DrT's Blog from the Health After Trauma Project

Good for the Women or the Children?

Changing the way we view and fund treatment in abused families…

by

Linda Toche-Manley

Domestic violence affects all of us – in our bodies, our emotions, our relationships and our children. 

To effectively tackle the impact of domestic violence, it must be addressed as a serious family problem – not as a “women’s” problem. This means using a multi-agency approach that often involves complex partnerships across child welfare and mental health agencies, medical, law enforcement, and criminal justice organizations. Unfortunately, most agencies that provide domestic violence services tend to operate as separate systems with only informal agreements to share information. When agencies do attempt to collaborate, poorly coordinated services and inefficient communication are common as each agency has its own goals and wanted outcomes.

This combined with the dismal state of funding of services that support women and children who are survivors of abuse perpetuates the perception that violence is acceptable and that services are not so badly needed by survivors. As a result, professionals, survivors and volunteers run many DV agencies with few monetary resources.  All too often, the formal funding base for domestic violence consists of “one-shot” block grants that allow for the “building to be built” but often provides little in the way of ongoing revenue to provide services.  As a result, agencies serving abused women often are forced to close down in the communities that need them the most.

But by focusing on working with communities to develop multi-layered agency partnerships to provide and fund services for abused women and families, a couple new events may occur.  One, with more entrance points into treatment via medicine, the courts, child welfare and other agency partnerships, it is likely that more women and their children will be served.  Second, the collection of data on these partnerships’ outcomes becomes more critical to attract richer financial players such as corporate sponsors, and public agencies such as child welfare to supplement grants and other traditional revenue sources that funds services for abused women and families.

These changes will require new planning and assessment tools.  We have recently been awarded from the National Institutes of Health a three-year grant for the development of a web-based assessment tool to support system level change towards agency partnership to address abused women.  In this project, assessments are completed on the Internet and clinical reports are generated.  Reports show women’s co-morbid mental health problems, strengths as well as factors associated with relational schema that will help women avoid victimization in future relationships.  Other tools have been designed by our group to evaluate the impact of abuse on children and to move them towards successful permanency.

Multi-agency partnerships require on going case and program data to support them in coordinating the correct intensity of services for women and children.  If agencies are to work together to improve care for women and families recovering from the aftermath of abuse, they must be able to communicate and share data effectively.  The data itself provides a language that shows from the voice of the survivor what she thinks is important to focus on in treatment and what she thinks are her strengths.  This is the beginning of truly including the survivor in treatment planning.  This person-centered approach to treatment planning reaffirms to her that others want to hear her voice and empowers her that she can change things for herself as well as for her children. 

As interagency collaboration grows we can envision that multi-agencies with pull together to form advocacy groups that shift policy to support empowered thinking and services that serve the survivor and their children.  But, I believe, it requires data to show the mental impact of abuse, the impact on relationships, and the impact on our children.  Policy makers and those with the money strings to support abused women and families must see with their own eyes the incredible pain and need in the voices of those who have been abused.  We hope that this project will support the development of these interagency collaborations at the medical, DV-child welfare and legal levels and yield a more firm financial and policy foundation for all of us devoted to supporting women and families from the recovery of abuse.
___________________________________

Linda Toche-Manley, Ph.D., is the Principal Investigator/Principal for the domestic violence and child welfare systems at Polaris Health Directions, PA.  She consults on multi-system change in youth and adult systems of care.  Please contact her at Linda@polarishealth.com to find out more about the NIH project and/or to discuss other possible collaborations.

An Article by Gail Fonda

Exercise and Life

By

Gail Fonda

All of us have daily responsibilities that can be emotionally very taxing and hard to live with. Sometimes I am so stressed out just from waking up at 6:15 AM every morning and doing what needs to be done just to get to work. I sometimes wonder how I can keep going on.

My husband and I have lost many family members in 2005, so we were happy to be rid of the year. In addition, we lost our beloved Alaskan Malamute, Timber, to a brain tumor. We expected him to live another five years or so. We were totally devastated. Our only comfort turned out to be placing his photo and memorial on Rainbow Bridge, a site for grieving animal parents.

