Dr. Jeremy Frank, Ph.D., C. Psych.
ASSESS-MED INC.
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Dr. Jeremy Frank is a Clinical and Rehabilitation Psychologist and his
training and experience to date includes work in psychological trauma,
the treatment of chronic pain, the assessment of disability, and
rehabilitation following injuries. He has completed the Microprogram in
Insurance Medicine and Medicolegal Expertise for Canadian Health
Professionals through the University of Montreal. He has considerable
teaching experience, having taught numerous undergraduate courses,
and having supervised Masters-level clinicians, doctoral students and
PhD-level psychologists in clinical and rehabilitation assessment and
treatment. He has co-authored a book chapter with statistical normative
data for using the Personality Assessment Inventory with Ontario MVA
claimants. He has performed thousands of psychological disability
assessments both at the request of plaintiff and defence, largely for
individuals who have been involved in motor vehicle accidents
(including Catastrophic, Post-104 disability, and assessment of treatment
necessity and other specified benefits), for individuals with WSIB and
LTD claims, and for individuals in other personal injury contexts (e.g.,
slip and fall, medical malpractice suits). His expert testimony has been
accepted by FSCO arbitrators. Dr. Frank currently serves as both Vice
President of the Canadian Academy of Psychologists in Disability
Assessment (CAPDA) and as chair of its Credentialing Committee.
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Psychiatrists
Psychologists
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Clinical Psychologists
Rehabilitation Psychologists
Neuropsychologists
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What are the symptom reports?
Is there evidence of a consistent and credible
presentation
Are there psychological impairments?
Is there a diagnosis?
Is psychological treatment required to address
the impairments?
Is there evidence of psychological disability?
Psychological assessment is multi-modal in nature – it requires
the collecting of multiple sources of data and a critical analysis
of convergences and discrepancies between sources of data.
Behavioural presentation
Self-reports at interview
Information derived from the medical brief
Information from co-assessors on a multidisciplinary team
Collateral information from family, friends, co-workers, etc
Psychological testing data
Psychological tests are one (albeit important) source of data that
must be examined in the context of other sources of data
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Performance Based Tests (e.g., WAIS-IV)
Self-Report Inventories (e.g., MMPI2, PAI)
Perceptual Tests (e.g., Rorschach Inkblot Test)
The onus is on the examinee to:
 tell a story
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that is consistent,
makes sense
is accurate
to try as hard as he/she can on testing challenges
presented
The onus is on the examiner to:
 consider all possible reasons why the examinee
may have provided invalid or distorted
information
PVTs (the old “SVTs”) – e.g., TOMM
Multidimensional “Personality” Inventories (e.g., PAI,
MMPI-2-RF)
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tap into highly improbable symptoms or experiences
tap into highly improbable symptom combinations
tap into patterns of responding which have been
shown statistically to be common among feigners vs.
legitimate responders
Severely depressed inpatients produce valid profiles that
show severe depression and not overreporting
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Assess consistencies between symptoms,
signs, scores on psychometrics, file
review, and common patterns of
psychopathology
Hypothesize about discrepancies
Do objective data support subjective
complaints?
Understanding the impact of psychological
impairments given the backdrop of their
personality, social environment and preexisting strengths and vulnerabilities.
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Malingering
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Deliberate Overreporting
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Non-deliberate Overreporting
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Severe presentation – e.g., severe depression
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Psychologists must consider the extent to
which the examinee’s background is
compatible with the normative reference group
Example: who has superior “mathematical
knowledge?” Battle of the sexes
Language, cultural effects
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Individuals from different cultures may
have different response biases:
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Items may reflect different content
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E.g., Yea-saying, nay-saying, Likert scale
ratings
E.g., sad, blue, down, heart-hurting, empty
Psychopathology itself can be manifested
differently
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E.g., Individual from traditional Chinese culture
may not exceed affective-depression and
cognitive-depression cutoffs but produce a high
physiological-depression score
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Multidimensional psychometric assessment
tools assess symptom severity, not
functional impairment
Disability assessment is dependent on the
credible reporting of symptoms and related
functional impairments
These tests assesses multiple domains that
can interfere with activity initiation,
persistence, concentration, and
performance or contribute to pain
experience
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Diagnosis does not equal disability!
One must arrive at a diagnostic formulation,
identify the resulting specific impairments,
consider essential tasks of a proposed job (or
other RTW demands) and determine if there is
a fit
Do the identified impairments allow the
individual to succeed with a return to work?
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Background
 2 years post-accident
 Suboptimal effort on FAEs
 Employed as a call centre technical support technician
Reported
 Mild to moderate pain
 Social isolation / avoidance due to anger and poor impulse
control
 Daily ETOH use
 Suicide attempts, one between assessment dates
 He tells me he drank two gallons of bleach the day prior to the
assessment. (Mr. B. G.: Bleach Guy)
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Behavioural Presentation:
Pleasant/euthymic, good range of affect
Testing
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TOMM – 35, 45, 48
SIRS – Definite feigning
MMPI-2-RF – Invalid based on over-reporting
PAI…
All three negative impression management scores
(the first of which is seen in the first peak to the
left) are very high
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Background
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Reported
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Public transportation driver involved in a pedestrian accident resulting in
death
Referred by WSIB
Charged with failing to yield to a pedestrian
Shaking and in shock after the accident
Denied negligence but expressed regret
Unsure if he was ready to return to work
Denied mood and anxiety symptoms or sleep disturbance
Reported stress
Observed
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Pleasant, engaged, and cooperative
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Testing
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DASS21 – Normal levels of depression, anxiety,
and stress
PAI…
The highest score on the profile is a measure of positive impression management.
The other measures suggest that he was not deliberately or consciously
denying problems
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Conclusion (after 6 sessions of individual
psychological treatment):
No signs of significant psychopathology or
distress
 Frustrated that he is being asked to return to
work on modified duties
 Discussion of the incident elicited regret but no
affective distress or anxiety
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