A quicker return to work after motivational counselling?

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Charlotte, how did you come up with the idea for your PhD research?

As a psychologist, my early career was devoted to incapacity for work. It was still a fairly new concept at the time. Back then, the only tool we had to determine whether or not a patient was motivated to work was a doctor's assessment.

So was there need for more research?

There was and is a need for a more scientific basis to determine whether motivation has an impact on the length of sick leave. And, if there is, to look at whether we can influence it or not.

With that idea, I started my PhD research at KU Leuven, and with the support of my employer, CM, sought partners for scientific research. We ended up surveying 336 people who had been on sick leave for at least three months.

Can you tell us a little more about people's motivation, and its various forms?

People differ in the quality of their motivation. Generally speaking, we can distinguish between three different types of motivation, which we can easily apply to a work context. There is a small group of people (5 - 10%) who are quite simply not motivated. A second, larger group, has what we call 'autonomous motivation'. They do a particular job because they like to do it, because they find it meaningful or because it's consistent with their personal development goals. A third, also large, group has 'controlled motivation'. They are motivated by less good reasons. They work, for example, for money or prestige, or they study or work in a particular field to make their parents proud. There is always some pressure behind this, which also unfortunately impacts their quality of life and mental wellbeing. This group reports more symptoms of depression, less job satisfaction and higher turnover.

Often, people have 'combined motivation', with a high levels of autonomous motivation and low levels of controlled motivation, or vice versa. High or low levels of both is also possible.

Can we also translate these types of motivation into the motivation to return to work?

We have found that the 'bad' type of motivation – controlled motivation – isn't only bad for people's quality of life. People who are on long-term sick leave also report more controlled motivation in comparison with the average population. That has a negative impact on people's prediction of how quickly they will return to work.

We also discovered that controlled and autonomous motivation can be present at the same time. Autonomous motivation, however, does not cancel out the negative effects of controlled motivation. People who find their job interesting or who enjoy their work expected to be off sick for longer if they were also driven by controlled motivation.

What determines the type of motivation you have?

The extent to which you have autonomous motivation – the 'good' kind of motivation – depends on whether you can satisfy three basic psychological needs. The first is the need for autonomy, to be able to manage oneself. The second is the need for connectedness, our desire to form relationships with people and colleagues and feel a sense of belonging. The third need is competence, or doing something you feel you're good at.

​“The extent to which you have autonomous motivation depends on whether you can satisfy your need for autonomy, connectedness and competence.”

These basic needs can also easily be translated to the work context. In our research, we found that people report a longer expected period of incapacity for work if they can't get their needs for autonomy, competence and connectedness fully satisfied in the workplace.

The predictive value of these frustrations in terms of basic needs will be further explored in the second part of our research. For this, we incorporated aspects from literature and psychology to come up with a new form of therapy: 'motivational counselling'.

How does motivational counselling work?

It is important to highlight the employer's role in eradicating incapacity for work. But we also want to give employees the right insights to feel more engaged at work and prevent long-term sick leave. This is why our motivational counselling focuses on the three basic needs, with a very individually tailored approach.

In terms of autonomy, for example, you can look into whether someone has enough autonomy at work, and whether they find meaning in the tasks they are asked to perform. Is it necessary to follow a strict routine,or is it better if you can incorporate some flexibility?

For the need for connectedness, we look at the work environment. How is your relationship with your manager? Do you identify with your company culture? Is bullying an issue at your company?

For the feeling of competence, we start by asking questions such as: are you in the right position? Are you doing what you're good at, what you've been trained for? For people who haven't had the opportunity to study, we look at whether there is a mismatch between their skills and what they like to do. And we look into whether they should perhaps get that opportunity to study.

The way we approach patients is also very important. We sometimes still have the tendency to see patients as passive participants, and tell them what they should be doing. I think that the art is above all in making people feel like doing something themselves. Not to see yourself as an expert and the other person as the recipient of your pearls of wisdom, but rather to work on developing a co-expert relationship. To create autonomous instead of controlled motivation.

And that goes beyond the work context. Too many people assume that the only purpose of the medical advisor is to extend their sick leave and claim their incapacity benefits. But we can do much more than that. The main objective, for the patient and doctor, should to have the best possible quality of life. And to work together to come up with a long-term solution.

Can motivational counselling lead to a quicker return to work?

It's still too early to tell, but we are cautiously optimistic. In this small pilot study, we can already see a difference in how quickly people return to work. Our qualitative research afterwards showed that the patients found the sessions positive and were more inclined to seek out help sooner. And that that they have been communicating with their employer, whereas they wouldn't have been so quick to do so in the past. This means that there are things we can do to influence and support people's motivation to return to work.

“In our pilot study, we can see a difference in how quickly people return to work." ​

We want to look into this further with our research team, with the support of KU Leuven and partners such as AG. We want to find out whether this method of counselling also works in the long term and on a larger scale. This applies both to private insurers and sickness funds. We do believe it will.

What are your plans for the next phase of research?

Up until now, the counselling was given only by me, in cooperation with my employer. But the idea is to roll this out more widely.

At the moment, we are recruiting doctors, paramedical practitioners and psychologists interested in undergoing training to participate in this study. The coronavirus situation, of course, doesn't help. After that, we will test and analyse on a broader scale. Have the people we have trained built up the necessary skillset? What has the counselling experience been like for the patients? Can we see effects after one month, six months, a year?

Everything needs to be thoroughly tested? Because it's one thing for people to return to work, but quite another to have them stay there. That will only happen if they are motivated.

Are there people who cannot be motivated?

I think so, yes. If the seed hasn't already been planted, it's a waste of time and energy. There are also very few resources, for doctors as well as for insurers, to be able to do much. Then, it's best to focus on cutting that big group of 60 to 70% with controlled motivation in half. To get them to autonomous motivation as much as possible.

You can't expect the impossible from people either. You have people whose mental resources are already very stretched, so it's really difficult for them to cope with certain pressures. They must have had all the help they can get, including from us, to recover and get back on their feet. Because we probably underestimate how much most people want to contribute to society and how much shame and guilt they feel about having to claim insurance benefits. It's important for us to be able to talk openly with them about this.

At the same time, there's no way around the coronavirus crisis. Do you feel, like many experts, that we're going to see a spike in the number of sick leave cases in the near future?

I am hopeful and believe in people's resilience. And if there is anything 'good' about this public health crisis, it's that it is a common good. Of course there are people who will feel the impact more, but the measures apply to everyone. It isn't just a few people who are victims while the rest of us can just happily carry on with life.

I don't see doom on the horizon. There will, of course, be an impact, and there are people who have it particularly bad. But I also think there is a group of people who will come out of this crisis even stronger than ever. People who will have saved their relationship, gotten closer to their children, found new ways to relax, or learned how to “unplug" as a result of working from home. For the population as a whole, we'll probably end up at the break-even point. That, of course, doesn't mean that we don't have a responsibility to everyone affected by the consequences of the coronavirus crisis.

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We are happy to be able to support the research of Charlotte Vanovenberghe and her colleagues. Incapacity for work and sustainable return-to-work assistance is a topic that truly matters to AG Employee Benefits. For further reading:

• Our recent paper on absenteeism (in cooperation with The VIGOR Unit)
• Our Return to Work assistance and guidance programme included as part of our Income Care income protection coverage​