Number of patients you work with

[bkennedy]

Hi Howard and Alicia – how do you decide how many patients you work with at any one time? I am inundated with patients see some of them only every few months. For some it is ok, but I think others lose the momentum of the ideas. I had a monthly intro class, and now expanded it to weekly to include focusing on more specific subjects as well as the intro (I had spoken with John Stracks a bit about his classes). I am wondering if maybe instead I should work with each patient for several months more consistently before adding in new patients. Wondering about your thoughts. Thank you!

[abatson]

I feel like for a patient who has a lot of symptoms and/or a lot of anxiety, I start out with every 2 week visits. I find that one week intervals are too soon – they don’t have time to experiment with the ideas, practice the tools and to notice pain shifting over time. With too frequent of visits, they will tend to over-rely on you and over-focus on their pain, expecting it to be gone with each visit. For a very anxious patient, they need more frequent visits than every few weeks or months, maybe every 2 weeks. They will need more consistent guidance in self-soothing, learning to calm the sympathetic nervous system, regular reassurance that they aren’t broken, regular reminders of the tools and techniques – the more a person’s SNS is turned on, the less they remember !! If they have less anxiety and more capacity to remember and practice, then visits can be more spaced out. I communicate that the extra time gives them time to practice the tools. So, in brief, I usually start out every 2 weeks for a few sessions, then as they improve, I go to monthly, then do that awhile and go to every other month. You are helping them build confidence that they can do this on their own. It’s like a child learning to walk and to separate from the parent – they will keep returning to you and looking back at you, as they learn and begin to develop the independence to explore and take risks on their own. Sometimes, they need to be nudged and allowed to figure it our on their own, but not too early or they will give up and relapse. I don’t think they benefit from direct learning, either 1:1 or in a didactic class, before entering a mutually supportive, interactive group class. A group class can be frustrating if the participants are not all at the same level of learning. I don’t think that answers the question about how many patients at a time, but I think that really depends on many factors. I’ve always had a mixed patient population of chronic pain patients and other mental health concerns, so I don’t really think about it like that.

[abatson]

I feel like for a patient who has a lot of symptoms and/or a lot of anxiety, I start out with every 2 week visits. I find that one week intervals are too soon – they don’t have time to experiment with the ideas, practice the tools and to notice pain shifting over time. With too frequent of visits, frequent visits than every few weeks or months, maybe every 2 weeks. They will need more consistent guidance in self-soothing, learning to calm the sympathetic nervous system, regular reassurance that they aren’t broken, regular reminders of the tools and techniques – the more a person’s SNS is turned on, the less they remember !! If they have less anxiety and more capacity to remember and practice, then visits can be more spaced out. I communicate ththey will tend to over-rely on you and over-focus on their pain, expecting it to be gone with each visit. For a very anxious patient, they need moreat the extra time gives them time to practice the tools. So, in brief, I usually start out every 2 weeks for a few sessions, then as they improve, I go to monthly, then do that awhile and go to every other month. You are helping them build confidence that they can do this on their own. It’s like a child learning to walk and to separate from the parent – they will keep returning to you and looking back at you, as they learn and begin to develop the independence to explore and take risks on their own. Sometimes, they need to be nudged and allowed to figure it our on their own, but not too early or they will give up and relapse. I don’t think they benefit from direct learning, either 1:1 or in a didactic class, before entering a mutually supportive, interactive group class. A group class can be frustrating if the participants are not all at the same level of learning. I don’t think that answers the question about how many patients at a time, but I think that really depends on many factors. I’ve always had a mixed patient population of chronic pain patients and other mental health concerns, so I don’t really think about it like that.

[hschubiner]

These are important questions, Becca. But ones that only you can figure out over time with your patients and your schedule. I found that my schedule dictated how much I could do, how many new patients I scheduled, and how often I saw them. You have to protect yourself and your schedule. If you get too overloaded, you may get back pain! 🙂 Keep your balance in your life to make sure that you stay able to help as many people as you can, but not more people than you can! 🙂
Best, Howard

[Author]

Posts