficiently recovered so as to not only be able to sit in the car, but actually drive herself to the session. As she stood on the doorstep pointing to the car she had driven, I was really pleased for her and spent time affirming and congratulating her.
Having apparently achieved her goal in therapy, I wanted to explore with Jane whether she considered it might be the right time for therapy to come to an end, or whether she felt there were any other issues of goals she wanted to consider. During this review, Jane stated that she wanted to explore where ‘God was in her accident’. At this point in the therapeutic process with Jane, I re-contracted with her, in that I explicitly sought her wishes as to whether she felt it would be helpful to explore her faith difficulties and I duly gained her permission to work in this area.
During the therapeutic process with Jane, I asked her views as to where she felt God was in the accident and this led to us exploring the belief that Jane held, which was that when a Christian suffers, they must have somehow ‘done something wrong in the past’.
In order to explore this belief further, I asked Jane whether she would be interested in drawing a Spiritual Genogram (Hodge, 2001). Jane agreed and this was helpful as it enabled Jane to describe how she had experienced God at varying times of her life and in addition assisted her to identify some of her unresolved issues of guilt and forgiveness. I also explored with Jane the value of spiritual meditation/relaxation (Collicutt et al, 2016). Both of these interventions helped me to facilitate Jane to resolve some of her difficulties and she reported the interventions helped her to ‘relax’ and to ‘feel closer to God’.
In reflecting on the therapeutic process with Jane, on the one hand, I consider if I had rejected Jane’s request to continue with the therapy outright, I would have denied her right to autonomy and self-determination and in addition it would have risked disrespecting her decision to explore issues that she believed were pertinent to her difficulties. Nevertheless, on the other hand, I did wonder whether Jane was finding a way to prolong the therapy and, in order to ensure I was working in Jane’s best interests, I discussed this issue in supervision. I also explored with Jane in more depth what the key issues were that she was concerned about.
After these discussions, I made a clinical judgement that it would be of benefit to Jane to continue the therapeutic relationship and to explore with Jane her faith concerns. Having reached this decision, I verbally re-contracted with Jane to ensure that there was a shared and clear agreement between us, with explicit permission from Jane, to explore faith issues and, if appropriate, make use of faith interventions in our work together.
Competent skills and ethical practice
Whether counselling students adopt an explicit approach from the very beginning of therapy with their client, or, as in the case study of ‘Jane’, take an explicit approach to integration later on in the therapeutic process, it is vital they develop competent and ethical skills when working with a client’s faith issues (Pate & High, 1995; Young et al, 2007; Aten & Worthington, 2009; Watson & Everleigh, 2014; Swinton, 2016).
Whilst the following eleven points are not an exhaustive list of the ethical guidance the programme provides to students, they highlight some of the key areas that I believe are crucial for trainers to address in order to ensure counselling students gain ethical competence when addressing a client’s faith issues and difficulties.
Students are facilitated to understand the importance of the following:
1. To openly explore and contract with their client their wishes regarding as to whether they want to or do not want to explore any faith issues and concerns and/or receive the use of faith interventions in therapy (see also point 2 below). This ensures the practitioner gains explicit informed consent from their client to work in this area and ensures the client’s right to autonomy (see British Association for Counselling and Psychotherapy (BACP), 2018 9). It also ensures that a shared understanding is reached between both the practitioner and the client regarding the client’s wishes (Chappelle, 2000; Hathaway & Ripley, 2009; Leach et al, 2009; Jenkins, 2011; Tan, 2011; Gubi, 2015).
2. Counselling students are often hesitant or concerned as to how to raise the issue of faith in the assessment session, mainly due to the fear of being accused of proselytising (Saunders et al, 2010). I discuss with students the need to exercise caution, but at the same time suggest that they ensure they allow sufficient space for clients to feel able to raise faith concerns if they desire to do so (Knox et al, 2005; Hage et al, 2006; Barnet & Johnson, 2011). Furthermore, I recommend students ask their clients questions such as ‘is there anything that is important to you or helps you find meaning?’, or ‘how do you find comfort in times of stress?’ I believe these open, non-leading, questions give a client permission and an opening to disclose any faith issues that they might want to discuss in therapy (Jenkins, 2011:34).
