Clients asking for letters to get out of restrictions

[erg923]

Again, "disability" in a benefits context is NOT the same as "disability" in an accommodations context. The legal definition is literally not the same. Also, the ADA/504 are NOT "vague, academic musings"--they are federal civil rights laws with lots of expensive, detailed case law behind them.

Ok. Agreed. At least I think so. Although I've never really done any specific work with "accomodations." I kinda side with others on that, in that I dont really like getting involved with all that if I can help it if I am in a treating role. Anyway, was not really talking to you or your comments specifically. Was just a general educational comment that I think many psychologists do not adhere to or maybe even realize when doing this type of work.

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[cara susanna]

Again, "disability" in a benefits context is NOT the same as "disability" in an accommodations context. The legal definition is literally not the same. Also, the ADA/504 are NOT "vague, academic musings"--they are federal civil rights laws with lots of expensive, detailed case law behind them.

Would you mind sharing the definition of a disability when it comes to accommodation requests? When I thought of disability with, say, ESA letter requests, I had been thinking of it along SSDI/VA lines so that would be really helpful to hear!

 

[PsyDr]

Not sure where I called you names? I'm not really sure that anyone in this thread seems to understand disability law outside of SSI/SSDI/VA disability, which is a very different thing with its own definition of disability. Yes, functional impairment depends on the context for sure (legally and practically), but saying that you will never write accommodation letters for clients (which don't actually establish disability, but do establish impairment) because its a medicolegal thing is sketchy from a disability/civil rights point of view. Yes, treatment can work in a lot of cases--but it's not a cure-all, and if those clients want to access reasonable accommodations (which is a legal term and not up to the provider to determine), I don't think it's entirely ethical to not provide documentation, ever, on principal of "they should get better, so no accommodations."

Also, I' m baffled that people in this thread truly don't seem to realize that "disability" is a very different legal term outside of beneficiary laws and confers actual, federally protected, extensively legislated civil rights and protections. This is making me realize that we need some integrated rehab psych education somewhere in the APA-mandated curriculum, because I was honestly assuming that this was common knowledge.

1) You provided a misguided interpretation of my statements and said they were "ableist".

2) At no point did I ever say I do not write accommodation letters. I'm happy to write science backed accommodation requests based upon impairments.

3) I DID say that, albeit without substantial clarity, that the primary malpractice insurer for psychologists has said that ESA letters are contraindicated. The Trust opines that the purpose of psychological treatment is improvement. Consequently, such letters are de facto evidence that your treatment is ineffective. That's not my opinion. That's my malpractice carriers' opinion. I would hope that if you choose to practice in such an arena, you would know about this matter.

4) I find it interesting that you are referring to definitions. Which definition would you like to choose? ADA? WHO? AMA?

5) You are aware that ESAs are not covered under the ADA, right?

6) When you talk about the ADA, what is your take on the repeated use of such phrases as "objective" and "impairment" to the near exclusion of the term "symptom" within the body of the text?

 

[Therapist4Chnge]

I had a physician refer to me to do an evaluation for a patient who wanted an extension on a leave from work for anxiety, after exhausting a 2 month letter from her PCP already. I canceled the referral, of course. PCP asked me what they should do, refuse to write the letter, refer out for treatment, as the patient had thus far refused treatment recs. Additionally, from chart review, it looked pretty clear from other notes that the pt had been planning to file for disability so she could file early for retirement benefits through her job for some time.

I get those every once in awhile, and with few exceptions, they all refuse psychotherapy or say "Oh, I tried, but it's not for me." They didn't really try. Usually telling the referring doc that psychotherapy is 100% required and resistance from the patient can provide some useful information about their motives takes care of the case.

Sadly, with the coronavirus out there, I've seen an uptick in SSDI requests for documentation...0'fer a bunch for cases that were legitimate. People are afraid and often have limited options, but I don't support fraud. Also, the research is pretty clear that being on disability is associated with poor life satisfaction, so I don't want to contribute to that for any patient.

 

[Therapist4Chnge]

I had a patient the other day request I write a letter to the managing pain doc to convince him to change his recommendation of medical marijuana v. tramadol....but not both. Of course, this was all discussed already and agreed upon, but he was hoping I'd change my mind.

 

[Fan_of_Meehl]

And I should clarify that my original statement of "I don't write letters" applies to situations where a patient wants me to just fire off a professional opinion in the form of a brief letter in order to address some problem they're having in their life on an ad hoc basis and where they've already predetermined what 'my' opinion on the matter is and what they want me to say.

It does not apply to legit practice of psychological assessment and articulation of conclusions/ recommendations based on mainstream psychological practice in an established clinical, forensic and/or psychoeducational arena.

 

[deleted106747]

We have differing standards for “rage” apparently

Here's mine:

 

[deleted480308]

Here's mine:
View attachment 305193

By the picture, I think that was the michigan state house? I don't recall reading about that group of protesters assaulting people with any regularity, do you have any information otherwise? Because if yelling at the govt is the best you have, we definitely disagree on what "rage" is

 

[deleted106747]

By the picture, I think that was the michigan state house? I don't recall reading about that group of protesters assaulting people with any regularity, do you have any information otherwise? Because if yelling at the govt is the best you have, we definitely disagree on what "rage" is

Yes, if you don't see rage in that photo we most certainly do disagree on what rage is. Apparently, you think it must be accompanied by assault.

 

[deleted480308]

Yes, if you don't see rage in that photo we most certainly do disagree on what rage is. Apparently, you think it must be accompanied by assault.

I think a crowd of 100+ guys with guns that didn’t use violence wasn’t all that enraged.
So yeah, we disagree

 

[psychRA]

To push back a bit, accommodations are legitimate things. Of course, not every request for accommodations is reasonable, but provider letters for accommodation purposes are a legitimate thing (e.g., for academic accommodations, standardized test accommodations. etc).

Sure, and I used to write a lot of letters for academic and standardized test accommodations back when I did that kind of work. A key difference is that there is a lot of research and existing literature in the area of learning disabilities and their impact on academic function. All of my recommendations were guided by that literature. We also have well-established assessments for intellectual, cognitive, and academic abilities, so my recommendations were based on specific, well-informed diagnoses.

We don't have established measures to determine which patients would benefit from an ESA, nor do we have literature to support writing letters to landlords. And when it comes to COVID-19, I don't think we're in a position to say with any degree of confidence that the state's restrictions should not apply to an individual. I'm not an epidemiologist, I'm not a virologist, and I have no meaningful expertise that would allow me to argue that my patient's mental health should take priority over public health.