Disability Definitions, Diagnoses, and Practice Implications

An Introduction for Counselors

Julie Smart

• Publisher: Routledge
• Year: 2018
• Print ISBN:
  9781138244696
• eBook ISBN:
  9781351997126
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

This introductory text defines and describes disability, while providing concrete practice guidelines and recommendations for students in the fields of counseling, social work, and the helping professions. Various specialty areas are explored in detail, including marriage and family counseling, adolescent counseling, addictions counseling, LGBTQ concerns, multicultural counseling, and career counseling.

The first three chapters lay the foundations by discussing the demand for counseling services by individuals with all types of disabilities; presenting clinical, legal, medical/biological, and personal definitions of disability; and describing physical, cognitive, and psychiatric disabilities. Next, author Julie Smart examines core beliefs about disability using a range of first-person accounts from experienced counselors. The last six chapters focus on practice guidelines for various aspects of disability—including ethical considerations, societal issues, social role demands, and individual responses—and consider new possibilities for disability counseling professions.

With rich case studies woven throughout, as well as valuable information on client needs, disability categorizations, and key Models of Disability, this essential textbook will be useful not only to counseling students but also to professional counselors, social workers, and psychologists.

One

A New Reality for Counselors

DOI: 10.4324/9781315276694-2

This chapter consists of three sections. The first section is a general rationale for the need for counselors of all specialties to provide services for individuals with disabilities (IWDs). The second section is entitled, “The Paradox of Disability.” The third section is the longest, and it discusses a convergence of factors that has changed the lives of IWDs.

Counselors Providing Services to IWDs

Increasingly, individuals with disabilities (IWDs) are seeking the services of counselors in all specialty areas, including career counseling; marriage and family counseling; child and adolescent counseling; aging and adult development; spiritual and pastoral counseling; lesbian, gay, bisexual, and transgendered issues counseling; college counseling; military veteran counseling; and more. This new demand for counseling services has resulted from the convergence of several factors, all of which are of recent origin, including demographic shifts, the enactment and enforcement of advanced human civil rights laws, more accurate portrayal of IWDs in the media, and the ever-growing group identity of IWDs.

Three Broad Categories of Disabilities

1. Physical disabilities
2. Cognitive disabilities
3. Psychiatric disabilities

Broadly speaking, definitions of disabilities are divided into three major categories, all of which are based on symptoms and not on causes. The first category is physical disabilities and includes sensory loss, such as blindness and deafness, orthopedic impairments, and chronic illnesses. The second broad category is labeled cognitive disabilities and includes intellectual disabilities and developmental disabilities, such as ASD (autism spectrum disorder). The third category is termed psychiatric disabilities and, typically, includes mental disorders, alcoholism, and other chemical and substance abuse conditions.

Chronic illnesses include diabetes; heart conditions; autoimmune diseases, such as lupus, rheumatoid arthritis, and multiple sclerosis; and many others. These chronic illnesses are considered to be disabilities because they limit an individual’s functioning, require lifelong management, and individuals with chronic illnesses and conditions are often the target of prejudice and discrimination. When considering the three main categories of disabilities, physical, cognitive, and psychiatric, chronic illnesses are placed in the physical disabilities category.

These categories never precisely and fully reflect the reality of the IWDs. For example, some IWDs experience more than one disability. Nonetheless, to gain a simple introductory explanation and understanding of the disability experience, these three categories provide a framework and a basic overview for all types of disabilities.

In the not-so-distant past, IWDs who desired counseling services were routinely referred to rehabilitation counselors and medical practitioners. The public and the counseling professions, including both practitioners and academicians, considered the disability(ies) of IWDs to be their defining identity or, at minimum, to be the most important self-identity. In this way, IWDs were marginalized or segregated to receive services almost exclusively from the medical professions. However, most IWDs do not consider their disability to be their most defining characteristic although the disability, and the mastery of it, is a valued and important part of the self-identity of most IWDs. As we shall see in this book, most IWDs consider themselves “normal” and as “individuals,” albeit with a disability. (This is probably less true of individuals with severe cognitive and psychiatric disabilities, a small minority of all IWDs.) Oliver Sacks (1985), the late neurologist/author explained this difference:

If a man has lost a leg or an eye, he knows that he has lost a leg or an eye; but if he has lost a sense of self—himself—he cannot know it, because he is no longer there to know it.

(pp. 35–36)

IWDs manage and negotiate the disability, but most view themselves as having the same motivations, emotions, needs, and goals as individuals without disabilities (IWODs). Also, like anyone else, IWDs consider themselves to have multiple identities, roles, and functions, instead of only “being disabled.” Additionally, most IWDs deal with the typical developmental demands and life demands as IWODs do, including education, career development, establishing long-term sexual relations, raising children, and developing a spiritual/philosophical/religious understanding of life. Izak Perlman, the world famous Israeli violinist, remembers when he first started his career, he was known as a “disabled violinist.” Now, after decades of success and hard work, the public describes Izak Perlman as a “violinist with a disability.” This second description more closely reflects Perlman’s self-concept because, while he does not deny or ignore his disability, a more important identity is as a violinist. Perlman contracted polio as a child and, because of lower limb paralysis, uses crutches (Olkin, 1999).

Ways in Which IWDs Consider Themselves “Normal”

• IWDs have the same motivations, emotions, and goals as IWODs.
• IWDs have the same life tasks.
• IWDs do not consider their disability to be their most defining identity.
• IWDs claim the right to self-identity, rather than being categorized in a disability group, such as the “blind” or the “mentally ill.”

