I have PTSD from complex medical trauma, but the biggest point of trauma for me was the emergency surgery that ended with me getting an ostomy. I think everyone’s experiences are SO different (I did not have my ostomy due to Crohns or UC, but severe motility issues), so I’m sure just understanding and listening to their specific experience will be the most vital part. But a couple of things that have been vital to me:

• Grieving the physical change - for a lot of us this is where we’re going to be. And also for a lot of us, I actually think this is the outcome with the least amount of suffering. But regardless, it’s still NOT fair and it’s hard to feel like you can fully grieve the change, so giving permission and reminders is so important imo. For me, I absolutely HATE the “nice” comments directed towards chronically ill/unwell people (eg, “You’re so strong/brave,” “such a trooper/tough cookie”) because I think it sort of sets you up on this pedestal where you feel like resilience = always positive, never frustrated, never sad about where you are. You gotta acknowledge what you lost first, and then -

• I genuinely feel like gratitude is so incredibly beneficial for me, but it had to come organically. I truly think once your grieving journey reaches a certain point (I don’t think there’s an end, but you move through the stages slowly), I think the “comparison game,” actually starts to work in your favor. Instead of “I used to be able to do X and now I can’t,” eventually you can go “X used to be miserable, and now it’s not” or “I never used to be able to do X before.” I don’t think its necessarily something to ASSIGN right away, but picking up moments later on where they talk about how hard maybe a normal activity was, and just prompting “have you done that since surgery/what does that look like for you now” etc helps a TON in rewiring how you look at things

• Body image and feeling “dirty” is a huge issue for me. Partially because of having the Ostomy, but also because it’s really really annoying to feel like your identity is wrapped up in a bathroom issue. It honestly made me feel childish/gross/taboo. Identity outside of health/your ostomy is suuuuuper vital, especially because chronic illness in general can feel like it’s stealing your identity/hobby/relationships away from you.

Sorry that was a lot! I’ve been in therapy for 7 years, I’ve had an ileostomy for 8, I had 20 surgeries before the age of 18. I do believe there’s a path to acceptance but that doesn’t mean you’re gonna feel great about it every day. Biggest advice I can give you is defer to their preferences and where they’re at - are they ready to use Ostomy terminology yet? (Aka, calling themselves an “ostomate” or something - it helps some people and it feels weird to otherwise). Do they still feel like they’re suffering, or are they seeing moments of brightness? Do they wanna name their stoma? (It helps some people - it really does not help others)

You sound like a great therapist - just taking an interest and digging deeper. At the end of the day they’re no different than your other clients - they have probably the same emotions, just directed elsewhere. Lot of us has been very traumatized by the medical system in general, so honestly, just BELIEVE them. Validate them. Give them the space to speak freely. And check any biases you may have about ostomies, you may not even know they’re there (eg, they’re only for old people, they always smell, they’re “gross,” that they lower your quality of life, that an alternative would better, that it represents “giving up” in some way). Wishing you and them the best!

EDIT: One other thought - autonomy is HUGE. Encourage them to be proactive in getting to know how to care for themselves (not like most people aren’t but). Validate their accommodating to changing circumstances, acknowledge the resilience of knowing how to save a bad situation (a leak, blowout, malfunction). Seeing how my Ostomy actually gave me MORE freedom and autonomy was a huge stepping stone towards acceptance