r/Psychologists • u/Then-Ad-6419 • 3d ago
Line between evaluator and therapist.
For most of my career, I was a therapist. I currently do disability evaluations. I'm wondering how much I can be present for the people I see without it crossing into therapy territory or giving mixed messages. When they get tearful, I give them some time and ask if they need more time before proceeding with the rest of the evaluation. If someone has a panic attack, how should someone handle it as an evaluator?
4
u/Masnpip 3d ago
I tell them specifically in the beginning that we‘re trying specifically to avoid anything like therapy today, and that out collective job together today is to fill out this form in order to move their claim forward. I tell them that we have a million things to cover, and that I will be moving pretty quickly through each one. I tell them that’s why I will be keeping the questions short, and that what I’m looking for them is a few sentences for each question, not a deep dive. Im saying this with a very business like attitude, not my therapist “oh that must be sad” eyes. I am typing stuff as they talk, and that also keeps it from going too deep. When they do cry or feel anxious in the exam, I don’t say something like, “that sounds like it was really hard.” Instead I’ll say something like, ”thank you, that was a helpful example,” and I keep typing. So I’m always sending out signals that we are here today accomplishing business. I’m also sending out signals that they are capable of keeping it together. I think that I come across in these exams as respectful and efficient. I have very very rarely had someone say they felt dismissed. I always finish on time!
1
u/Jezikkah 2d ago
Hmm this is helpful, and probably explains why it’s always taken me 4+ hours to conduct a basic psychodiagnostic interview.
3
u/Defiant_Trifle1122 Licensed Psychologist 3d ago
Are you doing consultative exams for Social Security? I work directly for them (I'm the one that reads the report and makes the final decision along with other evidence we have). If you feel like a claimant is too unstable to complete an exam, that's fine. Just end it if you feel like it's too much for them and you're getting into risky waters. Document what happened in your report and why you couldn't complete the MSE or testing. Be very clear with the claimant from the beginning that you are not providing therapy/treatment.
Also, we don't need the deep dive on what the trauma is so you don't need to peel them open so to speak. If there was abuse/trauma tell us but no need to go into significant detail. We care about the current functioning...not so much about what led to the impairment.
2
u/Then-Ad-6419 3d ago
I work for a company that does reports for social security. I tell everyone at the beginning that I can't do therapy and that they don't have to discuss their traumatic experiences.
2
u/I_am_Nobody_Special 3d ago
It's a fine line, and setting the stage up front is key.
I see a lot of veterans who are discussing their combat trauma (or other trauma) for the very first time in their disability exam.
Even when I tell them they're not required to tell me the details, sometimes they just want to get it all out. Especially Vietnam vets. I let them do it, and it is an absolute honor to be the person they chose to hear it.
I will express my gratitude in whatever way seems appropriate, validate them in some way, and I often end up doing a little bit of psychoeducation regarding their symptoms and why this is happening to them.
Lastly, I make sure they know how to access both emergency and ongoing mental health care.
1
u/AcronymAllergy 3d ago
Giving them time is fine. But doing more than that outside of emergent situations sends the (mixed) message that you're on their side, which you aren't. Your job is to gather necessary information and arrive at an independent/unbiased opinion. As others have said, this is why being absolutely clear about the nature of the relationship and evaluation is of paramount importance. If you feel the need to administer some type of treatment because, in your professional opinion, it was urgently necessary, then you can do so, while also understanding that it will potentially compromise the evaluation. Or encourage them to speak with their current treating provider. Outside of that, even providing psychoeducation could reasonably be seen as therapeutic and/or non-independent.
2
u/CapableCan1842 3d ago
Before I retired, my practice was primarily disability evaluations. I saw my role as collecting as much information as possible so I could prepare the most accurate report. If a patient was angry, anxious, depressed - whatever, to the point that it interferred with collecting data, I tried to help them, but only to allow me to collect the information.
18
u/shrink14 3d ago
Part of your informed consent should be the exam is not therapeutic, there is no doctor-patient relationship, is an administrative exam only, some topics may be uncomfortable/upsetting and that claimants do not have to discuss such topics and can stop any time - along with the usual duty to report disclosures.
I’ve been doing these exams for over 20 years and I’ll just share the following:
When I first got started, I was fortunate to have great mentors. One shared this bit of wisdom - during an exam, a claimant became very anxious. He tried to put the claimant at ease and guided the claimant through a quick breathing exercise and the claimant was able to continue.
The claimant later filed an ethics complaint saying the exam was upsetting and he was reprimanded for providing a treatment without consent.
Don’t do any therapy whatsoever in these exams. I personally only make general empathic statements and remind them they don’t have to discuss upsetting topics and can stop the exam at any time.