2017 in Review

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Copalis Beach, Washington

2017 was a busy year with lots of things coming together and many things nationally and globally falling apart. I added a new piece to my job at the VA this year. I am speaking now, not as a federal employee, but as an independently licensed health care provider. I have a 20% position with the national VA Office of Patient Centered Care & Cultural Transformation as a Whole Health Education Champion. You can learn more about the VA Whole Health program here. This job entails traveling to different VAs throughout the country and learning how to teach the several courses the Office promotes. I traveled to Madison, Minneapolis, Little Rock, Boston, and New Jersey and I will be going to Nashville later this month. I continue working in Primary Care Mental Health Integration at the Primary Care Clinic in Seattle. With the University of Washington I have moved from an Acting role to an Assistant Professor this past year.

I continue my work with Joseph Rael (Beautiful Painted Arrow), and we are well into the work of our next book which should likely be out later in 2018. Joseph is a continual joy and inspiration to work with and is often sending artwork and ideas for us to use in the next book. We easily have enough material for several more books. Another piece of news is that Walking the Medicine Wheel is being published in Vietnamese! I have yet to see the book, though. This is very important as the land and people of Vietnam and the Vietnam War are intimately intertwined with so many of our veterans’ lives and the history of the United States.

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Joseph Rael (Beautiful Painted Arrow) walking into his garden dome to perform Arbor Day Ceremony, April, 2017

I did a book tour, of sorts, for Walking the Medicine Wheel: Healing Trauma & PTSD. I made the trip back down under and saw some old friends and made some new ones, too. I took off from Seattle, almost missed my connection in Honolulu and landed in Sydney, Australia on September 13th, 2017. I went there for the biannual Australasian Doctors Health Conference, my fourth time presenting (I blogged earlier about this here). The conference was held at Luna Park, an amusement park in North Sydney with a great view of the city. My mate, Hilton Koppe, and I presented a workshop “The Hero’s Journey of the Healer,” that used Joseph Campbell’s concept of the hero’s journey to look at burnout and mentoring in health care workers. I also presented “Circle Medicine,” bringing together the holistic approaches of the medicine wheel, the VA circle of health, and my earlier work with Re-humanizing Medicine. It was great hanging out with Hilton and co-presenting with him, it was an extra treat when he stopped through Seattle on his way to some conferences in October. Here is a link to one of Hilton’s written pieces.

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View from my hotel in North Sydney, looking out at Luna Park (lit up), the Harbour Bridge, and Sydney.

I was also able to meet Father Gerry Arbuckle, whom I had been corresponding with for a few years via email. As well as being a Catholic priest, he has a PhD in applied cultural anthropology. He is the Co-director of the Refounding and Pastoral Development program. Gerry wrote a book called Humanizing Healthcare Reforms (2013) that I found very helpful in writing my Re-humanizing Medicine book. Gerry was also kind enough to write an endorsement of Walking the Medicine Wheel. His book Fundamentalism: At Home and Abroad is highly relevant to understanding political movements in the United States and throughout the world. I wrote a review of that book that can be found here. Gerry is from New Zealand, originally, and has now lived in Australia for many years. His next book is on loneliness and picks up on themes from his book on fundamentalism. He and I had a great chat, over 4 hours, and I hope we have a chance to meet again before long.

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Berkelouw Books, Sydney

Dr. Asha Chand organised a talk for me at Western Sydney University (see earlier blog on this here). It was great to meet faculty and staff there and have a chance to talk about “Caring for Self & Others” which is an adaptation of Re-humanizing Medicine. My friend, Laura Merritt, in Seattle has done a lot of work with me on putting together a workbook version that I drew on for that presentation. WSU recorded the talk and Asha has said we can share the links to the talk for anyone who is interested:

Caring For Self & Others, Part 1Part 2, Part 3

After Australia, I flew over to Auckland, New Zealand and straight away met up with some of my best friends. I did a talk called “Life After Rehab,” at Buchanan Rehabilitation Centre, where I served as Clinical Director during my time in New Zealand. I also did a book talk at Time Out Books, where a group of us used to meet monthly for the Auckland Holistic Writer’s Group.

