12/01/2016

Dysfunctional Career Thoughts and Persons Diagnosed with a Chronic Illness

By Levette S. Dames

Career decision making for persons with a chronic illness such as breast cancer (Sharp & Timmons, 2016), human immunodeficiency virus (HIV; Annequin, Lert, Spire, Dray-Spira, & VESPA2 Study Group, 2015), diabetes (Ervasti et al., 2015), and end stage renal disease (ESRD; Dames, McDowell, & Verndaht, in press) have been the focus of various studies over the years. This article seeks to examine how career counselor educators help students aid clients to seek career aspirations with the use of the non-illness interventions model and the cognitive information process theory (CIP) by helping these clients achieve positive career thoughts.

Dysfunctional Career Thoughts
Career thoughts are “…outcomes of one’s thinking about assumptions, attitudes, behaviors, beliefs, feelings, plan and/or strategies related to career problem solving and decision making” (Sampson, Peterson, Lenz, Reardon, & Saunders, 1996, p. 2). Using this definition, how do persons diagnosed with a chronic disease plan and strategize for their careers? What kind of career thoughts do they have related to their problem solving and decision making skills? Career counselors can help expand dysfunctional attitudes, behaviors, beliefs, and feelings after a client is diagnosed with a chronic disease (like heart disease, stroke, diabetes, and breast cancer).

Non-Illness Intervention Model
Employers are faced with increasing numbers of employees who are diagnosed with a chronic illness. After a client moves out of a medical crisis, their focus may be to continue with their life which can mean going back to work and career life goals continuation. Before going back to work or dealing with new career aspirations, some focus may be needed on assisting a client with medical illness stability. Counselors can use the non-illness intervention model. This model (Navon, 1999) has four components that assist clients with their illness story to improve career thoughts:

Component A: Rapport Building (Illness Themes)

• Encourage the client to tell their illness story and solicit any potential physical or cognitive limitations that may affect career goals.

Component B: “Cognitive Distinction Work enables the differentiation of illness versus non-Illness” (Navon, 1999, p. 256).

• It examines the non-illness positive supports list (e.g., upcoming wedding, supportive spouse and/or employer) and the illness list (chemotherapy, lymphoma, medication).
• Help the clients realize some items in the illness list are out of their control. If an attempt to control is to be made, the client should focus on the items in the non-illness column.

Component C: Cognitive Distinction Work (Patient Beliefs)
There are four categories of cognitive distinction work related to patient beliefs that can help clients with their career thoughts. Each of the four categories are described below using an example of a client who was diagnosed with end-stage renal failure. The counselor expresses some ways (statements) they can help the client to restructure or rephrase these different beliefs.

1. Total belief: (Client) “I have been depressed ever since I lost the use of my left arm that I use to type my work notes because of the dialysis access.”
   (Counselor) “Let us talk about the positive aspects of using your right arm to type your work notes”
2. Single Belief: (Client) "I am feeling a sense of doom after my dialysis treatment and I cannot work"
   (Counselor) “You have had many dialysis treatments before; do you feel this way after each one?”
3. One-sided Belief: (Client) "My job was my whole life before I went on dialysis.”
   (Counselor) “Your devotion to your job may have concealed some areas of concern before you were on dialysis.”
4. Rigidity Belief: (Client) "I can't stand it anymore: Either I'm well or I'm sick."
   (Counselor) “After your dialysis treatment you may or may not feel like working”

Component D: Adjuvant techniques: The adjuvant technique (for example reframing and use of metaphors) can enhance illness versus non illness patients’ beliefs.

• The reframing technique (an alternative interpretation of thoughts, feeling behavior) to help clients express their career attitudes, feelings and behavior toward the return or continuation of work after the diagnosis of a chronic disease. Sampson et al. (1996) uses a reframing technique in CIP.

Cognitive Information Processing and Chronic Disease
After a career counselor advances through the model above, their focus should then turn toward helping a client with career decisions. As counselor educators, we can train novice career trainees to use the CIP model (Sampson et al., 2000). Sampson et al. (2002) constructed three domains: Knowledge, decision-makings skills, and executive processing domains.

1. Knowledge Domain
   - Self-Knowledge:
   What do you value now after being diagnosed with (for example) breast cancer?
   Are you still interested in this type of career after the diagnosis?
   -Occupational Knowledge:
   What are the cognitive or physical skills needed for a particular career?
   How will your treatment regimen affect your educational goals and training?
2. Decision-Making Skills Domain
   Career counselors can use the decision making model not only for career concerns but medical decisions.
3. Executive Processing Domain
   Metacognitions: Counselors can assist in pointing out some self-defeating thought processes. Some examples of self-defeating thoughts are listed below.
   - Self-talk: “I will never be able to work and complete dialysis.”
   - Self-awareness: "I become shameful because I have to wear a wig as a waitress because of the side effect of chemotherapy.”
   - Monitoring and control: "I need help explaining what it is to be hospitalized.”

Career counselor educators may seek to develop courses, or segments of courses, that specifically help career counselor trainees counsel persons with a chronic illness – using the non-illness intervention model or CIP theory. Prospective clients with chronic illnesses can pursue their career aspirations and explore new career options. Counselor educators should caution career trainees to not attempt to counsel clients regarding any aspect that may affect major medical options. A career counselor, however, can assist with managing or reaching any decisions that affect their career concerns.

Additional Resources

Annequin, M., Lert, F., Spire, B., Dray-Spira, R., & VESPA2 Study Group. (2015). Has the
employment status of people living with HIV changed since the early 2000s? AIDS, 29(12), 1537-1547.

Dames, L. S., McDowell, C., & Eberhardt, V. (in press). The relationship between career
thoughts and optimism of Bahamian persons diagnosed with end stage renal disease (ESRD) on hemodialysis.

Ervasti, J., Virtanen, M., Pentti, J., Lallukka, T., Tinghög, P., Kjeldgard, L., ... & Alexanderson,
K. (2015). Work disability before and after diabetes diagnosis: A nationwide population-
based register study in Sweden. American journal of Public Health, 105(6), 22-29.

Navon, S. (1999). The non-illness intervention model: Psychotherapy for physically ill patients
and their families. American Journal of Family Therapy, 27(3), 251-270.

Sampson, J. P., Jr., Peterson, G. W., Reardon, R. C., & Lenz, J. G. (2000). Using readiness
assessment to improve career services: A cognitive information processing approach. The
Career Development Quarterly, 49, 146-174.

Sharp, L., & Timmons, A. (2016). Pre-diagnosis employment status and financial circumstances
predict cancer-related financial stress and strain among breast and prostate cancer
survivors. Supportive Care in Cancer, 24(2), 699-709.

Levette S. Dames, PhD, RN, is an Assistant Professor at North Carolina Central University, and a graduate of the University of South Florida. She is a Registered Nurse with a Master’s degree in School Counseling and a PhD in Curriculum and Instruction/Counselor Education. She has been a registered nurse for more than twenty years, and a school counselor for ten years, specializing in career counseling. She is also a licensed school counselor in North Carolina. She has worked in hospital settings, high schools, and in elementary schools. She has taught undergraduate and graduate courses. She developed and organized a Career Development course for student athletes at the University of South Florida and a human sexuality course at NCCU. She is a past-president of the Florida Career Development Association (2011-2012). She presently serves as the SACES International Counseling Interest Group co-chair, a faculty athletic senate member at NCCU, and the field site coordinator at NCCU. Her research focuses on career development for student athletes and persons diagnosed with a chronic illness especially breast cancer, end stage renal disease, high school students. She has also focused on group counseling research and social/emotional learning. She can be reached at  lsdames@nccu.edu.