What It's Like to Be a Rehabilitation Counsellor for Workers with Psychological Injury

Rehabilitation counsellors who work with psychological injury claims occupy one of the most challenging positions in the workplace wellbeing ecosystem. They sit at the intersection of individual trauma, organisational dysfunction, insurance imperatives, and legislative frameworks—tasked with helping injured workers return to the very environments that allegedly harmed them.

I've spent years researching organisational culture and its psychological costs. What rehabilitation counsellors see daily is the end point of what my research documents: the moment when cultural pressure, unreleased and unmanaged, breaks through the surface as diagnosable psychological injury.

This article explores what it's actually like to do this work—not from a clinical distance, but from the lived experience of practitioners navigating impossible tensions between care, compliance, and the hard realities of organisational systems that resist the very changes that would prevent future harm.

You Inherit the Wreckage of Organisational Failure

When a worker lands on a rehabilitation counsellor's desk with a psychological injury claim, something has already catastrophically failed. The employee didn't wake up one morning and decide to develop anxiety, depression, or an adjustment disorder. The injury accrued over time—through unmanaged workload, role ambiguity, bullying or harassment left unaddressed, restructures that decimated psychological safety, or the slow accumulation of cultural pressure that had no healthy release valve.

By the time the claim is lodged, the damage is done. Medical certificates have been issued. Work capacity has been assessed. The individual is often already off work, traumatised not only by what happened but by the process of having to prove it happened. And the rehabilitation counsellor's job is to somehow put this person back together—often while the organisational conditions that broke them remain untouched.

This is the first impossible tension: you are asked to repair individual damage without being given the authority to address systemic cause.

You Navigate Competing Stakeholder Interests That Are Rarely Aligned

Rehabilitation counsellors work within a stakeholder web where every party has different priorities, and those priorities are often in direct conflict:

The injured worker wants acknowledgment that what happened to them was real, harmful, and preventable. They want the organisation to take responsibility. They want safety guarantees before they return. They want healing, not just functional capacity.

The employer wants the claim resolved quickly and cost-effectively. They want the worker back at full capacity, ideally without organisational change. They want minimal disruption. They want liability contained.

The insurer wants evidence of improvement, clear return-to-work timelines, measurable outcomes, and cost containment. They fund treatment to a point, then the pressure mounts to close the claim.

The treating practitioners (GPs, psychologists, psychiatrists) provide clinical care but may have limited understanding of workplace dynamics or RTW feasibility. Their priority is patient wellbeing, not organisational accommodation.

The legislation provides frameworks, timelines, and obligations—but these are often blunt instruments applied to deeply contextual human situations.

The rehabilitation counsellor has to hold all of these interests simultaneously, knowing that what the injured worker needs (genuine organisational change, psychological safety, accountability) is often exactly what the employer is least willing to provide.

You become a translator, a negotiator, a mediator—trying to find a path through competing interests while the person at the center of it all is still suffering.

You See What Organisations Refuse to Acknowledge

Rehabilitation counsellors develop a unique form of organisational literacy. You see patterns that HR departments, executives, and even internal investigators miss or minimize:

●      The same manager generating multiple claims across different employees, with each incident treated as isolated rather than symptomatic of a leadership problem.

●      Departments with turnover patterns that scream cultural toxicity, but where retention is framed as an individual choice rather than a systemic issue.

●      Return-to-work plans that look compliant on paper but are designed to fail in practice—placing injured workers in roles they cannot sustain, with colleagues who resent their accommodations, under managers who never wanted them back.

●      Organisational "support" that is performative—the right words in meetings, the right signatures on documents, but no genuine commitment to changing the conditions that caused harm.

●      Workers whose injuries are dismissed as "personality conflicts" when the evidence clearly shows sustained bullying, harassment, or discriminatory treatment.

You see all of this. You document it. You advocate as much as your position allows.

And then you watch the same patterns repeat with the next claim. And the next.

This is the second impossible tension: you develop expertise in identifying organisational pathology, but you have limited power to intervene at the systemic level.

You Carry the Weight of Incomplete

Healing

Not every psychological injury claim ends in successful return to work. Not every injured worker heals fully. Not every situation can be resolved. Some workers will never return to their workplace because the injury is too severe, the trust too broken, or the organisational response too inadequate.