3. To always fully respect a client’s autonomy and to take care to ensure the client does not feel coerced or pressurised to engage with faith issues/material (Knox et al, 2005; Barnett & Johnson, 2011; West, 2011:222. See also BACP, 2018:16, item 25).
4. To appreciate there must be a clear rationale regarding their use of faith interventions; having given careful consideration as to the potential benefit or harm that the intervention might create (Tan, 2011; West, 2011; Sbanotto et al, 2016; Captari et al., 2018). This includes ensuring students understand the inappropriateness of attempting to proselytise and impose beliefs, Christian or otherwise, onto a client (Rose et al, 2008; Leach et al, 2009; Worthington et al, 2009; Tan, 2011; West, 2012).
5. To appreciate that faith can be viewed as an aspect of cultural diversity and that they need to develop sensitivity when working with clients who hold a variety of faith beliefs and/or come from a different (or even the same) cultural background (Pitner & Sakamoto, 2005; Hage, 2006; Wade et al, 2007; Schlosser & Safran, 2009). This is in order to ensure students develop inter-cultural (and intra-cultural) competence and practise in a non-discriminatory manner, avoiding oppressive practice (Hodge & Bushfield, 2007; Aten & Leach, 2009; Vieten, et al, 2016. See also BACP, 2018; 15, item 22). As Russell & Yarhouse highlight, faith is ‘an expression of diversity that warrants sensitivity and awareness in assessment and treatment planning’ (2006:435). (See also Plante, 2007 and Hathaway & Ripley, 2009.)
6. That a client’s faith beliefs should not be ignored or undermined, but fully respected, irrespective of whether the counselling student has a negative response to the client’s views and opinions (Young et al, 2007; Frazier & Hansen, 2009; Saunders et al, 2010; Barnett & Johnson, 2011; Cook, 2013).
7. Not to make assumptions about a client’s faith issues, but rather spend time listening to their client in order to gain a comprehensive understanding of the client’s faith difficulties (Captari et al, 2018).
8. Documenting their use of faith interventions (alongside their use of other interventions) and in addition discussing with their supervisor all of their work with clients, including any work undertaken in the faith and/or spiritual area (Chappelle, 2000; Russell & Yarhouse, 2006; Gubi, 2007; Barnett & Johnson, 2011).
9. Reflecting on the potential danger of role confusion if the therapist has another role with the client (for example, they are a member of the same church and/or act in another role, for example, a pastoral carer, a member of the clergy or hold a position of authority in a faith community) (Hage, 2006; Plante, 2007). Students are facilitated to appreciate that the responsibility to protect their clients and keep appropriate boundaries rests with themselves as the counsellor (Haug, 1999). This includes understanding the importance of avoiding dual/multiple relationships wherever possible and when this is not possible, to reflect with their supervisor on the ethical complexities and implications of the dual/multiple relationship. (The training provided by the programme pays particular attention to this issue, since there is evidence that the risk of a therapist holding dual/multiple relationships can be more prevalent within the Christian community [Hill & Mamalakis, 2001]). For example, in a survey amongst Christian therapists (albeit in the USA), 58% believed it was appropriate to deliver therapy to a client who belonged to their church (Sanders, Swenson & Schneller, 2011:336). When church ministers/vicars/leaders are also trained therapists and see their own church members as clients, there is the potential for role confusion to take place, which ultimately risks harm occurring to the client and/or a misuse of power and authority taking place (Haug, 1999; Sanders, 2013, b; Hill & Mamalakis, 2001).
10. Awareness that in certain circumstances there are sound reasons for excluding the use of faith interventions. For example, when a client has a severe mental illness or psychotic episode, where faith and/or religious hallucinations and delusions can occur. Students are provided with training to ensure they are aware that in these circumstances, supervisory advice should be urgently sought, together with, if appropriate and with informed consent from the client, advice from their client’s GP or psychiatrist (Siddle et al, 2002; Koenig, 2009; Jenkins, 2011; Sbanotto et al, 2016).
11. To appreciate that for some clients, experiences connected with faith, religion and spirituality have been far from a source of comfort or growth, but have been distressing and/or even traumatic (Aten & Leach, 2009).
