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Book Review   |    
Vocational Impact of Psychiatric Disorders: A Guide for Rehabilitation Professionals
Karen Marsh-Williams, O.T.R./L.
Psychiatric Services 2000; doi: 10.1176/appi.ps.51.7.943
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by Gary L. Fischler, Ph.D., and Nan Booth, M.S.W., M.P.H; Gaithersburg, Maryland, Aspen Publishers, 1999, 258 pages, $49

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True to its title, this book can serve as a guide for the vocational rehabilitation professional working with persons who have a psychiatric disorder and who are having difficulties seeking or keeping a job. The book is well organized, with chapters grouped by DSM-IV classifications, although the disorders are described less in psychiatric terms than by personality traits and the impact they have in the work setting.

Part 1 describes axis I disorders characterized by subjective distress, with chapters on mood disorders, anxiety disorders, and somatoform disorders. Part 2 describes axis II personality disorders grouped according to the personality clusters of odd, dramatic, and anxious. Part 3 addresses schizophrenia and other psychotic disorders, although in less depth than the preceding disorders.

Each chapter describes a set of disorders and their effects in the workplace. For each disorder, the authors present a case example— a composite of actual clients— to illustrate the impact of the individual's personality in the job setting and in working with the rehabilitation professional. A simple checklist describing the impact of impairment on the basic requirements of the work setting— understanding and memory, concentration and persistence, and social interaction and adaptation— is included as part of the summary of vocational strategies and accommodations for each case history.

As one might expect, each psychiatric disorder presents a significant challenge to the rehabilitation professional. The individuals described in the case examples experienced difficulties in most social situations, including work, but had not always sought necessary psychiatric care. They did not always see their personalities as playing a role in their work setting. In almost all cases the client had some work skills and a job history, thus creating a sense that the problems were with the work, the supervisor, the coworkers, or the client's expectations of the job.

The rehabilitation professional first must recognize the client's difficulties and seek consultation for psychological assessment or treatment, or both. Strategies for engaging the client in that process are described, and the authors emphasize the importance of obtaining an accurate picture of the client's disorder and of working with other professionals.

Another part of the necessary strategy for vocational success includes disclosure of the client's problem to the supervisor in the work setting. It is crucial that the client adapt to the setting, and for that to happen the supervisor must understand how best to work with the client and must be willing to accept the recommended accommodations.

Here too, in each scenario the authors offer strategies for the rehabilitation professional and for the supervisor to accomplish this goal. The vocational rehabilitation professional must be assertive, encouraging, supportive, and honest in order to build the best setting for success and satisfaction for both the employer and the employee.

The authors have accomplished their goal of providing a helpful guide for rehabilitation professionals working with clients who have a psychiatric disorder but whose illness alone does not preclude them from competitive employment. The authors' focus, descriptions, and strategies accurately present the challenges and offer hope for success in working with these individuals. For the rehabilitation professional working with clients with severe mental illness in a psychosocial setting, this book may not be as helpful— but the challenges and strategies in those circumstances probably require another book.

Ms. Marsh-Williams is rehabilitation services director at Eastern State Hospital in Williamsburg, Virginia.




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