Reply To: patient population considerations

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I agree that different people may need different approaches. This work is definitely not cookie cutter and we have to meet the patient where they are. I have worked in community mental health care settings located in underserved areas with underserved populations. Needs of safety come first, so helping a patient obtain needed resources for food, housing, transportation and personal safety usually take priority. After that, if a patient has high levels of anxiety, which often correlates with high levels of trauma (though not always), working on the skill of self-soothing and self-compassion skills comes next. Once they can bring down their anxiety levels so that they are not always in full panic, then they can better focus on how periodic shifts in anxiety and pain correlate with mental/emotional/present stressors. Then, they can begin to do the pain reprocessing therapy work and if that is not resolving everything, I will turn towards the emotional processing work. However, this is just a very general guide. I have also been known to do emotional processing work on the first visit and it has been very affective. Over time, you get a sense of where the patient is and what is driving their danger signal – in the moment. Sometimes, they just need to tell their story – it might be the very first time they have told anyone who took the time to listen. I have worked with homeless who have done well, but they had lower levels of anxiety. I don’t find lower socio-economic status to be a barrier – I really think it depends on the individual and what whether they are open to it or not. Some people associate more biomedical care with being acknowledged and affirmed and are reluctant to consider a non-biomedical approach, feeling like their needs are being ignored or diminished. This is unfortunate, because with more biomedical care and attention, in these cases, the negative outcomes are greater.