Special problems in the management of PTSD patients

Avoidance is one of the main symptoms of PTSD, and it can thus take years for the patient to seek help for this condition. It is important for clinicians to bear in mind that even those who seek help may find it hard to talk about the traumatic experience, and may show signs of avoidance such as irregular attendance or failure to disclose the worst moments of the trauma initially. Therapeutic techniques to deal with this problem include empathy, gradual encouragement, and giving the patient control over the timing and mode of working through the experience (e.g. writing, talking into a tape recorder, reliving with the support of the therapist).

One of the requirements for change is that the patient feels safe. Therapists therefore have to make sure that they establish a good relationship with the patient, and that the therapeutic setting or their behaviour does not remind the patient of the traumatic event. Sometimes support in changing living circumstances may be necessary if they prevent the patient from being safe (e.g. moving house if assaulted by a neighbour).

Patients with PTSD often suffer from poor sleep and concentration, and find it painful to face reminders of the trauma. For these reasons, they have difficulty in dealing with the aftermath of traumatic events such as legal procedures and continuing treatment for physical injuries, including the long delays that this usually involves. Such ongoing stressors impede recovery, and patients may therefore benefit from problem-solving and practical advice.

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