This paper is aimed at discussing the practices of counselors who are specialized in working with people struggling with various disabilities. These days, in the United States, about 50 million people suffer from some physical or mental problems (Cornish et al. 488). Many of them may require the services of psychotherapists. Assisting clients of this type may be rather challenging for a professional due to the fact that such patients are more vulnerable to various stressors. For instance, in many cases, these people feel stigmatized, isolated from the rest of society, different, lonely, weak, and unable. A disability, either congenital or obtained through the course of life, often serves as a source of negative emotions. Feeling fragile, people with disabilities may perceive any kind of intrusion into this sensitive subject as hostility and start to fight it (Thomas and Schwarzbaum 340).
As a result, they may not accept some of the suggestions offered by counselors, especially if these recommendations can indicate their disability. Thus, a therapist is to apply various techniques and models that can minimize the risks of clashing with the clients or making them feel uncomfortable or attacked. A variety of identity formation models has been created to help the specialists work with disabled and extremely sensitive individuals without hurting their feelings and exposing them to even more stress. The purpose of the identity formation models is to illustrate how people perceive their disability. Moreover, these theories can demonstrate how individuals can change their views on their physical problems. In turn, this paper will explore the use of Gibson’s Disability Identity Development Model. This framework is rather useful for explaining why therapists may fail to establish a close rapport with their clients. Furthermore, this method can help a counselor determine when a certain intervention can be made. However, it is also possible to apply the social model of disability because it can show how the external environment can make a person more reticent or even hostile towards other people. This essay will also include a set of recommendations that a therapist can use to increase the efficiency of their work.
Disability Identity Development as a Concept
Discussing the formation of a person’s identity also referred to as the self, it is important to emphasize that an individual’s view of themselves is rather complex and includes multiple layers and dimensions. Characterizing oneself, a person would not just mention one aspect. Human identity consists of a variety of notions. For example, one may identify as a citizen of a particular country, a part of a nation, culture, or ethnicity, a follower of a certain religion, an individual of a particular age, gender, or background, to name a few (Weeber 1). That way, identity is all-consuming, ubiquitous, and is vital to one’s perspective of the world and people around. The individuals’ identities form under a number of circumstances throughout the course of life and are impacted by multiple factors of internal and external character (Weeber 1).
When an individual identifies with a group devalued by the dominant society around, they subconsciously develop an inner conflict attempting to accept the characteristics of themselves that are considered negative or are in any way rejected by the society (Weeber 1). That way, a person with congenital or obtained disabilities is likely to suffer from an internal clash of dominant values of the surrounding culture and the qualities that comprise themselves (Thomas and Schwarzbaum 340). As a result, an individual with disabilities may develop low self-esteem. Discussing the nature of self-esteem, Voigt mentions that this concept, just like one’s identity, is not fixed (par. 1). On the contrary, self-esteem, as well as identity may change many times during one’s lifetime depending on various factors. People with disabilities may develop low self-esteem due to their way of thinking. For example, they may mislabel themselves as stupid, ugly, unable, or weak; they also can overgeneralize and jump to conclusions believing that since they have a disability no good job or no luck in personal life will ever be available for them; besides, social pressure makes them convinced that they “should” be able to do things their peers without disabilities can do (Voigt par. 3). Often, such a way of thinking occurs in the individuals who spend the largest portion of their time surrounded by people who do not have any disabilities. The inability to share their experiences with friends, family, or peers makes them feel misunderstood, lonely, inadequate, and “other”.
Summing up all the points above, one has to mention that developing healthy self-esteem and positive identity is a necessity for individuals with disabilities. Accomplishing this task is very challenging in a society that lacks equality for such people, and where they are forced to feel self-conscious or judged unfairly (Weeber 2).
The Practices of Counselors
Studying the issues of identity formation, the researchers focus on the competencies of therapists who work with people with various disabilities. For instance, one can refer to the research article by David Luterman, who notes that therapists should anticipate the emotional problems faced by such patients or their relatives (220). For instance, they should not overlook such responses as anger, guilt, or denial because they can significantly exacerbate different emotional problems. Additionally, counselors should apply various methods that are necessary for promoting patients’ acceptance of their physical challenges (Nicholls et al. 1082). Researchers argue that therapists should understand the reasons why customers may try to deny the existence of their physical disabilities (Olney et al. 4). As a rule, they are reluctant to do it because they associate a disability with inferiority. Thus, existing studies can illustrate the complexity of this problem faced by counselors and patients.
