–Julia Cameron

Julia Cameron, author of The Artist’s Way, found herself 50 pounds heavier after being placed on a new medication. What to do?

She found the answer in her own work after noticing that students taking her 12-week course in writing often left the class thinner than when they began the course.  She wrote the book, The Writing Diet, once she made this connection. You can read a Newsweek magazine interview with Julia by clicking here.

Tarcher Talks feature several of Julia Cameron’s books. To see the video featuring her book about writing for weight loss, click here.

Our bodies consist of billions of molecules. Stories, on the other hand, weave the fabric of our life.

Do you know what your story is? What shapes meaning and drive in your life? Many of us do not know but we can learn through the use of a personal writing practice, just 15 minutes a day three times a week.

To learn more about writing to know your story, please visit a previous post on this topic by clicking here.

When you suffer with a chronic healthcare problem, you deal with many factors that compose that problem. Some of these factors overlap, augment each other, or oppose each other.  And each factor may call for its own physician or treatment. If you want to succeed in your quest for wellness, the first thing you must do is drop out of the “I just do what my doctor tells me” school.

Join your healthcare team. Indeed, take over:

Any why not? You have the disease, not your doctor.

Growing evidence supports your role as a collaborative team member and captain. Remember, about 90 percent of what’s needed to help you improve comes directly from you, the person with the chronic health disorder.

When you become a team caption on your healthcare team, your care will improve as well as your satisfaction as a patient.

To learn more about the growing area of “patient self management,” check out the Stanford programs on self management by clicking here.

Intimate Partner Violence (IPV), the psychological, emotional, and physical abuse of your patients by a current or previous intimate partner affects close to four million women a year. A little over a third of these women report violent victimization. Like many other medical conditions, IPV often escalates in frequency and severity the longer it persists. For approximately 1,000 women each year the violence becomes fatal.

Few of us in healthcare are comfortable dealing with IPV. Couple this with the fact that many physicians feel that their patients do not have family violence issues and you end up with a devastating problem that goes unrecognized, unaddressed, and untreated.

The truth remains that IPV presents a major challenge to physicians in every practice setting and specialty, and the after effects of violence and abuse cast a long shadow on the patient’s current and future health.

Early recognition of IPV and an appropriate response to IPV goes a long way to getting patients the help they need to be safe and escape ongoing injuries and illness. In addition, a valuable added benefit occurs when the psychological and physical trauma of the abuse is addressed, laying the groundwork for the patient’s improved health and well being.

IPV problems can appear at any moment in any practice setting. In light of this fact, physicians and healthcare providers can improve patient care of IPV victims by implementing 10 Action Steps in their clinical settings.

Section One of our new book, Respond to Intimate Partner Violence—10 Action Steps You Can Take to Help Your Patients and Your Practice, provides guidance for the recognition and detection of IPV in the practice setting. Section Two stresses appropriate response to the identification of IPV by putting into place 10 action steps.

Action Step No. 1:  Respond Effectively to Patients Who Disclose Violent Relationships

When a patient tells you that IPV complicates her life, you have a unique opportunity to help her improve her health and well-being. Support her in making changes by validating the difficulties and challenges she is experiencing, as well as her need to make changes.

By validating victims and survivors of IPV, you give your patients a tonic more powerful than any prescribed drug. Validation occurs through therapeutic messages, listening, and providing supporting materials.

Some therapeutic messages that you tell the patient bear repeating several times during your time with the patient. Chief among these:

•    “You do not deserve to be hurt, no matter what.”
•    “You are not alone; help is available.”

Listening non-judgmentally is a therapeutic message in itself. Once you have validated your patient, you have her trust and can move to the next step in her care.

Action Step No. 2:  Respond to Your Patient’s Safety Needs

Start by determining how safe your patient is right now. There are numerous safety assessment tools you can us. One simple one is the Physical Abuse Ranking score. Ask about these ten things:

1.    Throwing things, punching the wall
2.    Pushing, shoving, grabbing, throwing things at the victim
3.    Slapping with an open hand
4.    Kicking, biting
5.    Hitting with closed fists
6.    Attempted strangulation
7.    Beating up (pinned to wall/floor, repeated kicks, punches)
8.    Threatening with a weapon
9.    Assault with a weapon

If your patient’s abuse-related incident ranked higher than five on this scale, your patient can be in extreme danger. However, even if the abuse ranks low on this scale, your patient may still be in danger. Any patient who feels in danger should be considered to be in danger.

Safety planning for your patient should be tailor made to conform to her needs. For instance, she may elect to stay in her relationship with her batterer because she feels that is safer than leaving at this time. Regardless of whether or not your patient elects to leave or stay with her batterer, she must not leave your clinical setting without a plan in place.

Action Step No. 3:  Manage Your Patient’s Referral Needs

Services available to help patients differ in each community. However, a fast call to the National domestic violence hotline, 1-800-799-SAFE, provides you with local resources that your patient can access. Be sure to identify yourself as a provider at the very beginning of the call.

