How Health Workers Can Promote Self-Care

Increasing emphasis on self-care will require major changes in the
relationships between health workers and their clients. No one I know
has thought longer or harder about this relationship than John Travis.

John Travis and his six co-workers at the Wellness Resource Center in
Mill Valley, California, do not practice medicine. They promote
wellness. Their model is educational, not pathological. They see no
patients, prescribe no drugs, perform no physical examinations. If a
client is ill, he or she is referred to another physician for
diagnosis and treatment.

It isn’t that Travis isn’t qualified to treat the sick. John graduated
from Tufts Medical School and the Johns Hopkins Medical Center
residency program in preventive medicine. But he found that even the
kind of “preventive medicine” taught there was too illness-oriented.
The Wellness Resource Center is the result of his personal quest to
shift medical orientation from sickness to health.

Tom Ferguson: John, maybe you would start by describing the
kind of relationship that exists between conventional health workers
and their clients – and why you have tried to change that model.

John Travis: I think that most health workers are trained to
want to rescue people – and most people go to health workers to be
rescued. Traditionally, Western medicine has viewed disease as
something out there, beyond the patient’s power or influence. When
disease strikes, you go to the doctor and he attacks the symptom with
the weapons of modern medicine. The doctor assumes total
responsibility, and the client becomes just a sort of unconcerned
bystander.

I call this the pill-fairy model of health care.

TF: What’s the alternative to the pill-fairy model?

JT: Taking a lot more self-responsibility. The pill-fairy model assumes that health is simply the absence of symptoms, that someone who doesn’t have any symptoms is healthy by definition. But that’s not true at all. There are as many degrees of wellness as there are of illness.

Medical education focuses on diagnosing and treating organic syndromes of disease. It’s frustrating to health workers when people come in who have no specific physical symptoms, but are bored, tense, depressed, anxious, or just generally dissatisfied with their lives.

TF: You’re saying that the treatment model doesn’t work with them.

JT: Right, though the treatment model is appropriate in some cases. Particularly in something like, say, bacterial pneumonia or acute appendicitis. If I had one of those illnesses, I’d want my doctor to use pills or surgery.

TF: What should a health worker do when somebody comes in who’s just bored and anxious?

JT: I think that once a specific organic illness is ruled out, they should turn them over to wellness educators.

TF: And what would a wellness educator do?

JT: The kind of thing we try to do here at the Wellness Resource Center – help people focus on the ways they are presently conducting their lives, suggest that other options are available, and support them in trying some of the options. The important difference from the pill-fairy model is that we make it very clear that we’re not providing diagnosis and treatment, we’re providing education.

We leave the responsibility for their own health squarely on their shoulders. It’s damn near impossible for a physician to do that. Existing doctor-patient relationships are set up in such a way that the doctor carries all the responsibility, makes all the decisions, calls all the shots.

When I work with a client, the first session is often spent with the client trying to hand the responsibility for his or her health back to me. And I have to keep saying no, no, no, you can do it yourself.

Your readers might assume that since I’m an M.D., I’m providing medical services. I’m not. I’m working as an educator. Having the M.D. experience is very helpful but not a prerequisite.

TF: How is it helpful?

JT: In having credibility. Mainly that. Also in knowing what the limitations of medicine are. In knowing if something might be organic or not. In understanding how bodies work, so there’s not an unknown between the psychological and the physiological. Some other practitioner might say. “Well maybe that’s something a doctor ought to look at.” I can often make that decision myself.

TF: Can a family practitioner use some of your techniques in
his or her practice? Or should it be a completely different person
doing it?

JT: It would depend on the circumstances. A family practitioner could certainly use biofeedback, but then it would become much more of a treatment. There’ s a real advantage to isolating the two. I think it would be ideal to have a family practitioner working closely with a wellness practitioner. Here’s what you can do and here’s what I can do.

TF: How do you define what you can do, when you’re making the initial contract with a client?

It’s essentially that we’re not diagnosing, treating, or taking care of the person. We’re serving as a consultant, to give them more information, teach them skills, to show them how to become more aware of their past, to see what’s going on inside their bodies, how to visualize, how to communicate better, how to love and accept themselves.

TF: What kind of success are you having in getting people that
come to your center to deal with those kinds of in-depth issues?

JT: I’ve been surprised that so few people are really willing to look at their lifestyles and consider changes. We see lots of people who have obvious, major stress related problems, but who aren’t willing to commit themselves to getting a full understanding of them and making changes.

What we’ve found is that there are quite a few people who’ll just come in for the initial evaluation÷but who aren’t willing to go any farther with it. Who essentially just want to come in and get themselves checked out, but aren’t interested in making any changes in their lives.

We’ve found that the people who are willing to commit themselves are people who are really hurting. It’s hard for people to feel comfortable about spending money on something they can’t see. They’ll spend ten thousand dollars on a car that can sit in their driveway, but they won’t spend two thousand dollars on themselves. Wellness is not a product, and we’re very product oriented.

TF: What are the kinds of hurting you see?

