Therapeutic environment

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The therapeutic environment is the environment in which treatment is conducted. The therapeutic environmnet may itself be a source of the improvement achieved through the therapy. See, for example, in milieu therapy.

In creating a therapeutic environment one should be mindful not only of the physical environment but also the institutional, psychological and social environmnent in which treatment occur.

Institutional environment

The facility environment and treatment facilities often set the tone for how therapy is conducted.

See also

• Community psychology
• Therapeutic community

Key texts

Books

• Benninghoven, D., Krebeck, S., & Bohlen, U. (2005). The Context of Family Assessment. Ashland, OH: Hogrefe & Huber Publishers.
• Brabender, V., & Fallon, A. (1993). Dimensions of the inpatient setting. Washington, DC: American Psychological Association.
• Brabender, V., & Fallon, A. (1993). The seven models: A comparative analysis. Washington, DC: American Psychological Association.
• Carson, S. H., & Langer, E. J. (2004). Mindful Practice for Clinicians and Patients. New York, NY: Oxford University Press.
• Chafetz, P. K., & Namazi, K. H. (2003). Structuring environments for people with cognitive impairment. Arlington, VA: American Psychiatric Publishing, Inc.
• Dishion, T. J., & Stormshak, E. A. (2007). The Ecology of the Child and Family Therapist. Washington, DC: American Psychological Association.
• Knapp, S. J., & VandeCreek, L. D. (2006). Multiple relationships and professional boundaries. Washington, DC: American Psychological Association.
• Kraus, J. E., & Stroup, T. S. (2006). Treatment of Schizophrenia in the Public Sector. Arlington, VA: American Psychiatric Publishing, Inc.
• Kushnir-Barash, N. (2003). Working as a Psychoanalyst in the Midst of Violence and Terror. New York, NY: Pace University Press.
• Pachana, N. A. (2002). Designing therapeutic environments for residential care facilities. Mahwah, NJ: Lawrence Erlbaum Associates Publishers.
• Piper, W. E., Rosie, J. S., Joyce, A. S., & Azim, H. F. A. (1996). The psychosocial environment as a predictor of outcome in the day treatment program. Washington, DC: American Psychological Association.
• Randall, K. W., & Salem, D. A. (2005). Mutual-Help Groups and Recovery: The Influence of Settings on Participants' Experience of Recovery. Washington, DC: American Psychological Association.
• Ransom, S. (2006). The Eden Alternative: Nurturing the Human Spirit in Long-Term Care. New York, NY: Springer Publishing Co.
• Reinstein, D. K. (2006). To hold and be held: The therapeutic school as a holding environment. New York, NY: Routledge/Taylor & Francis Group.
• Timimi, S., & Moody, E. (2006). Adolescent in-patient units: Changing the therapeutic philosophy. London, England: Free Association Books.
• Toran, R., & King, H. (2007). Building trust in the clinician's office and at the bedside. New York, NY: Oxford University Press.

