“Because you just get stuck in this hamster wheel” – experience and narratives of work-family conflicts among patients in psychosomatic rehabilitation

A secondary qualitative analysis of 32 semi-structured interviews identified eight recurring intrapersonal manifestations of work-family conflict and 13 narrative scenarios describing how patients connected work demands, family responsibilities and mental disorders with their perceived need for psychosomatic rehabilitation. The study involved parents with mental disorders undergoing inpatient rehabilitation at a single clinic in Germany, rather than a representative sample of all rehabilitation patients.

Researchers analysed interviews conducted between May and October 2024 as part of the Family-oriented Rehabilitation for Adults with Mental Disorders project. Participants were patients with children who were receiving regular psychosomatic rehabilitation but were not receiving the family-oriented programme being developed. The original interview guide focused on family life, expectations and concerns; work and work-family compatibility emerged repeatedly without being the study’s initial focus. The researchers used a mixed deductive and inductive category-development approach for the first research question and a separate typifying content analysis of case summaries for the second.

The sample comprised 20 women and 12 men aged 26 to 57. All had between one and four children living in their household, with children ranging from infancy to 25 years. Thirty participants were employed at least part-time, including 13 who were on sick leave and one on parental leave. Self-reported reasons for rehabilitation included depression, burnout, exhaustion and anxiety disorders. Interviews averaged 60 minutes and were transcribed, reviewed, edited and anonymised before analysis. All interview material was in German, with selected passages translated for publication.

The analysis initially used established categories of work-family conflict based on time, strain and behaviour. Some accounts fit those categories, including family caregiving pressures that impaired work performance and work demands such as overtime or shift work that disrupted family life. However, the researchers found that this framework did not fully capture the recurring configurations described by participants. They therefore developed an alternative organization of the material in which time-, strain- and behaviour-related aspects remained embedded within eight empirically derived intrapersonal manifestations.

The eight manifestations were External Control, Excessive Performance Demands, Self-Sacrifice, Uncontrolled Boundary Blurring, Moral Conflicts, Invisible Loneliness, Existential Anxiety and Threat to Self-Identity. These categories described recurrent patterns in participants’ thoughts, emotions and behaviours. They were not mutually exclusive and could co-occur, interact or reinforce one another. Participants commonly described the conflict as a persistent internal tension rather than an isolated episode, with some reporting that it continued even after an external source of stress had been removed.

Separate case summaries captured how each participant understood the relationship among work-related stress, family-related stress and mental disorder. The resulting 13 scenarios represented different relational configurations rather than 13 individual cases. Some participants described mental disorder as a consequence of sustained work or family strain, while others treated it as the starting point that affected both domains. Other accounts described accumulation, cascading effects or simultaneous interactions without assigning a clear causal direction. In several cases, a critical life event disrupted an earlier balance between work and family.

Participants’ choice of language varied with the narrative position they described. Those who primarily attributed their condition to external pressures more often used terms such as burnout, exhaustion or overload, whereas participants who described mental disorder as the origin of their difficulties more often used clinical labels such as depression or anxiety disorder. A preliminary pattern linked external attributions with external control, excessive performance demands, self-sacrifice and uncontrolled boundary blurring, and internal attributions with moral conflicts, invisible loneliness, existential anxiety and threat to self-identity. The authors cautioned that the sample was too small to establish whether these relationships occur systematically in larger populations.

Several manifestations resembled features of depression or burnout, but participants often treated work-family conflict as a separate, legitimate burden rooted in everyday role demands. The findings therefore do not establish that the manifestations are diagnostically distinct in every case. The analysis could not determine whether depression initiated, sustained or amplified work-family conflict. The scenarios also reconstruct participants’ temporal and causal attributions rather than demonstrating objective causal relationships, and the study did not measure treatment response, symptom reduction, return to work or quality of life.

Several limitations restrict the findings’ scope. The work-family theme was analysed secondarily from interviews designed primarily to explore family-related rehabilitation needs. The sample came from one German clinic and consisted specifically of parents recruited for a family-oriented project, so people with pronounced conflict may have been more likely to participate. It remains uncertain whether the findings apply to patients without children or to the broader German rehabilitation population. The exploratory category and scenario systems are also not exhaustive, and a larger sample could identify additional patterns.

The authors proposed that explicitly examining work-family conflict could complement clinical case formulation by making patients’ descriptions of persistent strain more visible. They also suggested that future longitudinal research should test how conflict relates to rehabilitation outcomes, including symptom reduction, return to work and quality of life. Those implications remain proposals: the present qualitative study did not test an intervention or demonstrate improved outcomes from addressing work-family conflict in rehabilitation.

Subject of Research: Qualitative study of work-family conflict among parents in German psychosomatic rehabilitation

Article Title: “Because you just get stuck in this hamster wheel” – experience and narratives of work-family conflicts among patients in psychosomatic rehabilitation

Article References: Bindels, H., Miluczenko, H., Bethge, M., & Schuler, M. (2026). “Because you just get stuck in this hamster wheel” – experience and narratives of work-family conflicts among patients in psychosomatic rehabilitation. BMC Psychology, 14(1), Article 1362. https://doi.org/10.1186/s40359-026-05615-x

Image Credits: AI Generated

DOI: 10.1186/s40359-026-05615-x

Keywords: work-family conflict, psychosomatic rehabilitation, mental disorders, parenting, qualitative interviews, narrative analysis, Germany, patient experience, caregiving, Because, just, stuck