"My boss says I can't go back to work" - Deborah, client with aphasia
Many clients who come to the intensive program are still desperately trying to get back to their jobs, frantic and under pressure to get better faster. To have someone start with the idea that work 'wasn't going to happen' was new.
Many clients are determined that they will return to their previous jobs no matter what. Exact same company and position. There's a belief that their position would still be available to them, even if it's been several months since their strokes. These clients usually refuse to even think about working anywhere else or in any other position. It's all or nothing.
Is it a bad idea to have a goal to return to work when it may be years before this could be an option? One the one hand, the idea of working again is certainly motivating this person to keep working hard. On the other hand, it creates a lot of stress for the client, the therapists and the family. This stress can negatively impact the re-learning of skills while at the program, actually working against their progress at times. If someone accepts their current abilities, will he or she still be motivated to improve?
Eventually the client is confronted with the fact that returning to work may not be an option. If it happens during the program, it definitely affects their performance and their desire to improve. If their identity or self-worth is entangled with their careers, and they can't have their careers, what's left for them? What are they supposed to do with their lives? There is no easy answer; change can be very hard. Coping usually happens in waves, not all at once.
Some clients have insisted that they can return to work, only to be fired or suddenly understand that they are out of their depths. It's too hard and they can't keep up. Now they've tried and failed, so here comes the crash. That failure can be a harsh lesson that can keep the client from trying again in a less-demanding role.
As the therapist, I have to balance hope and reality. If I try to tell someone they won't go back to work, there's going to be backlash. Then the client may shut down. As the therapist, I'm someone who can understand or sympathize with their situation. My advice is to be supportive in general while focusing on their progress over time. I typically tell clients, "let's make our goals for 3- 6 months and then reassess at that time. Focus on what we need to do today to make progress; right now you are not ready to work again". Same idea, different delivery, better results.
In time, each client will come to their own conclusions. You can be there to offer support and understanding. In this particular client's case, I think her acceptance of not returning to work helped her focus on her immediate goals, which made her progress much faster. There weren't the usual psychological issues outside of language skills. Ironically, this may eventually work in her favor and help her go back to work.