Additional material

Books

• Burnett, K. (2001). Self-help or sink-or-swim? The experience of residents in a UK concept-based therapeutic community. London, England: Jessica Kingsley Publishers.
• Carman, J. (2006). Therapeutic Gardens. New York, NY: Springer Publishing Co.
• Cloitre, M., Cohen, L. R., & Koenen, K. C. (2006). Treating survivors of childhood abuse: Psychotherapy for the interrupted life. New York, NY: Guilford Press.
• Epstein, N. B., & Baucom, D. H. (2002). Conducting couples therapy. Washington, DC: American Psychological Association.
• Firestone, R. W., & Catlett, J. (1986). The psychotherapeutic community. New York, NY: Human Sciences Press.
• Granger, B. P., & Kogan, L. R. (2006). Characteristics of animal-assisted therapy/activity in specialized settings. San Diego, CA: Academic Press.
• Heller, L. (2003). Using dementia care mapping in health and social care settings. Baltimore, MD: Health Professions Press.
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• Llewellyn, R. (2002). Sanity and sanctity: The counselor and multiple relationships in the church. New York, NY: Springer Publishing Co.
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• Parlett, M., & Lee, R. G. (2005). Contemporary gestalt therapy: Field theory. Thousand Oaks, CA: Sage Publications, Inc.
• Raimo, S. (2001). Democratic and concept-based therapeutic communities and the development of community therapy. London, England: Jessica Kingsley Publishers.
• Rosqvist, J., Sundsmo, A., MacLane, C., Cullen, K., & Cartinella, J. (2005). Outside the Office Walls: Ecological Relevance in the Treatment of Refractory Obsessive-Compulsive Disorder. Hauppauge, NY: Nova Biomedical Books.
• Savarimuthu, D. (2005). Can the 'Snoezelen' Affect Self-Injurious Behaviour? A Case Study. Hauppauge, NY: Nova Science Publishers.
• Schwekbe, S., & Gryski, C. (2003). Gravity and levity--pain and play: The child and the clown in the pediatric health care setting. Westport, CT: Praeger Publishers/Greenwood Publishing Group.
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• Senroy, S., & Senroy, P. (2007). Rediscover, reclaim and rejoice: The Sesame approach of drama and movement therapy with exploited girls in India. London, England: Jessica Kingsley Publishers.
• Stewart, K., & Schneider, S. (2000). The effects of music therapy on the sound environment in the NICU: A pilot study. New York, NY: The Louis & Lucille Armstrong Music Therapy Program.
• Volkan, V. D. (2004). After the Violence: The Internal World and Linking Objects of a Refugee Family. Mahwah, NJ: Analytic Press.
• Weisz, J. R., & Addis, M. E. (2006). The Research-Practice Tango and Other Choreographic Challenges: Using and Testing Evidence-Based Psychotherapies in Clinical Care Settings. Washington, DC: American Psychological Association.
• Zur, O. (2002). Out-of-office experience: When crossing office boundaries and engaging in dual relationships are clinically beneficial and ethically sound. New York, NY: Springer Publishing Co.
• Zur, O. (2007). The Home Office Practice. Washington, DC: American Psychological Association.
• Zur, O. (2007). Space for Therapy. Washington, DC: American Psychological Association.
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Papers

