Ask Kathy M. Archives
A Collection of Questions and Answers from TBI Advice Expert - Kathy Moeller

Topic: Work-Related Difficulties - Difficulty Returning to Work


Dear Kathy M.,

I'm doing pretty well with my rehab, but I can't seem to keep a job. I used to be an executive secretary with a non-profit agency and have a lot of skills (word processing, grant writing, other things), but I can't seem to apply what I know in any job. I tried going back to my old job and they were very good about adjusting my schedule and reducing duties. It didn't work out because of my anger (I think my personality has changed). I have been to two more companies and things just didn't work out. I'm not sure why. In the last one, the work was just plain boring! Sometimes I would forget things, sometimes I got too upset and frustrated and would have to leave. But sometimes it's THEM too! They gave me poor directions or expected me to read their minds, so I screwed up (anyone would). Also, they would ask me to do things in an inefficient way or they would change things mid-stream. Don't they know I am trying? Sometimes I think they give me confusing instructions just so I make a mistake and then they can get rid of me! I am VERY FRUSTRATED! I still have a lot to offer, but now my VR counselor doesn't seem to want to help me either (she says I have poor judgment). Please help!


Kathy's Response:

Dear Janice,

This is a complicated situation -- one I experienced as a person with brain injury who was trying to get back to work, and also now as a job coach. It sounds like you are gaining insight and experience, though, and this is very important! The journey is not over, and what you are learning should help you continue to grow.

Many of us have a number of jobs after our injuries, before we figure out the right mix (of skills, job duties, personalities, environment). My first suggestion is to not give up! If you want to work again, and are willing to figure out what went wrong and work at fixing things, you will probably find something.

Please don't be discouraged if the first job that "sticks" is not be your ideal job. Sometimes we have to start out with work that doesn't appeal to us in every aspect (we may feel it is "too low level" or a bit on the boring side, whatever). My suggestion is to try to learn from each work experience, continue to grow and know that better jobs will come!

Basic skills areas
First things first! No employer can afford to keep an employee who cannot follow through for them. Inappropriate outbursts of anger are deal-breakers. So is failing to follow through because of memory glitches. That's not to say that people with "anger management problems" or "memory problems" will not be able to work again. It does mean that these issues need to be under control so the person can function effectively for an employer!

It's one thing to get upset at home and lash out at a family member, or forget to pay a bill. It's quite another to lash out at a busy boss or forget to call a customer back. I'm sure you understand. Some people I have worked with do not. They feel that it's the employer's responsibility to "be understanding" or to "accommodate" their moods or mistakes. I don't see it that way (neither does the ADA, by the way). I worry a bit about your comment about "trying." I'm an employer myself now, and if I had an employee who was trying to control their anger, or trying to follow through, but ended up hollering at a customer or missing an important deadline, the fact that they were "trying" wouldn't keep me from going bankrupt! An employer can't afford to keep people on who are not able to do the job for them.

It sounds like you might benefit from working on (mastering) some basic compensatory skills before you try working again. In my experience, the basic skills area include:

  1. writing, storing, finding and using "Memory Notes"
  2. knowing how to handle basic communication (knowing what you want to talk to people about and being able to retrieve responses and instructions, also knowing how and when to "clarify and verify" communications),
  3. knowing how to handle routine tasks and procedures (including altering routines), and
  4. knowing how to manage "troubling feelings" (frustration, anger, confusion, disorientation, etc.). There are other skills areas, but these are the basics.

Janice, whenever I hear someone with a brain injury say "it's THEM" (meaning things that go wrong at work are the employer's fault), or that "they give me poor directions" or "(they) expect me to read their minds," this can indicate that some practice with communication skills would help.

Now, it's true that some problems at work are because employers or supervisors do not communicate well. Sometimes their instructions are confusing. That said, in my experience, when brain injury is involved, it is just as likely that the person with the injury could be mis-hearing, not tracking oral communication well, making assumptions or is simply unable to handle more than a two or three-step instruction. They often interpret the situation in such a way that the source of the problem is outside themselves.

Please do not misunderstand. This might not be the problem in your situation. I mention it because it is a common response.

"Clarify and Verify"
If I had to give up every strategy I've learned and were only permitted to use one, this is the one I would keep. "Clarify and Verify" solves so many problems and misunderstandings (civilians would be wise to use this strategy too, but we need it even more than they do).

"Clarify and Verify" is a strategy for making sure we understand another person and really know what is being communicated. It's a communication strategy that starts a sentence with, "Let me see if I understand you correctly. . ." Then fill in the blank!

If a multi-step instruction is involved (as if often the case in a work environment), the sentence could be something like this: "Let me see if I understand you correctly (Ms. Supervisor), you want me to box up all the widgets and ship half of them out today and the other half on Friday. Then you want me to put all the woogies in the storeroom and box them up next week, is that right?" (This is the "Clarify" part).

The next step is to write it down, and read it back to the person again. (This is the "Verify" part). Yes, this extra step is a pain sometimes, but it works in the long-run, and doesn't end up taking that much time. Now, the instruction I used in this example is not terribly complicated, but it's the kind of instruction that could easily get misunderstood, whether one of the parties has a brain injury or not! By practicing "Clarify and Verify" both people have a chance to make sure they are in alignment.

In fact, persons with brain injury who make "Clarify/Verify" part of their communication routine, often get the reputation of being more clear and easy to work with than civilians with intact memories who do not practice this communication strategy!

Advanced communication skills
Janice, some of what you are sharing in the last part of your message leads me to believe that you might benefit from talking to a counselor too. If you were an executive secretary, I must assume you have been working for a while, so it surprises me a bit to hear you say "they ask me to do things in an inefficient way" or "or they change things mid-stream." Didn't you encounter these kinds of situations pre-injury? Don't know about you, but in my experience, bosses generally want things done the way they want them done! Period! And they change their minds. Or customer demands change things. As employees, it's basically our job to do what is asked of us, even if we think we have a better way.

You also ask, "Don't they know I am trying? Sometimes I think they give me confusing instructions just so I make a mistake and then they can get rid of me! I am VERY FRUSTRATED." Janice, this also indicates to me that you would benefit from counseling. It's possible, I suppose, that some employers could be hiring you for the purpose of frustrating you to the point where you quit.

Again, I would look for patterns here. In an isolated situation, perhaps. In three or four jobs, it's less likely. A professional counselor should be able to help you sort some of these things out.

In general, working again places many demands on us after experiencing a brain injury. Demands that may be overwhelming. Tracking information, staying oriented in a new environment, switching gears, solving problems, getting along with people . . . lots of things.

The better our basic compensatory skills are, the easier it will be to make the transition back to work. After that, counseling can help too (I needed it).

Brain injury affects every aspect of our being -- our thinking, our emotions, our perceptions -- everything! Many people report it's like being a new person in a new body. Learning to work again, with all the changes we experience, can take time ("BI-time" I call it, which is longer than "normal time").

Janice, be gentle on yourself, because it may take some time and many more work experiences before this all gets sorted out. Don't get discouraged. Keep your eyes open though, keep reaching out, and continue to try to be open to what you can learn to make working again possible.

It's important that you are reaching out. Did you know that there are e-mail support lists on the Internet where you can talk to lots of folks with brain injury who have made it back to work (doctors, lawyers, and even psychologists)? This site has a comprehensive list of them which you can access by going to the following URL:

Hope this helps,

Kathy M.

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