Work and disability

It’s taken me some months to finally put something down about my favourite topic – work! I’m a fervent believer in the value of work as an incredibly important component of life, and one of the really telling ways to identify whether pain management skills have become embedded in the coping repertoire of an individual.

A model of work disability that I’ve found useful is based on Lent, Brown and Hackett’s social cognitive career theory, which is in turn based on Bandura’s work on motivation. This model suggests that people determine their work options based on self efficacy, outcome expectations and personal goals. Self efficacy is, in turn, based on personal performance and accomplishments; vicarious learning; social persuasion; and physiological and affective states. Outcome expectations are beliefs about the outcome of various behaviours, and personal goals are the determination to engage in a particular behaviour or achieve a certain outcome. In addition to these core areas, interests and values and contextual conditions influence opportunities and choice.

As a result of disability, individuals belief in their own self efficacy, and outcome expectations are changed. Many people find previous performance and accomplishments no longer count, anxiety about performance, as well as outcome expectations that they are ‘no longer reliable’ mean that they feel anxious about seeking work. Given the lack of knowledge about self that most teens have when choosing a career, it’s not surprising that people who experience work disability have a great deal of trouble identifying exactly what they can offer an employer.

Some of the basic predictions of the SCCT are: Some people eliminate possible occupations due to faulty self efficacy beliefs or outcome expectations, especially when they experience changed ability to perform tasks, without appropriate ways to test their strengths.
The greater the perceived barriers to an occupation, the less likely individuals are to pursue those careers So, if they’ve never been job seeking, they have trouble managing their home-based responsibilities, and there are no role models with disabilities in their employment history, it’s very difficult for them to consider a new work option.
Modifying faulty self efficacy and outcome expectations can help individuals acquire new successful experiences and open their eyes to new career occupations – and this is the work of a vocational specialist counsellor.

In our work as therapists, we all encounter situations in which we are directly or indirectly influencing the work choices of someone with a disability. It may be helpful to remind both ourselves and the person we’re working with that although their function may have changed in some domains, the majority of domains remain unchanged despite pain. So, although self efficacy for ‘lifting heavy things’ or ‘working physically’ may be changed due to poor biomechanics and difficulty tolerating increased pain, this doesn’t affect the global ability to ‘be a good worker’. We may need to support the person to become much more aware of their work style, and particularly their beliefs about what constitutes ‘a good worker’ – if their belief that ‘a good worker’ depends on ‘working 100% and not taking any breaks’, this will conflict with our suggestion that they break a task up into time contingent quota, and we may need to help them consider that ‘good workers’ come in many flavours!

Career decision-making tasks include evaluating career-related abilities and skills, gathering occupational information, selecting occupational goals, and making plans to implement a career goal (Betz & Taylor, 2001). Thus, career self-efficacy reflects an individual’s confidence in performing a self-evaluation, gathering occupational information, selecting a goal, and making implementation plans. We can help with each of these four areas within our therapy, by providing accurate self-evaluation, ensuring occupational information is gathered from as broad a range of job options as possible, helping realistc goal-setting to occur, and ensuring implementation plans are supported and monitored.

Helping people return to productive lives is an integral part of pain management – and one I hope we all can be part of.

Bandura, A. (1997). Self-efficacy: The exercise of control. New York: W. H. Freeman.

Lent, R. W., Hackett, G., & Brown, S. D. (1996) A social cognitive framework for studying career choice and transition to work. Journal of Vocational Education Research, 21(4), 3-31.


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