Let me tell you about a very strange transition that I see in my executive coaching practice. Fortunately, it happens infrequently, but when it occurs, I’m always amazed at how the rules of game shift – I think for the worse.

Here’s a typical narrative involving someone that I might be seeing.

An employee, invariably hard working and conscientious, begins to have problems in keeping-up with her  work. Paradoxically the cause can be even something good such as increased sales, although more recently in this tough economy it’s a trimmed payroll that increases the workload of all the remaining workers including my client.

Whatever the impetus, the first response of my conscientious client is to work harder – perhaps doing over-time, taking work home at night or coming-in on weekends. The initial step in the stress response has occurred, namely an increased activation of internal resources to meet the augmented external demands.

Continuing with the scenario, it is not unusual to hear that some of the additional duties require skills or abilities that my client is unaccustomed to performing. Since training funds are also limited, my client is told to “do the best she can”. When she comes to see me for the next coaching session, she is not only overwhelmed by the work, not only the amount, but also the difficulty of her new assignments.

Perhaps as well, the company has leveled its organizational structure so that my client is no longer reporting to her old supportive boss but a new VP who maintained his position in the organization by reading the “political winds” correctly. The current prevailing winds involve cutting costs. Instead of receiving support or concrete help, the employee gets stern talks about deadlines, with veiled hints of serious repercussions if they are missed.

At this point, the stress, initially characterized by over-work, begins to feel like something that threatens the employee’s basic job security. Now, instead of recharging her  batteries on the weekend, the employee finds it harder to turn-off her concerns about always being behind. As a result, she is less involved in family activities that now strike her as draining. Even when she is participating at home, she’s not really there since she is lost in a fog of ruminative thinking about problems and imagined horrible outcomes. Despite thinking about work almost all the time, she seems to fall further behind.

Although the details vary, the basic scenario is familiar to most people either from personal experience of seeing others going through this cycle. Most people would also agree that both the company, as well as the client have a problem. In fact, a good organizational psychologist, using a problem-solving approach, could point to any number of obvious targets of intervention:

• re-visiting the employee’s job description
• reviewing employee’s time-management practices
• creation of a formal training program to develop any required skills
• discussion with his (her) VP about more effective communication patterns

Now, I’m not sure that any of the above would work, but if they didn’t, I could think of ten other things that I might try. But, in this scenario, I rarely have the chance.Here is what often happens.

The obviously stressed worker with clear physiological symptoms of stress such as sweating, heart palpitations or difficulty breathing goes to her family doctor who hears about symptoms of anxiety. Invariably, the stressed worker is also emotionally beaten-down as her doubts her own competency either to do the job or deal with her aggressive boss.

The physician, recognizing symptoms of diagnosable anxiety or depression, prescribes an appropriate medication along with a note justifying a medical leave of absence.

At this point, a new entity enters the picture -a patient. Actually, a combined entity is produced the patient and her treating physician – often, an empathetic professional seeking to protect his patient from the work stressors while treating her disorder with medication. The problem is that the physician has only a limited view of the entire situation – details about the work environment or the client’s working style are rarely part of the doctor’s field of vision.

More importantly, this transition from worker to patient has now changed all the rules of the game.

• Instead of problem-solving, we are now treating.
• Instead of looking to the workplace for factors to change, we restrict our view to the individual.
• Instead of examining competencies related to work performance, we track symptoms.
• And most importantly, instead of dealing with an active participating agent, we interact with a victim of disease that has transformed an exaggerated but still understandable response to a bad work situation into a medical condition.

If insurance disability payments kick-in as salary replacement, then we enter a long and convoluted process to determine whether the patient is really anxious or depressed.

Precious time and effort are wasted as medical experts attempt with Jesuit-like precision to determine whether the person conforms to DSM criteria of a major depression or anxiety disorder. Meanwhile, the employee sits at-home, caught in a battle of validity where the name of the game is to prove suffering and disability. As the lengthy battle continues, the patient becomes increasingly disconnected from the workplace while steadily losing confidence about her unpracticed abilities.

Then, we wonder why return-to-work programs often fail.

Here’s the bottom-line:

Effective workplace disability interventions need to blend worker and patient. The transformation to an exclusive role as patient might immediately shelter the stressed employee from perceived hardships of the organization, however, in the long run, such a transformation does no one any good. We need to focus on the entire picture, worker and workplace, with interventions that keep the employee along with the patient. Solving a problem needs to be kept on an equal priority with treating a disease.