Additionally, one should bear in mind that patients can struggle with other problems as well. In particular, one should not disregard the impacts of depression, low level of self-esteem, inferiority complex, and anxiety disorders. Overall, the outcome of treatment depends on two variables. At first, one should speak about the preparedness of counselors and their ability to use various models and techniques. At the same time, it is important to remember the readiness of patients to change their views on their disability. Thus, they need to understand the process of identity formation.
A Mechanism of Identity Formation
Over the last several decades, many scholars have been focusing on the mechanism of formation of various identities (gender, racial, sexual orientation, cultural, to name a few). Analyzing and comparing several models of identity formation proposed by different scholars, Trusty, Looby, and Sandhu point out that even though they have a lot of differences, the basis of all of these models remains similar (79). At the primary stage of their identity formation, an individual tends to identify with the majority that surrounds them and reject the individual qualities that make them different from the rest of their environment (Trusty, Looby, and Sandhu 79). The realization of the personal differences and lack of desire to accept them is the factor that facilitates the internal conflict and launches a chain of consequences such as increased vulnerability, lack of confidence, and low self-esteem. The differences may be emphasized by some people from the surroundings of an individual (for example, mockery at school or at work), or they may be noticed by an individual personality through a comparison of themselves with the others. That way, external environments and people around play the most important role in the development of identification of a person (Kielhofner 97).
Identity Formation Model
Gibson’s Disability Identity Development Model
The model of disability identity development created by Jennifer Gibson has an objective to provide the counseling practitioners with tools and techniques that will allow them to deliver sensitive and appropriate clinical services to individuals struggling with various disabilities (Gibson 5). In other words, this framework has been designed to address the needs of persons with disabilities as well as the needs of the professionals assessing them. The author distinguishes several stages of a person’s identity formation. In particular, she distinguishes such stages as passive awareness, realization, and acceptance (DeLucia-Waack, Kalodner, and Riva 268). Each of these stages is marked by certain behavioral characteristics.
Stage 1: Passive Awareness
The first stage begins at the moment a person with a disability is born and may continue up to adulthood (Gibson 8). During the first stage of disability identity development, an individual is not able to recognize his/her disability. In many cases, this person does not believe that his/her life is impaired in any way. At this stage, the medical needs of a person are entirely satisfied. Such attitudes are usually typical of children. As a rule, they are safeguarded against external influences that can make them aware of their disability. Additionally, these people do not want to associate themselves with those individuals who may have a similar healthcare problem. As a rule, they do not want other people to pay attention to their disability. This way, the rejection of the presence of a disability at this stage may be both conscious and unconscious. If an infant may actually be unaware of their condition, an older individual who communicates with the world around them and the peers who do not have disabilities is likely to be aware of their differences and feel like “other”. Besides, a child’s disability often becomes a silent reality in a family which means that parents deliberately avoid discussing this subject with their child. Such treatment is intended as a protective action practiced in order to prevent a child from getting hurt emotionally, but in reality, it does exactly the opposite – it teaches the child that the reality of disability has to be ignored. As a result, such person is likely to start isolating themselves from the world of people without disabilities, shy away from other individuals’ attention, and be reluctant to speak about their disability (Gibson 8). Working with a person whose disability identity development is at this primary stage a counselor will notice a lot of unspoken emotions that can be expressed in a variety of ways some of which are anger, aggression, projection, anxiety, or crying. Such reactions occur due to the tension with which people at the first stage of disability identity development have to deal with attempting to ignore and avoid something that is all the time there.