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• Marsden, J. P., Calkins, M. P., & Briller, S. H. (2003). Educating LTC staff about therapeutic environments: Journal of Architectural and Planning Research Vol 20(1) Spr 2003, 68-73.
• Martin, G. P., Nancarrow, S. A., Parker, H., Phelps, K., & Regen, E. L. (2005). Place, policy and practitioners: On rehabilitation, independence and the therapeutic landscape in the changing geography of care provision to older people in the UK: Social Science & Medicine Vol 61(9) Nov 2005, 1893-1904.
• Mather, J. A., Nemecek, D., & Oliver, K. (1997). The effect of a walled garden on behavior of individuals with Alzheimer's: American Journal of Alzheimer's Disease Vol 12(6) Nov-Dec 1997, 252-257.
• Matson, J. L., & Boisjoli, J. A. (2009). The token economy for children with intellectual disability and/or autism: A review: Research in Developmental Disabilities Vol 30(2) Mar 2009, 240-248.
• McCarthy, M. C. (2003). Detecting acute confusion in older adults: Comparing clinical reasoning of nurses working in acute, long-term, and community health care environments: Research in Nursing & Health Vol 26(3) Jun 2003, 203-212.
• McDermott, B. M., McKelvey, R., Roberts, L., & Davies, L. (2002). Severity of children's psychopathology and impairment and its relationship to treatment setting: Psychiatric Services Vol 53(1) Jan 2002, 57-62.
• McElwain, B., Polizzi, L., & Polizzi, D. (2002). Moving psychological assessment: Accessing clients' lives at home: The Humanistic Psychologist Vol 30(1-2) Spr-Sum 2002, 85-101.
• McGilton, K. S., Rivera, T. M., & Dawson, P. (2003). Can we help persons with dementia find their way in a new environment? : Aging & Mental Health Vol 7(5) Sep 2003, 363-371.
• McGrath, M. (2008). The challenges of caring in a technological environment: Critical care nurses' experiences: Journal of Clinical Nursing Vol 17(8) Apr 2008, 1096-1104.
• McKellar, J., Kelly, J., Harris, A., & Moos, R. (2006). Pretreatment and during treatment risk factors for dropout among patients with substance use disorders: Addictive Behaviors Vol 31(3) Mar 2006, 450-460.
• Meyer, W. S. (2008). To see and not to see: The consequences of a strengths-based perspective: A commentary on Victoria Fitton's case study: Psychoanalytic Social Work Vol 15(2) 2008, 100-109.
• Milano, S. (2004). A therapeutic group in motion: A treatment experience with psychotic patients: Psicoterapia Psicoanalitica Vol 11(2) Jul-Dec 2004, 117-136.
• Miller, W. L., & Crabtree, B. F. (2005). Healing landscapes: Patients, relationships, and creating optimal healing places: The Journal of Alternative and Complementary Medicine Vol 11(Suppl 1) Dec 2005, S41-S49.
• Miwa, Y., & Hanyu, K. (2006). The Effects of Interior Design on Communication and Impressions of a Counselor in a Counseling Room: Environment and Behavior Vol 38(4) Jul 2006, 484-502.
• Molad, G. J. (2004). In search of "the white area": Some notes on art in clinical space: The American Journal of Psychoanalysis Vol 64(1) Mar 2004, 93-108.
• Mollen, D. (2005). Reviewing and revisting feminist psychology: Problems and permutations: Psychology of Women Quarterly Vol 29(4) Dec 2005, 451-452.
• Nacher, P. G. (1999). The analytic setting as a limit and the limits of the analytical setting: Revista de Psicoanalisis de la Asociacion Psicoanalitica de Madrid Vol 31 1999, 91-104.
• Nadler-Moodie, M., & Gold, J. (2005). A geropsychiatric unit without walls: Issues in Mental Health Nursing Vol 26(1) Jan 2005, 101-114.
• Needs, A. (2006). Review of From Toxic Institutions to Therapeutic Environments: Residential Settings in Mental Health Services: British Journal of Forensic Practice Vol 8(1) Feb 2006, 41-43.
• Nesset, M. B., Rossberg, J. I., Almvik, R., & Friis, S. (2009). Can a focused staff training programme improve the ward atmosphere and patient satisfaction in a forensic psychiatric hospital? A pilot study: Scandinavian Journal of Caring Sciences Vol 23(1) Mar 2009, 117-124.
• Nicolo Corigliano, A. M. (1993). The choice of the setting with the family and the adolescent: Interazioni Vol 1 1993, 9-33.
• No authorship, i. (1986). Review of Utilizing Prior Research in Evaluation Planning. New Directions for Program Evaluation, No. 27, September 1985: PsycCRITIQUES Vol 31 (11), Nov, 1986.
• No authorship, i. (2006). Editorial: British Journal of Psychotherapy Vol 22(3) Spr 2006, 293.
• No authorship, i. (2006). Review of From Toxic Institutions to Therapeutic Environments: Residential Settings in Mental Health Services: Journal of Psychiatric and Mental Health Nursing Vol 13(2) Apr 2006, 250-255.
• Orujev, E. (2000). A comparison of the efficacy of an inpatient treatment program and a residential day-treatment program for severely and persistently mentally ill patients. Dissertation Abstracts International: Section B: The Sciences and Engineering.
