Is the goal in treating injury-exacerbated psychological problems to cure them? This would seem futile since many of these people have had, and will continue to have, problems for years and years.
The best we can do for a pre-existing problem (eg. Anxiety disorder or Mood disorder) that has demonstrably been exacerbated by injury is to return the patient to baseline.
Baseline would be the level of functioning at which they were prior to injury.
A mistake many clinicians make is attempting, during the course of injury-related treatment, to address many or all of the problems that have disturbed the patient for years. This can include childhood abuse problems, educational/learning problems, marital problems, identity concerns, and long standing phobias, addictions and/or characterological traits.
In order to adequately treat those problems arising from injury, it must be established:
a. What was the patient_s premorbid (pre-injury) status?
b. What are attainable goals?
c. Can the patient accept the limitations of care?
d. Can the doctor accept that there are issues and concerns that are not to be addressed at this time?
e. What is a reasonable treatment duration to determine the patient_s ability to improve versus the point at which no further improvement will occur?
Many patients have virtually no activities with which to fill their time other than their doctor visits. It becomes quite easy for them to allow care to languish for many months beyond that which is appropriate to treat their injury-related psychological disorder(s).
If the doctor permits the patient to set the boundaries, he/she has essentially set aside a major responsibility in patient care_that is, determining when care should be ended.