Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression

How Much Counseling versus Psychotherapy

1. Counseling occurs any time anyone assists another individual in decision- making or problem resolution. It entails recommendations, advice and information. It is not a mental health procedure; it is merely the interaction between two people. Thus, I strongly suspect you are actually asking about psychotherapy.

2. Psychotherapy is a psychological procedure in which the needs, drives, motivation, and goals of the patient are explored and revealed. Often the patient is largely unaware of the factors that are operating. Problems are confounded within distorted perceptions.

In the past 75 years, over 100 forms of psychotherapy emerged as theories of personality development and function have been refined. The one with which you would be most familiar is psychoanalytic psychotherapy which deals with unconscious, and often sexual, drives which have become distorted, repressed and/or denied.

However, in recent years the chief focus of psychotherapy has been on cognitive-behavior psychotherapy in which the patient is assisted in seeing the relationship between their beliefs and their behaviors, their distortion and their own role in their problems, and how each contributes to the other.

3. Duration of care has greatly changed over the years. There was a time when a patient was seen 3-5 times per week literally for years. Today, most managed care organizations authorize 12-18 visits, and the preponderance of effective work can be achieved during that timeframe.

I always recommend that when a patient is authorized for psychotherapy that the adjustor or nurse case manager request a treatment plan and prognosis. I recommend that the patient is regularly re-evaluated for progress and a change of provider be implemented if the patient is not improving. There are many (perhaps the majority) of injured workers who do not readily benefit from psychotherapy because of educational and cultural differences (and stigma) attached to psychological care. I also recommend that the primary provider (most often a surgeon in these cases) be sent regular updates by the treating psychologist since progress (or absence thereof) can impact compliance with orthopedic care.

Studies indicate that injured workers whose subjective complaints exceed their objective orthopedic findings have psychological factors impacting the recovery process. For such patients, an evaluation for the viability and appropriateness of psychotherapy should be considered.

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