• Oury, J. (2007). Trajectory to the clinic: L'Evolution Psychiatrique Vol 72(1) Jan-Mar 2007, 3-14.
• Patterson, A. H. (1981). Therapeutic Environments: Theory and Reality: PsycCRITIQUES Vol 26 (7), Jul, 1981.
• Pearson, A., Pallas, L. O. B., Thomson, D., Doucette, E., Tucker, D., Wiechula, R., et al. (2006). Systematic review of evidence on the impact of nursing workload and staffing on establishing healthy work environments: International Journal of Evidence-Based Healthcare Vol 4(4) Dec 2006, 337-384.
• Pedersen, G., & Karterud, S. (2007). Associations between patient characteristics and ratings of treatment milieu: Nordic Journal of Psychiatry Vol 61(4) 2007, 271-278.
• Peebles-Wilkins, W. (2003). Collaborative Interventions: Children & Schools Vol 25(4) Oct 2003, 195-196.
• Peichl, J., & Schmitz, U. (2000). In-patient therapy of trauma: Trauma exposure or trauma limitation? The utilization of Konzentrative Bewegungstherapie (KBT; concentrative movement therapy) in the clinical practice: Psychotherapeut Vol 45(2) Mar 2000, 82-89.
• Perez, R., Ramirez, S. Z., & Kranz, P. L. (2007). Adjusting Limit Setting in Play Therapy with First-Generation Mexican-American Children: Journal of Instructional Psychology Vol 34(1) Mar 2007, 22-27.
• Perez, R., Ramirez, S. Z., & Kranz, P. L. (2007). "Adjusting limit setting in play therapy with first-generation Mexican-American children": Erratum: Journal of Instructional Psychology Vol 34(2) 2007, No Pagination Specified.
• Phillips, K. A. (2006). The Presentation of Body Dysmorphic Disorder in Medical Settings: Primary Psychiatry Vol 13(7) Jul 2006, 51-59.
• Pocock, M. (2008). Review of Design for nature in dementia care: Practice: Social Work in Action Vol 20(4) Dec 2008, 280-281.
• Polcin, D. L. (2003). Rethinking confrontation in alcohol and drug treatment: Consideration of the clinical context: Substance Use & Misuse Vol 38(2) Jan 2003, 165-183.
• Press, J. (2002). From noise to enigma: analytic psychotherapy of patients with somatic disorders: Psychotherapies Vol 22(2) 2002, 89-97.
• Pressly, P. K., & Heesacker, M. (2001). The physical environment and counseling: A review of theory and research: Journal of Counseling & Development Vol 79(2) Spr 2001, 148-160.
• Price, J. N., & Paley, G. (2008). A grounded theory study on the effect of the therapeutic setting on NHS psychodynamic psychotherapy from the perspective of the therapist: Psychodynamic Practice: Individuals, Groups and Organisations Vol 14(1) Feb 2008, 5-25.
• Profita, G., & Lo Mauro, V. (2003). Therapeutic settings as places of community anchoring. Clinical experiences with immigrants: Gruppi Vol 5(1) Jan-Apr 2003, 117-127.
• Quirk, A., Lelliott, P., & Seale, C. (2004). Service users' strategies for managing risk in the volatile environment of an acute psychiatric ward: Social Science & Medicine Vol 59(12) Nov 2004, 2573-2583.
• Ramchandani, D. (2007). Fooling others or oneself? A history of therapeutic fads and its current relevance: Psychiatric Quarterly Vol 78(4) Dec 2007, 287-293.
• Rasmussen, B. H., & Edvardsson, D. (2007). The influence of environment in palliative care: Supporting or hindering experiences of 'at-homeness.' Contemporary Nurse Vol 27(1) Dec 2007, 119-131.
• Riefolo, G. (2004). Group therapy with psychotic patients and role of the institution: Psicoterapia Psicoanalitica Vol 11(2) Jul-Dec 2004, 137-147.
• Rier, D. A., & Indyk, D. (2006). Flexible Rigidity: Supporting HIV Treatment Adherence in a Rapidly-Changing Treatment Environment: Social Work in Health Care Vol 42(3-4) 2006, 133-150.
• Roche, R. C. (1999). Methodological status of the analytic situation: Revista de Psicoanalisis de la Asociacion Psicoanalitica de Madrid Vol 31 1999, 69-89.
• Rooney, A. (2006). Review of Dangerous Families: Queer Writing on Surviving: The Family Journal Vol 14(2) Apr 2006, 198-199.
• Rose, M. (2002). Therapeutic communities for children and adolescents: A renaissance of heart and mind: Residential Treatment for Children & Youth Vol 19(3) 2002, 1-15.
• Rossberg, J. I., & Friis, S. (2004). Patients' and Staff's Perceptions of the Psychiatric Ward Environment: Psychiatric Services Vol 55(7) Jul 2004, 798-803.
• Rossiter, S. (2006). A Healing Place: Forget Me Not the Farm: Annals of the American Psychotherapy Assn Vol 9(1) Spr 2006, 30-32.
• Royer, A., & Cantinotti, M. (2007). Integrating smoking cessation in treating addiction: Obstacles, challenges and solutions: Drogues, sante et societe Vol 6(1) Oct 2007, 211-240.
• Rueffler, M. (2005). Healing a Collective: A PsychoPolitical Action Project: Journal of Psychohistory Vol 33(1) Sum 2005, 17-40.
• Salokangas, R. K. R., Honkonen, T., Stengard, E., & Koivisto, A.-M. (2002). Symptom dimensions and their association with outcome and treatment setting in long-term schizophrenia: Results of the DSP project: Nordic Journal of Psychiatry Vol 56(5) 2002, 319-327.
