The Visual Wellness Plan

The Visual Wellness Plan

Treatment plans can be very useful in keeping a client and a treatment

team working toward a common goal. However, they can also become a
bothersome piece of paperwork that is either avoided or rushed through
and never referred to again. What is outlined here is instead a Wellness
Plan. The usual elements of a treatment plan show up on the left (Away)
side of the diagram. While these can be very necessary parts of a Wellness
Plan, they are not the whole picture of a life well lived.

One problem is that treatment plans are about words, and most treatment
is about changing behaviors. While words can be useful at pointing to
behaviors, it’s often hard to refer back to words to track progress.

The Visual Treatment Plan changes that by using a combination of words

and a simple Matrix Diagram to first clearly map out the plan and then use
a simple time management metaphor to track progress.

1
The Visual Wellness Plan

The Visual Treatment Plan can be used with either groups or individuals. If
it’s begun in a group, an individual follow-up may be needed to add any
elements to the plan the person did not want revealed in a group setting.
However, many (if not most) people can create and track very meaningful
plans from group with no individual sessions.

The Visual Wellness Plan (VWP) can be used in Primary Care, Integrated
Primary Care (Primary Care Combined with Mental Health), or either
outpatient or inpatient Mental Health settings. The VWP can be particularly
useful with chronic conditions such as Pain and Diabetes that require
frequent monitoring.

The Visual Treatment Plan can be used with any type of psychotherapy
such as Cognitive Behavioral Therapy (CBT), Interpersonal,
Psychodynamic and Behavioral.

The Visual Treatment Plan takes advantage of a visual metaphor most

people in the world are familiar with, the view from space ships and
airplanes. While few of us have been in outer space, most of us have seen
the images that astronauts see when looking back at earth. Also, even if
one has not looked down at the earth from the window of jetliner, that
‘view’ has been seen in movies and television shows.

However one imagines it, the basic idea is that a person is looking at his or
her life from a distance, noticing toward and away behaviors with the intent
of wellness. This view is very easy to teach in one session and then can be
referred to during treatment and wellness activities.

2
The Visual Wellness Plan

The Wellness Matrix:

Notice that the Matrix is simply two lines that form four quadrants. The
horizontal line represents behaviors that anyone can see another person
doing like walking and talking. The vertical line separates ‘inside’ behaviors
or mental activities that work toward the important stuff of life like family,
friends, work and play, or internal behaviors to move away from unwanted
experiences like fear, sadness and pain (both emotional and physical).

From a Wellness Point of View mind, behaviors, toward and away activities
are simply part of life to be noticed. Everyone has and does both Away and
Toward behaviors thousands of times a day. The trick is to combine the
Away and Toward behaviors into a package that work’s for wellness.

Because it’s a point of view, the Visual Wellness Matrix can be “built” in a
number of ways. I have usually found it most useful to start in the lower,
right quadrant with the question, “Who is important to you?” However, one
can start in any of the quadrants, or even by focusing on the two lines. In
the end you end up with the Visual Wellness Plan no matter where you

3
The Visual Wellness Plan

start. I will start with the way I usually build the plan, and I will discuss some
other ways later in this manual.

4
The Visual Wellness Plan

Who is important to you?

As I said, I usually start with the question, “Who is important to you?” and
write the question in the lower, right and corner of the Wellness Matrix.

Note: I am usually working with a whiteboard. I have been working with

whiteboards for at least 15 years, so I have several across the offices and
rooms that I use. However, there are times when I only have access to a
blank sheet of paper. Across all of these scenarios I usually have the
people (or person) I’m working with take out a blank sheet of paper and
draw the vertical and horizontal line of the Wellness Matrix. As much as
possible I have people fill in their own Wellness Matrix. However,
sometimes I work with people that for some reason just can’t write. I watch
carefully for this because I don’t want to embarrass anyone. If I’m working
individually, then I fill it in for them. In a group I might have a co-facilitator
help them fill it in. If I don’t have a co-facilitator, then I wait until the end of
the group and help the person fill it in. In any case, at the end of the
presentation each person has a copy of their own Wellness Matrix. I also
usually hand out a Basic Matrix with the questions for each quadrant like
this:

5
The Visual Wellness Plan

After I have asked and written the question, I engage the people in the
room in a discussion about who is important to them. We talk about family,
friends, spouses, co-workers, son, daughters, etc. Anyone who is
important. If the conversation slows down a bit, then I have the people talk
about who anyone might find important. This is handy when there is
someone who says something like, “No one is important to me.” In those
case I can say, “Okay, can you think of people that other people might find
important?”