Some will accept termination settlements because it's psychologically safer than fighting. Some will move to other roles, carrying trauma that affects their capacity for years. And rehabilitation counsellors carry the knowledge of those incomplete outcomes.

You advocated. You coordinated. You built treatment plans, facilitated meetings, negotiated adjustments. You worked within the constraints you were given. But the structural limitations—the employer who refused meaningful change, the insurer who cut funding too early, the legislative framework that prioritises efficiency over healing—mean that some cases simply cannot be resolved in ways that honor the injured worker's experience or needs.

This is the grief of the work: knowing that individual effort cannot compensate for systemic inadequacy.

You Witness the Secondary Trauma of the Claims Process

One of the least discussed aspects of psychological injury claims is how traumatising the process itself can be for injured workers. They must prove their injury to skeptical stakeholders. They must relive the experiences that harmed them—in medical assessments, in interviews, in documentation reviews.

They must often engage with the very people who caused or contributed to their injury. They must navigate bureaucratic systems designed for efficiency rather than care. The claims process can become its own form of institutional trauma—a grinding, depersonalising experience where injured workers feel disbelieved, scrutinised, and blamed.

Rehabilitation counsellors witness this secondary harm daily. You see clients who were managing PTSD from workplace bullying develop new anxiety symptoms from the assessment process itself. You see people whose depression worsens as they navigate months of uncertainty about whether their claim will be accepted, whether treatment will be funded, whether they'll have a job to return to.

You try to buffer them from this as much as possible. You explain processes, prepare them for assessments, advocate for compassionate handling. But you cannot remove the fundamental reality that proving psychological injury in adversarial systems is, itself, psychologically injurious.

This is the third impossible tension: the system designed to support recovery can intensify the very harm it's meant to address.

You Develop a Cynicism About Organisational "Culture Change"

When rehabilitation counsellors see the same organisations generating multiple claims—often with similar patterns, similar contributing factors, similar failures of duty of care—there's a natural question: why isn't this changing?

The answer, uncomfortable as it is, comes down to incentive structures. For many organisations, managing psychological injury claims reactively is cheaper and less disruptive than preventing them proactively. Workers' compensation premiums are a known cost. Claims can be managed through insurers. Settlements can be reached. The organisational status quo can be preserved.

Genuine cultural change—the kind that would prevent psychological injury rather than just managing its aftermath—requires admitting that organisational practices, leadership behaviors, or structural conditions are actively harming people. It requires accountability. It requires investment. It requires disruption.

Most organisations are willing to say the right things about culture, wellbeing, and psychological safety. Far fewer are willing to do the deep, uncomfortable work of actually changing the systems that produce harm. Rehabilitation counsellors see this gap acutely. You read the wellbeing policies, attend the organisational meetings where culture is discussed in abstract terms, listen to HR presentations about values. And then you return to your caseload of workers psychologically broken by the reality beneath that rhetoric.

Over time, this produces a particular kind of professional cynicism—not about individuals (many leaders genuinely care), but about organisational capacity for self-examination and meaningful change.

You Learn to Find Meaning in Small Wins

Despite the systemic frustrations, rehabilitation counsellors continue this work because there are victories—small, sometimes fragile, but real. There's the worker who returns successfully to a role that's been genuinely adjusted to their capacity. There's the employer who, confronted with clear evidence and skilled advocacy, actually changes a harmful practice. There's the treatment plan that works, the psychological symptoms that improve, the moment when an injured worker tells you they feel heard, supported, and safe enough to try again.

These wins don't undo the systemic problems. But they matter profoundly to the individuals involved. Rehabilitation counsellors learn to find meaning in what can be achieved within constraints, to celebrate incremental progress, to advocate fiercely for individual workers even when broader change feels impossible.

This is the resilience of the profession: the capacity to continue caring, supporting, and fighting for individual outcomes even within systems that often feel designed to defeat those very efforts.

What Rehabilitation Counsellors Know That Organisations Need to Hear

If I could translate what rehabilitation counsellors see into actionable insights for organisational leaders, it would be this:

1. Prevention is possible—and infinitely preferable to remediation.

By the time a psychological injury claim reaches a rehabilitation counsellor, enormous harm has already occurred—to the individual, to team dynamics, to organisational trust, and to your bottom line. The conditions that produce these injuries are visible earlier if you're willing to look for them.