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View from Te Pane o Horoiwi (Achilles Point), St. Heliers, Auckland, New Zealand

My next stop was somewhere I have never been, but have wanted to travel to: Fiji. I flew into Nadi airport on the Northwest of Viti Levu, caught a short flight to the Southwest, to Suva. Dr. Neeta Ramkumar met me there and she had organised a talk and workshop for me at the University of the South Pacific. The talk was called “The Transformational Power of Stories in Clinical Work, Teaching, and Community Building,” and the following workshop was “Bringing Ancient Traditions of the Hero & the Warrior into Modern Day Life.” I very much enjoyed meeting all the wonderful people of Fiji and the University of South Pacific and felt honored to be able to speak there.

Bringing Ancient Traditions

Finally, I had a bit of a break from the speaking tour and from all the busy socializing with friends. I took a 45 minute boat trip out to Leleluvia Island and just relaxed. I snorkeled twice a day at the reef just off the island. I walked around the island several times and also kayaked around once. Such a beautiful place! I’ll share some of the photos from the trip and I hope you enjoy them!

After Leleluvia, I went back through Suva, hired a car, and drove back to Nadi, seeing the Sri Siva Subramaniya temple (which was scaffolded under construction), but I still walked around and had a nice lunch there. I also stopped for a walk through the Garden of the Sleeping Giant with its orchids prior to heading to the airport, flying back through LAX and to Seattle.

This next year promises to be quite busy again with travel: Nashville, Portland OR, Madison, and back to the Boston area two more times. Joseph Rael and I continue to work toward peace and world peace. As Joseph says, “A lot of people have tried to bring about peace, and it hasn’t worked! But you and I are too far into it to stop now, so we’ll have to keep going.” May you find peace in your heart and in your life this coming year, and may we all have some peace in this world that seems so focused on the opposite of peace at this current point in history.

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South coast of Viti Levu

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Copalis Rock, Washington Pacific Coast

Australasian Doctors Health Conference, Sydney, Australia, Sept. 15-16, 2017

I recently returned from a trip to Australia, New Zealand, and Fiji. I started in Sydney, Australia at the Australasian Doctors’ Health Conference. The conference was held at Luna Park in North Sydney with a great view of the city and the opera house.

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View of Luna Park (lit up below bridge) from the North Sydney Harbourview Hotel

I did two presentations at the conference. The first was a workshop co-facilitated with my mate, Hilton Koppe, called The Hero’s Journey of the Healer, where we looked at burnout as a necessary stage of the healer’s journey and also at the important role that mentors can play on the journey. We also made a distinction between instructors (who train you to do the technical job) and mentors (who help you find yourself in the work and sustain your humanity).

Title slide Healer Hero

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I have recently come across the concept of transformational learning as defined by Jack Mezirow it includes several steps that parallel the process of initiation and the hero’s journey: a disorienting dilemma, realization that disorientation is part of the growth process, and then a reintegration with a new, transformed identity.

Transformational Learning Model

The second presentation was Circle Medicine: What’s Good for the Client is Good for the Clinician. This presentation reviewed a few of the circular models of healing I have been using lately: the Hero’s Journey, Whole Health, and the Medicine Wheel. I believe that we need to include both linear medicine and circle medicine in order to best serve our clients.

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I had a great time at the conference, caught up with some old friends and made some new friends. I also spent a few hours speaking with Gerald Arbuckle, author of the book Fundamentalism that I recently reviewed. Gerry and I have had an ongoing correspondence since I used his models of medicine concept in my book Re-humanizing Medicine, and also he wrote an endorsement for Walking the Medicine Wheel. It was great to finally meet in person and have a really good chat!

More blog posts to follow from this trip!

