In 2015, American workers reported 3.3 million nonfatal work-related injuries and illnesses, according to the U.S. Bureau of Labor Statistics. These injuries are commonly a result of motor vehicle or pedestrian accidents, falls, occupational injuries and workplace violence or trauma. In addition to the medical treatment needed for such injuries, seriously hurt workers also need care for the psychological or behavioral issues that often accompany such injuries, such as pain and the inability to return to work.
One of the psychologists meeting the demand for this much-needed service is Howard Rombom, PhD, clinical director and CEO of Behavioral Medicine Associates in Great Neck, New York. Rombom and his team of 40 clinical psychologists provide cognitive-behavioral therapy (CBT), cognitive rehabilitation, pain management and evaluations to injured workers through the New York State Workers' Compensation Board.
The psychologists, most of whom are co-located in physicians' offices, work to help patients navigate their altered lives, says Kari Sherman, PhD, who has worked as a psychologist with Behavioral Medicine Associates for more than 15 years. "This isn't the end for them, but for a lot of these patients who have worked their whole lives, it feels that way," she says. "We teach them how to manage their pain, move on in their lives and often help them get other jobs."
The Monitor talked to Rombom about his work and how he built his business.
Tell us about your role as a workers' compensation psychologist.
The vast majority of patients we see are dealing with chronic pain and disability. These are individuals who have been working their whole lives, who have gotten injured and are not going to be able to return to their jobs. One of our primary functions is to teach them psychological pain management techniques, such as relaxation training, meditation, attention control and even cognitive restructuring. These treatments help patients develop another way of looking at things so that they can reduce their level of distress.
Support is also a huge piece of what we do because by the time we see them, very few of their families and friends want to pay attention to them. They have their own lives, they're busy and they don't have the capacity to be sympathetic any longer. We see a lot of families where there's some dysfunction now because the individual who was out of the house 10 hours a day is home all day now, and that can sometimes negatively affect the family dynamic.
In the midst of today's opioid explosion, we also try to help people develop techniques so they can cope with the pain without taking enormous amounts of painkillers.
What kind of trauma have your clients experienced?
We see a fair amount of New York City transit workers, including drivers and subway operators, who have experienced a psychological trauma. For example, some have witnessed people attempting suicide by jumping in front of a train. The train operator is mandated by the state to examine what they hit, so we see a lot of train operators who are traumatized by that.
There are also transit workers who are abused or assaulted and spat upon, and although being spat upon is not necessarily dangerous, it's still disgusting and degrading, and if the spit gets into their eyes or nose or mouth, they have to take antiviral medications, and for a period of time, they're wondering whether they've been infected with HIV or hepatitis C.
We also see home health aides who were assaulted by the people they're taking care of, psychiatric aides in hospitals who were assaulted by patients, as well as paraprofessionals in schools who were assaulted by students.
We also launched our own cognitive rehabilitation program about three years ago because we were seeing a lot of patients with brain injuries. I hired a neuropsychologist to help develop the program and guide us through it.
How did you get into this line of work?
After receiving my PhD in 1976, I worked for the New York City Department of Health, and then went into private practice. I started receiving referrals from a number of physicians who were seeing patients who had pain and other psychophysiological difficulties as a result of work-related injuries. Over time, I began to see that there were so many patients who were suffering from chronic pain, disability and trauma and were not receiving any kind of psychological care. The more I began to listen to these patients and speak to their doctors, the more I realized that this is an area that I enjoy and that was underserved. It became clear that there was an opportunity to develop a psychological program that would focus on these workers.
How did you get the training and experience you needed?
First in graduate school, where I learned the fundamentals of CBT, and then as I began to work with this population, I applied the skills and concepts of CBT to these problems. I read and researched post-traumatic stress disorder and the behavioral treatment of chronic pain and attended seminars, consulted with other experts in the field and gained experience providing direct clinical care. Now, I've been doing the work for 25 years.
We've also had to master the workers'-compensation system, which is the billing, the collecting and the amazing amount of logistics and administrative work that goes into doing that. It's not a simple system. We often have to work with a client's attorney to get psychology established as part of the injury, which generally means having a hearing or deposition in front of a judge. Often the insurance company will have their own psychologist examine the patient and determine the need for treatment. All of these administrative bumps in the road are important for us to master because otherwise we can't serve our patients correctly—or make a living.
What is challenging about the work?
We're very successful, but a lot of our patients will continue to suffer at some level, and that can be difficult. Many of our patients have significant substantive physical problems, and their psychological treatment is somewhat dependent upon their physical condition—for example, if they're having a new surgery, which can increase their pain for a while and interrupt their psychological treatment. The aging process alone often exacerbates injuries in people with chronic pain. Our goal is to reduce the frequency, duration and intensity of their difficulties.
What are you most proud of?
We've taken psychology to a population that often hasn't been exposed to it, or if they have been exposed it's usually not been a good experience. I like to think that we're helping people understand how important and successful psychological treatment can be, and hopefully, if they have friends or neighbors or family members who may have different kinds of problems in their lives, they may say, "You know, I saw this psychologist once and it was a really good experience. Why don't you go see a psychologist?"
