Art therapy and pet bereavement: Learning to cherish the past so we may live for a better tomorrow. IN FULFILLMENT OF THE PENNWEST EDINBORO COUNSELING AND ART THERAPY GRADUATE PROGRAMS Inspiration Being raised by my mother and father who own and run the Fredonia Animal Hospital My own experiences with mourning pet loss How to help others after the final chapter has closed on their pets? Art as a transformative and therapeutic process Statement of the Problem Despite pet bereavement being a difficult part of life that many people eventually face, the attitudes and stigma against mourning a pet is prevalent in our modern day (Hess-Holden et. al, 2017). Without a proper support in place, guilt and stigma can lead to extended issues processing and moving forward from the pet-loss (Milman et al., 2019). Art therapy has been shown to provide help with bereavement (Arnold, 2019; Packmen et al., 2017). Therefore, art therapy may also be helpful in allowing clients to discuss this stigma and work through pet bereavement in a safe and nonjudgmental setting. In other words: mourning a pet vs mourning a person, lack of research on pet-specific grief treatment, unprocessed grief, benefits of art therapy for grief treatment eight-week art therapybased curriculum for individuals experiencing pet bereavement. American Pet Products Association (APPA) found that almost 70% of U.S. families own a pet within the US (Coleman & Posey, 2022). Animals being seen as key sources of relief for stress, isolation, and boredom during the pandemic (Rocheleau, 2020; Stevens, 2021). Perceptions on the importance or value of animals as pets or companions vary from person-to-person, but pets are highly valued within society Therapy animals, guard dogs, K-9 units Terms Bereavement Art Therapy Counseling Support System * Stigma * Coping * Resiliency * Support System * Pet grief sometimes berated (Hess-Holden et. al, 2017) Disenfranchised grief Typical mourning resolution; extended unprocessed mourning isolation & unbalanced avoidance disruption of social, work, personal life bereavement (Appelbaum & Yousif, 2022; Coenen, 2018; Plangger et. al, 2022). Workplace policies are not always employee-centered and not many days are granted for the loss of a person, let alone granted for the loss of a pet; (Barclay & Kang, 2019; Kristvik, 2021; Wilson et. al, 2021). Lack of research which studies pets-specific loss, let alone both pet bereavement and art therapy are present. Bereavement Finding meaning as an additional phase of loss (Kessler, 2020). cause of death and the suddenness of the loss (Boelen and Lenferink (2021) healthy coping, coming to terms with the loss, mitigating avoidance, and utilizing support systems (Shear et. al, 2011). Mourning Complicated grief- ongoing mourning one year+ after the loss Dismissing loss as “more manageable” and replacing the loss, Redmalm (2015) and McKinney (2019). Dual-Process Model: Bereaved individuals must both focus on loss-oriented (LO) and restoration-oriented (RO) strategies (Fasse & Zech, 2016; Stroebe & Schut, 2010). LO: Primary stressors: intrusive thoughts, physicial reminders RO: secondary: adjustments and changes in the wake of loss Mourning Pet Loss McKinney (2019) study involving 80 participants, the author found four shared components of the grieving process: justifying the loss to self and others, accepting the pet passed away at the proper time, coping with and processing the loss, finding a new pet companion. Eckerd et al. (2016) found that higher grief severity was present in human loss over pet loss across participants in a sample size of almost 400, but that both groups experienced significant loss > Intensity CBT and Existentialism counseling Uncovering, challenging, and reframing thoughts and beliefs Irrational guilt in bereavement Existentialism: Finite time, Freedom & Responsibility (A responsible to live our lives authentically) Art therapy in Pet Bereavement Non-verbal and verbal healing Process ----------- product Visualizing problem, goals, change Positive Psychology • Reframing the loss in a positive light • Ending on a “good note” Creating a Curriculum: Purpose, Who Should Use it, Target Audience Intended for exploring, analyzing, discussing, and reframe bereavement or complicated loss related to pet and animal-companion loss. Meant to be facilitated by a master’s level art therapist who is versed in group dynamics, group therapy, loss, bereavement, and the skills needed to run a group using the art therapy interventions that will be outlined. The curriculum is designed to benefit individuals who would work well in a group setting, have experienced pet-loss, and do not suffer from active disorders which supersede the distress caused by the animal-related loss. The curriculum is made for use in adult populations, (18 or older). It may be adaptable for adolescent audiences, but only by an art therapist who is well-versed in working with that age group. Curricular structure The curriculum is outlined for a group that will have no more than ten members, and be a closed group; no new members should be added to the group once the first session begins. 5 – 10minute check-in Briefly how they are feeling, any thoughts on last week’s session, and any progress they made in their healing journey over the week. This time will also be used by the group leader to briefly summarize what was done in the previous session. 