My job is not that professionally fulfilling, it's a rather dull and repetitive, but secure, government job. I had trouble maintaining regular employment over the years, which I think stems from coming from a dysfunctional family and trying to make my way in the world with little or no direction in my life. Though I graduated from college with a B.A. in Journalism, I never had the confidence or self-esteem to reach the goals I had hoped for myself.

I needed to find some kind of outlet for my anger, anxiety, frustration and depression at not knowing what my life is supposed to be about. Why am I alive? I asked myself that since childhood and I still don't know the answer now that I am in middle age.

I drifted from boyfriend to boyfriend and job to job, questioning my own existence. But I finally got married, quite late in life, to a professional person who can at least offer me strength, encouragement and everything I need, both monetarily and psychologically. But I still needed to gain strength in other ways.

I began writing over the Internet nine years ago, hoping to make some kind of name for myself. It's been a tough road, since I am not a famous person and I don't have any particular specialty. But I think I found a little niche for myself.

I can write about relationships, since I've had so many, I can write about women's issues, since I've lived through so many traumatic experiences myself. I can give advice on what not to do, so that, hopefully, other people don't have to suffer what I suffered. Maybe I can offer help to others, emotionally, when I needed some myself, and there was nowhere for me to turn.

I have my writing, my dogs and my exercise. I've been exercising on a regular basis for about 22 years now. It gives me mental strength, physical strength and helps get rid of negative attitudes I've had my entire life.

Whatever anyone does for a living, it can get dull, boring and can bring you down. The endorphins I get from exercising helps tremendously. I've changed exercise routines and exercise facilities over the years, but, when I skip even a week of exercise, my moods become grim again, I get angrier quicker and the old negativity about life returns.

Exercise also helps lower my blood pressure, reduce hot flashes and helps prevent my migraines. I've had those all my life and they're horrible! Exercise will help maintain a healthy weight in addition to the psychological benefits. Just do it, and you'll find out for yourself how valuable exercise really is!
_______________________________

Gail Fonda is the author of "My Private Hell: Struggle & Survival," available through PublishAmerica.com. You'll read about the details of her personal journey from dysfunction to a healthier lifestyle with exercise.

A Thoughtful Response Regarding Forgiveness

Earlier this month, I noticed much activity on another website I maintain--all clustered around the topic of forgiveness. So on the 11th of January, I wrote a post on Forgiving and Healing. As part of the post, I included an excerpt from my book, WellWriting® for Health After Trauma and Abuse. Yesterday I received a thoughtful comment from Steve T.

I have decided to publish Steve's comments for two reasons:

1. Comments are often overlooked by blog readers as they tend not to stand out unless the word "comment" is selected at the end of an article.
2. The comment here pinpoints a major challenge in the area of forgiveness: forgiving following abuse from another.

Most of us think that forgiveness brings value to our lives because it helps us to heal. True enough but when the insult bestowed on any person looms large, the healing often has to happen before the forgiving can even begin. Author Nancy Richards in her book, Heal & Forgive, does an excellent job in illustrating this basic truth as did Steve T in his comment which follows:

"Hi Dr. T,

Forgiveness is a 'quality' that has been urged and often commanded by spiritual leaders for eons, commonly with the same admonitions you employ above. It's probably impossible to have lived on this planet very long without having heard those warnings many times, the bottom line of course is that forgiveness must be employed for the abused's "own good". Oddly, at least in cases where genuine remorse is immediately expressed by the offender (as in cases of unintentional injury), forgiveness seems to be an entirely natural and inherent part of human nature--no such authoritarian commandment is necessary to evoke it. In cases where remorse is NOT evident (or is pretended), "forgiveness"--especially the artificial, "spiritually" sanctioned, guilt-induced variety--translates in the mind of the abuser to "You have permission to continue treating me like something people scrape off the bottom of their shoes." The evil inherent here I hope is obvious.

You and Dr. Luskin are flat-out wrong. To use a position of authority, especially, to tell an abused person that he or she must "forgive your abuser lest ye be eaten alive by your own poison" is to have fallen into an ageless, destructive trap.

"Forgiveness" as you 'encourage' it is not part of the solution, it is an especially large part of the problem. 

Please make the effort to realize that if not for the conditioning that took place during your, Dr. Luskin's and no doubt the Stanford Project itself's upbringing and 'education', you would realize that you are NOT helping abused persons by perpetuating this sort of advice, you are instead advocating for everything that is wrong, upside down and backwards, and therefore being actively hurtful by siding with the abusers.

