Strategies for dealing with people with PTSD?

[Wahine]

Agreed Biciclista. I'm just thinking that even with setting boundries, there may be strategies that I can employ to help things go more smoothly. I want to help this person with their PT related issues and while I need to address the issue, I want to do it as sensitively as possible while getting the job done. I don't think setting boundries with this individual should be done in the same manner as I would with, let's say my SO or mother or a friend. Or even another patient that didn't constantly feel threatened and easily angered.

[Bethany1]

While I don't have experience with PTSD, I do deal with being bipolar and it is very hard to control your reactions. It doesn't excuse the behavior, but be aware that it's hard to stop once a person gets going. While it doesn't look like it, the person is trying. It's hard being in emotional or physical pain 100% of time trying to pretend you are fine and it's easy to blow up on people trying to help.

Sometimes anger is a silent plea for help that the person can't express like normal people can.

Before you work with the person again, pull the person aside privately, sit down and explain the rules and what you expect from this person and make an agreement that both of you can keep and understand. Sometimes the "unwritten" rules aren't clear to those who struggle emotionally. Make it clear that you want to work with this person but you can't if the behavior continues as it's not safe for you and everyone else.

[Wahine]

Solobiker, thank you. I've been thinking of actually writing something up with this patient. It's nice to have confirmation that this is expected practice in settings where you have to deal with behaioural stuff.

Bethany, thank you for sharing. It means a lot to me. The issues you brought up are why I want to do this properly. I realize that this person has trouble coping and I don't want this to be just another incident where they feel attacked or threatened.

[Kiwi Stoker]

They will have triggers to things, so I suggest talking to them about what situations or things that cause or are the stressors, and seeing if there is ways to minimise this.

Also recognise that aggressive behavior just needs to run it's course, so if the person becomes irrational, simply let them have their time to get over it, leave them alone or say "I think we need to have a break".

Also remeber the injury and pain also cause issues. So suggest they take painkillers beforehand and realise that they are working through a grief as well of their loss of health. Reassure them that things will pass (if they will) and injuries do get better.

PTSD is absoltely nothing to do with you, but everything to do with the person with PTSD.

I think most of the suggestions here are very good, but I also think you need to find out about the patient's stressors as well.

[bmccasland]

I have / had mild PTSD and the problem is you can't always control your triggers, or control when you're going to fall apart. We'd like to remain in control, or at least I would. I don't enjoy falling apart, or "over reacting."

Do you know if this person is being treated for the PTSD? Are they on meds, are they taking their meds? Is there a quieter time they could come in for their PT? Maybe the noise and activity is a trigger, so a quieter time might help.

That said, I've seen a Viet Nam vet - 30 years out of the combat zone, and otherwise level headed - freek out because a particular noise occurred behind him and he wasn't able to make the cognative leap that it wasn't an incoming rocket.

[NbyNW]

+1 re talking to your patients about their triggers. If they are receiving treatment, then a part of that should involve learning to recognize triggers, making decisions about whether those triggers can be avoided and if not, whether the patient can work cognitively to change his/her response to those triggers.

The PTSD may or may not be related to the injury for which you are treating them. It might be worthwhile to see if there is any research about the relationship between the physical aspects of living with/rehabbing an injury and the mental/emotional aspects of it, w/ or w/o PTSD. If any such research exists it might help shed light on how you discuss progress and setbacks with your patients, which I'm sure is something you find yourself doing from time to time anyway.

[Wahine]

Thank you to everyone for your input.

I have discussed trigger with him to some degree but perhaps I could explore this further. As for aggressive behaviour running its course, you are exactly right.

The only reason this patient is still seeing me is because I let them have a chance at the beginning of every appointment to "vent" in the privacy of my treatment room. Sometimes this takes 10 min, sometimes 30 min. For this reason I always have them booked before my lunch so that I never have to rush the appointment. This also happens to be a typically quiet time in the clinic and a time of the day when the patient is usually doing better physically. I've found that the only way to have any PT happen is to let this aggression run its course and then we get to treatment. So many days I end up running into my lunch hour to treat.

This individual has walked out on at least 4 other PTs in the area. I'm the only one that he has stuck with for any length of time. So in a sense I feel like I'm doing a good job handling him. He's getting treatment consistently. I must be doing something right to have him still coming in. But there are days when I wonder why I'm trying so hard to accomodate him when he does things like he did today. And really, today wasn't that bad, he wasn't truly aggressive, not to the extent where anyone was concerned for their safety. But he was very mean to my receptionist and said several hurtful things to her.

He is receiving psych treatment and he is on medication. But he is very ill and there are days when I feel like I'm in over my head.

NbyNW, I would love to see some research on those types of issues. That's part of what I was hoping for, some references to articles that would apply to my profession directly.

Alright. Now that I'm done venting... maybe we can get on with talking about bikes.