By Nicole Villarreal McCormick, EAMP, L.Ac.
Since becoming a clinical supervisor at the Seattle Institute of East Asian Medicine, it has come to my attention that acupuncturists aren’t given much training in how to work with patients with significant trauma and who may have very limited resources. As an acupuncturist who has found a calling in social services, I am trying to remedy that lack of education. Here is a brief introduction in how to work with this population:
- Trusting the patient’s view of themselves and their problem, and stating back to them that trust.
- Affirming that they know their body and that their perceptions are valid. They are the authority on themselves.
- Offer collaborative care by checking in with how the patient is feeling about things. Accept their choices as theirs to make, even if they may not be what we’d recommend for their condition. Practice harm reduction (see below for more detailed explanation).
- Some people with trauma or who have been marginalized may have distrust of conventional medical authorities, and will not seek out the level of care they need. As acupuncturists, we can be allies to them.
- Keep in mind the long game–it may take time to convince them to seek the care they need. Continue building trust by offering trust and showing you care about them.
- Know the low-barrier healthcare providers nearby who are used to working with marginalized and underserved patient populations.
- Make sure patients know their rights, and work to coach them if they’re worried that they may be treated dismissively or will be surrendering their autonomy by seeking care. Talking points include the importance of having all the information you need to make an informed decision, and that it’s your choice to consent to treatment.
- Know your boundaries. Keep in mind that with unstable people, it is very important to remember that their issues are not yours, and don’t take them on.
- Being nice is not the same as being kind. It is a kindness to prevent someone from harming you or others by maintaining firm boundaries and seeking protection if needed.
- If someone begins acting out, calmly, assertively and firmly state your boundaries or the boundaries of a group you are facilitating.
- If someone is disruptive and their presence isn’t welcome, start off by saying “I need you to please leave now,” or some variation of the need, politely and respectfully. For some more aggressive types, being firm but verbally deferential can help them manage their emotions. If a more polite approach isn’t working, stating “I need you to leave now” may be called for. Those who are inebriated or high may need this more direct approach.
- Know what allies you have in your immediate vicinity. If you are dealing with a population with a high amount of instability, make sure you have someone who can help nearby, and that they are alerted that you may need assistance at some point. Have a plan.
- If you don’t have much prior experience being assertive, you may want to practice.
Being mindful of personal bias:
- When treating a patient who makes you uncomfortable, assess if they’re a risk to your safety and well-being, or if they trigger a part of you that still needs care. If this is the case, refer them out or tell them you cannot treat them. You don’t owe them further explanation. We are not the right practitioner for everyone, especially if our own needs around an issue have not been met.
- If none of the above is true, acknowledge your discomfort. To the best of your ability, notice if you are reacting differently to this patient than you would similar patients who do not make you uncomfortable.
- Find practices that help you separate the discomfort from your role as a practitioner. Example: visualize putting your discomfort in a box to look at later, when you’re no longer treating that patient.
- Realize that everyone has biases, and that having them doesn’t make you a bad person. Be they reactions to race, mental health, class, gender identity, sexuality, etc., they are not fixed parts of us, and can be intentionally worked on.
- It’s normal to have feelings of shame around biases, but keep in mind that oftentimes, they’re part of our larger society or culture, and not innate parts of ourselves that can be labelled “bad”. Seek out resources to support yourself around undoing bias–you’re not alone in working with them.