Please reexamine the 'wisdom' of your 'remedy' for trauma victims. Yes, it's nearly universal and has been around for a very long time. So have abused, mistreated children (and women, and 'mentally ill' people, crime, war, and on and on and on)--and despite age-old advice identical to yours, all of this just keeps coming.

One plus one equals two.  I'd think that Stanford people would be able to see that.

For the sake of anyone who comes to this page I hope you one day soon see it yourself.

thank you,
Steve T., ACE score: 4"

Thank you, Steve, for taking the time to add your comments to this website and blog.

All comments on this topic are more than welcome. Please take a few minutes to add your comments to this post.

--Dr.T

A Book You Should Know About

If you help patients, clients, or friends who have just received big bad medical news, you should know about this book.

You can learn more about it by visiting my Writing Practice Prescription website. Click here to read about the book.

Bridge Drawing

A suggestion for creating a memorial book in honor of a loved one

By

Michaela J. Gagne

A Memorial Book is a valuable way to revisit the life of a loved one and highlight unforgettable memories.  It can be created and collaged with numerous photos, written descriptions, memorabilia, cards, awards, stories, etc.  A Memory Book can be a therapeutic project for the griever.  It features the positive experiences from a loved one’s life, and it provides a way for the living to constantly revisit this cherished life.  The book can be created as a gift to the deceased, a visible expression of the love that is held for this person.

Choose a book and materials that seem comfortable and appropriate for this activity.  Scrapbooking techniques may help provide inspiration for developing the format and lay-out of this book, and there is no end to the creativity that can be used to create such a treasure.   

Other Recommended Resources:

•    Bertman, S.L. (1999). Grief and the Healing Arts: Creativity as Therapy (Death, Value, and Meaning). Amityville, NY: Baywood Publishing Company.
•    Cocuzza-Zambelli, G. (1981). The use of art therapy with children in the bereavement process. In A. Evans, E. Kramer & I. Rosner (Eds.) Art Therapy: A Bridge between Worlds. Falls Church, VA: American Art Therapy Association.
•    Deits, B. (1992). Life After Loss: A Personal Guide Dealing with Death, Divorce, Job Change, and Relocation. Tucson, AZ:Fisher Books.
•    Dissanayake, E. (1988). What is art for? Seattle, WA: University of Washington Press.
•    Fitzgerald, H. (1994). The Mourning Handbook. New York, NY: Simon and Schuster.
•    Furth, G.M. (1988). The Secret World of Drawings: Healing through Art. Boston, MA: Sigo Press.
•    Glick, I., Weiss, R. S., & Parkes, C. M. (1974). The First Year of Bereavement. New York, NY: John Wiley & Sons.
•    Graves, S. (1994). Expressions of Healing. Van Nuys, CA: New Castle Publishing.
•    Hughes, M. (1995). Bereavement and Support: Healing in a Group Environment. Philadelphia, PA: Taylor and Francis.
•    Kahn, A. M. (1990). Coping with fear and grieving. In I. M. Lubkin (Ed.) Chronic illness: Impact and intervention. Boston, MA: Jones & Bartlett.
•    Kelly, K. (1992). The Psychology of Death. New York, NY: Springer Publishing,
•    Keyes, M.F. (1983). The Inward Journey. La Salle, IL: Open Court Books.
•    Kubler-Ross, E. (1981). Living with Death and Dying. New York, NY: Colliers Books.
•    Leick, N. & Davidsen-Nielsen, M. (1991). Healing Pain: Attachment, Loss and Grief Therapy. New York, NY: Routledge.
•    Levi, S., Gilad, R., & Friedman-Kalmovitcz, A. (1996). Pictorial art as a teaching strategy in death education. Nursing Times Research, 1(3), 198-205.
•    Malchiodi, C.  (2002). Art Therapy Sourcebook. New York, NY: Guilford Press.
•    Malchiodi, C.  (2006). Handbook of Art Therapy. USA: McGraw-Hill.
•    Malchiodi, C.  (2002). The Soul's Palette: Drawing on Art's Transformative Powers.  Boston, MA: Shambhala.
•    Miller, J.E. (1992). Helping the Bereaved Celebrate the Holidays: A Sourcebook for Planning Instructional and Remembrance Events. Fort Wayne, IN: Willowgreen Productions.
•    Osterweis, M., Solomon, F., & Green, M. (1984). Bereavement:Reactions, Consequences and Care.Washington, DC: National Academy Press
•    Parkes, C.M. (1986). Bereavement: Studies of Grief in Adult Life. New York, NY: Basic Books.
•    Parkes, C.M. & Weiss, R. S. (1983). Recovery from Bereavement. New York, NY: Basic Books.
•    Platt, L. & Persico, V.R. (1992). Grief in Cross-cultural Perspective: A casebook. New York, NY: Garland Publishing.
•    Rogers, J.E (Ed).  (2007). The Art of Grief: The Use of Expressive Arts in a Grief Support Group (Death, Dying, and Bereavement). New York, NY: Routledge.
•    Rogers, N.  (1993).  The Creative Connection: Expressive Arts as Healing.  Palo Alto, CA: Science and Behavior Books, Inc.
•    Sanders, C.M.  (1992).  Surviving Grief and Learning to Live Again.  New York, NY: Wiley.
•    Stack, P.  (2006).  Art Therapy Activities: A Practical Guide for Teachers, Therapists and Parents.  Springfield, IL: Charles C. Thomas.
•    Stroebe, W., & Stroebe, M.S. (1987). Bereavement and health. New York, NY: Cambridge University Press.
•    Zambelli, G.C., Clark, E.J. & Heegaard, M. (1989). Art Therapy for Bereaved Children. In H. Wadeson, J. Durkin, & D. Perach (Eds.), Advances in Art Therapy. New York, NY: John Wiley & Sons.