Self-awareness of the student: counter-transference and developing a reflexive approach
As I designed the programme curricula, I also considered it essential that sufficient space was provided in the timetables to ensure students were able to critically reflect on their own Christian faith, their beliefs and their faith journey in order to enhance their self-awareness and their ability to identify any assumptions and prejudices that they might hold (Barnett & Johnson, 2011; Schmidt & Adkins, 2011). Underpinning this approach is evidence that a therapist’s self-awareness of their own personal responses and difficulties with faith, is a determining factor as to how effectively they are able to respond to their client’s faith material in clinical practice (Crossley & Salter, 2005; Hodge & Bushfield, 2007; Young et al, 2009). As Worthington et al, note,‘knowing about a client’s spiritual and religious values and background is not sufficient unless therapists recognise their own values and the consequent biases’ (2009:273).
Furthermore, I considered it essential that students were facilitated to reflect on how their own faith issues might trigger a potential transference/counter-transference response, which in turn, might negatively impact their work with their clients (Swinton, 2007; Young et al, 2007; Frazier & Hansen, 2009; Jackson & Coyle, 2009; Wiggins, 2009; Jenkins, 2011:33). The following case study illustrates the importance of this in practice.
Case study, Pam (a pseudonym)
Very early on in my counselling career, a client, Pam, was referred to me by a church leader (not from my own church). Having formed what I felt was an effective therapeutic relationship, Pam disclosed a number of painful life events, including childhood sexual abuse and what we both deemed was a form of spiritual abuse in adult life. We spent time together exploring the abuse Pam had experienced, both in childhood and in adult life. After several months of therapy, Pam announced during one session that she felt the therapy had really helped her ‘feel a lot better’ and as a result had decided to ‘stop attending church’ and in addition, was questioning whether she was ‘really a Christian’.
I remember feeling very uneasy during the session and a subsequent session with my supervisor valuably pulled out of me two concerns (which were largely unconscious prior to the discussion I held with my supervisor). Firstly, as we looked back over the work with Pam, I identified that I had felt quite ‘flattered’ when the pastor had referred the client to me. As I continued to reflect on this, I identified that I was now somewhat anxious as to how he would view my counselling abilities now Pam had decided to leave the church.
Secondly, I felt ‘very responsible’ that Pam was questioning her faith and wondered whether I had done something wrong in the therapy to cause this. As I continued to reflect on this issue, both on my own and with my supervisor, I became conscious of an even deeper issue, namely that I was concerned that I had somehow let God down in my work with this client. Nevertheless, I continued my work with Pam and helped her explore her future goals and plans. (See below for a further reflection.)
It was important that I was able to identify and acknowledge the unconscious dynamic that was occurring in my work with Pam, not least because without this insight and recognition, I might have unconsciously influenced the client, and/or imposed my own views, rather than recognising her autonomy and helping her explore her own life choices, including those that surrounded her faith beliefs and practices. This case study illustrates to students the importance of developing a high level of self-awareness and to become, as far as is possible, consciously aware of the unconscious dynamics that might occur between themselves and their clients. It is also important that students understand the value of undertaking reflexive practice.
The appropriate use of Scripture in clinical practice
A further area included in the curricula is that students are facilitated to appreciate both the benefits and limitations/dangers over the use of Scripture in counselling. As explained in part 1 of this paper (published in the previous edition), a high regard for Scripture is taken on the programmes as a source of knowledge, on the basis that many Christians believe it to be the inspired Word of God (2 Timothy 3: 16) (Hurding, 1992; Johnson, 1992; McMinn, 1996; Hughes, 2002; Kallmier, 2011). Nevertheless, as Johnson notes, the ‘task of relating the Bible to the human science is fraught with difficulty’ (1992:346) and this is certainly true when it comes to the use of Scripture in clinical practice. For this reason, the programme specifically facilitates students to critically evaluate the use of Scripture, not least because there is considerable evidence that some Christian counsellors can use Scripture texts as a corrective tool; a means of ‘speaking truth in love’ (Powlison, 2010:258). Counselling students are facilitated to understand that this directive approach is unhelpful and risks unethical practice; as Tan points out: ‘the thoughtless and superficial use of scripture in therapy can lead to harmful consequences’ (2011:353).