Stage 2: Realization
At the second stage of disability identity development, a person begins to understand that he or she has some disability. In part, this result can be explained by his/her encounters with other people, especially peers. The negative experience they start to associate with their disabilities appears from the fact that they notice that living their lives the way that their peers without disabilities do is often impossible for them. As a result, their self-worth rapidly goes down. In adolescents, evidence of disability may be their lack of success in dating life. While their peers explore romance and go on dates, the persons with disabilities feel unwanted, inadequate, and lonely blaming their conditions in what is happening or even catastrophizing their situations and beginning to believe that nothing good will ever happen to them due to their disabilities (Voigt par. 3). This way of thinking causes self-hate and is quite dangerous. Associating their conditions with a profound injustice, such persons require the help of a counselor. The latter is to be extremely gentle and understanding when dealing with clients going through the second stage. In many cases, such clients are likely to become hostile towards the counselor and reject their advice and insights especially if the counselor suggests that change in the lifestyle and self-perception is needed. For example, a person with visual impairments can reject the idea that a guide dog is needed. This description is applicable to those cases when a disability ruins the professional career of a person and makes a negative impact on his/her relations with other people. The change in way of thinking is another extremely challenging objective a counselor is to help their clients with disabilities achieve. While adopting new behaviors, buying tools that have never been used by these people before requires some adjustments, the change of self-perception and outlook on life and the self occurs only over deep analysis, and acceptance of one’s disabilities as a normal part of their everyday life. In other words, disability has to stop being an enemy, but this goal is hard to reach since for most clients a disability is a constant source of negative emotions and disappointments.
Stage 3: Acceptance
Finally, during the third stage, people no longer deny the fact that they have a disability. However, they do not regard it as a deficiency. Instead, they attempt to view it as a difference that distinguishes them from others. Moreover, they want to find a role model whose behavior can be emulated. For instance, they try to emulate the behavior of people who were able to achieve success despite their disabilities. This behavioral tendency is of great value for counselors because it helps a patient overcome his/her depression. At the third stage of disability identity development, the individuals do not only start to actively interact with other people who have disabilities but also begin to integrate themselves into the surrounding world without thinking of themselves as “others” (Gibson 8).
In turn, counselors should understand how patients’ perceptions evolve over time. This knowledge is essential for determining when a certain intervention can be appropriate. The professionals should bear in mind that it is difficult for many people to pass from the second to the third stage. According to various surveys, only 11 percent of respondents accept that they have to struggle with different physical or mental problems (Olney et al. 4). As it has been said before, they associate disabilities with a certain stigma. Additionally, they believe that these impairments can prevent them from establishing relations with other people. Furthermore, they think that their employment opportunities will be limited (Olney et al. 4). So, they feel discriminated against in multiple ways.
The social model of disability
Counselors should also consider the social model of disability. This theory implies that disability is primarily a social construct. It results from the misfit between the standards set for a person and his/her physical capabilities. For instance, one can mention the standards of physical attractiveness established in the community. According to this approach, society can exacerbate the effects of a disability on the individual. Due to these influences, many patients can believe that they are outcasts. The knowledge provided by this model is useful because it can explain why people can resist any form of counseling. In particular, such individuals can assume that other people treat them as inferiors. Therefore, it may be difficult for a counselor to gain the trust of a client. It is one of the difficulties that should be taken into account by the therapist. Nevertheless, despite these challenges, a counselor can help a client adopt a more positive attitude towards his/her identity as well as other people.
Admittedly, counselors can consider other models, but the chosen approaches are useful for explaining the behavior and perceptions of people who have disabilities. Additionally, these two approaches should be distinguished because they illustrate two important obstacles to overcome for the counselors and their clients. At first, the counselors need to consider the willingness of a person to turn a blind eye to his/her health problems. Without a client’s agreement, further therapy or improvement will not be possible. Additionally, they should not forget about the negative and extremely powerful influences of the external environment that are inseparable from the clients and their identities. That way, working with people who have disabilities, a professional is to approach the matter environmentally and address this complex issue from a variety of aspects as it penetrates every sphere of the client’s everyday life. In turn, it is important to find ways of removing these barriers.
The Steps That a Counselor Should Take
A counselor should take several steps. In particular, first of all, they need to diagnose the identity development stage of a patient. Further, they are to determine if patients are ready to speak about their disability in an open and honest manner. The reticence of clients suggests that they are still unwilling to change their lifestyles or ways of thinking. The patients may be encouraged to complete a questionnaire. It is useful for showing if a patient is ready to share opinions and feelings they have about the disability. Moreover, it is necessary to help a client address and adjust their perceptions of other people. Namely, working with such a client a counselor has to focus on the feeling that others will judge or discriminate against the client, and the belief that people around view a disability as something ugly, funny, or inappropriate, the fear to be rejected and devalued. A counselor should encourage a person to think of those cases when other people were supportive and helpful. This approach is necessary for reducing a person’s hostility towards other individuals, especially his/her peers. In other words, dealing with a person who struggles with a disability a professional is to remember that such clients are challenged by both internal and external conflicts. As a result, they position their disabilities and conditions as unfair circumstances and treat them almost like a curse turning their own bodies into enemies. Besides, they view the world around them as hostile and unwelcoming. Such an approach creates an overall feeling of extreme loneliness and vulnerability. The role of a counselor is to help the clients find self-worth, confidence, and inner strength and stop seeing themselves as eternal victims of the circumstances.
