Vocational Implications of Psychiatric Disabilities
Anthony, Cohen and Farkas postulated that a person's diagnosis or set of symptoms does not determine certain career areas or employability (Anthony, Cohen, Farkas, Gagne, 2002). Their premise is that it is more important to focus on how an individual functions in the work world than on specific limitations or symptoms. The medical model has often been used to identify functional limitations. This is helpful when looking at areas that need to be acknowledged or strengthened but it can also be limiting. The rehabilitation model in comparison emphasizes a person's strengths, abilities to grow, change, improve and make progress.
Specific skills, interests, abilities and strengths are more important factors to understand in the career development process. Understanding psychiatric disorders, treatments and therapy approaches provide the counselor with a shared language and a common structural basis for working with the mental health system and the client's support network (Anthony, et al., 2002). Overemphasizing a psychiatric diagnosis can obscure the career counselor's perceptions in evaluating the client's potential and chances for career success. The role of the career counselor is to identify and build on the client's strengths and abilities.
Employment and careers provide many psycho-social benefits which can assist persons with psychiatric disabilities to become members of the work team, create bonds with co-workers, build friendships and contribute to their communities. Career possibilities for persons with psychiatric disabilities can range from competitive positions in the labor market to jobs in sheltered employment settings.
"Some individuals with mental illness, such as bipolar disorder or schizophrenia (whose symptoms are controlled by medications) have the ability to work in high-paying positions in professional career tracks. Those whose symptoms are less well controlled may still be capable of jobs in the competitive labor market. Some individuals whose acute symptoms are seriously disabling may only be capable of working in supported employment settings". (Anthony, et al. 2002)
Collaboration and Engaging Clients
Building rapport and working collaboratively with the client is an important part of the career counseling process. Be aware of the diagnosis, but do not treat the individual as the diagnosis. Respect and appreciation for each person's unique career and life journey is essential. Carl Roger's client-centered approach, congruence, authenticity of the counselor, unconditional positive regard and empathetic understanding for the client are good guidelines to utilize in the career counseling process. (Rogers, 1951)
Initial positive contact and connection is very significant in setting the tone for future meetings. Active listening, empathy and direct eye contact can help someone who has been marginalized in life and within the mental health system to feel more confident. Validate frustrations and emotions for the client to feel heard and understood. Explain the client's responsibility for action. Clarify expectations by getting a commitment and outlining a protocol about making and scheduling appointments.
Define the career development steps each individual is expected to follow. This creates a road map. If an individual starts to experience an increase in symptoms or is slowed down by side effects of medication, personal obstacles or lack of resources, refer back to the road map. This ultimately helps to arrive at the destination: a career area to explore. Each goal in the plan can be broken down into small steps, which can be broken down into even smaller steps. If any activity is too much or becomes overwhelming, it can be scaled back to what the client can more easily accomplish.
The key point to making progress is taking action and following through on agreements. The mental health system often reinforces a passive attitude. If a client arrives for counseling with hope and an idea for a career goal that is beyond their present capacity, frame the career plan and strategy in terms of short and long term goals. Short term goals can complement and add up to the career goal that presently appears beyond reach. People increase their capacity and build on success by advancing through the career plan.
Many individuals with long term mental illness are beginning career development a decade or two behind their peers. Clients with bipolar disorder, depression or PTSD tend to have more of a job history than those with schizophrenia. A key indicator in the beginning of the career development process is past job experience and job history. (Henry, Lucca, 2004). Begin to identify transferable skills. Start rapport building by getting to know the client's abilities, skills and strengths simply by asking, "What experiences in your life have been most meaningful?"
Frame the career development process as exploratory, rather than all or nothing, to help overcome anxiety and fear of failure. The client may have been in crisis management mode in which their effort has gone toward limiting symptoms. Help provide a positive approach that expands their awareness beyond crisis management to increased knowledge that opens up possibilities for the future.
A significant part of the career development process is to empower the client and provide information and hope. Informational interviews, completing a career interest inventory and designing a resume are all concrete activities that give the client a sense of identity, a clear objective and hope about the future.
Anthony, W.A., Cohen, MR.,Farkas M.D. Gagne,C.(2002). Psychiatric Rehabilitation, (2nd edition.) Boston, MA; Boston University, Center for Psychiatric Rehabilitation.
Henry D. Alexis, Lucca Anna M. (2004) Facilitators and Barriers to Employment: the Perspectives of People with Psychiatric Disabilities and Employment Service Providers. IOS Press Volume 22, Number 3/2004.
Rogers Carl, (1951) Client Centered Counseling, Boston: Houghton-Mifflin.
Janice D. Rubin, M.S., CRC, CDFI, is a self-employed Vocational Rehabilitation Counselor and Career Development Facilitator Instructor. This is her eleventh year as a self-employed counselor. A large part of her work is with the state offices of Vocational Rehabilitation. She lives and works in Eugene, Oregon and may be contacted at firstname.lastname@example.org.