EXAMPLE ANSWER: Q26

Q26. Discuss the term malingering as it relates to your client and offer strategies to deal with this.

Learning outcomes: 1.10

Student answer Malingering is a term which has become more widely used within the popular press with the focus on ‘deserving’ and ‘non-deserving’ benefit recipients. As the criteria and assessments for benefits such as Disability Living Allowance have become more stringent, the opinion as to how someone “should” feel or what they “should” be capable of doing in comparison to others has become a contentious issue. Malingering in this context is seen as an exaggeration of physical or emotional symptoms with an underlying purpose of gain. It is often used when the reported pain or disability level is greater than ‘expected levels.’ Of course this is very difficult to address – everyone has an individual experience of pain and it cannot be subjectively measured. Added to the difficulty is reason for measuring – maintained benefits, compensation payments- and the potentially conflicting approaches of the client and assessor. The perception that an assessment is being completed to ‘remove’ or cut payments is one which caused ATOS healthcare to re-brand the assessment arm of its company in 2013 as it had become irrevocably associated with harsh assessment outcomes due to targets of reducing benefit payments Within this context hypnotherapy may be used to help address pain or underlying issues. Therefore the therapist may encounter statements which cause them to consider whether the reported experience is influenced by other factors. An example would be a client for whom a secondary gain of not being able to drive is that their partner has to drive them and therefore is ‘looking after them.’ In order to address this, the therapist would need to engage the client to be able to see that this is in fact part of what is happening. What could the couple do to spend quality time together rather than time just being driven? What does it feel like to be ‘looked after’ and why is this desirable? Does this relate to a fear of driving- if unable to drive I won’t have to take my turn? Are there other issues – if my husband has to drive me then he can’t drink alcohol… A control panel in relation to pain may increase the perceived control over the pain per se and the impact that it has upon the client’s life. They would then be able to examine and address what changes could be made to make this desirable for example work could focus on confidence and ability – feeling strong and independent (allowing that this is seen as a positive thing from the clients perspective). (LO 1.10 An understanding of primary, secondary, and tertiary gain, and malingering)

Tutor feedback (DO NOT delete/edit feedback. Write amendments, additional information & thoughts underneath this table) Correct, thank you a good comprehension of the term and how it relates in differing circumstances.

Q26. Discuss the term malingering as it relates to your client and offer strategies to deal with this.

Learning outcomes: 1.10

(Student answer here) Further Student Example Answer:  Malingering is often considered as intentionally (thou may be sub consciously) exaggerating symptoms and conditions for the purpose of gaining some external/secondary gains, such as if I’m too ill to do things for myself my partner will do them for me or I’m unable to change my life as its too difficult/stressful for me to do all these things today. By getting the client to see and accept this is their strategy and then they can take responsibility for their actions, which is the first step to bringing about change. To show them the positives in doing things for themselves, growing self confidence and self worth etc. or how each small step can build into a massive change over time and that they are able to grow as a human being with small changes on a daily basis.

Tutor feedback (DO NOT delete/edit feedback. Write amendments, additional information & thoughts underneath this table) Q26. Correct. You have presented an understanding of malingering and how to deal with such. Asserting that a person is malingering where the complaint is of a subjective nature is a tricky area In the Medico legal arena steps are taken to attempt to determine whether the individual 'should' be feeling pain, for example, to the extent that they state they do when dealing with issues of compensation for injury. Usually the term is used when the pain is not accompanied by objectively demonstrable organic abnormalities. However, sensations of pain are subjective and pain thresholds vary. As you say, this can be an subconscious process though the pain sensations can be very real. This often occurs in relation to complaints of pain in situations where the person is entitled to receive pain contingent compensation or is suing for damages. There are at present no valid clinical methods for detection of malingered pain, though hypnotherapy can often bring about significant relief with one's perception of pain signals when the secondary gain and/or other factors have been addressed.

(Further student work goes here if requested through feedback)