JT: Headaches, asthma, angina, high blood pressure, total body pain, insomnia, lack of concentration, sexual problems, chronic anxiety, fear, depression, the whole gamut.

TF: In terms of personal satisfaction. how would you compare
the kind of work you’re doing with the traditional medical role?

I think most helping professionals get positive feedback by helping other people, and in general have a hard time asking for and getting the same attention for just being themselves. I think that has to be debilitating in the long run. They don’t really take very good care of their health. They’ve externalized their attention to other people÷to their own detriment. They have high rates of suicide, they have heart attacks at an early age, they tend to be very uptight, in poor physical shape, they may be overweight. All because they’re so externalized to taking care of other people.

JT: So how does the model you’re creating offer an alternative to all that?

By making clear the limits of responsibility of the professional÷that he or she can only assist the other person in doing things for him or herself. Being a consultant, rather than taking on the main responsibility for the other person. Also, if you’re suggesting all this self-nurturing and self-care to others, it’s important to practice what you preach.

I see a lot of health workers who are feeling burned out. There’s a great deal of anger, a real feeling that the present system isn’t working. A lot of health workers come to the workshops we give here at the Center, looking for tricks and techniques they can add to their practice. They want the five easy steps to wellness.

TF: For themselves?

JT: No, for their patients. They figure that if they can just make their patients well, they’ll be okay.

TF: So do you give them the five easy steps?

JT: (Laughs.) No. We just share our own experiences and try to get them to go through a wellness evaluation themselves to think about starting their own wellness program.

You’d be amazed at how difficult it is for some health workers to start looking at themselves! They want techniques and tricks and handouts they can copy and give out to their patients. We have to say, “No. We can’t give you that.” And sometimes they get angry.

They expect some kind of magic formula. And what we tell them is that they’ve got to start by detaching themselves from the rescuer role. That seems to be the basic source of conflict for most health workers.

Health workers are trained to be rescuers, and then they burn out and come in trying to suck us into the rescuer role for them. Rescuers always end up becoming victims.

So we health workers need to start seeing clients as responsible people÷not victims÷who are making certain choices in their lives and that’s okay. You can’t take on the responsibility for them. It takes a very high degree of autonomy and self-confidence, and a very real sense of your own limits and the limits of medicine.

TF: The trick is to stay concerned, but not try to take on responsibility for the person’s problem.

JT: Yes. And that isn’t a cop-out. It’s just a matter of realizing your limits. Smokers used to drive me crazy. Now it’s okay with me if someone chooses to smoke÷ as long as they don’t do it when I’m around. I’ve managed to let that one go. But if they decide they want to quit, I’ll be there with suggestions, resources, a chapter in a book, or whatever.

It’s not that difficult to let people take responsibility for headaches or ulcers or high blood pressure. It’s much harder for, say, genetic diseases or accident victims. But you can do the same thing with them. I’ve been impressed by how many health workers rely on some kind of religious or spiritual belief system to support them in allowing the people they work with to be autonomous spiritual beings. We’ve ended up talking about religious belief and spiritual awareness at a number of the workshops. People seem to be hungry for this sort of thing. I think it’s particularly important for health workers÷who are going to be communicating about this change to others÷to keep growing spiritually.

The fact that you’re granting some kind of spiritual quality to people you’re interacting with can’t help but show. They can’t help but feel that respect. They pick that up, and they’ll probably respond in kind. They’re going to start taking more responsibility. If our attitude is that they’re helpless wretches, and if we don’t do something for them, they’re in bad trouble, they’re going to pick that up and live that out. And then they resent you and do everything they can to defeat you.

TF: It seems to me you’ve been getting more and more interested
in the changes that are taking place for the health professional. Is
that true?

JT: Yes. I’m interested in self-care from the point of view of the professionals who are groping, who see the problem, and in order to deal with the problem, have to grow themselves. If they grow, it’s going to rub off on their clients. Besides, once they open up real communications, they might find that some of their clients are a lot more grown up than they are.

I think the biggest lesson in this whole thing, personally, is an ego lesson. First of all, learning to handle power I never expected to have to deal with. I thought I was starting a nice, quiet two-person private practice in Mill Valley. I’d never heard of holistic health when I moved here. Then, suddenly, I got plunged right into the center of a movement. It’s done a lot for my own growth. It’s gotten me to look at my own feelings of competitiveness, of jealousy. Every time somebody else gets invited to a conference and I don’t, there’s that thought: Why wasn’t I invited?

I guess you need an ego to establish self-identity and purpose and determination. And then you have to learn to give it up. You outgrow it. At least sometimes you outgrow it.

One of my own focuses now is dealing with my own burnout, as a result of all this running around speaking and doing conferences. At a workshop recently, a friend took me aside and said “John, a little loving concern. People have been saying how tired you look!” I was a little defensive at the time, but I think he’s right. I spend most of my day with phone calls and meeting people. A lot of it’s gotten to be not really as satisfying as I could wish it to be. So I’m cutting back a little, learning to take my own time, to choose pleasure for myself.

It really does come back to taking care of yourself in the end.