How do I calm a terrified or combative patient?

You have learned to settle most people who sit in your chair. The ones who still rattle you are at the far edges, the truly terrified and the openly combative. Those take more out of anyone, and being shaken by them does not undo how far you have come. Both the terror and the fight usually come from the same root: fear of being hurt and having no control. When you remember that the combative patient is often just a frightened one with sharper edges, they stop being your enemy. They become someone to steady, not to beat. Slow everything down when it starts to spike. Lower your voice, name what you are doing before you do it, give them one small choice so they feel some control. You cannot erase their fear, but you can be the calm thing in the room. Often that is enough to bring the moment back down.