When I’m using a whiteboard I end up with a diagram that looks like this...

6
The Visual Wellness Plan

Later we can add other important stuff like work and play. I tend to stick
with “who” to start because humans are social animals and moving toward
people is the most rewarding.

7
The Visual Wellness Plan

What are the internal barriers moving toward who’s important to you?

Barriers (internal barriers) are written in the lower, left quadrant of the
Wellness Matrix. I start by explaining that the number one internal barrier is
fear, and I write fear like this...

Then we go to work filling in more inside stuff that can turn into barriers.
Emotions like sadness, depression, anger and anxiety often show up in this
list. Thoughts like, “I can do it,” and “It’s too hard to do,” also show up.
Sometimes someone might bring up an external barrier like another
person. At those times I simply say something like, “That an external barrier
and we will get to those later.” Then I turn the attention back to internal stuff
that shows up. I end up with a diagram that looks like this...

8
The Visual Wellness Plan

I finish this section by saying something like, “You see this stuff over here
like fear can show up and get in the way of moving toward who’s important
to you. Now we will list the stuff that you do to try and get rid of or manage
the stuff like fear, anger and anxiety.

9
The Visual Wellness Plan

What do you do to manage or get away from unwanted mental

experiences?

I write these “away” behaviors in the upper, left quadrant of the Wellness
Matrix. I carefully explain that these are behaviors that everyone does to
move away from or manage stuff like fear and pain. I most often use this
example:

Imagine you step off of a curb and look to your left and see a bus coming
right at you. Fear shows up and you jump back onto the sidewalk away
from the fear AND away from the bus. A very “wellness” move.

That means that some away moves work for wellness and other don’t work
so well for wellness. We put them all in the upper, left part of the Wellness
Matrix so we can notice them and notice how they work for wellness.

Other than moving away from busses, activities like the following often
show up:

Mediation to manage stress,

Deep breathing to manage anxiety,
Walking to reduce fatigue,
Drinking alcohol to avoid sadness,
Using street drugs to get away from pain,
Talking to others to manage depression,
Going to the gym for tiredness,
Going to talk therapy,
Sleeping for depression.

I end up with a diagram on the whiteboard that looks like this...

10
The Visual Wellness Plan

I point out that invariably the behaviors on the list are only short-term
solutions to whatever is going on inside of them. That leads to...

11
The Visual Wellness Plan

The short-term solutions spiral.

I explain that sometimes we can get into a short-term solutions spiral. For
example, in some people boredom shows up. To get rid of the boredom
they drink some alcohol. That works for awhile, but what invariably
happens? That’s right, the boredom shows up again, so more alcohol is
consumed. If a person get’s stuck in that cycle, the system spirals down to
‘Stuck’ that you can see written right above Away on the diagram.

I have presented this diagram to thousands of people and every one of

them knew what Stuck feels like. We have all gotten ourselves into a stuck
spiral trying to get rid of some unwanted mental experiencing. It might be
talking to lessen anxiety, so we talk and talk and talk, but the anxiety comes
back with a vengeance. Maybe we try harder because of frustration, but the
frustration comes back all the more. The list goes on and on; we all know
stuck. The trick is to notice being stuck and make different choices, and
that’s a lot of what the Visual Wellness Plan is about...noticing when your
stuck and what you do next.

12
The Visual Wellness Plan

Choosing what to do next...

The Visual Wellness Plan finishes up with a discussion about what can be
done to move Toward people who are important to you AND taking the
unwanted stuff from quadrant 2 along with us. An easy example of this is a
teenager who wants to ask someone out on a date. The fear of rejection is
great, but the desire for socialization is also great. When the teen asks for
the date, fear is along for the ride.

