A sociological perspective on "the unmotivated client": public accountability and professional work methods in vocational rehabilitation.
OBJECTIVE
This study aims at a sociological understanding of the concept of (un)motivation in order to provide clues for improving vocational rehabilitation (VR) support.


METHODS
(Un)motivation is understood as the product of the interaction between clients and professionals in an institutional context. To gain better understanding of this construction of (un)motivation, in depth-interviews are held with 14 VR professionals. Based on the stories professionals told about their professional practices, we analysed the ways in which they guide their clients during their VR path within the institutional context of the Dutch welfare state.


RESULTS
"The unmotivated client" is a judgment that arises in the interaction between professional and client if the institutional goals of VR are not achieved. Two work methods are distinguished in which this judgment takes shapes in various ways, namely "Professional as a Signpost" and "Professional as a Personal Guide".


CONCLUSIONS
Professionals work in a dichotomous public accountability framework with a strong focus on labour participation. This causes professionals to look for ways out of VR paths in which labour participation is not achieved. The construction of "the unmotivated client" is such a way out. An alternative way out is to explicitly value clients' (intermediary) achievements.


CONCLUSIONS
• In vocational rehabilitation (VR) there exists the risk that a perceived lack of motivation is only considered a personal problem in stead of a social issue. • Reconsideration of the public accountability framework of VR may lead to more inclusive VR support in which a differentiated concept of participation is valued. • Lessons can be drawn from the articulation of achievements made in VR paths that are now considered unsuccessful. • For more inclusive VR support, the specific situation and situated needs of clients need to be taken as a starting point instead of a primary focus on the final goal of labour participation.
Department of Health Ethics and Society, Research School CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands. lineke.vanhal@maastrichtuniversity.nl
Lineke
L
van Hal
Agnes
A
Meershoek
Frans
F
Nijhuis
Klasien
K
Horstman
D006801:Humans; D007407:Interviews as Topic; D009042:Motivation; D033262:Narration; D009426:Netherlands; D010043:Outcome and Process Assessment, Health Care; D010349:Patient Compliance; D010817:Physician-Patient Relations; D011364:Professional Practice / Q000458:organization & administration*; D012050:Rehabilitation, Vocational / Q000379:methods*; D012941:Social Responsibility