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“We Need to Be Disoriented Says Psychiatrist”

Here is a link to an article, “We Need to Be Disoriented, Says Psychiatrist,” by Chris Kelly from my recent talk at Western Sydney University, Australia. The article appears in Hunter and Bligh.

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Thank you Chris Kelly and Hunter and Bligh for this article that captures the essence of transformational learning – that we need to be disoriented and lose our bearings in order to really have the opportunity for transformational learning – learning that changes who we are beyond just learning new information. Transformational learning is a concept that Jack Mezirow developed. He listed ten different steps that I have condensed down to three steps in the circle below, corresponding to the circle of initiation: separation, initiation, return. This model also fits with Joseph Campbell’s hero’s journey model in which transformation comes through transitioning between worlds, cultures, or states of consciousness.

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This was part of a 2 hour talk I did for staff and students called “Caring for Self & Others,” based on the Caring for Self & Others workbook that Laura Merritt and I have adapted from my first book, Re-humanizing Medicine: A Holistic Guide for Transforming Your Self, Your Practice, and the Culture of Medicine. We had a great discussion about creating a counter-curriculum of self-care and contributing to the compassion revolution!

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Thank you to Sneh Prasad for connecting me with Dr. Asha Chand at Western Sydney University who coordinated this event while I was in Australia for the Australasian Doctors Health Conference. Thank you everyone involved in the talk! I will be posting about the other talks I did on my trip as well as some of the photos soon…

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Dr David Kopacz speaking at Western Sydney University about anxiety and stress. Image: Christopher Kelly

 

 

A Review of Patient-Centered Medicine: A Human Experience

A Review of Patient-Centered Medicine: A Human Experience

By David H. Rosen and Uyen Bao Hoang

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This is a new and updated edition of Medicine as a Human Experience originally published in 1984 by David H. Rosen and David E. Reiser with two guest chapters by George L. Engel (one of the founders of the biopsychosocial model still taught in medical schools). As a disclosure, one of the current authors, Uyen, is a friend of mine whom I know through living and working in New Zealand.

This new edition features a foreword by Andrew Weil, MD, who puts the book in context within the current frameworks of the biopsychosocialspiritual model of medicine and integrative medicine. Dr. Weil writes that not only does Patient-Centered Medicine “define the role of health professionals in the new model of medicine that is coming into being, it gives a great deal of practical advice about the attitudes and skills they should develop to care best for patients” (ix).  The current edition includes Norman Cousins’ (author of Anatomy of an Illness and The Healing Heart) original foreword entitled “Physician as Humanist,” which invokes the framework of humanism as a partner or counter-balance to the technological and interventionist aspects of medicine. Cousins stresses the interconnectedness of science and humanism, ending with the statement, “I pray that, even as you attach the highest value to your science, you will never forget that it works best when it serves your humanity” (xvii).

The book next includes a prologue, written by Dr. Uyen B. Hoang. Uyen tells of her own path as a healer, as a Vietnamese-born American, training in medicine, going through burnout in the contemporary practice of psychiatry in the United States, and then moving to New Zealand to practice, “in search of something greater, on a quest for expansion and truth” (xxv). With honesty and integrity, Uyen brings her own personal experiences of medical practice to the book which bridges the thirty-some years since the book was first written. Dr. Rosen also shares personal elements of his own work and journey to humanize the more theoretical aspects of the text.

The text elaborates the four essential principles of medicine as a human experience: acceptance, empathy, conceptualization, and competence, stating that these are required to prepare physicians to be “compassionate champions for health” (4). The grounding of the book is in the frameworks of humanism and the psychotherapeutic understanding of human relationships. George Engel’s two chapters give us the opportunity to read, in his own words, the ideas of the founder of the biopsychosocial model. Throughout the book, Drs. Rosen and Hoang focus on the idea that there is no separation between the humanistic and scientific approaches. Rather than a duality between the art and science of medicine, they offer the perspective that the therapeutic relationship is rooted in the human science of presence and connected observation.

