Counseling with Physically Disabled
Physically Disabled Counseling discusses that Disability is an experience often perceived by persons without disabilities and society as a negative experience and as something undesired. Such attitudes are not necessarily the same as those held by individuals with disabilities and their families (Dunn & Brody, 2008; Wright, 1991); yet, it is the negative aspects of having and living with a disability that continues to be a primary focus and feature for people who do not understand disability (Smart, 2009).
In an effort to help counselors improve their understanding, skill, and comfort level when addressing the diverse needs of persons with disabilities, Stuntzner and colleagues (2014) conducted a Pre-conference Learning Institute at the 2014 American Counseling Association Conference. Topics presented and discussed with session participants included the importance of using proper language to describe the person and the disability.
- Identifying personal and societal barriers encountered by individuals with disabilities;
- Devising a theoretical framework from which to understand adjustment to disability;
- Learning counseling techniques to enhance therapeutic effectiveness; and being mindful of general counseling tips when working with persons with Disabilities
Barriers Encountered by Individuals and Families With Disabilities
Counselors can enhance their understanding and knowledge of issues relevant to the needs of persons with disabilities and their families by learning about the various forms of personal and societal barriers they often encounter. Of particular importance is for counselors to collaborate with their clients to (a) identify which barriers are most salient, (b) examine the ways the identified barriers inhibit their functioning or prevent them from coping more positively, (c) explore which ones are within their control to change, and (d) determine strategies they can use to cope with and move past them. This process is not always easy, nor is it particularly linear, and may require some time and effort to resolve. Throughout this process, counselors who do not regularly work with individuals with disabilities first need to become aware of the fact that such barriers are a reality, even if they cannot visually see or understand them. Common barriers referred to through personal accounts and the rehabilitation literature stress the fact that many individuals, regardless of disability type, face attitudinal, architectural, environmental, medical, employment, access, and personal barriers.
Having such knowledge is essential because individuals may be looking to counselors for support and guidance when they do not yet know how to proceed. Complicating the situation is the fact that many individuals with disabilities are not given proper exposure, training, or information pertaining to the existence of societal barriers. Oftentimes many do not receive self-advocacy skills training while in school or later in life. As a result, they are on their own to figure out how to best make sense of their experiences and to develop the skills they need to move beyond them (Stuntzner, in press). One the most cumbersome and problematic barriers have been identified counselors can assist individuals in uncovering the ways such barriers impact their life and in determining which ones they can change. Such a process requires counselors to work collaboratively with their clients to differentiate between self-imposed versus other imposed
Exploration of Adjustment to Disability
Adjustment to disability is another area of relevance to individuals with disabilities and the counseling relationship. Counselors who counsel individuals are encouraged to understand the meaning of adjustment, factors which may influence its development and occurrence, and theoretical models of adjustment to disability to provide context to the experience of coping with disability. The process of learning such knowledge and being able to effectively integrate it requires effort on the counselor’s part, especially given the fact that most counseling and psychology programs do not offer extensive training in such areas. Nonetheless, understanding adjustment to disability and theoretical models that help explain the adjustment and adaptation process are very useful.
Factors Influencing Adjustment to Disability
Factors known to influence adjustment to disability are many and are used by counseling professionals to better understand “the probability of successful versus unsuccessful adjustment . Those factors that are most salient to each individual may vary; however, counselors need to be cognizant of what they might be. Some of the factors associated with adjustment to disability discussed throughout the rehabilitation literature include;
- locus of control
- self-blame or unresolved feelings for cause of disability
- negative feelings and emotional distress
- coping strategies
- familial support
- socioeconomic status and financial health
- level of education and employment
- societal attitudes
Other factors discussed by Smart (2009) included the meaning one ascribes to the disability, severity of disability, visibility versus invisibility of the disability, and the amount of stigma experienced and associated with the disability. Techniques for Counselors to Enhance Effectiveness Beyond the many personal and societal issues and the coping and adaptation to disability process, are the techniques and strategies counselors may incorporate into the therapeutic relationship. The techniques proposed in this section are not necessarily connected with specific counseling approaches or theories; however, many of them focus on changing a person’s thoughts, feelings, and behaviors in relation to themselves, others, or God. Furthermore, some approaches have been empirically studied and are known to reduce negative thoughts and emotions (i.e., forgiveness, self-compassion) or are discussed extensively throughout the literature as essential skills for living well with a disability (i.e., resiliency, self-advocacy, self-concept).
Counselors that want to use and integrate the following techniques can consider using them as individual techniques or interventions or as supplements to their theoretical paradigm. Therefore, the focus in this section is on primarily introducing topics and approaches that can be used to change the way persons with disabilities think, feel, or actin situations related to the presence of their disability. Forgiveness, self-compassion, and resiliency are three constructs which have been empirically studied. More specifically, forgiveness and self-compassion have been shown to reduce negative emotions and improve overall functioning and well-being . Both constructs and approaches have much relevance to the lives of persons with disabilities due to the magnitude of negative experiences and treatment faced by persons with disabilities. Furthermore, resiliency is an identified skill which has been found to have much relevance to the needs and issues of persons with disabilities and may be taught to enhance functioning. Counselors interested in teaching their clients forgiveness are afforded access to intervention approaches such as Enright’s (2001) forgiveness process model. Those interested in teaching self-compassion can use self-compassion intervention following its release. In the meantime, trainings on self-compassion are offered to professionals wanting to know more about how to teach self-compassion . Both of these interventions can be used to teach clients essential skills pertaining to forgiveness and self-compassion as it relates to coping, adaptation, and self-acceptance. Interventions that can be used to teach resiliency-based skills are still unfolding . Researchers are currently developing a resiliency-based intervention for persons with disabilities; however, counselors may also construct ways to teach clients specific skills known to influence and enhance resiliency (i.e., social support). Counselors may also use techniques pertaining to dealing with difficult emotions, redefining self-concept and self-identity, learning how to self-advocate, and integrating the skills learned to become more empowered.