I also believe it is essential that students are aware that counselling is not an appropriate space to have doctrinal discussions and debates. Therefore, if a client raises the use of Scripture during their counselling session (and it would normally be expected that the client and not the therapist would refer to Scripture) students are encouraged to take a neutral and curious exploration approach; providing clients with sufficient space to explore their own (and not the therapist’s) interpretation of Scripture (Young et al, 2009). I believe this nondirective and curious exploration approach is ethical and allows a client’s perceptions to be explored. I also explain to students that it is of far more therapeutic value to listen to what a client’s beliefs and views are than to take a directive approach, which risks a practitioner’s own agenda being imposed.
In addition, if a client requests the use of Scripture in counselling, students are urged to discover what biblical texts the client personally finds brings them comfort and/or they find helpful (Johnson, 1992). This approach is demonstrated by the following case study.
Case study, Ann (a pseudonym)
Ann sought counselling over what she described as a ‘problem with anger’. She disclosed during the assessment session that she was a Christian and that she wanted to explore her difficulties from ‘a Christian perspective’.
As we discussed together some of Ann’s life experiences, we explored some of the losses that she had recently experienced, including the loss of her mother six months previously. As we continued to discuss and explore the last year of Ann’s mother’s life, Ann became very angry at what she perceived was the neglect of her mother by some of the hospital staff.
One of the interventions that I used was to ask Ann to write a letter (that would at this point not be sent) setting out her concerns and feelings at her mother’s perceived mistreatment. As Ann read the letter back to me in a subsequent session, she made a comment along the lines of that ‘God would be very unhappy with my anger’ and that it ‘demonstrated a lack of forgiveness’ on her part. I asked Ann if we could explore a little more this concept that God would be unhappy with her anger and this caused Ann to disclose that anger was something she had never been allowed to express as a child. As we continued the exploration, I spent time listening and encouraging Ann to express her grief and anger.
At one point, Ann again stated that she thought God was disapproving of her anger and I asked her whether she believed God always disapproved of anger. This caused Ann to mention that she thought the Bible indicated that Jesus might have been angry in the temple and that this was possibly ‘OK anger’. I asked Ann to help me understand why her anger was ‘not OK anger’ as a Christian.
This was of therapeutic value, because during subsequent sessions Ann felt able to express anger and grief, reaching a point where she said during one session that she thought ‘God was OK over her anger’.
As we continued to work in this area over several weeks, I observed from her comments that she seemed to be slowly changing her perception of God from a harsh, disapproving God to a God who loved and cared for her.
Benefits and limitations of faith interventions and/or a Christian therapist/client dyad
The programme training also endeavours to facilitate students to attend to all aspects of culture and to develop cultural competence when working with both similarity as well as difference in counselling practice (Collins & Arthur, 2010). This is particularly relevant when working with Christian faith, since this has frequently been referred to as an aspect of cultural diversity (Brawer et al, 2002; Bufford, 2007; Barnett & Johnson, 2011; Delaney et al, 2007).
I consider the programme training has two key tasks in this area. Firstly, to facilitate students to reflect on the potential damage and limitations, as well as the benefits, of the use of Christian faith interventions in therapy. Secondly to assist students to consider the potential limitations of a Christian therapist counselling a Christian client. The following two sections discuss this in more depth.
Benefits/damage of the use of Christian faith interventions
Students are facilitated to critically evaluate literature which demonstrates the benefits of the use of Christian faith interventions and/or the exploration of a client’s faith issues (see Knox et al, 2005; Post & Wade, 2009; Cragun & Friedlander, 2012; Greenidge & Baker, 2012; Zenkert et al, 2014). However, students are also required to evaluate research which indicates the problems and difficulties that can occur when working with a client’s faith beliefs and material. For example, research by Martinez et al, (2007) highlighted at times:
i. Counsellors were ‘condescending’ and/or ‘offensive’ in their delivery of faith interventions (2007:952);
ii. The use of faith interventions increased the client’s feelings of anxiety and/or guilt and/or the client felt judged by the counsellor;
iii. There was a lack of clarity over role boundaries, for example, when the counsellor was also the client’s spiritual leader;
iv. There was a lack of understanding as to when it was inappropriate to use faith interventions in therapy, for example, when the client felt they should not be addressed in therapy.
One issue that is particularly emphasised to students regarding the potential misuse of faith interventions is over the issue of power. They consider in depth the work of Peter Gubi who highlights how faith interventions have the potential to create a ‘power imbalance’ (2009:119).
