When the System and the Client Don't Align: Navigating Occupational Health Psychology
Presented by Michael Chong. Written by Yvette Tan. Reviewed by Bernie and Michael, registered psychologists.
On the Couch is a series that brings expert knowledge into the room, translating the insights of health psychology professionals into accessible, thoughtful reads for anyone curious about the intersection of mind and body.
In this instalment, Michael Chong, a registered psychologist with many years of experience in the public sector, shares his insights on occupational health, drawing from a presentation he delivered to a group of health psychology professionals. What follows is an exploration of the tensions that arise when workplace systems and individual needs pull in different directions, and what psychology can do when it finds itself navigating the space between them.
About Michael
A registered psychologist with a Masters in Health Psychology, Michael Chong spent many years working in the public sector, most recently in work health and safety, specifically in the rehabilitation and return to work space. In that role, he led a team of case managers supporting employees who had been injured or unwell, working with a panel of psychologists, occupational therapists, and counsellors to help workers through their recovery journey.
That background gives Michael a perspective that is genuinely rare. He has sat on both sides of the table, first as a consumer and manager of psychological services, and now as a practitioner providing them. He knows what the system looks like from the inside, what it asks of workers, and where it falls short, and stepping into a psychology role has only sharpened that awareness. It is an awareness that begins with understanding the terrain, and the very real risks that exist within it.
The Landscape: What Psychosocial Hazards Actually Look Like
Before diving into the tensions and challenges of his work, Michael grounds the conversation in something concrete: the formal recognition of psychosocial hazards under Queensland Work Health and Safety legislation. These are recognised risks in the workplace that can cause psychological harm, and they include high job demands and low job control, poor support from supervisors or colleagues, role conflict and ambiguity, workplace bullying and harassment, exposure to traumatic content or events, organisational change and job insecurity, and effort-reward imbalance.
They are not abstract concepts. They are the daily reality of many workplaces, and the foundation on which Michael builds his central argument: that when these hazards lead to injury or illness, the tension between what the system needs and what the individual needs can become very difficult to bridge.
The Core Tension: When System Goals and Client Goals Diverge
At the heart of Michael's presentation is a framework he calls the Alignment Assessment. It asks one fundamental question before any return to work plan begins: where do the system's goals and the client's goals actually sit in relation to each other, and how much of a bridge needs to be built between them?
On one side sit the system goals. These are the things that organisations, insurers, and return to work frameworks are built around: cost containment, timely return to work, liability management, operational continuity, manager performance, and insurer expectations. They are not unreasonable goals. But they are, by design, focused on the system's needs.
On the other side sit the client goals. A worker who has been injured or unwell is typically seeking validation and safety, a paced recovery that respects where they are, acknowledgement of any injustice they feel they have experienced, financial security, the space to process trauma, and a genuine sense of agency and voice in decisions about their return.
The overlap between these two sets of goals, the bridge, is where meaningful progress becomes possible. Shared return to work goals, a safe workplace, agreed support plans, and the role of psychoeducation all sit in that middle space. But the bridge has to be built deliberately. It doesn't happen by default.
"We like to think that everything's aligned, but in some cases, they are at opposing ends. And that can be quite challenging to manage."
Michael's question, posed to the room and to himself, is whether psychologists are doing enough to assess that alignment before treatment begins. Is there sufficient alignment to make return to work achievable right now? And if not, what needs to shift first, and for whom?
What Gets in the Way
Understanding the tension is one thing. Navigating it in practice is another. Michael identifies four broad categories of barriers that make the gap between system and client goals so difficult to close.
The first is relational and cultural. Manager-staff conflict, power imbalances, and a sense of organisational injustice can make other issues more complex to manage. When significant conflict exists between individuals in a workplace, the effects ripple outward. Avoidance becomes the default response, from managers who delay difficult conversations, from workers who avoid returning or disclosing what they are experiencing, and sometimes from the system itself.
The second is psychological and trauma-related. Vicarious trauma, pre-existing mental health conditions, hypervigilance and threat sensitivity, and worker avoidance of treatment or return to work triggers all create complexity. Michael notes that in his experience, organisations tend to be far more confident and mature in managing physical injuries than psychological ones.
