Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

Nurturance or Nonsense?

Under the guise of kindness, too much nurturance can undermine case management.

Anyone put in a patient role can become mildly to moderately manipulative
Patients can learn to be demanding and entitled very rapidly
Meeting a patient’s dependency needs often does not enable the patient to recover
The ultimate goal of any relationship is to have the patient become self-sufficient
Patients can have financial, drug, and even criminal concerns that they do not share but will use their illness role to their own advantage
It is easier to drug-seek when you have someone whom you have convinced that you cannot function without narcotics
There is always the potential for counter-transference in which the case manager or even the primary physician becomes overly identified with the patient_s plight and loses objectivity while concurrently lacking all of the data.

By way of analogy, I recent saw a patient whose concept of disability was being strongly advocated by a pain clinic which was providing him with high levels of OxyContin. The pain clinic, however, was sorely lacking in data regarding the patient’s criminal, economic, addictive, and social past. This included his dishonorable discharge from the military, drug convictions, alcoholism, past prison terms, estimated eight divorces and other data which suggested that he had poor impulse control and perhaps incapacity to benefit from his own experiences.

While becoming supportive of a patient is appropriate, it quite often occurs with decidedly poor understanding as to what is truly operating the patient.

If the case manager appears overly involved, she should be redirected as to whether she has a full and accurate understanding of the patient.

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