The return to work from a psychological disability can be harrowing, but worse yet, it can fail.  A roundtable discussion and report from medical disability and human resource experts in Canada revealed that the longer the disability leave continued, the worse the prognosis for returning became.  Seventy-five percent of disabled workers are able to return after 12 weeks, only two percent after one year. http://www.mentalhealthroundtable.ca/june_2004/monitor_june2004.pdf

Although not examining psychological disability per se, Baril writing in the Society of Scientific Medicine in 2003 found that if a company was interested in the disabled employee’s well-being, perhaps by being willing to make adjustments to the job to accommodate the worker, then the return was more successful. This study also found that “the more contact with the co-workers, the better the results.

However in my professional experience, workers with stress or depression leaves, there are serious hurdles to overcome to maintain this contact.

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As explained in my previous posts on the topic of returning to work, the worker disabled by psychological workplace issues needs a comprehensive psychological and occupational assessment.  Often this dual assessment leads to various cognitive behavioural interventions that address the employee’s stress or depression as well as an understanding of the workplace issues that led to the stress or depression.

However, returning to work enlightened and rested is not enough; something has to change.  Hence, my clients and I spend considerable time developing a detailed plan of how things can be different at work.

Tackling the issues:

Sometimes The Plan focuses just on the individual worker.  For instance, I often help managers work on their organizational skills or sales people draw on their creativity.  Other times, a simple action plan related to health habits does the trick. Behavioral changes as simple as regulating sleep patterns or accommodating exercise into a busy work schedule often leave my clients feeling revamped and ready to work.

More typically, the plan involves another person – a boss, a co-worker or even a troublesome subordinate.  In my experience, it is rare that someone reaches the point of burnout just by working too hard; most often, there is conflict with another or several individuals.

Recently, I had a discussion with a marketing VP who was unnerved by the CEO’s weekly demands for reports of sales variances that might have occurred in any one of a hundred of the nationally-based retail outlets.  The conversations were always defensive – my client was only asked to explain why bad things happened, the boss never inquired about successes. The meetings became dreaded and began to color the overall interaction between the two individuals.

My client and I developed a plan around a meeting with the CEO where we established different ways of tackling the issue, the first step being a frank discussion between the employee and the CEO.

In other cases, the plan addresses the organizational culture.  I remember a senior financial analyst who had to deliver credit reports at a meeting where humiliation and attack were perfected to the level of blood sports. The meetings pitted those who wanted the deal on one side of the table against those who were opposed on the other; no matter what my client found in his analysis, he would be attacked by one side or the other.  I wish that I could report that a meeting with the organization’s CEO dramatically changed the climate, it didn’t.

In fact, the meeting could never realistically occur.  However, my client did return to work with a more adaptive attitude – he simply gave-up trying to defend himself and took on a new perception that the attacks were part of the “play” where various participants played their role.  In this case the plan was a cognitive shift that involved seeing the battle more impersonally.

Whether the plan involves a new exercise regimen or a new, more assertive approach to facing the boss, a successful return to work requires some form of change; rest just doesn’t cut it. When a realistic plan is developed, confidence to make a successful return to work is dramatically enhanced.

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This is another post in the series about returning to work from a psychological disability. Previously, I described some issues involved in assessing the clinical or psychological aspects of a workplace disability.   Now, we will examine the second half of the assessment, the occupational.

I begin with what the Industrial Psychologist calls the KSA’s, or my client’s knowledge, skills and abilities.  I routinely ask to see the client’s CV, recent performance appraisals, or even non-confidential work samples to get a better idea of how my client executes his or her job.  Most often, I’m impressed by the competencies that I see in my clients. In other areas, I’m able to pinpoint skills that need to be acquired or styles of execution that need to be changed.

In the stylistic area, I recently saw an engineer who managed several large manufacturing facilities. He complained that his written correspondence took too long. I quickly saw why.  Every memo to his plant supervisors was tediously long and painful even for me to read.  Each recommendation came with possible objections that were then logically refuted in Jesuit-like logic.  Upon questioning, it became apparent that he was writing the memos to avoid any potential disagreement – a kind of ineffective psychological insurance against conflict.  We discussed what conflict meant, and concluded that reasonable objections ot his recommendations could actually be a good thing rather than something to avoid.