The third is physical and compensation-related. Organisations can become highly risk-averse when compensation costs are rising, sometimes to the point where fear of aggravating an existing injury blocks any return to work at all. Chronic pain, fatigue, and functional decline add further complexity, particularly when the system's instinct is to wait until someone is fully recovered before bringing them back, which as Michael notes, doesn't necessarily help with conditioning.
The fourth is systemic and communication-related. This is perhaps the most structural of the four and the hardest to shift from a one-on-one clinical position. A lack of psychoeducation on mental health challenges, illness and injuries for managers and teams, siloed case management across insurers, employers and clinicians, inadequate suitable duties planning, and return to work goals that are misaligned across stakeholders all sit within this category.
The Access Barrier: Where the Psychologist's Influence Stops
One of the most compelling ideas in Michael's presentation is what he calls the psychologist's circle of influence. It captures a structural problem that many psychologists working in the return to work space will recognise.
The psychologist has direct access to the client and can do meaningful work there, helping them make sense of what has happened, processing the emotional and psychological impact, working through their beliefs about returning, and building the communication skills and confidence to advocate for what they need.
But on the other side of a formal access barrier sits the manager, who holds significant power over the return to work outcome. The manager's own avoidance, liability fears, stigma around mental health, guilt, or unprocessed distress can all become barriers to a successful return. And without a formal mandate, the psychologist's influence stops at that barrier.
"Without a formal mandate, our influence stops at the barrier. If we don't have access, how do we advocate for access without overstepping our contract or the therapeutic relationship?"
There are some pathways to gaining access, when the organisation formally engages the psychologist for manager support, or through facilitated conversations with client consent, but these are not always available and are rarely the default.
This leads Michael to one of his most thought-provoking observations: the manager, in many return to work situations, is effectively an unacknowledged client. The manager plays a significant role in the return to work outcome, and yet sits outside the psychologist's formal remit. When a manager's avoidance is the primary barrier to return to work, Michael asks, whose wellbeing are we actually responsible for? And do we have the authority to intervene at that level?
Where It Gets Complex
Some areas of occupational health deserve closer attention for the particular complexity they bring and for the questions they raise about the psychologist's role.
Relational conflict in the workplace is one of them. Power dynamics shape what workers feel safe to say and to whom, and when conflict is entrenched between individuals or teams, legal complexity, manager avoidance, and worker reluctance to disclose all add layers that are difficult to navigate. It is an area where health psychology has a role to play, and one that invites reflection on whether the profession's full range of skills is being brought to bear in this particular space.
Vicarious trauma is another. Michael defines it as the cumulative, harmful transformation in a worker's worldview that results from empathic engagement with traumatised clients. It is distinct from burnout in an important way: burnout affects how you feel about your work, but vicarious trauma changes how you see the world. In certain professions, child protection and legal work involving traumatic content, the exposure is significant. And yet a cultural barrier persists in many high-exposure workplaces: a hardening mentality where seeking help is perceived as weakness and acknowledging the psychological cost of the work is discouraged, which may go some way to explaining why vicarious trauma, though recognised in policy, is not always consistently screened for or taken seriously in practice.Lauren is direct about one thing: talking alone is not enough. Non-psychologists are often surprised to see her walking clients rather than sitting with them, expecting the work to happen in the cognitive space alone. But as Lauren is clear: anxiety will not reduce without the behavioural component. "Any breathlessness, it really isn't effective to just talk about it," she says. Walking, in this context, is exposure therapy to breathlessness. To address avoidance, you have to actually experience breathlessness in a safe, controlled, and carefully graduated way.
Questions Worth Sitting With
Michael closes his presentation not with answers, but with questions, a reflection of both the complexity of the field and his own honest position as someone still navigating it. He poses several questions for those working in and around this space to sit with. Three in particular stand out as threads that run through everything covered in this article.
One question that runs through the whole conversation is around avoidance — how do we name the fact that waiting until ready is often just avoidance in disguise, without triggering defensiveness in the worker, the manager, or the system?
Another sits at the heart of the access barrier challenge — when manager avoidance is the primary barrier to return to work, whose wellbeing are we actually responsible for? And do we have the authority to intervene at that level?
And perhaps the most fundamental of all: before any return to work plan begins, should there be a formal check on whether system goals and client goals are actually aligned, rather than assuming they are compatible?
These are not rhetorical questions. They are the kinds of questions that don't have easy answers, and that is precisely why they are worth asking.
