It is very distressing to see a psychologist begin to treat a patient who has not a clue as to why they are being seen.
They enter into open-ended “care,” and then, if office notes are even generated, the notes reflect complete non-relatedness of this “treatment” to the work-injury. Or, worse yet, the notes reflect elaborate descriptions of how the patient is a victim in the workers’ compensation system.
While the latter may well be accurate, focusing upon this with a patient almost always creates additional anger and animosity and entrenches any depressive symptoms. Identifying with the patient-as-a-victim leads the patient to believe that you can/will somehow change the system. Instead, the focus of care must be upon the patient’s strengths and viable options.
Also, and we have discussed this before, many industrially-injured patients do not have the educational/intellectual/social ability to benefit from psychological care. They may be marginally educated. Their only experience with the mental health system is often some relative with an addictive disorder, a relative in the State hospital or a family member with Alzheimer’s Disease.
The industrially injured worker in Georgia does not come from a social group that sees their shrink once per week, yet this is what they are said to need after work-related injury. This can be counterproductive, if not dangerous, in its encouragement of dependency.
In most cases, following a psychological examination, psychological care is not indicated and would not be productive. This is often true even for those patients referred for treatment.
If the patient does not know why they are in psychological care…the treatment plan and the goals of such…they should not be there.”
In those cases where psychological care is clearly indicated, it should occur 1-2 times per month and most often will span no more than 8-10 visits.