What My Thesis Taught Me About Rehabilitation Counselling


So.... did I mention that I wrote my Masters thesis on Self-Efficacy? That might explain why I've already published this post and this post about how important self-efficacy is in helping people get back to work.

The last two posts I wrote about this topic were all about what we already know based on the existing research:

  1. Self-Efficacy is an important factor in how people set, work towards, and achieve goals.
  2. Rehabilitation Counsellors MUST discuss self-efficacy with their clients if we want to look at the whole picture.

But today's post is different.

It's based on my actual thesis. The findings surprised me and brought up an aspect of Rehab Counselling that I hadn't considered before. I think you will find this one useful and I'd love to hear your thoughts:

Picture of a Spinal Cord - Self-Efficacy plays a role in recovery and working again

What I Did:

I've spent the last 18 months completing a study that looks at the role of self-efficacy in employment for people with a Spinal Cord Injury.

If you've read my previous posts on this topic, you'll remember that just because people can functionally achieve something, this doesn't mean that they will actually go out and do it.

The problem with vocational rehabilitation is that we still rely heavily on medicalised notions of fitness. We talk about capacity and readiness, compartmentalise the illness and in doing so we forget about the whole person: a complex bundle of thoughts, feelings and experiences.

It's these thoughts, feelings and experiences that help us make sense of the world, make predictions about the future and behave in certain ways. If our experience, observation, or some source of information tells us that we might not be successful at something - we probably aren't going to have a go at it.

The Study

As I began to interview people with a Spinal Cord Injury, it became clear that their decisions about working again were impacted by their self-efficacy. Just as importantly, the participants all wanted a career - not "just a job".

Returning to work wasn't simply a question of: "Can I work? Yes. OK- Off to work I go then."

The people in the study had a range of incentives for working - financial needs, a desire to contribute and be productive, wanting to be part of a community. But it appeared that that how they acted on these incentives, and their engagement in the job-seeking process, was impacted by their self-efficacy.

Boromir from Lord of the rings: one does not simply get a job thesis

People made self-assessments about all the activities involved in preparing for work, getting a job, and staying at work. Some examples:

  • People made career choices based on how well they felt they were functioning at home, what they observed others achieving, and the opinions of people in their social circle;
  • People who felt insecure about their ability to develop a resume, talk to employers, positively disclose their disability and ask for accommodations were less likely to have done so - they more often would seek out an employment broker to do this for them;
  • People who had used an employment broker to negotiate their employment and accommodations typically did not feel confident in their ability to ask for the support and accommodations they needed while at work.

The Meaning

So people with a Spinal Cord Injury who had low confidence in their ability to prepare for, return to, and remain at work were typically more passive in how they approached employment.

There's nothing wrong with using the help of an employment broker to get back to work. But when the broker leaves the picture, we have a person in a job where they have never had the the opportunity to develop the interpersonal skills needed to stay at work and progress their career.

Not being able to negotiate for accommodations or advocate for themselves (something that a Rehabilitation Counsellor would work with their client on) puts our clients at risk for unemployment in the long term.

Oh no! Now what?

Well, we need to be speaking to our clients about how confident they feel about the tasks involved in working again. For people with a spinal cord injury, this can include more instrumental tasks like being able to manage self-care or toileting at work.

More so, we need to be speaking to our clients about their confidence in talking to employers, advocating for themselves and their needs (not to mention selling themselves on their unique value as a person and employee).

Through helping our clients become certain of their worth, their abilities, and most importantly to feel secure in their capacity to cope at work, we are giving them the best chance of finding rewarding and sustainable employment.

If our clients' self-efficacy is low in these areas, we can address this through providing opportunities for incremental success, positive role models and verbal encouragement. For more practical advice, read my previous post on how we can help people improve their confidence and achieve the things that matter to them.

Your thoughts?

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