2. Cultural pressure is a precursor to psychological injury.

Rehabilitation counsellors can often trace the arc of an injury back through escalating pressure points: unmanaged workload, role ambiguity, interpersonal conflict left to fester, restructures handled without regard for psychological impact, leadership behavior that created fear or uncertainty. These pressure points are detectable before they become diagnosable injuries. Organisations that learn to read early warning signs can intervene preventatively.

3. Return to work fails when organisational conditions haven't changed.

You cannot successfully return an injured worker to the environment that harmed them without addressing what caused the harm. Accommodation plans and graduated hours are necessary but insufficient. If the bullying manager is still there, the unsustainable workload persists, or the toxic team dynamics remain unchanged, RTW will fail.

4. The claims process itself can be traumatising.

How organisations handle psychological injury claims matters enormously. Adversarial approaches, skeptical questioning, delays in decision-making, and failure to provide genuine support all compound the original injury. Compassionate, transparent, responsive claims management can be part of healing—or part of further harm.

5. Repeat patterns indicate systemic problems, not bad luck.

When the same department, the same manager, or the same organisational practice generates multiple psychological injury claims, this is not coincidence. It's a signal. Organisations that respond to that signal by investigating root causes and implementing genuine change prevent future claims. Organisations that treat each as isolated continue the pattern.

A Final Reflection: The Work Rehabilitation Counsellors Shouldn't Have to Do

Here's the uncomfortable truth: in a truly psychologically safe organisation with effective cultural pressure management and genuine leadership accountability, the volume of psychological injury claims requiring rehabilitation counselling would be dramatically lower.

Rehabilitation counsellors do essential work. They support people through some of the most difficult professional experiences imaginable. They coordinate complex systems, advocate against considerable resistance, and help injured workers rebuild capacity and confidence. Much of this work is addressing harm that was preventable.

My research into organisational culture has shown me that psychological injury is rarely random or inevitable. It emerges from specific, identifiable organisational conditions: normative control systems that demand too much, cultural pressure without release mechanisms, leadership behavior that creates fear, structures that prevent people from speaking up, and change processes that ignore psychological impact.

Organisations have the tools to identify and address these conditions before they produce diagnosable harm. The Culture Pressure Map framework I've developed makes these invisible risk factors visible. Psychosocial risk assessments can identify hazards. Leadership development can address harmful management practices. Cultural diagnostics can reveal where pressure is building before it breaks through as injury.

The question is whether organisations are willing to invest in prevention with the same urgency they bring to managing claims reactively. Rehabilitation counsellors already know the answer: most aren't. Yet.

But perhaps that's changing. The rising cost of psychological injury claims, the tightening legislative requirements around psychosocial risk, and the growing recognition that workplace mental health is a leadership responsibility—not just an individual challenge—are creating new pressures for genuine organisational change.

If that change happens, it won't be because organisations suddenly became more ethical. It will be because the cost of maintaining harmful systems finally exceeded the cost of changing them.

And when that shift occurs, rehabilitation counsellors will still have essential work to do—supporting those in crisis, coordinating complex cases and facilitating recovery.

However, there will be fewer people needing that support. Because the work they do to repair individuals will have been complemented by the work organisations finally do to repair the systems that cause harm in the first place. That's the future worth building: one where psychological injury is genuinely rare, not because we've gotten better at managing claims, but because we've gotten better at preventing the conditions that produce them.

For organisations ready to move from reactive claims management to proactive risk prevention, Mind Culture Life Australia offers specialised services in organizational culture diagnostics, the Culture Pressure Map system, and psychosocial risk assessment.

For a confidential discussion about how we can support your organisation's approach to workplace mental health, contact us at +61 02 8114 4454 or info@mindculturelife.com.au

Dr Anna Kiaos is a researcher and practitioner working at the intersection of organisational culture, workplace change, and mental health. She is the founder of Mind Culture Life Australia, supporting leaders and People and Culture teams to understand cultural pressure dynamics and prevent psychological harm before it occurs.

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