Benefits/limitations of a Christian therapist/client dyad
Students also evaluate research which gives evidence that when Christians seek counselling, many actively seek faith-based (Christian) counselling (Aten & Hernandez, 2004; Aten & Leach, 2009; Post & Wade, 2009; Worthington et al, 2009) and in addition they review research which indicates that clients can benefit by being matched with a counsellor who holds similar (Christian) faith beliefs and values as themselves (Aten & Hernandez, 2004; McMinn et al, 2010). The findings from this research are perhaps unsurprising, since there is evidence that better client outcomes can be achieved when a client and therapist are culturally matched (Farsimadan et al, 2007). As Clarkson highlights, ‘people who share similar problems or come from similar backgrounds may have greater ease in establishing rapport, empathy or an effective early working alliance’ (2003:42).
Whilst acknowledging the benefits of a Christian therapist/client dyad, nevertheless, it is also important that students appreciate, as Clarkson points out, that this very similarity can sometimes cause difficulties and that as therapy progresses, a ‘greater perceived dissimilarity’ can be more beneficial ‘(2003:42. See also Jackson et al, 2013:10).
Plumb also highlights the danger of an ‘over identification,’ especially since a practitioner might make the assumption that the client holds the same belief system and then ‘proceed without caution’ when making use of faith interventions (2011:14). As Penny points out, within a faith matched dyad, there is a risk that therapists may be less alert to the danger of potential areas of collusion, misunderstanding or have ‘mismatched expectations about the goals and process of counselling’ (2018:9). Students also consider Bretherton’s paper which highlights a further danger of a faith-matched dyad, namely the risk that those who belong to ‘your particular’ group are consciously/unconsciously perceived to be ‘right’ and those who do not can be perceived to be ‘lacking’ (2006:269). This difficulty is supported by research (again which students evaluate) conducted by Scott (2013), which found that some Christian counsellors; those who ‘had mostly had Christian influences in training, supervision and work place,’ struggled to accept the client’s belief systems (2013:274, 278).
The development of a core competence framework for working with a client’s religious/spiritual issues
Having developed counselling training for students over many years which has taken into account all of the principles that have been set out in this paper, it is worth mentioning that in 2021, I turned my attention to developing a framework which specifically assists Christian counsellors to work ethically, empathically and competently with Christian clients whose faith/religious/spiritual concerns emerge in clinical practice. This framework was published by the Association of Christian Counsellors in 2021 and is available as a resource at www.acc-uk.org › the Churchill Framework.
To bring this paper to a conclusion, in summary, this second part has endeavoured to set out a brief explanation of the principles underpinning the counselling training provided by Waverley Abbey College and in addition briefly pointed the reader to the development of a core competence framework when working with a client’s faith, religious or spiritual issues.
It is important to acknowledge that an obvious limitation of the training (and indeed the competence framework), is that its benefit to the counselling profession might be considered as being restricted to only those who hold a Christian faith. As a Christian, I consider it is important to respect and embrace diversity and to build positive relationships with those who belong to different faith communities to myself (Greggs, 2010; Holland & Walker, 2018; Robinson, 2019). I therefore hope that practitioners who hold different faith beliefs or none will find the principles set out in this paper to be of interest, utilised and potentially adapted to meet the specific needs of other faith communities. Furthermore, my hope is that the success of the counselling programme will encourage those from other faiths (for example, Muslim, Jewish, Hindu) to create similar counselling programmes from within their own faith tradition.
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About the author
Dr Heather Churchill, DCPsych (PW) (Middlesex), MTh (Middlesex) BA (Hons) (Brunel), Registered member BACP (Senior Accred, Counsellor/Psychotherapist) and Supervisor, Fellow of Association of Christian Counsellors and Registered Accredited Counsellor
Heather is Head of Counselling Faculty for Waverley Abbey College and has many years of experience as a trainer, counsellor/psychotherapist and a supervisor. She has co-authored two books: Insight into Helping Survivors of Childhood Sexual Abuse and Insight into Shame and has published a number of articles in the Accord journal of the Association of Christian Counsellors. In her private clinical practice, Heather specialises in counselling adults who have experienced abuse in childhood.
Copyright 2022 Heather Churchill