Most patients dealing with the presence of intimate partner violence in their lives don’t need to be admitted to the hospital. If your patient has medical or mental health needs that require admission, and her perpetrator remains free or poses a threat to your patient, consider admitting her as a Jane or John Doe patient. Note that HIPAA provides that patients can request not to be listed in the healthcare facility directory. 

Action Step No. 4:  Document Your Findings

Good documentation builds a bridge of communication among healthcare providers attending the patient and also assists when community advocacy and legal referrals are indicated. When taking care of victims of IPV, the three main modes of documentation consist of:

•    Charting
•    Body maps
•    Photo documentation

Action Step No 5:  Meet Your State and Local IPV Reporting Requirements

Mandatory injury reporting requirements vary considerably from state to state. To provide effective IPV intervention, you need to understand your state and local reporting laws, procedures, and the methods of enforcement, whether the issue is IPV, child abuse, elder abuse, abuse of someone with a disability, or assault involving weapons.

Specific information about state reporting laws can be found at the http://www.endabuse.org/ website.

Action Step No. 6:  Respond to Your Patient’s Stage of Change

Change is not easy. Leaving an abuser or staying in a relationship with new family dynamics often represents a major life change. You can best help your patient to bring about necessary changes in her life by understanding that change occurs in stages and that relapse is a normal part of the change process.

Action Step No. 7:  Address IPV in Special Populations

There can be additional barriers, special needs, and safety issues when working with IPV victims across age groups, gender, sexual orientation, and different cultures. You can best help individual patients in each of these groups by understanding the special needs each group has. For instance, a male victim of IPV struggles with issues separate from a teenage girl being abused by her partner or an elderly widow who remarries and then finds herself a victim of abuse.

Action Step No. 8:  Address Special Clinical Situations Involving IPV

In addition to separate populations, special clinical situations arise when treating IPV patients. For instance, the IPV victim and her perpetrator may both be your patient. Or your patient may be suicidal. Another special situation arises when her abusive partner manually strangled your patient during an assault.

Action Step No. 9:  Develop a System for Addressing IPV in Your Practice Setting

You need a team approach to lay the groundwork for effective IPV intervention in your practice setting. Two critical ingredients set the stage for success:

• Provide training for your staff to understand IPV and to respond to it.
• Designate a practice setting “IPV Champion” who becomes your local expert on policies, procedures, and local resource coordination.

Action Step No. 10:  Respond to Abusers

Although your first concern must be the safety of the IPV victim, who is not safe until the abuse and battering stops, you must also care about your patient’s abuser. Caring about IPV abusers can be a means of ending the abuse and ensuring the victim’s safety. Remember, even when victims leave their abusers and are safe, there is a high probability that their untreated abuser will victimize a new partner.

You can learn more about identifying IPV in your practice and preparing your practice setting for effective intervention in the book, Respond to Intimate Partner Violence—10 Action Steps You Can Take to Help Your Patients and Your Practice. The accompanying CD-ROM in the book contains resources such as medical record forms, patient handouts, and even a staff-training guide. The book can be ordered from the Virtual Lecture Hall of Medical Directions, Inc. by visiting their website or through Amazon.com. Online training with CME credits featuring the information in the book can also be found at http://www.vlh.com/.

Physicians and healthcare providers have a unique opportunity to identify and intervene with IPV in their practice settings. Doing so can save lives, promote their patients’ health, and enhance their patients’ well being. Los Angeles physician Bruce B. Ettinger sums this up quite well, “Set up a response system if one does not already exist, and take the risk and ask questions. The reward will equal anything you have ever done in medicine. You will save a life.”

Author’s note: You have permission to copy this article for distribution for web and print publications as long as you do not change content or remove hyperlinks in your online distribution. Notification of your use of the article is appreciated. For questions or to arrange for one of the  authors to speak at your event, please contact DrT at: DrTspeaks@gmail.com.

The 2008 Writers Digest 101 Best Websites for Writers just arrived in my mailbox. I look forward to this list each year and find that I have some favorites that I follow, such as C. Hope Clark’s Funds for Writers. Having exchanged some emails with Hope in the past (she is a neat lady), I find myself rooting for her to make the list each year. Once again, she is there with her content-rich website.

Writers, whether or not they intend to keep their writing personal for their own healing or hope to be published, need resources. Why not take a stroll over to this year’s 101 Best Websites and start exploring right now?

Not so long ago, a book came in the mail with a letter from author Tom Pace, CEO of the PaceButler corporation in Edmund, OK. Tom had recently joined the National Speakers Association (NSA) and sent every member a copy of the book. I rescued the book from my “books to read” stack a few days ago and sandwiched it into my reading time.

