In my mind at least, the word ‘therapy’ conjures images of an analyst’s couch and an authoritatively bearded man nodding sagely and puffing on a cigar while his client relates obscure imagery of childhood trauma. None of which sounds particularly relevant to RTW or, as it turns out, to CBT.

While the ‘T’ in CBT definitely stands for therapy, CBT has little in common with traditional forms of psychoanalysis, the talking therapy we associate with Sigmund Freud and Woody Allen.

“CBT is a very practical intervention,” Dr Peter McEvoy from WA’s Centre for Clinical Interventions told us. “It’s designed to teach individuals a number of strategies they can apply to manage their particular problem.”

As we saw in Parts One and Two of this illustrious series, CBT helped Ms W identify unhelpful thoughts and behaviour that were impeding both her peace of mind and her recovery from a wrist strain injury. Ms W was then able to come up with more helpful alternatives and take a more active role in her own rehabilitation and return to work.

The practical, empowering nature of CBT makes it seem like an obvious solution for difficult, drawn out cases of return to work, especially when the medical issues seem to be complicated by emotional or personal problems.

But how do you know when to suggest that a worker might benefit from CBT? And how should you go about making such a suggestion?

Dr McEvoy suggested two broad principles that are useful when it comes to broaching the subject of therapy.

1. Get educated. “It’s important for people in the position of doing these sorts of assessments  of workers and making those sorts of decisions, to educate themselves a bit about some of the core features and signs of some of the key mental disorders, like anxiety disorders or depression.”
2. Ask sensitively. “Speak to the individual about how they’re feeling. Ask them to tell you how they’re coping, about how they feel about being in the workplace and about their physical problem. Get them talking to you. And don’t take a punitive approach: frame it as concern for their welfare, rather than as a disciplinary problem.”

So is CBT right for everyone?

CBT is a tried and true method for helping people with anxiety and depression, but that doesn’t mean that it is a blanket solution, suitable for every person and every problem. If a workers’ main concern is pain management, for example, other therapies such as mindfulness-based cognitive therapy focused on stress reduction may be the best option.

And how long before the benefits of CBT kick in?

While it is possible that very short term therapy will be enough to assist someone with a specific, contained problem, the required ‘treatment time’ will vary from person to person and problem to problem. One person might see a change in their thoughts, behaviour and feelings after four sessions: another person might make gradual improvements over twenty sessions. 

When emotional difficulties like anxiety and depression occur in conjunction with, or as a result of, physical injuries or illness, a multi-disciplinary approach may be required. In this instance, treatment time may well be greater.

However, the real advantage of CBT is not how long the therapy takes, but how long the benefits last. Dr McEvoy described teaching clients skills that help prevent the same problems recurring in the future. 

“It’s important for clients to learn how to identify the early warning signs of a worsening condition, and to implement their new strategies as soon as possible. What might be important for someone who’s in rehabilitation is recognising when their mood might be getting worse for instance, or their condition might be worsening and applying those strategies as soon as possible. Those strategies are designed to help them manage their symptoms so that they’re less debilitating, and also to help them rebuild their confidence to perform and to make a meaningful contribution to the workplace or whatever domain in their life that they value.”

Thanks to Dr Peter McEvoy for his assistance with this series of articles. You can find out more about the Centre for Clinical Interventions, a specialist state-wide service funded by the WA government, here.