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Article   |    
Am J Psychiatry 1954;111:289-300.
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The Department of Neuropsychiatry, Louisiana State University, School of Medicine, New Orleans, Louisiana.

Program supervisor of Psychiatric Social Work, Clinical Center, National Institutes of Mental Health, Bethesda, Md.

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1. An approach to the vocational rehabilitation of chronically unemployed psychiatric patients is described, consisting of a collaborative effort between a psychiatrist and a social worker.2. Twenty of 25 patients returned to work and have remained working steadily for 6 months or longer. The average number of interviews before a return to work was 10; thus no great expenditure of time was involved.3. Diagnostic category, age, duration of illness, and duration of unemployment did not influence the results. Lack of education and training, excessive dependency, and lack of supportive family relationships were handicaps, but not insuperable obstacles to rehabilitation.4. Significant techniques and factors in successful cases were:(a) Preliminary clarification of the patient's physical condition with appropriate treatment or reassurance and explanations.(b) Adequate working through of the primary psychological problems.(c) Deliberate focussing of discussions on the topic of employment.(d) Generous support and reassurance from the social worker during the period of return to work.(e) Increase of economic pressure by planned termination of public assistance.(f) Attention to selection of jobs suitable to the patients' psychological needs.(g) Continuous therapist-patient relationships.

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