Employers and return-to-work professionals consider self-direction by sick-listed employees an effective way to achieve work resumption. Yet, there is no unambiguous definition of ‘self-direction by employees during sick leave’. Therefore, it is questionable whether professionals mean the same when they refer to self-direction. We argue that self-direction by sick-listed employees consists of satisfaction of their basic psychological needs. These are: autonomy (involvement in decision making about their own work resumption), competence (being able to resume work), and connectedness (receiving support from their employers that matches their needs) (based on Deci & Ryan, 1985, 2000, 2008). We also argue that the Dutch Improved Gatekeeper Act provides sick-listed employees with possibilities to take self-direction in their work resumption processes. Yet, this Act does not optimally stimulate the self-direction by sick-listed employees. We base our argumentation on findings of an applied PhD research in the field of sick leave and return-to-work. Moreover, we provide advice to researchers and practice professionals who aim to support the self-direction from sick-listed employees. Finally, we reflect on applicability and feasibility of our conceptualization of self-direction.