5 minutes to introduce the art directive 50 – 55 minutes for the artwork, 40 minutes to share, 5 minutes for wrap-up The total time for every session will be around two hours. Further Instructions HIPPAA Informed Consent Screening Therapeutic environment Outline Session 1: Reviewing and discussion on group rules, confidentiality, and introductions. The rest of session one will be centered on an artdirective about what group members hope to get from the group or achieve during the group. Session 2: Brief check-in, and recap what was discussed in session one. The group facilitator should explain change and how it impacts us in the wake up a pet loss. The group will work on art which helps them visualize their headspace and feelings before and after the pet loss. Session 3: Focus on building trust in the group and beginning to discuss pet loss. The art directive will allow clients to begin to process thoughts on the pet-loss in a safe way while also allowing them to creatively express positive qualities and memories of their pet. Session 4: Focus on guilt. After summarizing the last session and doing check-ins, an art directive will be introduced which asks members to think about any guilt or thoughts which fueled their depression during the mourning process (or last week) and express it through art, and then creating a new piece of art or modifying the art based off any ways in which group members can challenge their unhealthy beliefs. Session 5: Group recalls what they discussed last session and what unhealthy thoughts were replaced with an alternative, healthy, more valid thought and express the feelings associated with that through the art. Group then processes and reflects, further changing from thoughts of guilt or blame to healthy outlooks and resolution. Sessions 6 – 8 Memorializing the pets through the group members’ artwork. This will be an art directive which simply asks the clients to use any 2D or 3D means they feel comfortable with to create a visualization of the pet or what their pet meant for them. The facilitator will also ask group members to focus on how they will move forward with the loss as they work on the art. At the end of each session, group members will share their progress, and have their artwork completed by the end of the final session. The final session will also ask members to reflect on what they have learned or will take with them from this group. Session 1: New Beginnings Introduction of Group The beginning of Group is an excellent opportunity for the art therapist to introduce themselves, summarize the purpose of the group, and explain why each participant was allowed into the group. This may be information already made clear during prior intakes or screening processes, but serves as a refresher on this information. This may serve as an ice breaker between the newly introduced group members. Introductions & Check-In After the art therapist has introduced themselves, the group should be asked to introduce themselves one at a time. This can occur in a variety of ways, but one recommended format is to ask each group member to say their name, one hobby or interest they have, and to briefly list any ideas for what they are hoping to get out of the group. Typically, each group session will begin with a check-in, where each group member is allowed time to discuss how their week went, how they are feeling, and any thoughts they have for the previous group session. For this first session, the introductions suffice. Group Rules Ideally, the group rules were explained and agreed on by each group member prior to the beginning of the group. Regardless, they should be reiterated and agreed upon by the group as a whole. This should also be a time to invite group members to suggest any additional rules. This opens discussion up for the group, and allows for a relatively low-risk conversation to begin getting group members to actively participate. Experiential: Draw/Paint/Sculpt your Goals Purpose This art exercise is intended to be a low-risk method of getting group members invested in artmaking, sharing, and agreeing upon group goals. Goal To encourage each group member to contemplate and establish their own individual goals for the group; to link similar goals together in order to come up with a consensus for the collective group's goals. Materials Any art mediums and materials available that are safe within reason for each group member to use. Instructions Think about what you hope to gain or achieve from this group. This can be anything from “feeling better” to “moving forwards”. You are free to express one over-arching goal, or come up with multiple goals. Express these goals using any art materials available to you. Take your time and try not to feel rushed. You have 50 minutes to complete your artwork. Discussion Questions Ask group members to volunteer to share their art. The following questions will help facilitate group discussion: 1. What do you hope to achieve from this group? 2. How did you express that through your art? 3. Are any of your goals similar to another group members’ goals? 