Besides the individual’s own skill set, I’m also very much interested in organizational aspects including reporting structures, areas of responsibility and recognition policies / procedures in the organization.  Regrettably, it is in this area that I am saddened to find the source of distress of many of my clients.

I say that because I think many of the organizational problems that I encounter are simple to solve.  I don’t have a clue about how to build cars, run a telecommunications system,  or manage large tracts of rental properties, but I do know that it’s a good idea to do the following:

• clearly tell employees what they should do
• perhaps train them in some explicit way
• measure them performance in some semi-objective fashion
• reward them accordingly

To me as a psychologist this is all painfully simple, but for most of my clients, their workplace violates some basic tenets of good psychology and management.  I’ve had employees with bosses who took credit for their work, or with colleagues who jealously guarded important information as a form of job security. I’ve seen family business meetings rocked by emotional outbursts that would have shocked even season family therapists.

Paradoxically, many of these observations have been personally disheartening, but in a way a relief to my clients who began to realize that their working climate might have direct bearing on what they are feeling.  Clearly understanding the working style of the worker and their unique organizational context comprise the important second step of the assessment process.

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Most of my clients suffering from workplace stress or burnout have symptoms in two areas–clinical and the occupational. As a result, I have to treat the client’s psychological symptoms but I also have to understand how the factors in the workplace might have contributed to the presenting psychological symptoms.  Focusing upon just one provides only a partial solution.

In this post, I’ll describe the clinical.  When stressed workers first come to see me, they are often mired in the symptoms of their workplace problem.  The original problem in the workplace is often secondary to the subsequent emotional distress.  In other words, these workers are not only stressed or depressed, but also worried about their stress or depression.

If depressed, they are likely to wonder if their fatigue will ever lift, if their focus will ever be the same, or if they will ever be able have another night of restorative and uninterrupted sleep.

If anxious, they are worried if their physical symptoms of arousal such as their rapid heart rate or dizziness mean that they are physically sick as well as emotional upset.

Since most of my clients are successful managers or professionals not used to being disabled with psychological issues, it is easy for many of them to extrapolate a catastrophic spiral with imagined outcomes of poverty and unemployment.

Cognitive Behaviour Therapy or CBT offers many useful tools to help individuals in this acute phase of the disability.  As a first step, we work together to comprehensively untangle the jumble of upsetting feelings, ideas, and physical symptoms to produce a rational explanation of what is happening.  Often, in the case of depression, clients are unglued by their own state of lethargy and hopelessness, a reaction that serves to perpetuate their distress by diminishing their confidence.  In the case of stress, often clients have catastrophic interpretations of their physical symptoms or pessimistic scenarios involving their lifelong duration.

In this phase, we teach the importance of the so-called “cognitive model” where one one’s thoughts, especially the most pessimistic and alarmist, promote our upsetting feelings.

All of the above material is relevant grist of the mill of cognitive behaviour therapy; however, it does not address what caused the problem initially. For that, we have to advance to an occupational assessment.

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People are curious.  Office romances, organizational changes, either real or imagined, vie with hockey pools as major themes of work place conversations.  High-up on this water-cool conversational list are sick leaves, especially an absence related to psychological problems.

Whether it be; “There but the grace of God, go I” or “If she’s off with stress, then I should be at home as well” – the imminent return to work of someone with a psychologically-based disability will be on the radar screens of all your co-workers.

Most of my clients who are on the verge of returning want nothing to do with this potential conversation.

They appropriately view their problems as their own business. This privacy is fully endorsed and promoted by all the major players in the disability arena from the patient’s doctor to the company’s HR department.  In fact, in most North American work places, the confidentiality of an employee’s medical disability is legally enforced.  When I managed a hospital department, all I knew was that the employee was “off for medical reasons.”

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Return to Work