Getting ready for assessment: common issues and tips to manage resistance
Assessment is a key part of disability support planning and management for participants with a psychosocial disability, but it can be a fraught process for many participants, families, and support coordinators. Motivation, preparation, and openness to answering doubts about the process are critical.
Common issues that participants experience that could be contributing to resistance
-Fatigue from over-treatment and sustained contact with healthcare professionals. “I have way too many healthcare appointments and I’m tired of going over my story every week to a new person.”
-Stigmatising experiences with mental health professionals in the past. “I don’t need another psychologist telling me that my chronic pain is psychosomatic or connected to anxiety”.
-Feeling unclear about the link between assessment and request for certain supports. “I don’t know why a psychologist needs to see me, it’s pretty clear that I need stable housing. Can’t my case manager just provide a letter?”.
-Mental illness related capacity issues that affect motivation and willingness to engage:
- Debilitating paranoia, distressing hallucinations, severe motivation deficits and apathy associated with schizophrenia.
-Significant difficulties with trust and emotion regulation such as in the case of certain personality disorders.
-Attention, regulating emotional responses (e.g. aggression or irritability), task initiation difficulties associated with ADHD or acquired brain injury.
Managing resistance
-Ask and you shall receive a solution: Ask and listen, figure out the exact nature of the participant’s concerns. See common issues highlighted above. Strategies to motivate or prepare a participant for assessment can directly come from understanding the exact nature of their concerns and problem solving accordingly (e.g. pacing sessions farther apart so as to not overwhelm the participant week on week, scheduling sessions earlier in the day when participant’s hallucinations and paranoia may not be that disruptive).
-Link engagement with the participant’s goals: Participants may not fully grasp the process of assessment—recommendation—funding—supports—goals. Linking it to their goals and cherished aspirations motivates them to engage because it feels personal rather than procedural.
- Normalise discomfort: Anxiety, resistance or hesitation associated with seeing a new psychologist or sitting through an assessment process is normal. Ask what they need from you to make it a bit easy.
-Prepare the psychologist before session 1: They would benefit from the relationship you share with your participant and the nuanced understanding you have of what makes them tick and what ticks them off! If there is previous extensive patient history recorded in other reports, share that with the psychologist so that they don’t have go over all those details again. This saves the participant’s precious energy and puts them at ease.
-Prepare the participant before session 1: The psychologist can advise further on how best to prepare the participant if there are unique issues to bear in mind, or time and attention considerations, any considerations around how trauma may be discussed safely, etc. Ask them how their sessions are structured, how best to motivate the participant or set up the testing environment so as to sit through the 60 or 90 min session.
-Sometimes it is ok to back off and put the assessment process on hold: Where trust is still being established between a support coordinator and participant, or future engagement with allied healthcare professionals may be impacted, or the wellbeing of the participant may stand to suffer as a result of pushing through the assessment process, it might be wise to listen to your participant and actually put the process on hold. Revisit it when these background factors are more stable.