Chronic Illness Workbook: Strategies and Solutions forTaking Back Your Life, The

American Journal of Clinical Hypnosis,  Apr 2003  by Olson, Jean A

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The Chronic Illness Workbook: Strategies and Solutions for Taking Back Your Life. Patricia A. Fennell. Oakland, CA: New Harbinger (2001). 239 pages, $16.95 (paper). Reviewed by: Jean A. Olson, MSN, RN, CS, LPCC Albuquerque, NM

"Society doesn't prepare anyone to cope with chronic illness" (p. 8). Thus, The Chronic Illness Workbook is intended to provide individuals diagnosed with any type of chronic illness with a format for processing their experience and adapting to their new life situation. Patricia A. Fennell begins with a discussion of the sociocultural context of chronic illness. She then employs a model derived from trauma and crisis theories to delineate four phases of response to a chronic illness: Crisis, stabilization, resolution, and integration. For each phase, the author identifies an overall strategy followed by specific tactics and skills to navigate the phase successfully. The goal is to "...integrate your illness into a different but meaningful life" (p.32). Sociocultural responses, including the vicarious traumatization of those people in relationship with the identified patient, are addressed throughout each of the phases.

The crisis phase begins when symptoms interfere with functioning to the extent that they can no longer be ignored or dismissed. A medical diagnosis may or may not have been reached. The goal of this phase is to contain the crisis, which the author also refers to as "going into the bunker" (p. 49). Strategies include staying safe physically, hanging on psychologically, and working with others. Exercises to organize health care tasks and emergency information, assess and adapt activities/schedules, track symptoms, and begin a narrative life story are included followed by sets of questions about relationships with family, coworkers, and health care providers.

The goal of the stabilization phase is "to stabilize and begin restructuring your life" (p.95). Using the strategy of "living the enforced monastic life" (p. 95), the individual is directed to learn new physical boundaries, regroup psychologically, work with the reactions of others. It is assumed that most people entering this phase have reached a plateau with their symptoms such that there is some predictability. The exercises include ways of revamping activities to meet current needs, examining content versus process, assessing traumas related to the chronic illness, maintaining insight, and values clarification, as well as two worksheets to address financial status.

The goal of the resolution phase "is to develop meaning and to construct a new self" (p. 126). The strategies are to assume management of physical care, act creatively to develop meaning, and take control in the wider world. The first group of exercises in this chapter deals with current symptomatology and health care issues. The reader is then asked to identify the losses that were brought about by the illness and to examine what might be reincorporated into daily life based of the needs and desires of the authentic self.

In the final phase of integration, the goal is "to integrate your suffering into a meaningful, sustaining, and rewarding life" (p. 157). The strategies provided involve living in the present, continuing creative and spiritual growth, and expanding social horizons. The are no specific written exercises in this chapter; however readers are encouraged to continue to maintain a personal narrative of their experience.

The remaining section of the workbook addresses a variety of special topics. There are chapters devoted to obtaining and managing health care, handling special situations (ceremonial events, travel, etc.), and understanding the countertransference reactions that might arise from health care professionals. Another chapter deals with chronic illness from the caregiver's point of view, including caring for a chronically ill child. There is no mention of hypnosis in the book.

The strength of The Chronic Illness Workbook is its content. Ms. Fennell does a reasonably thorough job of presenting the various aspects of coping with a chronic illness. The incorporation of the sociocultural dimension to the individual's response to their situation adds greater perspective. Of particular value is the information on vicarious traumatization of those involved with the individual and the possible countertransference reactions of clinicians. I also appreciated her discussion of suffering and the role of palliative care in the treatment of chronic illness. Ms. Fennel's description of trying to pass as normal, physically and/or emotionally, when nothing works the way it used to and the resultant sense of failure, guilt, and shame was also helpful. While some of her recommendations regarding dealing with health care systems and resources are laudable, they seem somewhat idealistic given the constraints of many managed care plans.

The major weakness of the text is in the delivery of its content. The introduction is conversational in its presentation of case vignettes and the book's basic premises; however, there is a shift to a significantly more didactic tone as soon as one enters the body of the text. While the information is valuable, the reading level would seem to exceed that of the average client, particularly if that individual is experiencing diminished concentration as a result of their disease process and/or the stress response to becoming ill. The first exercise doesn't appear until page 53, almost a quarter of the way through the text. I also question the utility of beginning to write a life story when one is in the crisis phase of responding to a chronic illness (p. 75). Finally, I perceived a subtle bias toward women, particularly those of at least middle class stature, throughout the text and the examples provided.