What could be improved in this book for the next edition? I think the authors do a good job of retaining the focus of the original and updating it to the present times. I think a larger discussion of what is now called the biopsychosocialspiritual model that Dr. Weil mentions in his foreword could be helpful. Another area to consider is the work on compassion-based practices as an antidote to burnout. These elements are present in the book, but could be further developed. That said, this book easily joins the work of other healers such as Robin Youngson, Tony Fernando, Allan D. Peterkin, Andrew Weil, Lewis Mehl-Madrona, and the late Lee Lipsenthal who have been engaged in what I call the compassion revolution in medicine.

Patient-Centered Medicine: A Human Experience gives the reader a great overview of biopsychosocial, humanist and psychotherapeutic perspectives of human interconnection and inter-relatedness. It combines the enthusiasm of the younger psychiatrist with the wisdom of the older psychiatrist in order to guide students, doctors, nurses, and clinicians through training and into practice. Patient-Centered Medicine is also a source of renewal for practicing doctors and clinicians, reminding us all why we went into medicine and health care in the first place.  Drs. Rosen and Hoang close with the following sentences: “We must encourage introspection, healthy relationships, play, openness, and joyous, creative expression. We must spawn a generation of doctors who are not afraid to love” (142).

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David H. Rosen and Uyen Bao Hoang

 

 

Re-humanizing Medicine Review

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The American Medical Writers Association has published a review of Re-humanizing Medicine: A Holistic Framework for Transforming Your Self, Your Practice, and the Culture of Medicine.

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You can find the full review at this link. Below are some excerpts from the review written by Debamita Chatterjee.

“Re-humanizing Medicine by David R. Kopacz is an incisive reflection on the existing medical practices of an increasingly corporatized world. At the same time, it seeks to teach the medical and health care community how to correct that dehumanized outlook by being more compassionate and holistic.”

“Considering the absurdly frenetic pace of modern medical practice, this book does an excellent job of nourishing the soul of practicing physicians first, thereby helping them to regain their humanity. This, in turn, may translate into a more humanized treatment of patients and, ultimately, establish a pathway to a whole new paradigm of medical practice.”

“This book helps us to understand, appreciate, and correct the wrongs of modern-day medicine by inspiring us to be more connected—to be more human.”

 

Reviewer: Debamita Chatterjee

Debamita is a graduate of the University of Rochester in biomedical sciences. She has written for the University of Rochester Medical Center and journals including eLife and The Scientist.

Re-humanizing Medicine & Walking the Medicine – Books of the Month in the Royal College of Psychiatrists Newsletter

Royal College of Psychiatrists

Pan American Division Newsletter, February 2017 (Issue 26)

RCPsych PanAm Book club: Book of the Month

This month’s recommendation was sent by Dr. David Kopacz who responded to our call to “rediscover the soul of daily practice” and to connect with more members of our Division. Dr. Kopacz is a psychiatrist working in Primary Care Mental Health Integration at the Puget Sound Veterans Affairs in Seattle, Washington, US. He is the author of our two books of the month:

  • Walking the Medicine Wheel: Healing Trauma & PTSD By David Kopacz and Joseph Rael (Beautiful Painted Arrow) Millichap Books/Pointer Oak, 2016
  • Re-humanizing Medicine: A Holistic Framework for Transforming Your Self, Your Practice, and the Culture of Medicine. By David Kopacz (Ayni Press, a division of John Hunt Publishing, 2014)

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Thanks RCP!

The Book is Here!!!

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The book that I have been working on with Joseph Rael (Beautiful Painted Arrow) over the past 2 years just arrived in the mail! It looks like it is still not shipping from Amazon yet, but should be soon as it has shipped from the printer.

Judith Gadd has been working with the publisher, Paulette Millichap of Millichap books and has put up a nice website with 4 videos that my sister, Karen Kopacz, filmed earlier in the year.