4. Is the way in which you expressed your art similar to someone else’s? 5. How would you describe each picture in one word? Why? 6. How could these goals be achieved? * During discussion, link (or point out) similar or repeated group goals that members share. These repeating goals can then be written on a white board or document for the group to agree on what shared goals the group will collectively work towards * Wrap-up The group leader should end by summarizing the Experiential, what group members expressed, and what the agreed goals are, and briefly say what the group will work on next week. Take the time to also point out the progress the group has already made. Session 2: Dichotomy Introduction Summarize session one, particularly the goals which the group agreed to work toward. Remind the group of any similarities pointed out last session in similar hobbies, art styles, or shared thoughts/feelings on grief. Check-in This is a time for each member to individually discuss their week, reflections on the previous session, feelings about the group, mood, or thoughts to the rest of the group. This is also an opportunity for other group members to relate to each other or offer feedback. Check-in also allows the group leader to gauge how the group as a whole is doing. Experiential: “Then and Now” Purpose “Then and Now” is an art therapy prompt created by Seymour (2022). This prompt asks clients to symbolically express their life through art in two distinct ways: what their life was like before the death of a loved one, and after the death occurred. The nature of this prompt gives the art therapist insight into the clients’ perception of their lives, thoughts, and affect before the loss, and what their perception is in the present, providing a baseline for where everyone is in their mourning process. Additionally, it allows a way for group members to relate to each other about their perceptions of their lives and loss, while being a relatively low-risk first art therapy Experiential for each group member. Goal: This directive is meant to help clients visualize and analyze their individual perception of their life before and after their pet passed away. This exercise may also help clients identify distortions in their view on life and identify emptiness in their life from the loss. Materials • Paper, Brushes and acrylic paints , Markers, Color Pencils, Oil Pastels, Magazines, Scissors, Glue sticks Instructions Part 1: Think about your pet and all they meant within your life. Reflect on the impact they have had on you. Now, using the art materials available to you, express what it was like when that pet was in your life. Part 2: Now, reflect on how your life is currently. How is it different from when your pet was still alive? How has your daily life or mood changed? Express what the present is like on a separate piece of paper. Change is dynamic and continuous; Never entirely negative or entirely positive. Do not become overwhelmed or “Stuck” in trying to summarize every week or month of your life since the loss. Instead, simply do your best to express what your mind space and feelings are currently. Discussion Questions Ask group members to volunteer to share their art. The following questions will help facilitate group discussion: 1. What stands out the most about the two images? 2. How has your life changed from the loss? 3. How would you describe each picture in one word? Why? 4. How accurately do you believe your images reflect your current situation? (How accurate is the client’s perception to reality). 5. How have you changed from before the loss to now? Wrap-up It is important to summarize not just the artworks, but the shared thoughts and feelings that occurred within the group. The group leader should also ask and emphasize the group’s desire to regain the positive affect or emotional states emphasized in the first pictures. The group is to be encouraged to bring their attention to positive moments in their week and write some of them down to share next week. Session 3: Disenfranchised Grief Introduction Summarize session two, taking time to highlight unique qualities and similarities between pictures and group members’ responses from last week. This will serve to further highlight similarities and positive interactions the group has, as well as show that the group leader is getting to know each individual member. Ask if there are any lingering questions or comments about last week’s group. Check-in This is a time for each member to individually discuss their week, reflections on the previous session, feelings about the group, mood, or thoughts to the rest of the group. This is also an opportunity for other group members to relate to each other or offer feedback. Check-in also allows the group leader to gauge how the group as a whole is doing. Experiential: Memory Box Purpose A “memory box”, “worry box”, or “keep box” is a way to artistically contain thoughts or fears the client may not be ready to share in a counseling setting (See Mehlomakulu, 2019). In this context, the memory box is a way for clients to process and contain their emotions, thoughts, and memories of a deceased loved one inside of a jar or box, while starting to memorialize the deceased in a positive perspective on the exterior of the box. It is a way to symbolically contain and protect one’s emotions and thoughts, while literally containing objects, pictures, or written thoughts within a lidded object. Goal To begin memorializing the deceased or lost pet in a positive light and present a relatively safe way for group members to open-up more about their deceased pet and the memories associated with the pet. The thoughts and feelings within the box can also be analyzed or disputed should a member feel safe in sharing and doing so. Materials • Cardboard or small, already-constructed boxes can be obtained by the group leader, Construction paper: a variety of colors, Brushes and acrylic paints , Markers, Color Pencils, Oil Pastels, Magazines, Scissors, Glue sticks, hot glue gun if safe. Instructions Think of some thoughts you have related to the pet loss. This can take forms such as “the pet was in pain” “we could have/should have done things differently” , “it was the right time”, or “Write some of those frustrations and thoughts onto scraps of paper. Cut the paper so that each thought is a separate piece. Then, create a box with a lid for holding in all of those thoughts. On the outside of the box, use any of the materials provided to express positive emotions or memories from when your pet was alive. Discussion Questions 1. How did you go about constructing and/or decorating your box? 2. What shape is your box? Why did you choose that shape? 