• Schaff, P., & Shapiro, J. (2006). The Limits of Narrative and Culture: Reflections on Lorrie Moore's "People Like That Are the Only People Here: Canonical Babbling in Peed Onk." Journal of Medical Humanities Vol 27(1) Mar 2006, 1-17.
• Schneider, J., Bosley, J. T., Ferguson, G., & Main, M. (2006). The challenges of sexual offense treatment programs in correctional facilities: Journal of Psychiatry & Law Vol 34(2) Sum 2006, 169-196.
• Sclafani, M. J., Humphrey, F. J., II, Repko, S., Ko, H. S., Wallen, M. C., & DiGiacomo, A. (2008). Reducing patient restraints: A pilot approach using clinical case review: Perspectives in Psychiatric Care Vol 44(1) Jan 2008, 32-39.
• Scott, C. K., Foss, M. A., & Dennis, M. L. (2003). Factors influencing initial and longer-term responses to substance abuse treatment: A path analysis: Evaluation and Program Planning Vol 26(3) Aug 2003, 287-295.
• Sezaki, S., & Bloomgarden, J. (2000). Home-based art therapy for older adults: Art Therapy Vol 17(4) 2000, 283-290.
• Shilkret, R. (2008). Can architecture cure? : PsycCRITIQUES Vol 53 (16), 2008.
• Slaughter, S., Calkins, M., Eliasziw, M., & Reimer, M. (2006). Measuring Physical and Social Environments in Nursing Homes for People with Middle- to Late-Stage Dementia: Journal of the American Geriatrics Society Vol 54(9) Sep 2006, 1436-1441.
• Soban, C. (2006). What about the boys?: Addressing issues of masculinity within male anorexia nervosa in a feminist therapeutic environment: International Journal of Men's Health Vol 5(3) Fal 2006, 251-267.
• Stalker, C. A. (2007). Review of Treating survivors of childhood abuse: Psychotherapy for the interrupted life: The Canadian Journal of Psychiatry / La Revue canadienne de psychiatrie Vol 52(8) Aug 2007, 540-541.
• Stremel, K., & Campbell, P. H. (2007). Implementation of early intervention within natural environments: Early Childhood Services: An Interdisciplinary Journal of Effectiveness Vol 1(2) Jun 2007, 83-105.
• Stuart, P. H. (2004). Individualization and Prevention: Richard C. Cabot and Early Medical Social Work: Social Work in Mental Health Vol 2(2-3) 2004, 7-20.
• Sucharov, M. S. (2002). Representation and the intrapsychic: Cartesian barriers to empathic contact: Psychoanalytic Inquiry Vol 22(5) 2002, 686-707.
• Sullivan, G. (2007). The need for "community cultural competence." Psychiatric Services Vol 58(9) Sep 2007, 1145.
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• Svarstad, B. L., Mount, J. K., & Bigelow, W. (2001). Variations in the treatment culture of nursing homes and responses to regulations to reduce drug use: Psychiatric Services Vol 52(5) May 2001, 666-672.
• Swartz, H. A., Shear, M. K., Frank, E., Cherry, C. R., Scholle, S. H., & Kupfer, D. J. (2002). A pilot study of community mental health care for depression in a supermarket setting: Psychiatric Services Vol 53(9) Sep 2002, 1132-1137.
• Tabares, J. (1999). The analytic setting as a bond: Revista de Psicoanalisis de la Asociacion Psicoanalitica de Madrid Vol 31 1999, 105-129.
• Tarnanas, I., & Adam, D. (2003). Sonic Intelligence as a Virtual Therapeutic Environment: CyberPsychology & Behavior Vol 6(3) Jun 2003, 309-314.
• Tasca, G., Flynn, C., & Bissada, H. (2002). Comparison of group climate in an eating disorders partial hospital group and a psychiatric partial hospital group: International Journal of Group Psychotherapy Vol 52(3) Jul 2002, 409-417.
• Tasca, G. A., Balfour, L., Ritchie, K., & Bissada, H. (2006). Developmental changes in group climate in two types of group therapy for binge-eating disorder: A growth curve analysis: Psychotherapy Research Vol 16(4) Aug 2006, 499-514.
• Teshuva, K. (2008). Review of Long-term care assisting: Aged care and disability: Australasian Journal on Ageing Vol 27(1) Mar 2008, 54.
• Tetreault, M.-H., & Passini, R. (2003). Architects' use of information in designing therapeutic environments: Journal of Architectural and Planning Research Vol 20(1) Spr 2003, 48-56.
• Tichon, J., & Banks, J. (2006). Virtual Reality Exposure Therapy: 150-Degree Screen to Desktop PC: CyberPsychology & Behavior Vol 9(4) Aug 2006, 480-488.
• Tiet, Q. Q., Ilgen, M. A., Byrnes, H. F., Harris, A. H. S., & Finney, J. W. (2007). Treatment setting and baseline substance use severity interact to predict patients' outcomes: Addiction Vol 102(3) Mar 2007, 432-440.
• Tillman, R., Geller, B., Frazier, J., Beringer, L., Zimerman, B., Klages, T., et al. (2005). Children With a Prepubertal and Early Adolescent Bipolar Disorder Phenotype From Pediatric Versus Psychiatric Facilities: Journal of the American Academy of Child & Adolescent Psychiatry Vol 44(8) Aug 2005, 776-781.
• Tilt, R. (2003). High security hospitals: British Journal of Psychiatry Vol 182(6) Jun 2003, 548.
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Dissertations

