The Forensic Examiner Articles

Loss of Self-Esteem

Another significant factor in resisting a return to work after an illness or accident is rooted in psychological issues such as depression, anxiety, and low self-esteem. Frese and Mohr (1987) stated, “Depressed persons who are inactive and pessimistic in their outlook will be unemployed much longer or will become unemployed more readily.”

Weinstein (1978) pointed out that a worker’s loss of self-esteem taking place simultaneously with decreased productivity are two key factors in unacceptable disability that requires an explanatory event, such as a future accident or injury in order to justify continuing dysfunction and ultimately a prolonged period of lost time from work. In other words, Weinstein believed that a worker’s loss of self-esteem is a key predictor to future vocational disability even before the accident that will be labeled the cause of lost time. Furthermore, Weinstein pointed out that following the explanatory event, medical, psychological, and social factors may actually work to restore the individual’s self-esteem and allow for him or her to be declared “honorably disabled,” thereby signaling a stabilization and chronicity to the disability.

In the final analysis, intractable cases of depression and/or personality dysfunction will need to be referred to competent mental health professionals who understand behavioral medicine and the importance of vocational rehabilitation. Of course, most rehabilitation counselors are not trained as clinical psychologists, but there are interventions that vocational counselors can and should utilize. Basic interventions that can be applied in counseling clients who are resisting return-to-work would include the following:

• Discussing the importance and the value of work with the client.

• Identifying and discussing psychological issues, especially depression, the loss of self-esteem, and the need to find ways to overcome them.

• Discussing locus of control and causal attributions and their significance to motivation and productive return-to-work efforts.

• Recognizing learned helplessness and planning a way to achieve countervailing strategies to prevent helplessness from establishing itself.

• Setting realistic goals with clients and helping them work to achieve goals.

• Supporting the client throughout the counseling and behavioral change processes.

Kelly (1955) said of vocational development, “It is one of the principal means by which one’s life role is given clarity and meaning.” Vocational rehabilitation counselors hold a significant responsibility to assist clients in understanding the obstacles to personal fulfillment through work and to provide the professional guidance to help their clients achieve clarity and meaning.

To be continued.