3. What thoughts or feelings did you write down (and are willing to share)? 4. How does it feel to contain those thoughts within the box? 5. Did you face any challenges in creating the box? How did you overcome them? 6. Is there anything you would like to change or add onto the box you’ve created? * Take note of any thoughts related to guilt that may come up as people share their work * Wrap-up Summarize the feelings, thoughts, and any thoughts specific to guilt expressed in the session. Congratulate the group for the progress made so far in opening up and beginning to trust one another. For homework, the group members should be encouraged to add something further to the outside of the memory box, whether it be a flower, a printed-out photo, a representation of an object the pet loved, or some other element. Session 4: Guilt and Change Introduction Summarize session three, taking time to briefly summarize any thoughts of guilt that might have come up from the previous session. It is also important to highlight any ways in which group members related to one another, offered feedback, or helped one another. Ask if there are any lingering questions or comments about last week’s group. Check-in This is a time for each member to individually discuss their week, reflections on the previous session, feelings about the group, mood, or thoughts to the rest of the group. This is also an opportunity for other group members to relate to each other or offer feedback. The group leader should also ask each client (as they do check-in) if and how they worked on their memory box any further outside of session. Experiential: “Draw Your Wall” Art Experiential: “Draw Your Wall” (The initial art response, hour-glass “smashing through” the wall) (“We all chose to make the most of it!”) Purpose “Draw your Wall” (Wilds, 2021) is an experiential originally meant to help clients visualize a wide variety of problems, traumas, barriers to treatment, or being stuck in life. In the context of bereaved individuals and pet-loss, guilt can come up in thinking the pet was put down (euthanized) at the wrong time or that they caused pain to the pet in waiting too long or not long enough. Guilt can also occur from the suddenness or unexpected way that pet died. The thoughts are likely irrational (taking the form of “could have” and “would have” statements) and have created a metaphorical wall or barrier which contributes to bereavement. Goal To help group members visualize the thoughts and guilt which are preventing them from processing and moving forward with their pet-related loss, and show/recognize that the guilt and unhealthy thoughts they hold onto are in fact barriers to their recovery. Materials • Clay. Clay carving tools, Printmaking tools, Linoleum printing blocks, 8 x 10, A starter kit of printmaking tools, printing ink, Cardboard, scissors, hot glue gun * * * (If there are concerns about the mediums being too triggering, creating a two-dimensional image with colored pencils and paper can be done instead) * * * Instructions Mourning is a process which takes on a different form and duration for each of us, though we also share components such as sadness, remembering the lost loved one, and accepting the death. Feelings of guilt can also occur, particularly when we dwell on what “could have” or “should have” been done with end-of-life care for our pets, or contemplating whether or not we could have done something different to have saved or protected our pets. These thoughts often create an irrational guilt over a situation where we did our best at the time to care for the pet. Once these thoughts cycle in our heads for long periods of time, they are also intrusive and difficult to overcome, creating a wall which stops us from forgiving ourselves and moving forward with our lives. Pause and think about what thoughts can cause you guilt or grief when trying to process your pet loss. Using the materials provided, sculpt, print, or cut and glue cardboard to create a wall that symbolize those draining thoughts. Once your “wall” is complete, create a tool that can be used to transform your wall. Think about what you need to resolve your feelings of guilt or regret. Once done, change or break down the wall using your new tool: carve the clay wall into a new shape, modify the cardboard barrier, print the carving of the new tool over your first print, or draw a new picture of the changed or broken-down wall. Discussion Questions 1. What materials or objects is your wall made of? 2. How did you represent your “Wall”? 3. What thoughts are this barrier to healing composed of? 4. What tool did you make? 5. What thought or change does the new tool represent? 