A common one that shows up on the list is, “Going out with friends (or
family) and being tired.” “Going to family gathering and being anxious,”
shows up a lot too.

I often draw a line connecting the behavior with the unwanted sfuff like
this...

13
The Visual Wellness Plan

Now we can add the “What’s important to me?” questions.

14
The Visual Wellness Plan

What’s important to you?

While we started off in quadrant one talking about Who’s important to you?,
we all have other stuff of life that we move toward like Work, Play, and
Health. In the larger scheme of things we probably move toward those for
social reasons, but most people find it easier to also focus on the, “What’s
important to me?” question.

At this point I simply ask the “What’s important to you?” question and fill in
some answers like this...

Then I ask, “And what behaviors might you do to move toward work, play
and health?”

Behaviors like, “Going to work,” “Running with my wife,” “Going to the gym,”
Meditate for health,” show up on this list and I write them on the white
board.

Notice that any behavior can show up as an Away or a Toward move. For
example, you can see that we have “meditation” listed as an away move

15
The Visual Wellness Plan

from anxiety, and as a toward move for health. For the purpose of the VWP
it’s the intent of the behavior that’s important.

I always explain that any behavior can show up as a Toward or and Away
move. Sometimes people then ask, but what if it’s an Away and a Toward at
the same time? I explain that happens often, and at those times we simply
apply a percentage to the behavior. So meditation might be 40% for
reducing anxiety and 60% for health, or 30% for health and 70% for
reducing anxiety. Whatever amounts the person applies are correct, as
long as they add up to 100%.

Now we are ready for the next step in the Visual Wellness Matrix...time.

16
The Visual Wellness Plan

How much time do you spend on each side of the Wellness Matrix?

Many people have written about looking at the “big picture” or “taking the
long view” of life, and that’s exactly why we’ve been building the Visual
Wellness Matrix. If you look back across the diagrams you will see that we
have created a “self portrait” of a person. It contains who and what is
important to the person, the internal barriers that show up the most, the
behaviors that are done to move away from the barriers, and the behaviors
done to move toward who and what’s important. If we wanted we could
replace the “Noticing” circle with a picture of the person. However, we will
just use the “Noticing” circle.

The “Noticing” circle in the center of the Matrix represents the long view
we’ve all been talking about. In three dimensions the “Noticing” circle would
sit above the Matrix looking back on the what’s going on mentally and
behaviorally. Obviously there is not that mind/body separation, but it’s easy
enough to imagine, and that’s the “Visual” part of the Visual Wellness
Matrix.

From this View we can look a the very big picture of our life from the day
we were born until now. We can even project that view out to the end of our
life. We can of course shorten the view to this moment. With that said, I
usually start with the Day View.

The Day View

We all know that a day adds up to 24 hours. So with the last 24 hours in
mind I have the group divide up their behaviors into the Away and Toward
side of the Matrix so that the time spent doing the behaviors adds up to 24
hours. I start with the obvious 12/12 split like this...

17
The Visual Wellness Plan

I then ask people if anyone has the following split?...

Of course no one spends zero time doing toward moves, so I change it to...

18
The Visual Wellness Plan

Of course that is equally as silly; no one spends all of their time doing
Toward moves. So I then asked the members of the group to realistically
divide up the last 24 hours of their life just using a ‘gut’ feel.

Note: Some people prefer to do a percentage, and that’s fine. I just change
the diagram to represent percentages that add up to 100% like this:

19
The Visual Wellness Plan

Depending on the situation I might continue to do weekly, monthly, yearly,

etc. estimates, but most of the time I stick with a day and then move onto
future plans, but first we need to develop some “homework” based on the
Wellness Matrix.

In the diagram below you will notice that I have written “Hooks” below the
word Noticing. I get there by asking something like,

Have you ever had a time when something happened and you had a
quick, emotional response? Maybe someone cut you off in traffic.
Maybe someone cut in line ahead of you. Maybe someone said a
cutting remark to you. These and thousands more are times when
you get ‘hooked.’ These times are great opportunities to notice
behaviors. First you notice being hooked, and then you notice what
you do next.