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My sister, Karen , at Design for the Arts, is in the process of updating my webpage:

davidkopacz.com 

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I will be setting up some book talks as the next step. In general Joseph will not be traveling much, but we will kick it off together in Albuquerque and will also look at setting something up in Durango. Here is the schedule so far:

November 4, 2016: Mayo Clinic Humanities in Medicine Symposium, Phoenix, AZ

November 10, 2016: Bookworks, Albuquerque, NM (with Joseph)

December 7, 2016: University of Washington Bookstore, Seattle, WA

March 9th, 2017: Minneapolis VA

More news as it is available…

A Proposition for a Counter-Curriculum in Healthcare Education and Practice

This is a copy of the blog post that I published in the member’s blog of the Academy of Integrative Health & Medicine 8/11/16.

By AIHM Member Dave Kopacz

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What is a counter-curriculum and why do we need it?

A counter-curriculum is a course of self-study (which includes the study of the self) alongside the technical curriculum for training healthcare professionals.

We need it because something important is missing from the contemporary curriculum of healthcare providers.

I first developed this concept of a counter-curriculum when I was in medical school, actually even before that, back in high school when I realized that there were important areas I needed to be educated in that were outside of what I could learn through schools. My counter-curriculum included the works of Carl Jung, and writings in Zen Buddhism, poetry, literature and mysticism. It included looking at the best of being fully human, as well as the worst, so I had to study the “forgotten histories” of genocides of Native Americans and other marginalized peoples and cultures. I had to study the assumptions of the current facts that were being taught, which led to the philosophy of science and history of medicine as well as of different cultural and historical models of health and illness.

The counter-curriculum is more than reading books, however.  In order to be fully human, to counteract the dehumanizing aspects of professional training, in order to be the best doctor and the best human being I could be, I practiced various forms of meditation, yoga, tai chi, martial arts, fencing, going to various gym classes, working out, running, free and easy wandering in the woods with Thoreau and Chuang Tzu in my pack. The counter-curriculum led me to study various forms of healing, of energy, life force, breath and consciousness. It led me to seek out different forms of education and experience. It recently led me to start working with Native American visionary Joseph Rael (Beautiful Painted Arrow), who taught me that we only truly exist in moments when we are raising our consciousness, the rest of the time we are just busy trying to keep everything the same, which is persistence―not existence.

And, finally, the counter-curriculum led me to write my book, Re-humanizing Medicine. And it led me to write this blog post and to encourage you to find your own counter-curriculum, so you can be a whole person, so you can be fully human, so you can truly exist.

Dave Kopacz is a psychiatrist, a founding diplomate of the ABIHM, and is recently certified through the ABoIM. He works in primary care mental health integration at the Puget Sound VA and is on faculty at the University of Washington. He has worked in a number of practice settings in the US and New Zealand. His first book, Re-humanizing Medicine: A Holistic Framework for Transforming Your Self, Your Practice, and the Culture of Medicine develops the concept of a counter-curriculum and presents a guide for being a whole person to treat a whole person. His latest book, with co-author Joseph Rael (Beautiful Painted Arrow), is called Walking the Medicine Wheel: Healing Trauma & PTSD and is due out October 15th, 2016.

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Treating All of the Patient Physio Matters Interview, August 2016

The following is the text of an interview I did for Physio Matters, (member magazine of Physiotherapy New Zealand) August 2016.

FEATURE 22 | PHYSIO MATTERS AUGUST 2016

Treating All of the Patient
Interview by Rhonwyn Newson

David Kopacz, author of the book, Re-humanizing Medicine: A Holistic Framework for Transforming Your Self, Your Practice, and the Culture of Medicine, defines a holistic approach to healthcare means taking into account all human dimensions that influence health and illness.

These include not just the physical, but also the emotional, relational, mental, creative and spiritual dimensions of the person.

“To be holistic is the opposite of being reductionist. In addition to focussing on the physical body, we also are heartcentred, bringing caring and compassion to our work,” Dr Kopacz says.

How can physiotherapists provide a more holistic approach to treating patients?

