Clinical Assessment: Part II Returning to work


Clinical Assessment: Part II Returning to work

  • By Ian Bradley
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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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