6. How does it help you overcome the wall? 7. What awaits on the other side of the barrier? * It is particularly important that the group leader empathized (sympathize? I always get the two mixed up) with each client and take the time to understand what they are going through. Help group members to reach out to one another during sharing. If group members are willing, help them begin to dispute an unhealthy thought related to their pet loss* Wrap-up Summarize the guilt-ridden thoughts that were expressed in the session, along with how other group members related to one another, console each other, and any way in which group members (or the group leader) began to dispute irrational thoughts of guilt. Emphasize the importance of changing our perspective on these thoughts. For homework, the group members should choose at least one thought that contributes to guilt or sadness and attempt to replace it with a positive thought. Session 5: Positive Perspective Introduction Summarize what occurred in session four, with particular attention to the thoughts discussed at the end of last week’s session. Also highlight any irrational or guilt-ridden thoughts that group members began to analyze, question, or dispute. Ask if there are any lingering questions or comments about last week’s group. Check-in This is a time for each member to individually discuss their week, reflect on the previous session, feelings about the group, mood, or thoughts to the rest of the group. This is also an opportunity for other group members to relate to each other or offer feedback. The group leader should also ask each client (as they do check-in) if they disputed/analyzed a guilt-related thought related to their pet loss since the previous group session, and whether they found this helpful. Experiential: Forgiveness Experiential: Forgiveness Purpose This art directive asks clients to contemplate (or in the case of this group, re-examine) thoughts which contribute to guilt, and artistically express what it would be like to forgive themselves instead of bringing themselves down over how their pet’s death “should have” or “could have” Goal To examine and dispute irrational beliefs, thought distortions, or irrational guilt related to the pet loss. To forgive themselves, to understand the loss was not their fault, and how forgiving themselves would feel. To have clients think gone differently had they acted about how this would help them differently. (Seymour, 2002, p. 29). The move forward in their mourning art directive also helps to interrupt the process. cycle of negative self-talk and the barrier to healing it creates. Materials Any art mediums and materials available that are safe within reason for each group member to use. Instructions Think about the thoughts and beliefs that created your barrier (or wall) to recovery from last week. Are the thoughts which hold you back from moving past the mourning rational, or is there evidence to suggest it is an irrational or unhealthy thought outweigh that? Would your pet that has passed away want you to be stuck in a place of guilt or held back by regrets? Imagine what it would be like to let go of the regrets, doubts, and guilt, or to forgive yourself for what “could have”, “should have”, or “might have” happened. Using the materials you have, artistically express what this feeling or state of forgiveness would be like. Discussion Questions 1. What materials or objects is your artwork made of? 2. Who is in this art piece? If not, what feelings or ideas are being represented? 3. What thoughts or beliefs did you dispute or let go of through this artwork? 4. How do you feel about forgiving yourself through this art piece? 5. How does this new outlook compare to the thoughts from the previous week? *The purpose of this exercise is to provide group members with a new, healthier, positive way of interpreting their pet loss and evaluating themselves. Be sure to highlight all positive thoughts, beliefs, and feelings associated with the “forgiveness” art works, and encourage them to continue this new mindset* Wrap-up Summarize the positive feelings and thoughts shared within today’s group, and especially any positive affirmations or feedback given between group members. Let the group know that there are three sessions remaining, and that we will be beginning a longer, final project about their deceased pet. For homework, the group is to be encouraged to remind themselves of the thoughts and feelings associated with the “Forgiveness” Experiential any time they feel depressed or guilty about their pet loss. Sessions 6 - 8: “In Memoriam” Introduction Summarize what occurred in session five, with particular attention to the process and progress made in analyzing and changing unhealthy beliefs the group has experienced over the last few weeks. As with the last several sessions, ask if there are any lingering questions or comments about last week’s group. Also stress that the group has made good progress overall and is ready to use art to memorialize their pet in a positive manner. Check-in This is a time for each member to individually discuss their week, reflections on the previous session, feelings about the group, mood, or thoughts to the rest of the group. This is also an opportunity for other group members to relate to each other or offer feedback. The group leader should also ask each client (as they do check-in) what benefit they gained from the last two art experiential activities, in particular last week’s experiential. Art Experiential: Memorializing the Pet Purpose The purpose of this final art therapy directive is for group members to practice the skills they have learned from the previous five weeks (such as trust, communication, thinking about their loss and/or themselves in a guilt-free way) to create a work of art representing their pet. Goal To create a work of art which celebrates and memorializes their pet, framing the loss and memories in a positive way, rather than focusing on the guilt or irrational thoughts that has hindered their mourning process. This will help the group to experience positive emotions and ultimately move forward with their grief. Materials Any art materials and mediums that are safe for group members to use can be used in this art project. 