Returning to work after lengthy rehabilitation
Successful rehabilitation sometimes gives the green light for a return to work. But does this depend solely on the quality of the rehabilitation? What is the role of the patient's entourage? What responsibility do employers and managers have? Are patients able to assess for themselves whether they are ready to return to work or to resume self-employment? Gabriel Oksenberg, Clinical Psychologist and Psychotherapist at emeis, highlights the conditions, obstacles and levers for a successful return to work.
Away from work: what are the psychological repercussions?
From the very beginnings of modern psychology, many thinkers have emphasised the importance of work in building and maintaining mental health.
Sigmund Freud, one of the founders of modern psychology, claimed that psychological health could be summed up as the ability to love and work ("lieben und arbeiten"). Work is not only an economic necessity, but also a factor in structuring personality, self-esteem and social integration. And yet, for many people suffering from serious illnesses or who have been involved in accidents, the inevitable transition to rehabilitation can keep them away from work for several months or even years.
Back to work: what matters
According to the EU-OSHA report (2016), "Rehabilitation and return to work: Analysis report", the rate of return to work after a long period of rehabilitation varies considerably: between 22% and 74% in the first six months after stopping work (early phase); between 44% and 94% after six months (late phase). The wide range of figures reflects the diversity of situations and contexts.
The severity of the illness or injury remains the main factor, both in the short and long term. Other important factors that encourage people to return to work are the adaptation of their workstation, access to rehabilitation care, the possibility of part-time work or even professional redeployment. Gabriel Oksenberg adds: "Maintaining links with the employer and support from the occupational physician or social services department significantly improve the chances of returning to work under the best possible conditions."
Going back to work: what role does our relationship with work play?
The conditions for returning to work vary so much from one individual to another that it is impossible to have a common approach to assessing and managing a return to work. Certain serious illnesses, such as cancer, and certain types of traumas can delay or even prevent a return to work. Added to this is a dimension that is sometimes overlooked: the relationship with work. "Workplace psychodynamics plays an essential role. I see patients who, in addition to their somatic problems, have complicated relationships with their work environment. Certain states of depression (burn outs) can be directly linked to the activity". Gabriel Oksenberg draws one conclusion from this: above all, don't conform to a stereotype of a 'good' return to work. The essential condition that could be common to all patients facing a return to work after a long absence is above all "their ability to listen to their own suffering. Only they know whether they are ready or not".
Returning to work means reflecting, repositioning and moving forward
Gabriel Oksenberg has observed how difficult it is for people to free themselves from the social gaze. Returning to work is sometimes motivated by fear of judgement and the desire to look good. Certain figures can legitimise the fear of losing one's job. In the private sector, employers are obliged to offer redeployment to employees who have been declared unfit for work after a long absence. But in practice, the actual redeployment rate remains low. According to various studies[1], it varies between 20% and 30%. In the majority of cases, redundancy is the preferred option due to the lack of a suitable position or if the employee refuses. "The risk is that the first signs of improvement may be interpreted as green signals for a recovery". Behind this eagerness, there is sometimes a real desire to return to work. This is the case for people who love their work and find it a source of fulfilment. For others, it's the feeling of guilt that predominates. So, it's important to take the time to sound out your deepest motivations, so as not to get carried away by decisions you may later regret.
The therapeutic role of work in rehabilitation
"The classic case is that of the lawyer; these are patients who don't disconnect and continue to work. They have organised themselves by putting work at the centre of their lives. Work acts as therapy for them. This over-investment in work during their rehabilitation prevents them from collapsing mentally because they still feel useful". One thing is clear: on the one hand, this rehabilitation through work does not concern manual professions. Secondly, it is only possible if the patient has full intellectual capacity. Once rehabilitation in a hospital or clinic has been completed, another form of rehabilitation takes over: rehabilitation through work. It is the company's responsibility to prepare for the employee's return to work and to support the employee's return, working hand in hand with the occupational health department. In addition, to ensure that the patient's return is as successful as possible, the manager will need to communicate with the team in order to get people talking. "By inviting the team to express their fears, doubts and resentments about a colleague's prolonged absence and a possible work overload, the manager helps to dispel fantasies and put an end to rumours," explains Gabriel Oksenberg. It's a win-win situation, and tensions are eased.
Caring for patients... and their loved-ones
"At emeis, we have a role to play in ensuring continuity of care. When we feel that a patient needs longer care after coming to us, we can refer them to a psychologist or a medical and psychological center to ensure continuity of support, at the same time as they return to work". The difficult times they have been through, the physical and psychological after-effects, can affect their self-esteem. For some people, returning to work is a positive form of therapy, and it's easy to get back into the swing of things. For others, it's much more complicated. It all depends on the individual's life history and psychological background: "People who have already experienced depression are more fragile and vulnerable. They tend to withdraw into themselves and develop a new depression". And Gabriel Oksenberg adds: "We must always legitimise the suffering of others and welcome it. This applies to both private and professional contacts. It's not uncommon for those close to you to need support in accepting suffering, including their own. They too are exposed to upheaval. If a father comes home with his leg amputated, the whole family dynamic is thrown off balance".
Preparing patients to return to work after a long period of rehabilitation is therefore a key stage in their treatment. Tailored to the individual, it takes into account the medical aspect, the patient's psychological state and the professional context. Successfully returning to work does not depend solely on the patient. It involves a whole range of players - the medical profession, the employer, family and friends - who, working together and through dialogue, will promote a return to work that is both sustainable and appropriate.
