Unfolding the values of work – therapists´ experience of addressing the return to work process in occupational rehabilitation based on Acceptance and Commitment Therapy

Abstract

BackgroundFacilitating return to work can be challenging due to the complexity of work disability. Few studies have examined rehabilitation programs based on Acceptance and Commitment Therapy that intend to support return to work, and none have investigated therapists’ experience with providing such programs. The aim of this study was therefore to explore therapists’ experience of addressing the return to work process in an inpatient occupational rehabilitation program based on Acceptance and Commitment Therapy.MethodsThis was a qualitative interview study supported by participant observation. Therapists were interviewed regarding their experiences with addressing return to work in an inpatient occupational rehabilitation program based on Acceptance and Commitment Therapy. In addition, the rehabilitation program was investigated through participant observation. The interviews were analysed according to Interpretative Phenomenological Analysis and informed by an analysis of field notes from the participant observation.ResultsAcceptance and Commitment Therapy was experienced as a meaningful approach to facilitate return to work, as it allowed therapists to address all relevant aspects of the individual participant’s life that might influence work participation. The therapists’ twofold goal was to support participants in building both a meaningful life and sustainable work participation. To do so, they attempted to instil long-term and interrelated processes concerning ownership, causes of sick leave, relation to expectations, the values of work, and the scope of agency.ConclusionUnfolding values connected to work participation might reconcile the tension between work and family life by integrating work with other areas of life. Providing work participation with personal meaning also seems especially commensurable with a context where economy presents a poor incentive for return to work. Therapists should, however, be attentive to the need to secure the prominence of return to work by relating participants’ chosen themes explicitly to their return to work process. Therapists should also be aware of the dilemma that may arise when they attempt to refrain from providing advice while simultaneously encouraging actions they consider appropriate to facilitate sustainable work participation. In addition, having an individual-oriented approach to occupational rehabilitation may obscure the extent to which return to work is a multi-stakeholder process.

Work ethics and societal norms influence sick leave and return to work: tales of transformation

“…It indicates that if the return is not in line with the individual's goal it may reinforce the tragic aspects of the individual's narrative, in the sense that they experience feelings of inadequacy and shame for not being able to return to work or perform as before their sick leave. A previous study suggested that therapists using an Acceptance and Commitment Therapy based approach to RTW found it beneficial to try to align personal values to work participation [6]. In the present study we can see the struggle involved in conforming one's own personal values to the societal values of work when abilities are lacking.…”

“…Over the last decades a shift has occurred in return to work (RTW) research, from a biomedical model to biopsychosocial model, which recognises that other factors, regardless of the injury/illness, can influence RTW [5]. Among these factors are age, sex, socioeconomic status, work demands, RTW-coordination and multidisciplinary interventions [6]. The interactions with the stakeholders involved in the process, such as the health care system and case managers at the Social Insurance Agency (SIA) have also been suggested as important influences in the RTW process [7][8][9].…”

Aligning stakeholders’ understandings of the return-to-work process: a qualitative study on workplace meetings in inpatient multimodal occupational rehabilitation

“…Coutu et al ( 2013 ) have emphasized the need to address illness representations to find consensual return-to-work strategies, or, at a minimum, ones that make sense to the employee (Coutu et al, 2013 ). A previous study on therapists’ experiences with addressing the return-to-work process in the same rehabilitation programme as this study found that the therapists attempted to help participants develop more appropriate illness representations (Klevanger et al, 2018 ). Aligning supervisors’ understandings of such representations may also increase adherence to the return-to-work plans made in workplace meetings.…”

Health, Work, and Family Strain – Psychosocial Experiences at the Early Stages of Long-Term Sickness Absence

“…Participants had mixed feelings toward being on sick leave. As described above, sick leave was experienced as necessary to redistribute remaining energy to improve their situation, but sick leave also led to social avoidance behavior and a feeling of being ‘abnormal.’ Working can be viewed as a signal to others that one is normal and beneficial to society ( Hamnes et al, 2017 ) and sustainable work participation has also been closely linked to experiencing a meaningful life ( Klevanger et al, 2018 ). Disruption of roles that are important to one’s self-image may cause individuals to feel ‘lost’ ( Goode, 1960 ), and illness may lead to loss of self-image and social isolation ( Charmaz, 1983 ).…”