How to Help Your Psychologist Help You

Jason Vella

Psychological Services Manager

Injury Treatment Pty Ltd

28 February 2016

A guide for Agents, Providers, Employers & Employees

A medical certificate is returned with a month long interval but no additional

treatment plan

Psych Treatment Plans use only broad terms such as ‘CBT’

It is simple to discuss progress in the gym, but confidentiality prevents detailed

discussion about progress in the counselling room

Suitable duties boil down to: You either can or you can’t

Job Dictionaries are precise for physical demands and general for psychological

ones

It is unclear where (or if) the psychologist draws the line between functional

treatment goals and whole of person treatment

Questionable diagnoses and questionable impact on progress

Practical workplace applications of therapeutic suggestions are absent

Familiar Scenarios?

Edwin Smith Papyrus

Anonymous 1600BCE(ish)

fMRI

History of Psychology

The Golgi Method

(1890s)

A scientific endeavour without direct observation

MBTI

Keirsey Temperament Sorter

MMPI

16PF

Jung’s Cognitive Functions

History of Psychology

16 Personalities

Personality Theory: Introspection + Statistics?

A. The development of emotional or behavioural symptoms in response to an identifiable stressor(s) occurring within 3 months of the onset of the stressor(s).

B. These symptoms or behaviours are clinically significant, as evidenced by one or both of the following:

1. Marked distress that is out of proportion to the severity or intensity of the stressor, taking into account the external context and the cultural factors that might influence symptom severity and presentation.

2. Significant impairment in social, occupational, or other important areas of functioning.

C. The stress-related disturbance does not meet the criteria for another mental disorder and is not merely an exacerbation of a pre-existing mental disorder.

D. The symptoms do not represent normal bereavement.

E. Once the stressor or its consequences have terminated, the symptoms do not persist for more than an additional 6 months.

Specify whether:

With depressed mood Low mood, tearfulness, or feelings of hopelessness are predominant.

With anxiety Nervousness, worry, jitteriness, or separation anxiety is predominant.

With mixed anxiety and depressed mood A combination of depression and anxiety is predominant.

With disturbance of conduct Disturbance of conduct is predominant.

With mixed disturbance of emotions and conduct Both emotional symptoms (e.g., depression, anxiety)

and a disturbance of conduct are predominant.

Unspecified For maladaptive reactions that are not classifiable as one of the specific subtypes of adjustment disorder.

Diagnostic Criteria: Adjustment Disorder

A. The development of emotional or behavioural symptoms in response to an identifiable stressor(s) occurring within 3 months of the onset of the stressor(s).

B. These symptoms or behaviours are clinically significant, as evidenced by one or both of the following:

1. Marked distress that is out of proportion to the severity or intensity of the stressor, taking into account the external context and the cultural factors that might influence symptom severity and presentation.

2. Significant impairment in social, occupational, or other important areas of functioning.

C. The stress-related disturbance does not meet the criteria for another mental disorder and is not merely an exacerbation of a pre-existing mental disorder.

D. The symptoms do not represent normal bereavement.

E. Once the stressor or its consequences have terminated, the symptoms do not persist for more than an additional 6 months.

Specify whether:

With depressed mood Low mood, tearfulness, or feelings of hopelessness are predominant.

With anxiety Nervousness, worry, jitteriness, or separation anxiety is predominant.

With mixed anxiety and depressed mood A combination of depression and anxiety is predominant.

With disturbance of conduct Disturbance of conduct is predominant.

With mixed disturbance of emotions and conduct Both emotional symptoms (e.g., depression, anxiety) and a disturbance of conduct are predominant.

Unspecified: For maladaptive reactions that are not classifiable as one of the specific subtypes of adjustment disorder.

Diagnostic Criteria: Adj. Disorder

Psychological Function

Psychological Functional Analysis

Cognitive

Accuracy

Attention to Detail

Judgement

Memory

Speed

Variability

Knowledge

Interpersonal

Team Size

Power Differences

Communication Style

Audience

Media

Age Range

Intent

Emotional Regulation

Conflict Management

Freedom of Expression

Access to Support

Access to protective

factors

Dealing with distress

Degree of Risk

Psychological Functional Analysis

Environment

Familiarity

Ownership/Control

Visibility

Required Travel

Dress Standard

Shift timing

Exposure

Culture

Management Style

Independence

Autonomy

KPIs

Organisational Alignment

Workplace Based Treatment Plans

Workplace Based Treatment Plans

Key Features:

Combination of treatment plan and a suitable duties plan goals

Articulates the specific functional demands associated with duties

Specific interventions are associated with those demands

Gradations are articulated as increases in functional demands

Treatment goals are functional/activity based

Time frames based on treatment or workplace needs

Workplace Based Treatment Plans

Psychological Treatment Formulation:

Early family history of conflict

Current financial concerns within family unit

Relationship conflict with spouse

Passive communication style

Avoidant coping mechanisms

Low self-esteem/tendency towards self criticism

Cardio-vascular symptoms leaning towards panic

Excessive rumination

Poor sleep hygiene

Social withdrawal and decline in usual activities

Low mood

An Example

An Example

Likely Capacity for Work:

Avoid contact with Manager

Travel/location restrictions

Avoid new customer meetings

Restricted meeting numbers/day

3 days per week

4-6 hrs per day

Likely Suitable Duties Considerations:

New/temp line manager

Provide new temp area

Stick to familiar areas

Temp suspension of performance

discussion

Hours

An Example

Functional Psychological Job Task Analyses

Functional Treatment Goal: Adapt to new geographical region

Cognitive: Develop understanding of new clients, develop new travel routine

Interpersonal: Build new sales relationships in person + remote media

Emotional: Dealing with frustration/rejection

Environment: Plan for unfamiliar routines & client locations, regular travel

Culture: Work to specific targets

Psychological Treatment Formulation:

Early family history of conflict

Current financial concerns within family unit

Passive communication style

Avoidant coping mechanisms

Low self-esteem/tendency towards self criticism

Cardio-vascular symptoms leaning towards panic

Excessive rumination

Poor sleep hygiene

Social withdrawal and decline in usual activities

Low mood

Relationship conflict with spouse

An Example

An Example

Graded Recovery at Work Towards Functional Goal

Potential Gradations:

Time to plan new routes

Time to develop strategies for new clients

Opportunity for regular review, with a meeting agenda

Structure client visit expectations in a way that supports time for practising arousal

reduction, note taking, debriefing

Attend clients with support

An Example

Graded Recovery at Work Towards Functional Goal

Potential Psychological Interventions:

Arousal Reduction

Education/Normalisation

Cognitive Restructuring

Exposure

Goal Setting/Planning

Time Management

Assertiveness

Where To From Here

Development of a best practise taxonomy for psychological functional demands

Earlier and more thorough integration of psychologists in RTW planning

Development of best practise models of functional treatment goals

Better understanding of confidentiality in treatment

Research into resilience in the workplace

Contact Details

Jason Vella

Psychological Services Manager

Injury Treatment Pty Ltd

Phone: 02 8746 1354

Mobile: 0455 086 141

Email: Jason.Vella@injurytreatment.com.au

Renee Thornton

General Manager of Customers

Injury Treatment Pty Ltd

Phone: 02 8746 3307

Mobile: 0415 620 298

Email: Renee.Thornton@injurytreatment.com.au