The book is delightful because it lends itself to short reading times or you can whiz right through it in a short time at a single reading. The book follows young Tony from his days in jail as a 19-year-old through his coming of age as a budding entrepreneur. He meets his mentor, a CEO named Malcolm, while in jail and then meets him again the day after he is released from jail. Under Malcolm’s guidance, Tony learns:

• “People that have self-esteem do esteemable things.”
• “It takes a lot of energy to be angry about something. You can be right or you can be happy. Sometimes it’s better to let the little things go so that you can be happy.”
• Exercise is one of the most important things he can add to his life

A short chapter at the end of the book advises the reader how to find a mentor. The author encourages the reader by noting that, “Most successful people want to share their stories and help because they owe their success to people who helped them.”

How true. While there is no substitute for live and present mentors who are dedicated to helping you succeed, many more mentors wait for you at your local bookstore or library. Some have left this earth, but their words stay behind to offer guidance and encouragement.

You, too, can be a mentor. Have you ever had a major turning point that presented you with the choice of giving up and suffering or moving forward and overcoming the misery? If so, you have a story. When you write it out with all the details of how that turning point changed your life, you experience the healing of disclosing your pain and perhaps your long-held secrets. When you write the details of the journey you took to overcome the pain and distress of the turning point, you lay the groundwork to help others achieve relief and success in their own lives. Detail who helped you along the way. Then you can fictionalize your experience by writing about a mentor (you) who then helps another who suffers what happened to you.

When it’s all done, you may even have what publishers call a “pass-along” book. These books are bought in quantity for “passing the book on” to friends, family, and clients.

Did Tom Pace, in his book Mentor, The Kid & the CEO, believe that he wrote a “pass-along” book? I suspect so, because the letter he sent with the book ends with an amazing postscript: “I also want to extend you a personal guarantee; which is if you read my book and believe it to be a waste of your time, then I will personally give you $100.”

Tom won’t be sending this reader the $100.

____________________

Notes:

1. Christopher Vogler: The Writer’s Journey, Mythic structure for writers.

Kim and I met at the Maui Writers Conference a few years back. She is a family practice doc with heart and courage. Most of her writing work focuses on fiction, but she does not hold back her pen when a chance to help others by advocating comes along. A recovering alcoholic, Dr. Mallin captures her ownership of her problem with these encouraging words: “Gifts don’t always come in pretty packages, tied up with big colorful bows. Sometimes they don’t even look like gifts at the time. Sometimes they look like the worst things that could possibly happen, and only with the passage of time does the gift becomes apparent…such was the case with my alcoholism.”

Her contribution to this important book serves as a good example of “bibliotherapy” through memoir writing. The basic concept of bibliotherapy is that reading can be a healing experience.

Click here to review the Press Release for this book.

Writing as Therapy

by

Laura Woodruff, LCSW

I have found writing to be such a good tool for emoting. It is such a great way to cleanse the soul! There are some things that are not appropriate for the blog, as we all know. So, I have had to find some other writing outlets! I just wanted to suggest to anyone that may be having rough times—- write, write, and write some more. I think some of the most beautiful writing is done in painful times. It can also be a great comfort to others as pain is a universal emotion we have all felt. So, when in pain—write, write, and write some more. I have also discovered that it feels better than eating, eating, and eating! So, those are my words of wisdom for others! I know, such a nugget of wisdom! Luckily, there is always humor too, which is also very helpful. I rely on humor a little too much. Thank goodness for kids and the rigors of life, that force you to forget about problems and delve into reality. I never thought I would be thankful for poopy diapers, but sometimes the mundane can be a relief from reality. Frightening but true. These are my thoughts for today!

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Laura is a 35 year-old mother of five who lives in Utah. You can check out her blog by clicking here.

Worse, in spite of numerous past attempts to fix the system, 47 million Americans or one in six under the age of 65 have no health insurance. Uninsured cancer patients receive less care than cancer patients with insurance and thus may be more likely to die from their cancer. We have one of the finest trauma care systems in the world but uninsured auto accident victims receive less care and have higher mortality rates.

What’s left? An “unfair, dysfunctional, and spectacularly expensive system” that does not suit or fit. In fact, the 2006 cost of our healthcare was “almost as much as the worldwide market for petroleum.” Most shocking, our annual cost for this healthcare system exceeds what the United States spends on food.

Is there any hope?

Indeed, hope exists and lies in the wisdom of knowing when to access and use the healthcare system and when to turn to self-help that might work just as well. In spite of the fact that every other advertisement on TV tells us about new pills and cures for all sorts of ailments, simpler and less harmful healing aids exist.

Consider the lowly pen and paper toiling on without the benefit of costly advertisement, just waiting for us to engage them in the act of writing as therapy. They beckon us to write our personal stories to frame our plight and capture insights that provide healing.

One of the case histories in my book, WellWriting for Health After Trauma and Abuse,  features “Debra” who began to have severe migraines after a traumatic period in her life. She turned to writing to resolve and accept her situation, deal with the confusion and ambiguity of her emotions, and develop the wisdom she needed at that point in her life.

Debra sums up her experience this way: “Writing is something you can do for yourself. It’s not expensive, and it doesn’t hurt anybody, but you can gain personal benefit from it.” She ends by laughing and offers this advice, “You can’t afford a therapist? Write.”