In this final part of a four part series, the discussion of readiness to assist in psychological claims turns to establishing an overall goal for rehabilitation. In prior articles we have discussed the beliefs and attitudes that impact upon the rehabilitation professional, the conceptual model that organises thinking about these injuries, and the gathering of relevant information.

The problem with psychological claims is that people lock themselves into a repeating story about what it is that's wrong with them and the nature of their limitations. The story gets repeated over and over as the injured person encounters new people during the process of intervention and care. They repeat it to their friends and family. But most of all, they repeat it to themselves, over and over and over. Practice makes perfect. With enough repetition, any story can become a person's reality.

Contrast this with the fact that our psychological state is always changing. Whether the scenario is improving or the opposite, the people involved are always reacting to the current environment, including each other. Even focusing on the injured people, we often see good days, triumphs, bad days and setbacks. At the same time, diagnosis in psychological claims is most often a snapshot frozen in time, as if once diagnosed the person will always have the condition described.

This difference between the reality of a fluid and dynamic psychological situation, and the fixed labels we place on people, can be a huge impediment to rehabilitation. Words have a lot of power. When a person describes themselves in terms of a fixed diagnosis, there is no possibility of change and little chance of variation. Their interpretation of events influences their perception of all that happens and the natural human tendency is to ignore or explain away anything that doesn't fit the expectation.

Now let's look again at the psychological claimant. Once a diagnosis is delivered, "what they have" becomes a big part of the story – after all, it's the external validation for all the pain they've gone through, and a key to their continued support. With enough repetition it becomes part of the unchanging reality of the story. Because the story doesn't change, neither does the reality of the person experiencing it.

As a rehabilitation professional working with psychological claims, the most important single job is to empower the injured person to change their story. I don't mean that they willalter the facts or their perception of what has already happened. But what hasn't yet happened can be changed, and recognition of the possibility that things can be different empowers an injured person to grow beyond their diagnosis, and toward a new reality.

How do you change the story?

First, stop the repetition. Brain scientists tell us that repetition actually changes the way our brain cells connect and makes for faster, "more automatic" responses. Anyone who has ever learned a sport, a musical instrument or just a route habitually travelled to work understands the power of repetition in establishing these habits. But we also know that if they aren't used, over time the learned ability decays as we get "a little rusty". This allows the possibility of a "new habit" to replace the old one.

When a person with a psychological harm labels themselves, uses technical language to describe current feelings or attempts to recite the story of their injury again, it may be appropriate to gently interrupt and guide them to understanding the difference between what happened (and what they have been told), and what they are experiencing right now and want to experience in the future.

That interruption should be followed with future-oriented questions. A few suggestions: “What are you feeling right now? What would you like the rest of your day to be like? How about the next month or next year? Would you like to return to the old job (if the "problem" were removed)? What would you like to be doing with the rest of your life? What would take to make you feel safe? What can we do together, right now, to start to make that happen?”

A strange thing happens when the injured person regains a sense of control over his or her life. They usually feel better. Some of the anxiety and hopelessness goes away, at least for a little while. Repeat that process and, over time, it becomes the new story. New habits of thinking can replace the old ones that weren't working. Almost every report of a "miracle" turn-around of a person who seemed to have given up on life started with their realisation that the future was available to them to shape.

Of course, getting yourself ready for these claims doesn't make the work any easier, or magically ensure success. But readiness to intervene and acknowledgement of the different tools needed to make a difference is a huge step toward becoming more comfortable and effective.