Occupational Therapy enjoys an important relationship with the domain of work, with work being a primary occupation for human beings and one which gives identity, meaning, security and wellbeing.  In the UK the role of OTs in vocational settings has grown alongside a general growth in vocational rehabilitation services as a whole. Work has been a significant interest of mine both personally and professionally. Professionally, my last regular OT jobs were in vocational settings including a role as an Occupational Coach. Personally, I know all too well the effect that work related issues have on my wellbeing and identity.

One of the strengths of coaching in this arena is that it helps people clarify their values and desires around work, identify conflicting values and barriers to healthy work but also helps people with difficult transitions. Coaching also helps people build strategies at work to manage their personal wellbeing – whatever that may be.  So when I find coaching literature related specifically to managing long term conditions at work, my ears always prick up.

Browsing through the International Journal of Coaching and Mentoring Research is always a joy and this February a paper entitled “Coaching employees with chronic illness: Supporting professional identities through biographical work” was published (Beatty and McGonagle 2016).  “The coaching described in this study addresses both the workplace and chronic illness domains… the complex issues facing people with chronic illness at work, and ask how coaching can support their adaptation to evolving and on-going illness symptoms” (p3)

Importantly, this paper asserts that chronic illness results in “biographical disruption”, the physical self and on the person’s sense of identity. In reviewing the literature, the authors note four kinds of biographical work that need to happen: first is contextualising, in which the person incorporates the illness into their biography, by forward and backward reviews of the person’s life; second is coming to terms with illness and arriving at some acceptance that the body is no longer performing as previously expected;  third is identity reconstitution into a new concept of wholeness around their limitations; finally, finding new direction through biographical recasting.

This study looked at coaching as a specific means to carry out this biographical reconstruction. Participants were given 6, one hour coaching sessions, based on the semi-structured GROW format (behavioural coaching). This was followed by a survey 3 months later.

The results showed two types of internal biographical work: identity work and behavioural strategies.  The identity work revolved around 4 themes 1) accepting illness 2) realising value as an employee 3) developing confidence 4) establishing realistic expectations and goals.  The behavioural strategies revolved around three main themes 1) Understanding illness dynamics 2) Developing structures and processes 3) Adopting assistive devices. External biographical work also took place – that is coaching issues surrounding Impression management, Communicating about illness (including disclosure), and asking about accommodation.

The general feedback about the coaching was very positive: “Workers reported a variety of benefits from coaching … (it) helped them to accept their illness and to develop strategies for incorporating both the uncertainty and physical limitations of their illness into their work and personal lives. The positive results seen in this study indicate that contextualised coaching may also be beneficial to other worker populations who experience identity disruptions.” (p12)

I have long felt that OTs are ideally place to carry out this type of coaching – perhaps you already do? My assertion is that coaching should be the starting point and giving advice and information should be secondary. What do you think? You can see the full article here http://ijebcm.brookes.ac.uk/documents/vol14issue1-paper-01.pdf

June 12, 2016

Coaching for Chronic Illness at Work

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