As a rehabilitation consultant or return to work officer, you've just been assigned a file for an initial assessment of a psychological claim, or a physical injury that has a psychological overlay. Are you feeling excited? Confident? Ready to face the challenge?

Like many rehabilitation and return to work professionals, you just might be feeling something different. If so, there are four simple steps to preparing yourself to deal with these challenging claims:

1. Take stock of yourself;
2. Adopt a "model" of the harm mechanism;
3. Use the opportunity to take a history to learn something new; and,
4. After taking the history once, it's time to change the story.

Each of these four steps will be explored in a separate article over the coming weeks.

1. Take stock of yourself

How do you react when you get a file with a claim of psychological harm, or a file that contains a psychological overlay to a physical claim? If you are not particularly comfortable with them, you are not alone. But it might be a good time to look at what it is about those claims that brings on that reaction.

These claims are different.

For recovery from physical injury, the professional helps the injured person get over their fear-avoidance reactions, understand their healing progress, test their limits and transition back to work as the physical injury is resolved. The biggest trick is getting everyone to work together toward the goal of return to work.

Psychological injuries don't seem fit well into the same paradigm. The knowledge and techniques that you have developed working with physical injuries don't always apply in these cases, and you might not understand them as well as you might like. Your "tool box" might not be as full as you might like either, leaving you feeling ill-equipped.
 

It's hard to understand what's going on

Psychological claims are quite subjective in nature. The language to describe them isn't very explicit and you can't just point and say "it hurts here". When you have not experienced the same thing (or experienced something similar but it had a less severe effect), it's harder to empathise with the injured person. If you don't really know what's happening, it's hard to either have an impact or to relate to the injured person's challenge.

Cooperation is hard to get

There is a reason that employers are less cooperative in these cases. The issue of "reasonable administrative action" often makes these cases adversarial. The employer feels like they did the right thing and they are now being "punished" with a claim and an employee that they cannot manage, correct or discipline. If the employer is resistant, it is essential to understand the nature of the resistance so that there is a chance for successful return to work. There is often resentment towards the employer from the worker that must be addressed as part of the return to work process. Moreover, the health care providers may or may not be making matters worse by either being dismissive or overly solicitous of the complaints.

The clients are not always pleasant to work with

People in psychological distress are often less able to gauge their impact on others, sometimes distrustful of interventions seen to benefit the employer and may have a pain-avoidance reaction that makes them seem overly reactive or sensitive. It is sometimes difficult to identify with such people and the lack of identification can interfere with the process of helping them find a solution to the problems they perceive.

The result of these factors may be a withdrawal from active involvement in the case, in favour of coordination of efforts to resolve the complaints by others. The withdrawal may be perceived by the injured person as a rejection, and returned in kind.

The claims take too much time

The claims take extra time because much of what is currently done either doesn't help, or may actually further entrench the injured person's behaviours. Success rates are low for many of the same reasons. Most likely, this reaction is a combination of one or more of the concerns already mentioned. If you understand what is causing your reaction, you maximise your chances of making a difference.

The worst is over

You've done the hardest and most important part – you've taken an honest look at yourself. You can't address what you don't acknowledge. But to get to success needs more than a clear idea of the destination. Next time we'll discuss a "road map" that will also help you on your way.