Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

For Whom is Brief Care Effective or Ineffective

If someone truly does need psychotherapy following injury, what are the current standards of care…and why?

For most injured workers, emotional upheavals are transient and tied to pain, economic changes, relationship pressures and fears of the future.

The current treatment paradigm enforced by managed care is short-term — a few sessions to relieve symptoms and quick termination. This treatment model assumes that emotional upset usually resolves quickly, especially with help.

Patients may return for additional sessions if there is a recurrence of difficulty.

For some patients, this model works quite well, is cost-effective, and avoids the stigma of mental or emotional problems. Even psychotropic medication can be added to the package, given the availability of relatively safe and efficacious selective serotonin reuptake inhibitors (SSRIs). The prescription most often comes from the patient’s primary care physician.

The problem with this ubiquitous conceptualization and treatment of behavioral health patients is that it may mishandle some patients who suffer from chronic or relapsing behavioral health syndromes.

Schizophrenic, bipolar patients, panic disorder, obsessive-compulsive disorder, anorexia nervosa, bulimia, generalized anxiety disorder, social phobia, chronic post-traumatic stress disorder (chronic), attention deficit disorder, dissociative disorders, sexual and gender identity disorders, and all severe substance abuse and personality disorders may not respond to the rigid boundaries required by managed care.

This leads us once again to the importance of accurate diagnosis and differential determination as to the true etiology (cause) of the psychological disorder.

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