Additionally, a therapist should not overlook the significance of models that a patient should consider. This example should be both inspiring and motivating. It should demonstrate that a person must not perceive oneself as inferior in any way. In this way, one can identify behavioral goals that a person should achieve.
Much attention should be paid to the listening techniques that a therapist should apply. This professional should not interrupt a client. Instead, it is better to make short verifying questions if some utterances of a patient are not sufficiently clear.
Furthermore, the counselor should avoid making mistakes that can make a patient feel inferior in some way. For instance, it is not necessary to use non-verbal gestures when talking to a person with visual impairments. In particular, one can mention nods or shakes that signify agreement or disagreement. In this case, they should always be accompanied by short verbal responses. Thus, counselors should know how patients with a disability can communicate with other people.
To sum up, beginning to work with a person with a disability, a counselor is to carefully think through their approach as there are numerous challenges that may complicate the therapy and the client’s journey towards success. Fortunately, models such as Gibson’s disability identity development stages were created to help the counselors address the problems of people with disabilities in the most effective and gentle way. Overall, counselors should be able to anticipate various challenges that can impact their relations with people affected by a disability. Therefore, a high level of professional and personal flexibility is necessary for a counselor to assist the client’s success and to adhere to all the ethical norms required in such cases. Before suggesting any specific intervention, a therapist should consider the possible reactions of a person. In many cases, a patient’s denial of his/her can impact the process of counseling. In turn, therapists need to select an evidence-based theory showing how a person’s perceptions of his/her disability evolve with time passing. This knowledge can significantly improve the experiences of many patients. Additionally, therapists should be skilled in using different counseling techniques that are necessary for building a rapport with a client.
Cornish, Jennifer, Kimberly Gorgens, Samantha Monson, Barbora Palombi, Rhoda
Olkin, Arnold Abels. “Perspectives on Ethical Practice with People Who have Disabilities.” Professional Psychology: Research and Practice 39.5 (2008): 488-97. ProQuest. Web. 2015.
DeLucia-Waack, Janice L., Cynthia R. Kalodner, and Maria Riva. Handbook of Group Counseling and Psychotherapy. Thousand Oaks, California: Sage Publications, 2004. Print.
Gibson, Jennifer. “Disability and Clinical Competency: An Introduction.” The California Psychologist 39.6 (2006): 6-10.
Kielhofner, Gary. Model of Human Occupation. Baltimore, Maryland: Lippincott Williams & Wilkins, 2008. Print.
Luterman, David. “Counseling Families Of Children With Hearing Loss And Special Needs.” Volta Review 104.4 (2004): 215-220 6p. CINAHL Complete. Web. 2015.
Nicholls, Elizabeth, Tara Lehan, Silvia Plaza, Xiaoyan Deng, Jose Romero, and Jose Pizarro. “Factors Influencing Acceptance Of Disability In Individuals With Spinal Cord Injury In Neiva, Colombia, South America.” Disability & Rehabilitation 34.13 (2012): 1082-1088. Print.
Olney, Marjorie, Jae Kennedy, Karin Brockelman, and Mark Newsom. “Do You Have A Disability? A Population-Based Test Of Acceptance, Denial, And Adjustment Among Adults With Disabilities In The U.S.” Journal Of Rehabilitation 70.1 (2004): 4-9. Print.
Thomas, Anita Jones, and Sara Schwarzbaum. Culture and Identity: Life Stories for Counselors and Therapists. Thousand Oaks, California: Sage Publications, 2006. Print.
Trusty, Jerry, Eugenie Joan Looby, and Daya Singh Sandhu. Multicultural Counseling: Context, Theory and Practice, and Competence Huntington, New York: Nova Science Publishers, 2002. Print.
Voigt, Ryan J. Who Me? Self-Esteem for People with Disabilities. 2015. Web.
Weeber, Joy Elizabeth. Disability Community Leaders’ Disability Identity Development: A Journey of Integration and Expansion. 2004. Web.