Editor's note: This article concludes a handout used by the author to teach art therapy to parents who have lost a child. The rest of the handout can be found in previous posts.

   

Art and Expressive Therapy Projects for the Grieving and Healing Soul--Part Four

Bridge Drawing

A suggestion for creating an image to explore your loss, your grief, and your goals

By

Michaela J. Gagne

Fold a piece of paper into 4 sections.  Number each box 1-4 and using only images, create the following in a symbolic sense with regards to dealing with your personal grief and healing process.  There is no right or wrong in the images you create.  Abstract images and shapes can work very well.

1)    Where was I in my grief process when I had to initially deal with my loss?
2)    Where do I want to be in my grief and healing process?
3)    What is in my way to getting there?
4)    How am I going to overcome the obstacles I might have?

Hold a large piece of paper horizontally.  I suggest an 11”x 17” paper or larger, but smaller can work as well if this is not available.  Either draw or find a picture of a bridge.  The Internet is a great way to find a picture of a bridge if you are uncomfortable with drawing one.  Place the bridge in the middle of your piece of paper, leaving space above, below, and on both sides. 

Decide which direction you want to travel over your bridge.  If you are traveling from left to right, then use your images from Box #1 on the left side of the bridge and your images from Box #2 on the right side of your bridge (if you are traveling right to left, then reverse these instructions).  You may cut out and paste the images you have already made or use them to help you develop new images you would like to use in conjunction with your bridge. 

Use the images from Box #3 over, under, and on your bridge.  Place these images where they feel appropriate.

Decide where you are on your bridge.  Remember where you were and where you want to be, and draw your self or a symbol of yourself accordingly on the bridge.  Give yourself the tools you need from Box #4 to make sure you will later get to the other side of the bridge.  Feel free to add anything to any of the images or add more images.

Re-visit this drawing in the future and evaluate if you have moved on your bridge, either forward or backward, and why this has happened.  Determine if there is anything you want to change about your bridge or how you can accomplish your goals.  Journaling about your bridge can also be powerful and productive.

Editor's note: This article is part of a handout used by the author to teach art therapy to parents who have lost a child. The remainder of the handout will be published daily over the next few days.

Sowing Seeds of Change

Years ago I heard Shirley MacLaine sum up what she learned from her round-the-world spiritual search: "What you give is what you get."

So true. Still when and where we get what we give can be remote. Ten years ago when Physicians for a Violence-free Society was still alive and well, we developed a four-hour domestic violence documentation course. At the time, digital photography was still an infant and had not yet legitimate standing in the forensic world. Therefore, each registrant went home with a top of the line Spectrum Polaroid camera.