3-dimensional work should be encouraged (but not required), as working three-dimensionally can open the art project to many more opportunities and options for creativity and may not be an art-form that group members will otherwise consider. Instructions We have learned a lot in this group. We have practiced trust and openness in sharing our loss with each other, and, helped one another visualize and dispute the thoughts which have kept us from moving forward from our pet losses. Now, it is time to create a work of art that can frame and memorize our pets and the life we shared with them in a positive light. This project will take the majority of our last three group sessions, so you are encouraged to explore creative ways of completing the artwork; this can mean using new materials that are not always present in art, such as pebbles, glitter, pipe-cleaners, or working three-dimensionally with clay or cardboard. This is a time where you are given a lot of freedom for what kind of art you make and what you choose to represent, because there is no right or wrong answer. Remember that even though this is a three-week long project, it is not intended to go to a museum or be graded. Trust yourself to focus on what you are trying to express in the art and do the best work that you can. You are welcome to reach out for guidance or advice from the group leader or talk to the other members of the group at any time during the art-making. Week 6 Discussion Questions 1. How have you chosen to represent your pet? (Literally, abstractly, three-dimensionally, two-dimensionally?) 2. What materials have you used? What additional materials will you be using? 3. How will you continue to work on the art next week? 4. -What features of your art representation look most like your pet's and bring joy while looking at? 5. Is there any unique material that can be added to your art representation that is symbolic to your pet? (I'm thinking of a piece of their favorite toy or a piece of pet clothing/blanket, etc.) Week 7 Discussion Questions 1. What progress have you made on this art work? 2. How will you complete it next week? 3. What features of your art representation look most like your pet's and bring joy while looking at? 4. What features are you most proud of in your pet's art representation? 5. Is there any unique material that can be added to your art representation that is symbolic to your pet? (I'm thinking of a piece of their favorite toy or a piece of pet clothing/blanket, etc.) Week 8 Discussion Questions 1. This was a 3-week long process. What do you think about your completed piece? 2. What emotions does your completed artwork evoke/make you feel? 3. What have you accomplished in this art piece and through this group? 4. What features are you most proud of in your pet's art representation? 5. What title would you give your final art representation of your pet? 6. How have you progressed in the last eight weeks? How have your thoughts, feelings, and/or behaviors changed? 7. How will you move forward from grief now that this group is over? Wrap-up For weeks 6 and 7, remark about the progress this group has made both since week 1 up to this final art-therapy project. Remember to remind the group that there are only 2 or 1 session(s) left. Ask group members to continue to occasionally think about how to progress on the memorializing project and working on themselves for next week in between sessions. For the final session, summarize the progress that has been made as a group, the feedback and trust group members developed in each other, and how they have helped each other work through their bereavement. Thank them for their hard work and encourage and empower the group to continue to practice self-forgiveness. Encourage each member to remember their pet in a positive light and treat themselves with compassion as they continue with their lives. Limitations Not founded upon every single theory on grief and bereavement treatment, but common components of grief and a few major theories were researched more in-depth Dual-Process Model, (Stroebe and Schut, 1999) coping mechanisms, resiliency, stigma, meaning-making different types of bereavement McKinney’s (2019) four stages of processing pet-loss The curriculum is only theoretical Limited by the social narrative of disenfranchised grief Work within the group does not change the circumstances outside of group Mourning experience changes from person-to-person, and effected by individual’s support system Suggestions for Future Research or Running the Group Follow the directions Pilot group Quantitative vs Qualitative Super Cool Fun References List About art therapy. American Art Therapy Association. (2022). Retrieved June 19, 2022, from https://arttherapy.org/about-art-therapy/ Appelbaum, P., & Yousif, L. (2022, May). Prolonged grief disorder. Psychiatry.org. 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