• Babson, L. J. C. (2008). Effectiveness of self-monitoring of negative self-statements with chronic pain patients. Dissertation Abstracts International: Section B: The Sciences and Engineering.
• Berry-Harris, T. A. (2008). Examining therapists' perceptions of confidentiality across various therapeutic environments, professional organizations, and client development (an exploratory study). Dissertation Abstracts International: Section B: The Sciences and Engineering.
• Dinapoli, V. A. (2008). Alterations in JAK/STAT signaling pathway and blood-brain barrier function: Mechanisms underlying worsened outcome following stroke in the aged rat. Dissertation Abstracts International: Section B: The Sciences and Engineering.
• Dudley, W. C. (2000). The effects of ward atmosphere on the therapeutic alliance. Dissertation Abstracts International: Section B: The Sciences and Engineering.
• Greene, P. E. (2005). The lived experience of psychiatric-mental health nurses who work with suicidal adolescents in inpatient psychiatric settings. Dissertation Abstracts International: Section B: The Sciences and Engineering.
• Gross, P. S. (2008). Biological children in therapeutic foster families: A phenomenological study. Dissertation Abstracts International: Section B: The Sciences and Engineering.
• Hartjes, D. T. (2004). The honeymoon period: An exploratory study. Dissertation Abstracts International: Section B: The Sciences and Engineering.
• La Chance, C. P. (2008). Supporting the therapeutic environment: A program plan for training direct care staff within the shelter care environment. Dissertation Abstracts International: Section B: The Sciences and Engineering.
• Mitchell, K. N. (2003). Cultural knowing: A means to therapeutic alliance between White and African-American women. Dissertation Abstracts International Section A: Humanities and Social Sciences.
• Seo, M.-Y. (2008). Therapeutic and developmental design: The relationship between spatial enclosure and impaired elder-child social interaction. Dissertation Abstracts International Section A: Humanities and Social Sciences.
• Solomon-Mazzanti, A. (2000). Effects of a staff growth group on the therapeutic atmosphere of an adult female admissions unit. Dissertation Abstracts International: Section B: The Sciences and Engineering.
• Wentzel, E. G. (2008). The relationship between IDEIA disability identification and the developmental assets: Implications for a therapeutic setting. Dissertation Abstracts International Section A: Humanities and Social Sciences.