Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression

Jar

jarJar:  The purpose of licensing laws, and the restriction on the use of specific terms, is intended to protect the public. While there are many articles in print and online about psychological disorders, the people that discuss these disorders on television, for example, are often not psychologists. The viewing public may have no awareness of education, training or credentials. Some media personalities have never been licensed to practice; others may not be licensed but hold some obscure credential and others still may have once been licensed and surrendered that license.

There are a number of ways to search for and evaluate the credentials of those to whom you refer, or for whom you authorize care. It is not enough to rely solely upon a recommendation of the authorized treating physician or accept anyone who appears on a panel of providers.  A jar is intended to keep things outside and to keep things inside.

Before referring to specific clinicians in the field of psychology, this is the progression that I make and recommend, and this defines the jar:

  1. Verify that a person is indeed a psychologist licensed in the state of residence
  2. Determine if the individual’s training and claimed area of expertise treats adults with physical injuries and is not simply a general practitioner in my field
  3. Refer to the American Academy of Clinical Psychology to insure that the individual has been admitted; this, in turn, will also insure that the psychologist has been board certified in Clinical Psychology by the American Board of Professional Psychology
  4. Determine whether the individual is a member of the National Registry of Health Service Providers which insures that training and credentials are in order
  5. Optionally, see if the psychologist holds the Certificate of Professional Qualifications which makes all credentials available as a packet and adds some assurance that the psychologist’s credentials are also accepted in several other states

In the area of workers compensation, this is what I find most often:

– The individual is either not a psychologist but some form of counselor.

– The referring party may (but likely does not) know this.

– The counselor allows himself/herself to be addressed as a psychologist and does not clarify this to those referring.

– The treatment is not evidence-based (that is, the patient is seen at the personal discretion of the counselor, rather than scientifically-based standards)

– This person may primarily be involved with treating couples, children, addicted patients or corporate coaching.

Most often the insurer does not ask for specific diagnoses and treatment plan, and does not even request detailed progress notes for each visit.

Psychological standards of care are clearly outlined, but despite this, the patient is misdiagnosed and ineffectively treated. (and this is not brought to my attention for many months if at all.

Everyone involved in trying to mobilize the patient feels grave frustration and disappointment, but they also allow this process to continue without investigating credentials or challenging prolonged (>12 visits) or inappropriate (more than weekly) care.

Over-treatment enables dependency, not progress.

Bottom line:

  1. a) evaluate competency;
  2. b) authorize visits by number and frequency;
  3. c) request all notes; and

d), assess progress after completion of the initial authorized care before authorizing more

Always keep in mind that iatrogenic problems are those that are created in a patient for which care was the cause…not the cure.

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