CHAPTER 26 COUNSELING PERSONS WITH DISABILITIES

Statistics on Persons with Disabilities Chapter begins with a vignette and discusses the case of Ms. Buckman, who experiences discrimination due to her disability. There are about 54 million individuals with some level of disability. About 21 million families in the United States have at least one member with a disability. Individuals with disabilities experience high unemployment rates and in low-income families may suffer abuse.

Discrimination Discrimination is rampant against people with disabilities—they receive lower pay and have more difficulty finding employment. The Americans with Disabilities Act (ADA) was signed into law in 1990, extending the federal mandate of nondiscrimination toward individuals with disabilities to the state and local governments and the private sector.

Myths about People with Disabilities Most people are in wheelchairs. People with disabilities are a drain on the economy. The greatest barriers to people with disabilities are physical ones. Businesses dislike the ADA. Government health insurance covers people with disabilities.

Models of Disability Moral model Medical model Minority model The following are three models of disability affecting the way the condition is perceived: Moral model Medical model Minority model Three models of disability affecting the way the condition is perceived is presented here: Moral model—douse on the “defect” as representing some sort of sin or moral lapse Medical model—the disability represents a defect or loss of function that resides in the individual and action is taken to rehabilitate the condition Minority model—Disability is seen as an external problem involving an environment that fails to accommodate the needs of individuals with disabilities

Life Satisfaction and Depression On the whole, people with disabilities tend to have lower life satisfaction than those without disabilities—people with spinal cord injuries are particularly affected. Close social relationships and paid employment are associated with increased life satisfaction. Many health care professionals hold negative views toward the disabled.

Sexuality and Reproduction People with disabilities may express concerns over sexual functioning and reproduction. Many counselors may feel uncomfortable broaching sexuality with clients who are disabled.

Spirituality and Religiosity Spirituality can be a source of inner strength and support. Connection to a higher power is associated with increased life satisfaction.

Strengths For those with traumatic brain injuries, coping strategies, hope, and optimism are associated with a higher quality of life. Qualities such as creativity, resilience, self-control, and the ability to make positive connections can be tapped into during therapy. Focus on empowering the client and encourage active decision making.

Prejudice and Discrimination Ableism favors those without a disability and implies that those possessing a disability are inferior. Individuals may be evaluated on a deficit perspective. Language such as “wheelchair-bound” is discriminatory. Prejudicial terms such as retarded or lame are often used but are microaggressions. The general public has low expectations for people with disabilities.

Counseling Issues with Individuals with Disabilities Many cognitive and neuropsychological assessments can miss other forms of disabilities, so it is important to assess for issues such as hearing loss with your client. Counselors may feel uncomfortable when working with people with disabilities or may experience guilt or pity.

Recommendations Treat people regardless of disability status with the same expectations. Gather information about your client’s disability—do not rely solely on your client to educate you. A client’s disability may not be the focus of treatment.

Family Counseling Family caregivers are integral to care. Help reduce the impact of stressors on caregivers. Emotions such as distress, guilt, self-punishment, or anger may need to be dealt with.

Implications for Clinical Practice Identify your beliefs, assumptions, and attitudes about individuals with disabilities. Understand the prejudice, discrimination, inconveniences, and barriers faced by individuals with disabilities. Redirect internalized self-blame for the disability to societal attitudes. Employ the appropriate communication format and address the client directly rather than addressing an accompanying individual. Determine if the disability is related to the presenting problem or if it will impact treatment strategies. If it is not an issue, continue with your usual assessments.

Implications for Clinical Practice If the disability is related to the problem, identify whether the client adheres to the moral model (disability is a result of moral lapse or a sin), medical model (disability is a physical limitation), or minority model (disability is the result of a lack of accommodation by the environment). If formal tests are employed, provide appropriate accommodations. Interpret the results with care since most are not standardized with members of this population. Recognize that family members and other social supports are important. Include them in your assessment, goal formation, and selection of techniques, it is also important to determine their model of disability. Identify environmental changes or accommodations that are associated with the problem, and assist the family in changing them.

Implications for Clinical Practice Help family members reframe the problem so that positives can be identified. Strengthen positive attributes. Develop self-advocacy skills for both the individual with the disability and the family members. Note that counseling strategies that focus on problem identification, developing and implementing changes, and evaluating effectiveness are useful. Realize that mental health professionals may have to serve as advocates or consultants to initiate changes in academic and work settings.