Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression

Patient Candidacy

CandidacyCandidacy: A patient may be depressed, phobic, have a traumatic disorder, illness anxiety disorder or a host of other mental or emotional problems. This does not mean that psychological care can help all patients even though they have the same disorder.

There are matters of motivation, capacity to verbalize complaints, ability to develop intellectual insight and a willingness to follow through with a treatment plan. Not all patients have those positive treatment attributes. Despite subjective distress, not all patients are willing to address their problems. An analogy would be that a toothache does not drive all patients to a dentist. Or perhaps more directly, an orthopedic injury does not insure that the patient will comply with physical therapy; candidacy without willingness.

One of the refinements of psychological diagnostic assessment is that it can determine whether a patient is likely to benefit from care or even comply with the recommendation for care. Thus, we have:

a. Patient needs and will comply with care

b. Patient needs but will not comply with care

c. Patient needs and will comply with care but will not commit energy directed toward change

d. Patient does not feel he/she needs care But we also have another situation: Patient needs, wants and will comply with care, but if it continues “too long” a dependency is created.

This is very problematic since patients vary in the rapidity with which they respond. And during the course of psychological care, their medical and surgical care and providers, procedures and medications may have changed multiple times.  With these changes may come a change in their candidacy for psychological care.

One of the more complex situations occur when the authorized treating physician feels the patient needs care but the physician is resistant to hearing that the patient does not want and/or will not comply and/or cannot benefit from psychological care.

The physician sometimes sees the referral itself as “treatment,” but fails to appreciate the extent to which the patient’s motivation, or lack thereof, determines treatment compliance and outcome.

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