This does not mean that you are trying to get rid of the hook. If you do
that, you will have the hood all the more. Instead you simply notice
you are hooked and you notice what you do next.

20
The Visual Wellness Plan

Your homework will be to notice getting hooked and what you do

next. The next time I see you I may well ask, “Did you notice any
hooks?”

I also explain that this “noticing hooks” homework works whether you
do it or don’t do it. Simply notice noticing hooks or not noticing hooks;
either way works.

By doing or not doing the noticing hooks homework we get a better feel for
how much time is spent Away and Toward and how that split is working (or
not working) for overall wellness.

Choosing:

Of course, rather than just noticing what behavior is done after a hook, one
can also go about choosing what behavior to do next. That leads us to the
next topic...

21
The Visual Wellness Plan

Future Wellness Plans

Let’s review the quadrants...

1. Who and what’s important to you (values),

2. Internal, unwanted stuff that can become barriers to moving toward who
and what’s important,
3. Behaviors to move away from the unwanted internal stuff,
4. Behaviors to move toward values while having the unwanted internal
stuff. Note: This quadrant also has toward behaviors during which you
really don’t have much unwanted stuff.

The Visual Wellness Plan is therefore about,

1. Knowing your values (who and what’s important to you),

2. Knowing the internal stuff that can become barriers,
3. Knowing the behaviors you do to move away from unwanted internal
stuff, especially stuck cycles,
4. Knowing behaviors that move you toward your values, realizing that
sometimes you take the unwanted stuff along with you.

The Wellness Matrix comes together in the form of choosing values to

move toward and Toward and Away behaviors to get there. While it might
still seem strange to talk about “Away” behaviors as “Toward” behaviors,
simply recall the “moving away from fear and a bus” example. How about
when you smell some rotten food, disgust shows up, and you avoid it.
Again, this is a very “wellness” oriented away move. The fear, disgust and
other unwanted internal stuff are useful information.

For that matter, most Away behaviors are fine as long as you don’t get
‘stuck’ in a pattern of away moves. With the VWP and some practice it’s
relatively easy to notice when you are stuck and choose a different
behavior, which is a move toward wellness. To get “wellness” into the view
we will tweak the diagram a bit like this...

22
The Visual Wellness Plan

Notice that now “Noticing Wellness” is in the center of the diagram. From
that view, one can notice when an Away move works for wellness and
when a Toward move works for wellness. Wellness is a collection of both
Away and Toward moves. Let’s do an example.

Get out a clean sheet of paper and draw the two lines like this:

23
The Visual Wellness Plan

And write in some values in the lower, right area (Quadrant 1). For
example, “Health.”

Next write in some Toward behaviors that would move you toward those
values in the upper right quadrant and any Away behaviors that would work
for health. For example, you might write “Walking for Health” in the upper
right and “Meditate to reduce anxiety” in the upper left, with “Anxiety” in the
lower, left.

24
The Visual Wellness Plan

Remember than any behavior can end up being a Toward or and Away
move. “Take a walk” could be away and “Meditate” a toward move,
depending on the intent of the action.

Once you get your first VWP made, figure out a way to take it with you.
Stick it in a notebook, datebook, or fold it up and stick it in your pocket. The
goal is to put it in a place where you will find it several times a day and look
at it. Remember that this is a Visual Wellness Plan. You look it over,
noticing the Toward and Away items. You might ask yourself, “Is this a
“Toward” day or an “Away” day on average?” Don’t ponder it long, just put
the VWP away again and wait for the next opportunity to look at it.

Sometime during the day, or maybe every other day, you will want to spend
a bit more time with the VWP and add and subtract items from it as
needed. You might discover important people to add to your Toward list.
You might discover new barriers you were not so aware of before. You will
also add and subtract Toward and Away behaviors as you notice them.

25
The Visual Wellness Plan

The ultimate question is to look at the VWP and ask, “Are my Away and
Toward behaviors adding up to wellness?” You will know the answer to that
question in a flash with no thought needed. If you think about it, you are not
doing wellness. Wellness is one of those things you just know about
yourself with no thought. Just remember this is a Visual Wellness Plan, not
a thinking wellness plan.

Here is clean Wellness Matrix so you can get started right away...

26