Claimants who have experienced a psychological injury as a result of being in a significant accident will report a variety of psychological symptoms ranging from stress, trauma, anxiety, low mood and chronic pain. Some or all of these experiences may be severe, disruptive both at home and at work, and ongoing.
The initial medical and subsequent psychological report commissioned by either the claimant’s legal team or the defendant’s team will consider whether such psychological effects are severe and would be reduced and resolved by a series of therapy sessions with a psychologist. We know that many such symptoms gradually decrease and resolve over a period of six to 12 months, but for those that become entrenched and ‘chronic’, therapy should be considered and can make a significant contribution to recovery.
Following a comprehensive psychological assessment, the treatment of choice is predominantly cognitive behavioural therapy (CBT), one of the most popular forms of talking therapy for these types of distressing and unpleasant symptoms. It is popular because there is significant evidence that supports its effectiveness at treating a wide range of mental health disorders. How does it work? The main factors include:
- A focused and practical understanding of how the trauma has resulted in anxiety, avoidance and repetitive distress
- An understanding of how distorted illogical thoughts and ‘negative automatic thoughts’ have become upsetting and disruptive
- This gets explored in detail in conversations with a therapist who is ‘warm, genuine and unconditionally positive’ in their attitude to the claimant
- An understanding of how faulty reasoning (jumping to conclusions, overgeneralising, black and white thinking or plain illogical thinking) can adversely affect how the claimant operates on a daily basis.
How CBT principles can be useful
Here are some examples of how this works using two particular problems.
Problem one: travel anxiety
Following a serious road accident, individuals typically worry about getting back in their car, feel very frightened and, as a result, avoid many – if not all – journeys, either as a driver or passenger or both. They will often say things like “all drivers are idiots” and use this false assumption to back up their avoidance of specific journeys, for example travelling on motorways or busy journeys.
CBT helps to explore and modify their faulty reasoning and set goals to gradually start or extend their driving. As an example, for the driving phobic, i.e. someone who feels unable to drive at all since the accident, they are encouraged to drive in a local car park where traffic is non-existent. Therapists support claimants to practice short, easier journeys to start with and gradually, over a number of weeks, extend the length and complexity of journeys to build on confidence and competence.
The key to a successful outcome is the incremental goal setting so that the individual doesn’t feel too anxious and can learn through relaxation exercise training to control their anxiety. Some mild anxiety is, of course, understandable and unavoidable. In addition to this goal setting, the therapist uses their own warmth, genuineness and unconditional regard to build up a collaborative relationship with the claimant.
Problem two: everyday depression
The second example involves an individual who, as a result of the index accident, has lost considerable confidence in their abilities and is experiencing chronic low mood. CBT helps the individual be hopeful and, bit-by-bit, helps them build up positive thoughts about what they can do, rather than be preoccupied with feelings of inability and thinking they can’t do something.
It is not unusual for a depressed claimant to cut back on general daily activity, including socialising, due to the feelings of hopelessness and helplessness that have occurred and built up since the index accident. The therapist helps to set small, incremental goals for greater activity including leaving the house, shopping, part-time work attendance and other everyday activities. Having a supportive relationship with a therapist helps the claimant build-up confidence to become more active and this becomes a ‘virtuous cycle’ of positivity.
Therapy as part of the compensation process
Providing some time limited therapy sessions, typically using the CBT model, offers the claimant a route to improvement and relief from distressing feelings and thoughts and is a valuable mechanism for the legal team to make available to the claimant after a rigorous assessment.
The treating therapist will typically be asked to provide interim therapy reports to the legal team indicating changes and, hopefully, improvement in psychological symptoms. At an appropriate point, the legal team will often ask the initial expert witness psychologist to re-assess the claimant, advising on symptom change and the need for further therapy sessions.
Both the interim therapy report(s) and the independent expert witness psychologist’s second report are necessary for the ongoing review and conclusion of litigation.
There are several different models of psychological therapy. However, CBT has a considerable evidence base and is based on having a clear focus for treatment which entails practical steps to address the claimant’s presenting problems. This is not to reject the recommendation for other therapies such as EMDR, short-term psychotherapy, but CBT is widely thought to be the treatment of choice for many single-event adverse psychological reactions.
Professor Hugh Koch is a clinical psychologist based in Cheltenham. He is a Visiting Professor in Law and Psychology at Birmingham City University. Professor Koch is the author of From Therapist’s Chair to Court Room, published by CPD Publishings.
www.hughkochassociates.co.uk