Canadian Association of Occupational Therapists

Volume 6 (5), September/October • 2004

Three sessions and back to work: Seven more to ensure success

Jennifer Radley

When I met Alice*, a petite, polite, soft-spoken women in her late 40s, she had been away from her job as a sales representative at a pharmaceutical company for over a year. She had found that her performance at work was deteriorating, in addition to an increase in the frequency of her migraine headaches from which she had suffered all her life. Finally, when she was no longer able to function at work, she was diagnosed with major depression and went on long-term disability. She spent six long months feeling suicidal and barely able to manage her self-care, but with psychiatric care and anti-depressant medication, she slowly climbed out of the depths of her depression. She made an early attempt to return to work on her own, which lasted less than four days. Four months later, her rehabilitation coordinator stepped in to facilitate a healthier process. As the date approached for her to start a gradual, eight-week return to work, it was apparent that, although her depression had lifted, her basic coping strategies had not changed. In fact, because of the concern that her health might again suffer unless she learned new behaviours, I was asked to see her for 10 sessions through her transition back to work.

Alice shyly welcomed me into her home and proceeded to tell me about several sad personal events that had occurred in the two years prior to her illness, including three deaths and a faltering relationship. However, when asked about her work, her expression brightened; she loved her job, and the organization where she had worked for 10 years was friendly and supportive. Although she was looking forward to working again, she confessed that she was anxious and afraid of failure. Her self-esteem had plummeted.

As I discovered more about Alice, it was clear that she had not handled past misfortunes well, making poor choices and allowing herself to be manipulated. Under stress, she experienced gastrointestinal symptoms, would lose weight, develop frequent migraines and sleep poorly. With her return-to-work date looming, these symptoms were increasing. I had only three sessions to get her ready to walk in the door and prove she could do it, but I would continue to follow her for seven more weeks to help ensure that this would be a more successful experience.

My initial work with Alice involved teaching her about stress and coaching her in relaxation techniques. By exploring her daily routines and self-care habits, she began to establish healthier patterns and learn how to pace herself. She was given homework to build her concentration and stamina. The day before she was to start work, we went through the practical exercise of visualizing the entire morning in detail, from the moment she would walk through the door. She was prepared for every eventuality, including what to say to coworkers when asked about her long absence.

As I continued to see Alice while she gradually increased her working hours, we addressed several situations that arose on the job. With practice, she was able to communicate some of her opinions and concerns to her supervisor, and was surprised when they were well received. She negotiated a win-win, flexible work schedule to deal with her chronic migraine condition. Through learning about negative thinking habits, she began to develop a new perspective on situations that used to make her feel vulnerable or powerless. Rehearsing communication techniques to deal with manipulation and difficult situations proved helpful. Her confidence soared and so did the respect she received at work. She was delighted she could be more assertive and still be well-liked, which was vitally important to her. By setting limits on her time and energy, she was very focused and as a result her sales accounts increased at a higher rate than expected.

On a personal level, Alice made an important decision about her on-again off-again relationship: to end it. Although it was difficult, she decided that the manipulation and game playing was damaging to her self-esteem and that she deserved better. She joined a club and began to make new friends.

When I last saw Alice, she was back to a full-time schedule at work and doing well. There had been a few days missed due to migraines, but she had made them up according to her new flexible schedule. Her clients were reportedly glad to be dealing with her again and sales were on target. Still eager to improve, she asked for a list of relevant reading material and relaxation tapes. I had no doubt that she would soon be visiting her local bookstore.    

* not her real name         

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