Strategies for dealing with people with PTSD?

[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.

[smilingcat]

I've only experienced someone with PTSD from a distant. It was back in college, mid 70s. He was a floor counselor at a dorm. He was a Viet Nam Vet as a medic.

On one rare occasion when the guys were playing poker with him, he drifted off without a warning and into his own world, back into the combat zone. The guys who were playing poker said it was really eerie seeing him drift off without warning then snapping out of the "trance". The trigger was noise of rain drops hitting the window during a heavy thunderstorm. He said the sound reminded him of...

Then I also think of people with phobias and I see similarities. Both PTSD and phobia seems to be "out of control" of the individual. You can reason through it, but when the trigger hits, its there. Knew a really smart engineer with one of the worst flying phobias ever. Only way we could get him to fly was he needed an escort or two and some understanding from the flight crew...

I will also admit that I have bit of phobia of being alone where there are no one around. It's okay if I have one of our dogs with me or if there is a stranger nearby. It's just uncomfortable when I'm all alone whether this is in my own house when my animals were still at the other house, or when I'm in the garden or when I'm out in the wild. I have this irrational fear. but I manage. So in this regard, I have a vague understanding of not being able to control it.

Is there a way to find out what triggers his PTSD reaction? Like Beth was saying about a 30 year vet with the incoming rocket kind of thing.

From my little experience, it seems that one way to deal with the "events" are to redirect him away from the trigger.

I hope his anger doesn't escalate into physical violence.

And remember too that there are times when it's just beyond our means to help. It's over our head.

Be safe,

[mmouwse]

wow. I am in awe of all of you who have replied to Wahine's post, sharing your experience, knowledge and compassion to help her and her patient. Many of you demonstrated sincere compassion and understanding for both the patient and Wahine. I am heartened that you had the courage and compassion, Wahine, to reach out for help for you and your patient. Your patient is blessed to have you in their life. You are rare. It only takes 1 caring compassionate person to make a difference in someone's life... to help someone heal and recover; to save someone's life. Thank you for being that person.

[Wahine]

wow. I am in awe of all of you who have replied to Wahine's post, sharing your experience, knowledge and compassion to help her and her patient. Many of you demonstrated sincere compassion and understanding for both the patient and Wahine. I am heartened that you had the courage and compassion, Wahine, to reach out for help for you and your patient. Your patient is blessed to have you in their life. You are rare. It only takes 1 caring compassionate person to make a difference in someone's life... to help someone heal and recover; to save someone's life. Thank you for being that person.

Wow. Thank you. You just made my morning.

[Biciclista]

Wahine, you are awesome! You show a lot of courage. Good luck.

[Wahine]

Thank you Biciclista.

There's a fascinating story about how this fella came into my life but it's a very long story. Definitely interesting, but perhaps too long for TE. The Cole's version is I never used to be able to tolerate people who demonstrated self destructive behavior or people couldn't take action when action was needed. When dealing with these patients, I would get very frustrated to the point of it being unhealthy for me. Over the last 6 years, I have worked very hard to understand that some people are just not wired like I am. That their drive is different and that I needed to be more compassionate with those individuals for my own good. I did better but it was still a struggle for me to understand.

The day before this fella came into my life I was involved in a group role playing/problem solving session that went down a very strange path. A path that I thought had nothing to do with my current life circumstances. It ended up dealing with PTSD. The very next day, this man comes into my clinic for an evaluation. He ranted for 30 min at the get go and I sat and listened. I didn't get frustrated, I just let him go. Eventually, we got through it and got on to the business of PT. I was able to help him.

I came out of that appointment knowing that there was a very important life lesson for me in my relationship with this person. So, I've tried to keep that my focus through all of this.

I really appreciate everyone's input and kind words. It is very helpful because I do still struggle with it. Even though I know that when it's all over I will have learned something from it all that will result in a happier and healthier me. So really, it is all about me.

[Miranda]

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.

You might consider if the patient would sign a release of patient confidentiality consent for you to contact his therapist and see what suggestions he/she might have (and/or start with asking the medical doctor's advice- since your PT order stems from them).

This link below should go to a website that briefly notes some information about EMDR (sure there are more indepth articles, this was just the 1st web site that popped up in google for me).

http://www.safeharborhouse.com/artic...PTSD-Treatment

I've personally undergone this techinique before and it was helpful. But I did have some side effects as my session was "incomplete" the therapists called it. Which she explained everything to me before. To that I was grateful or I would have thought I'd completely lost my mind when they happened.

Just sharing that experience in that if possible to establish a relation with his other care providers it might give you a heads up on how to problem solve even better.

As others have stated, agreed about your caring attitude and going the extra mile. Your patient is blessed to have you.

Good Luck.

[Wahine]

You might consider if the patient would sign a release of patient confidentiality consent for you to contact his therapist and see what suggestions he/she might have (and/or start with asking the medical doctor's advice- since your PT order stems from them).

As others have stated, agreed about your caring attitude and going the extra mile. Your patient is blessed to have you.

Good Luck.

Thank you for your input. I've done these techniques myself and did find them very useful.

[indysteel]

Thank you for your input. I've done these techniques myself and did find them very useful.

Me too. My therapist asked me to volunteer for it so that she could get enough hours to be certified in EMDR. While I don't technically have PSTD, I do have some things from my childhood that were traumatic, and EMDR really helped me process through them in a way that talk therapy had not. If your patient hasn't considered it, perhaps that's something you could discuss with him.

As others have stated, your compassion toward this man and desire to help and understand him is admirable.