The Economy’s Impact on Vocational Services

Traditionally, behavioral health patients have been referred for vocational counseling because their illness has formed a barrier to obtaining and maintaining employment. Patients may have presented with ambivalence about entering the work force, or fears that their treatment may interfere with the scheduling demands of a regular job. Along with the downturn in the economy, however, there has been a shift in patient’s issues and needs. More often we are seeing patients who have a substantial work history and are eager to work again.

Identity issues are different. Instead of dealing with the maturation from dependence to independence, people who have lost their jobs have usually already developed a mature work identity, and are struggling with its loss, as well as other losses including income, structured time, socialization and purpose. In addition to the nuts and bolts of vocational counseling such as updating a resume and assisting with job search strategies, as therapists we also try to support patients in this mourning process. The reality of the current recession is also forcing patients to learn acceptance, perhaps by taking a lower paying, lower prestige and often less interesting job. Throughout this process, we encourage patients to re-evaluate their lifestyle choices, spending habits and ways in which they allocate their free time.

Now more than ever, patients are encouraged to learn and incorporate stress management techniques into their daily lives. When people are searching for a job, experiencing financial pressure, depression and anxiety, they can easily feel like they don’t deserve to engage in enjoyable leisure activities. We continually remind patients that there are plenty of low-cost ways to relax and spend quality time with people they care about, which in and of itself can be a powerful stress booster.

Volunteer work is also useful, often providing the same depth of experience as a paying job, but without the income. Volunteer work can also provide a current reference to a prospective employer, as well as a sign of initiative and motivation, and valuable ties to the community.

Also vitally important right now are practices of good follow-through in the job search strategy. As anyone looking for work knows, this is made more difficult by companies utilizing internet sites for advertising positions (e.g.,,, etc.) No longer can applicants forge a phone relationship with a voice from Human Resources or the department of hiring, as sending resumes into the ether of the internet has become the norm. As always, however, using and expanding one’s personal network is essential and in fact, 85% of people find their jobs through a personal contact. Letting friends, family, acquaintances and former colleagues know you are on a job search is a very important technique as well as a way to avoid social isolation. Simply continuing to ask the questions, “Do you know of any job openings?” or “Do you know anyone who might know of any openings?” can make a big difference in urging personal contacts to pass your name along to someone else who just may be hiring. While many of these may sound like very basic techniques, learning to market oneself is a real challenge for people struggling with depression and feelings of shame.

A period of unemployment can also present an opportunity to evaluate a career change and re-tool one’s skills sets. Especially for older job candidates, this is often the time to update things like computer skills and presentation style. There are free or low-cost skill development classes in every area, and learning or improving on skills like these results in a feeling of mastery, as well as the ability to offer a prospective employer all that much more.

Until the economy turns around, the needs of the behavioral health patients we serve will undoubtedly be affected by the changing work climate. This recession is uncharted territory for all of us, and it is important to remember to try to learn as we go, get advice from people we trust, and as always, help each other. I am certain that the vocational therapists and the rest of the staff at New York-Presbyterian Hospital will continue to find strategies to meet this challenge and support our community, whatever the future brings.

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