Recently, Dr. Rochelle Wilson from southern California wrote to report that she attended one of our courses and, "The camera I received helped commit a child molester since then."

Good work, Dr. W! Every person can make a difference to make the world a better place. Thank you for making a difference in that child's life.

Art and Expressive Therapy Projects for the Grieving and Healing Soul--Part Three

Letter and Journal Writing

A suggestion for creating a letter or journal to your loved one
or to hold the emotions you may feel about the death of your loved one.

By
Michaela J. Gagne

Choose a journal book or piece of paper that feels appropriate on which to express your feelings and thoughts.  Also choose a writing or drawing utensil(s) (pen, pencil, marker, charcoal, paint, colored pencils, pastels, etc.) that is comfortable, does not offer too much resistance, and seems fitting to you.  This process can be an on-going way to communicate with yourself or with your loved one, or can be an activity that takes place only once.  You can decide what feels right.  Art can also play a helpful role in this process.  Explore images as a means to express emotions.  Colors, shapes, scribbling, abstraction, etc. all have the ability to help provide a sense of healing.

The following are suggestions for writing a letter or keeping a journal to your loved one.  This can be a means to heal and feel a personal, ongoing connection with your loved one.  It can make emotions and experiences seem less overwhelming by containing them in a safe format.  Art, including forms of symbols and images, can also be used in conjunction with writing or as a substitute for writing.
•    What do you wish you could have said to your loved one while that person was alive?
•    What do you wish to tell your loved one now?
•    Tell your loved one about what is happening in yours and your family’s lives.
•    What do you hope your loved one is doing now?
•    Ask your loved one for strength and courage, guidance and inspiration, and a means to find it all from within yourself.


The following are suggestions for writing a letter or keeping a journal for yourself.  This can be a means to sort out your feelings, reflect on your emotions and experiences, and clarify your personal goals.  This is a safe way to express anger, sadness, confusion, and other overwhelming emotions you may be experiencing.  It is a confidential means to review your own thoughts and progress, all with the ability to revisit these entries and view your own growth.  Art, including forms of symbols and images, can also be used in conjunction with writing or as a substitute for writing.
•    Express your personal emotions daily or weekly.  Report on your daily or weekly activities as well.  Don’t be afraid to look back at what you have written in past entries and notice similarities and differences.
•    Compile a list of goals for yourself in your life, related or not related to your grief and healing process.  Be sure to add goals that are new and different hobbies, activities, and/or challenges.
•    Use free association while reflecting on your life.  Free association is writing down any single word that comes to your mind, no matter how seemingly ridiculous and disconnected.  Simply allow yourself to write without inhibition.  Only when you are finished with your list, reflect on why you might have written each word.
•    Keep track of overwhelming emotions and notice if any change occurs over time.


There is no right or wrong in your journal or letter writing.  Try to develop the courage to attempt something different during this process, including incorporating art.  Creating something new can lead to new thoughts and ideas that can be inspiring. 

Editor's note: This article is part of a handout used by the author to teach art therapy to parents who have lost a child. The remainder of the handout will be published daily over the next few days.

Art and Expressive Therapy Projects for the Grieving and Healing Soul--Part Two

The Legacy Box

A suggestion for creating a memorial vessel as a tribute to a lost one

By
Michaela J. Gagne

WARM-UP

Fold 4 pieces of paper into two sections and number the sections 1-8 (1&2 are on one paper, 3&4 on the next sheet, and so on).  In each of these sections create an image and/or write words to represent the following topics:

•    In Section 1 describe an activity or activities your loved one enjoyed doing with other people.
•    In Section 2 describe an activity or activities your loved one enjoyed doing individually.
•    In Section 3 describe the physical appearance of your loved one.
•    In Section 4 describe the personality characteristics of your loved one.
•    In Section 5 describe how you believe the world saw your loved one.
•    In Section 6 describe how you believe your loved one saw and felt the world.
•    In Section 7 describe the emotions you felt and memories you have of your loved one
•    In Section 8 describe the emotions your loved one felt and memories that person had with you and others.

