Ask An Occupational Therapist: Working While Depressed

Welcome to our monthly blog ‘Ask an Occupational Therapist’ which attempts to answer all of your🔥 burning🔥occupational therapy-related questions. 

Occupational therapy bridges the gap between therapy and real life, turning awareness into action so you can manage your energy, build healthy routines, and get back to the activities that matter most to you. For this month’s blog post, I’m responding to a question from someone struggling with the same things many of my clients do...

Dear Juanita,

At 44 years old, I find myself in a situation that many may not understand. Despite graduating from University with a BA, because of my struggle with major depressive disorder, I've never held a job for more than a couple years at a time, let alone worked toward a career. This has left me feeling lost and uncertain about my place in the world. For years, I've grappled with feelings of worthlessness and a lack of direction. The idea of engaging in work again feels both exciting and terrifying. I long to find meaning and purpose in my life, and I believe that returning to work could be a crucial step in that direction. However, I worry about how my mental health will hold up and whether I can handle the pressures that come with an actual career. Just the thought of stepping into a competitive environment after such a long absence is daunting--where would I even start?

Sincerely,

Working While Depressed

The struggle to find meaning and purpose in life is something most people can probably relate to, even if they aren't struggling with the same mental health concern and/or the feeling isn't as directly tied to their paid employment. While identifying the desire to engage in work again is a significant step that reflects a need for connection and a sense of contributing to the world around you, there are definitely a lot of barriers to jumping back into the working world. For someone with major depressive disorder, blocks to working could include low energy, concentration difficulties, past trauma, or limited confidence from never having worked before (or only having done so in a limited capacity). Even for someone with an understanding of these blocks, developing strategies to overcome them can be incredibly difficult. Luckily, that's where the OT comes in!

How Occupational Therapy (OT) is different from other therapeutic treatments when it comes to helping someone navigate working while depressed.

As I talked about in my first 'Ask an Occupational Therapist' post, unlike with a Psychologist or Counsellor, psychoeducation and psychotherapy are only part of the work I do with clients. A Psychologist might treat the underlying causes of depression (e.g. attachment issues, previous trauma, etc.) to promote healing and recovery. The OT however, will explore activities with the client that they struggle to engage with because of their low self-confidence (in this instance, working compettively). That's because, central to OT, is doing.

OT looks at how you spend your time to promote wellness. This includes your daily routines, habits, and meaningful activities, but also the influences on how you spend your time, like your mood, the environment, cognition, attention, neurodivergence, and more.  OT starts by providing you insights into what’s blocking you from spending your time in a way that makes you feel satisfied with your life. It then helps you put those insights into practice by building routines, strategies, and skills that support recovery. For someone living with depression who wants to return to work, OT doesn’t just ask why you’re struggling, it asks: how can we help you get back into the workforce in a way that feels meaningful and sustainable?

What would an Occupational Therapist actually do to support someone who has never worked due to their struggle with mental illness?

The first step for the OT would be understanding the client’s personal goals and values around work. In this case, the goal is clear: engaging in the occupation of work again. To help identify the client's values, the OT would begin with an informational interview to learn about their interests, strengths, challenges, and what meaningful work looks like to them. This exploration is not about “fixing” the client, but about getting to know who they are, honouring their journey, and identifying what type of work could potentially bring them purpose. The OT would also gain information (either by administering assessments or through the informational interview) about the client’s physical, cognitive, and social functioning to get a sense of what types of jobs would be best suited for the client and provide the client with the right balance in their life.

With that information in tow, the OT would turn their attention to what's getting in the way as the client tries to achieve their goal in a way that makes sense to them. Ultimately, OTs are trained to uncover the blocks that keep people from reaching their goals. In this case, as I mentioned above, these blocks might include low energy, concentration difficulties, past trauma, or limited confidence. An Occupational Therapist might use assessments to explore these barriers and then apply therapeutic approaches like cognitive-behavioral strategies, Acceptance and Commitment Therapy (ACT), or even environmental modifications (e.g. workplace accommodations) to try and address them. In OT, the goal is not to eliminate the client's depression but to create a pathway forward despite it. If a client is looking to further manage, or potentially even lessen, the symptoms of depression, they may choose to work with other providers (like psychologists or psychiatrists) at the same time.

After addressing barriers, the OT helps the client build concrete skills and strategies--in this case, to make returning to work more feasible. For example, they might explore:

• Energy conservation techniques so fatigue is manageable;

• Routine building to create consistency around sleep, meals, and daily structure;

• Job readiness skills like time management, communication, resume and cover letter creation, interview skills, and stress regulation;

• Gradual exposure to work through volunteering, part-time opportunities, or supported employment programs.

Throughout this process, the OT acts as a guide and supporter, providing a roadmap and checking in regularly until the client feels confident and ready to move forward independently. Progress is measured not only by “getting a job” but also by building confidence, structure, and a sense of purpose along the way. And sometimes clients choose to pursue self-employment--or something entirely different--through occupational therapy and that’s okay too!

Because OT is goal-based and individualized, the duration of this process can really vary. Typically clients have weekly or biweekly sessions (60 minutes each) over the course of 3–6 months. However, others may benefit from longer-term support (6–12 months), especially if they're working toward a complex goal such as entering the workforce for the first time.

If any of the above sounds like a good fit for you or someone in your life, I would encourage you to read my bio and complete your intake with us today!