Dr Kopacz believes clinicians can only provide holistic healthcare by first developing one’s own ‘wholeness’.

“We cannot give to someone else what we have not first developed in ourselves. Healthcare is both an art and a science, although we often forget the art and only focus on the science. If we want to give more compassionate care, we must cultivate our own compassion.”

‘Counter-curriculum of self-care’

Dr Kopacz notes that healthcare workers are often not trained to take care of themselves.

“If we do not care for and replenish ourselves, we end up with professional burn-out, which leads to a loss of caring in healthcare, and ultimately a loss of health for both the healthcare worker and the client.”

The basics are a great place to start – stretching, exercise, regular movement and engagement in life. Proper nutrition and relaxation techniques are helpful too. From there, the concept of mind-body-spirit should be looked at, and this applies to both the clinician and the patient.

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David Kopacz at Re-humanizing Medicine book signing at University of Washington Bookstore, January 2014 (Photo: Salin Sriudomporn)

According to Dr Kopacz, there are nine dimensions that need to be looked at:

  • How can a person engage their body for health?
  • How can a person engage their emotions for health?
  • How can a person engage their mind for health?
  • How can a person engage their heart for health?
  • How can a person engage their creativity for health?
  • How can a person engage their intuition for health?
  • How can a person engage their spirit for health?
  • How can a person engage their context and surroundings for health?
  • How can a person engage their time for health?

Looking at these nine dimensions gives a holistic view of a person, and each dimension has health benefits. Physiotherapists can individualise a treatment plan by finding out how to support a person to engage all of the dimensions of their health. “We don’t have to be an expert at working with each of these different dimensions, but as healthcare workers, we need to have basic fluency in each dimension.”

Treating more than just an injury

“When people are injured or have a movement disorder, it doesn’t just affect the physical body as a machine – the body also ‘thinks’,” Dr Sandra Bassett, senior lecturer in Physiotherapy at AUT says.

Dr Bassett believes a biopsychosocial healthcare approach means taking into account the beliefs people have about their treatment and their injury.

“It means taking the time to talk to a patient about any limitations to adhering to treatments – what their time and social commitments are.”

From Dr Bassett’s perspective biopsychosocial healthcare is different to providing holistic healthcare.

“It’s about finding out and respecting what a patient thinks. What their commitments are, and how they think their bodies work.”

She also believes patient education is so important. Knowing how the body works, and how treatment will help, means patients are more likely to adhere to their treatment and manage their disability.

“I often hear physios saying, ‘But I’m not a counsellor’, and that’s true,” she says. “However, physiotherapists are well-placed to connect with people, and get them to think about their day and when they might be able to fit in their treatment exercise regime, for example.”

Physios can also place responsibility on a patient to encourage self-efficacy. “Our research shows that when patients take responsibility and ownership of their treatment, they cope much better. Patients feel better about themselves and think more positively.” In this sense, the physiotherapist may act as more of a coach by setting goals, and providing encouragement and support, as well as educating the patient.

Dr Kopacz says an injured person may also suffer from grief over lost physical functionality, anxiety over being re-injured, and even depression around an injury. These emotional and mental elements need to be addressed in order for a person to even have the motivation, and commitment, to doing the exercises that physiotherapists know would help them.

“A key question is asking a patient, ‘What do you want your health for?’ This helps to motivate a person, and individualise their care. It’s not enough to provide information or appeal to a person’s intellect. We need to focus on engendering hope as much as providing an evidence-based physical treatment,” he says.

Although this may seem like a lot to take on in a busy clinical setting, it is a vital component of providing care.

“…really, it comes down to making sure that we are good human beings to each other as well as being a good technician or clinician. Kindness and caring only take a moment and we need to make sure that we make space for that moment to occur.”

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Joseph Rael (Beautiful Painted Arrow) and David Kopacz working on their new book, Walking the Medicine Wheel: Healing Trauma & PTSD. (Photo: Karen Kopacz, 2016)