Recovering from family violence – and using those techniques to help my patients

Imaan Joshi

8/03/2019 1:59:26 PM

Dr Imaan Joshi recently spoke about surviving family violence, raising children and gaining Fellowship. Now she writes about how she recovered from her trauma.

‘It is never the end until you give up,’ Dr Joshi said.
‘It is never the end until you give up,’ Dr Joshi said.

After my abusive marriage ended in 2011, I found myself alone with four young children aged between three months and five years.
No one in my family was in Australia, and I didn’t want to tell them the details as it would not have been helpful in any sense except to cause more worry.
Without child support, I was forced to go onto welfare – the Single Parenting Pension – for the first and only time in my life while I considered my options.
I had been training in obstetrics and gynaecology, but the lack of support for working nights and weekends meant that continuing my final two years had become impossible.
I had fortunately been accepted into GP training and decided to begin the following year, when my youngest would be 11 months old.
During those intervening months, my ex continued to harass and threaten me, mainly via text messages and phone calls. He’d threaten to come and take the kids.
My children all remember how we responded. Whenever we arrived home, I would lock them in the car while I did a quick check of the surrounds of the house before letting them out. They remember being trained to cry or call for help if they were grabbed.
I look back now and I suspect I had PTSD coupled with depression. But when I was in the middle of it, it was hard to see the forest for the trees. So I continued on, as so many high-functioning doctors do, as long as they remain safe at work.
But over the following months, flashbacks, constant fear and nightmares began taking their toll. So when I began GP training in 2012, I decided to take up mental health training, so I could help myself first.
It was the best thing I could have done – it immediately gave me a sense of hope.

Mindfulness and CBT
After spending three days learning the basics of cognitive behavioural therapy (CBT) at the Black Dog Institute, I began actively applying those principles to my own life.
Having a name for the problems that plagued me was liberating, as the psychologists I had seen had not been terribly helpful in dealing with chronic trauma.
The trainer at one of the CBT sessions mentioned Acceptance and Commitment Therapy (ACT), a form of mindfulness-based CBT, and how helpful that had been in his own training. The idea of combining mindfulness and CBT appealed, so I signed up for a course in Sydney.
It was, quite simply, life changing.

Dr Joshi found combining mindfulness and CBT to be ‘life-changing’.
ACT essentially teaches a form of acceptance of difficult situations and feelings, and committing to improvement in seemingly impossible situations based on one’s values – independent of the situation. It does not rely on dissection of the past, or even focus too much on the past at all.
I was drawn to ACT by its focus on the present and how learning to sit with uncomfortable thoughts and feelings can allow one to make progress through life’s difficulties.
During that first two-day workshop, the presenter asked for a volunteer for a 15-minute one-on-one session on stage, talking about selective self-disclosure. I looked around the room. There were around 100 professionals, mostly psychologists. I was nervous, but I felt I had to do it.
We held a session on stage. It was powerful – so powerful that something fundamental shifted on that day. Until that moment, I’d been in a kind of despair. I felt like things would never get better, and that I was responsible for the mess that was my life at that stage.
But now, for the first time, I felt hope.
After that, I decided to train in this modality so I could help myself and my children (who were also showing signs of trauma) and, by extension, patients who were suffering from similar issues.

I trained in ACT to an advanced level over the next two years. In my clinical practice, I took on a small selection of patients who had suffered loss and who didn’t want to address it with a new person.
I had a patient who had lost her firstborn to stillbirth, another who had lost his marriage, and a third with terrible social anxiety. I used classic CBT techniques, while also integrating the mindfulness techniques that I’d learnt from ACT to help effect change in their outlook.
My patient with a broken marriage was wracked with guilt, mixed through with a desperate desire to get his wife back. He simply didn’t know how to go about it. So we worked together around acceptance of what she was saying, about what she’d told him about his behaviour that had led her to leave in the first place. That way, he could begin to address these issues first.
As for my recovery, I found that combining CBT with mindfulness gave me increased hope within six sessions. It made me realise there could be a way forward without needing to delve into the nitty gritty details of the past.
Mindfulness was an important component, one that enabled me to anchor myself when I felt flooded, or otherwise overcome with feelings and unable to think logically when hijacked by my limbic system. My patients told me they had the same results.
But the best part of it all? Boundaries.
The intermediate ACT course  features a page of notes handed out to practitioners addressing issues and behaviours that may be unhelpful, and a way to approach them with any patient undertaking therapy. In effect, it’s about noticing the therapist’s own discomfort when we notice unhelpful behaviour on the patient’s behalf, and learning how to bring that up softly, with phrases like ‘I am noticing that you are saying and doing this’. 
This, for me, was essential in learning how to say unpalatable things to people even while fearing their anger, and even being able to terminate a therapeutic relationship on occasion due to a poor fit.
And it led to my passion, in helping myself, my children, my patients and, eventually, as a clinical teaching visitor for trainees and other junior doctors who struggle to say no, to speak up and to feel that their opinions matter.
When I look back at the last few years and the adversity I have overcome, I realised that I am, in fact, a glass-half-full person. I never used to think that, but it is true. At some point, I embraced the saying that ‘failure is simply feedback’.
It is never the end until you give up.

cognitive behavioural therapy family violence International Women's Day mindfulness PTSD

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Fatima   8/03/2019 9:07:38 PM

Thankyou for sharing your journey & its a lot what you have been through.May you find nothing but peace,serenity & happiness in your life ahead.Ameen

Jane   12/03/2019 7:48:20 PM

How you now serve others with empathy and insight is wonderful. How you teach doctors to support thier patients with CBT is valuable. THank you for sharing your story.

Rosa O'Kane   13/03/2019 5:18:45 PM

Dr Joshi thankyou for the courage and truth required to share your experience .Best wishes for your and your childrens future .

Prof Kirsty Anne Douglas   14/03/2019 8:22:17 PM

reading this makes me proud to be a GP - you are caring, empathetic and tough - Congratulations and how lucky your patients are to have you.