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Unique Requests I often Receive as a Therapist for Chronic Illness and Medical Trauma
As a telehealth therapist for clients with complex chronic illness, I often receive requests that most therapists who don't work with this client demographic receive. This is one of the ways I create affirming space for clients with chronic health issues; nothing is "too weird" to talk about here. Honestly, having a ch
ronic illness is a weird experience. This is where you bring that reality. If you think a request or a symptom might be too odd to tell me about, try me! As a therapist for clients with chronic illness, I'll probably be excited (and a little surprised) if it's something I haven't heard before. Whatever it is, we'll figure it out together. The answer is almost always going to be "yes".
Unique requests I often receive as a therapist for chronic illness and medical trauma:
“Can I do my injection during our session?”
Maybe it’s monthly subcutaneous immunoglobulin. Maybe it’s an IM antibiotic. Perhaps it’s an anticoagulant post blood clot. Maybe it’s an injection related to fertility treatments.
Sometimes, a client will ask if they can do their first (physician prescribed) injection during our session because they haven’t been able to work through their anxiety about it. Or, they’ve done so many that they’re now meeting an emotional or somatic resistance. If the client knows how to do the (physician taught) injection but they can’t get there when trying to do it, then yes. I’ll be there. Let’s see if we can get your nervous system there together.
“Can I take my pills while I’m talking to you?”
Many of my clients, especially my clients with Lyme, Long COVID, and ME/CFS, are taking 15+ pills three times per day. Between medication and supplements, the pill fatigue is real.
Sometimes, it helps clients to bring their sorted pill box with them and take their next dose while we’re talking. Or, sometimes they just have to because of the timing of the session. Often, I’ll have the client tell me a benign story while they’re trying to get all of the pills in, if the pill fatigue is creating resistance. It can help to slightly split focus (as long as the pills are sorted and ready, so you don’t have to count).
“Can we have my session while I’m in the parking lot of my doctor’s office?”
For my clients with medical trauma, this is has been a helpful option.
Sometimes, we schedule the session before an appointment with a physician the client is nervous to see. We review the client’s questions, concerns, and practice voicing them to address “freeze” responses that can happen in the clinic. Or, I’ll schedule after the client’s appointment if they’re receiving results and have what we call scanxiety, because they’re not sure what imaging results are or aren’t going to have revealed.
“Can I tell you about a bodily function or is that TMI?”
Nothing is “TMI” here. In fact, tell me everything. Are you freaked out about something your body did? I get it. being the owner of a rogue body is a wild experience.
Often, telling me about the weird physical symptom is the first moment I witness a client exhale since it happened. Maybe it’s a scary bowel symptom post surgery. Maybe it’s pain during sex that’s causing frustration or shame. Maybe it’s a urinary symptom a client feels embarrassed about. Saying it here, where nothing is too weird to talk about, opens up space for emotional processing but also for figuring out what we’re going to do about that next.
“Can I lay down during session?” or
“Can I close my eyes?”
For clients with orthostatic intolerance, POTS, exertion intolerance or post exertional malaise, it helps to stay supine during session. For clients with neuro symptoms, migraines or sensory sensitivity, it helps to close their eyes.
I don’t believe therapy needs to look one way to work. In fact, if you’re physically uncomfortable here and we’re exacerbating symptoms, I’m pretty sure it’s not going to work. I bring my toolbox (EMDR, Brainspotting, IFS, etc) and I adapt it to what you need, not the other way around.
PSA for Clinicians treating clients with Chronic Illness:
Life with chronic illness is weird. Make space for that.
Also, don’t under estimate the power of responding to an unusual question with “let’s figure that out together”. Most clients living in divergent bodies have had to try to contort or stretch themselves beyond capacity to fit into boxes they don’t comfortably fit into. They’ve also had to quietly navigate unusual symptoms alone. So, even if you’re not sure how to respond or navigate in the moment, allowing space to collaboratively figure out how you’re going to adapt the space or your approach to the client’s needs can be a corrective experience. So can allowing space for all the weird to be welcome.