CREATION

Boxes are often used in art therapy projects because of their many surfaces, various size and properties, and their internal vs. external structure.  Choose a box that feels it would be a good representation of you and your loved one.  You may already have a box that has a special meaning.  Lids for the box may or may not be used.  If trying to find a box that works, give consideration to the material (for example, maybe you feel that wood represents strength and growth, or maybe an athletic shoe box seems appropriate, etc.)  Choose a size that feels neither too overwhelming nor too constrained for you, and most importantly do not feel that there is a right or wrong choice to make with choosing your box.  Let yourself be creative!

Next, give yourself a wide array of art materials.  “Art materials” does not have to include traditional materials used by artists.  Your materials can include anything that inspires you (magazines, aluminum foil, photos, fabric, cotton, buttons, tissue paper, old newspaper, markers or other drawing utensils, glass or mirror pieces, trinkets, etc.)…the possibilities are endless!  Some form of adhesive will probably (but not necessarily) be needed, such as tape, glue, glue gun, etc.

Using the pieces of paper from earlier, decide on a way to represent the odd numbers (1,3,5,7) on the outside of your box (the external surface), and represent the even numbers (2,4,6,8) on the inside of your box (the internal surface).  For example, if your loved one enjoyed playing basketball with others, maybe gluing a shoelace to the outside (or keeping the box closed with a shoe lace) would be appropriate.  If your loved one particularly enjoyed outdoor activities on his or her own, maybe lacquering a leaf to the inside of the box cover might be fitting.  The inside of the box can also be a place to hold treasured items and memories, or even smaller boxes. 

Don’t feel that all of the sections need to be used, and other ideas can be added however you see fit.  The pieces of paper you filled in can simply be used as a guide when you might need a sense of direction.  You may not want to use the pieces of paper at all, and that is okay.  You can begin on the outside or the inside, and it can be a project created swiftly, one that is under constant construction, or anywhere in between.  Your box can always be changed if this feels comfortable for you, whether it be through adding, subtracting, and layering.  Feel free to share or not share the box and its contents with others.  Some people may want it kept private, others may feel the urge to let others explore the box.  Use your box however it feels appropriate to you.

Editor's note: This article is part of a handout used by the author to teach art therapy to parents who have lost a child. The remainder of the handout will be published daily over the next few days.

Art and Expressive Therapy Projects for the Grieving and Healing Soul--Part One

By
Michaela J. Gagne

What is Art Therapy?

The profession of Art Therapy is dedicated to the belief that the process involved in creative expression is healing and life-enhancing.  Art Therapy and other Expressive Therapies are growing fields that utilize the arts as an alternative and/or complement to verbal counseling and therapy.  Art Therapy provides access to various parts of the brain, providing an alternate means for physical, mental, emotional, and spiritual well-being.  It provides a unique method of processing and healing through visual expression of thoughts and feelings. 

While “therapy” or “counseling” may hold negative connotations in some people’s minds, Art Therapy can be seen as simply a means for personal imagination and exploration to take place…and not a single word has to be said!  Art Therapy requires NO artistic ability, only an open mind and the courage to simply create.

Where should I be in my grieving process?  What is right or wrong?

There is no right or wrong when it comes to your feelings and the way you are experiencing loss.  One of the most important pieces in the grieving process is acceptance.  You must accept and know that you are okay with where you are at in your grieving process.  Everyone experiences grief and its journey differently.  Grief is normal and needed in order to heal and grow.

Remember: “Grief is not the process of forgetting.  Grief is the process of remembering with less pain and more joy.” (-unknown)

How can the Expressive Therapies help me with my grief and loss?

Grief can be very difficult to express with words…Often words are simply not enough.  Art offers the opportunity to express emotions non-verbally, in a manner that can be less overwhelming and more containing than verbal communication.  Art can provide a sense of comfort and a means to discover personal inner strength.

Throughout history, art in the form of concrete symbols and images has often been made in the memory of someone who has died and as a means for the living to commemorate and remember.  Creativity can be a means to maintaining a special relationship, and it can be a means for coping with the trauma of death.  Art can be used to provide a safe, non-threatening outlet to simply express.

Everyone has different ways of coping with grief.  Art and other artistic forms of expression are just a few suggestions for this healing and growth process.

Editor's note:

• For this article, the author cites: Hill, M.A.  Healing Grief Through Art.  (2007).  Retrieved November 15, 2007, from http://www.drawntogether.com/healing.htm
• This article is part of a handout used by the author to teach art therapy to parents who have lost a child. The remainder of the handout will be published daily over the next few days.