A consistently recurring problem occurs when attempting to assist injured workers who develop these high levels of distrust despite all that that is done on their behalf. I I refer to this as _the crisis of distrust and mistrust._ After an injury, a patient is placed in a helpless position and must invest trust in one or more people to insure that their needs are met. Often that trust is misplaced.
Ultimately, the trust needs to be placed in those attempting to treat and rehabilitate the patient. The only healthy assumption is that the patient wishes to, and is motivated for, recovery.
However, in reality, family, friends and others, may be invested with trust by patient without actually warranting this trust. There can be those close to the patient who manipulate him/her for their own gain. This gain can be a sense of control over them or the promise of a future financial reward.
The patient, in a position of vulnerability, places trust in those who have not earned it, and concurrently distrust those whose efforts would benefit them.
A case comes to mind in which an injured worker followed every medical visit with visits to his own physicians. He never invested trust in those providing care for his injury, and he consistently invested trust in those were often less skilled, and, in this case, gave him inaccurate information and ineffective care.
When you are attempting to manage such a case, it would be reasonable to state very early what your goals are, place it in the form of a contract so that the patient can review your goals for him/her. If you sense/detect that they patient is withdrawing trust and/or investing trust in counterproductive relationships, verbalize this observation to the patient. If he/she can accept redirection, then you can be of benefit to the patient. If data suggests that the patient has invested trust elsewhere in opposition to your efforts, you will certainly find yourself unsuccessful in rehabilitating the patient.