Transcript chapter 1 the multicultural journey to cultural competence

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
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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
The following are three models of disability
affecting the way the condition is perceived:
Moral model
 Medical model
 Minority model

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, selfpunishment, 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.