The concept of “normality” also includes the self-identity of the IWD as an individual. In the past, IWDs have been viewed as belonging to categories rather than as individuals. Many IWDs have felt that they were forced to accept stigmatizing diagnoses in order to receive services. These categories included “the disabled” or “the blind” or the “mentally ill,” and a myriad of other demeaning, stereotyped labels. It is a short step from categorization to stereotyping, such as “All blind people are musically talented” or “All IWDs must be depressed.” Additionally, these categories, mostly defined by diagnostic groups, tend to be negative, pathologizing the entire person and relegating the IWD, regardless of personal resources, to an isolated, inferior status.

Nonetheless, medical services are important to IWDs, especially in the stabilization period after the diagnosis/onset of the disability, in times of relapse, and for medication management. For most IWDs, medical management will be a lifelong process, treating the physical, organic, and biological aspects of the disability, avoiding secondary conditions or complications, and maintaining the highest possible quality of life (QOL). When using medical services, the disability of the individual is rightly the presenting problem. However, thinking in terms of counseling, there is much more to an IWD than their disability and, therefore, IWDs require the same professional services that IWODs seek out.

To clarify the counseling needs of IWDs, we may look at three broad categories.

1. Most often, the IWD is requesting the expertise of the counselor in their specialty or theoretical orientation. In these cases, the disability and the individual’s experience of the disability may be of little relevance.
2. Occasionally, the client’s experience of their disability, including both medical and social aspects, may have some significance. Nonetheless, the disability is not the presenting problem.
3. The IWD may request counseling services to help with their response to the disability, including the emotional management of the disability (Elliott & Gramling, 1990; Elliott & Warren, 2007).

In all three of these categories, counselors will need both an understanding of and awareness of the disability experience, and based upon this rudimentary knowledge, counselors will be able to understand the client’s idiosyncratic response to their disability. Practice applications for these three categories are provided in Chapters 5, 6, 7, 8, 9, and 10.

Although not everyone has a disability, the possibility of acquiring a disability (or being diagnosed with a disability) is universal. The surgeon/author Atul Gawande described this universal possibility by stating, “Life is a preexisting condition” (p. 45). Much like the counseling approach of “successful aging” or “reorientation and coping with major life changes” (Boerner & Jopp, 2007; Grant, 2005), IWDs seek to maintain control of their lives, activate goal optimization, and find alternative methods to reach desired goals. Substitution of goals, maximizing abilities and resources, including civil rights, are effective coping devices for anyone experiencing major life changes, including IWDs. However, in addition to these adaptive strategies, IWDs encounter added needs, including the medical aspects of the disability, managing the disability, reducing relapses, and avoiding secondary conditions or complications. Societal prejudice and discrimination may or may not be a part of many major life changes; however, prejudice and discrimination are almost always a barrier to which the IWD must respond and negotiate. Indeed, many IWDs consider prejudice and discrimination and lack of accommodations to be a greater difficulty than the disability itself (Hahn, 1988). Twenty-five years ago, Madeline Will, former assistant secretary for education and head of the Office of Special Education and Rehabilitation (OSER), explained:

Most disabled people … will tell that despite what everyone thinks, the disability itself is not what makes everything different. What causes the disabilities is the attitude society has about being disabled, attitudes that make a disabled person embarrassed, insecure, uncomfortable, dependent. Of course, disabled people rarely talk about quality of life. But, it has precious little to do with deformity and great deal to do with society’s own defects.

(as cited in Weisgerber, 1991, p. 6)

Hopefully, this book will be a start to close the gap between the aspirational directives of ethical codes of the helping professions.

The Paradox of Disability

How can an IWD think of themselves as “normal”? Are not disabilities to be prevented and avoided? There are laws mandating seat belt use, laws against drunk driving, and government-provided prenatal care for pregnant women, all which reflect government/societal actions to decrease the incidence of disability. Also, when an individual is injured, a great number of resources are marshaled to return the individual to pre-injury functioning. Do not disabilities involve impairment and reduced functioning? To use a single example, is it not better to be able to hear than to be d/Deaf? Disabilities are often painful, difficult, require substantial management and treatment, and societal-provided accommodations. Without doubt, most disabilities are expensive and the IWD, or his family, rarely pays the entire sum for the treatment/rehabilitation. Nonetheless, after medical stabilization, most IWDs return to a “new normal,” which is life with a disability.

Carol Gill, a psychologist who is paraplegic, noted that most IWDs identify themselves as typical, ordinary people with the usual life concerns, such as family, career, and community life. Nevertheless, often IWDs are unpleasantly reminded that others may not see them as ordinary or typical people.

Unless they have developed a cultural consciousness that centralizes difference, most disabled people identify as typical… . Moreover, most disabled people think of themselves as ordinary because impairments receded in importance as they are integrated into daily routines. It can be repeatedly jolting for individuals who identify as ordinary to be persistently categorized as extraordinary or pathetic by those whom they regard as peers, even intimates.

(Gill, 2000, p. 351)

Legal Aspects

The Difference Between Civil Rights Laws and Service Laws

American law does recognize the medical/organic aspect of disability. Protection under the law in the United States is provided by the Americans with Disabilities A...

Table of contents

• Cover
• Half Title Page
• Title Page
• Copyright Page
• Contents
• Preface
• Introduction to the Chapters
• 1 A New Reality for Counselors
• 2 Defining, Diagnosing, and Measuring Disability
• 3 Models of Disability: Another Way to Describe Disability
• 4 Six Core Beliefs About Disability of Highly Empathetic Counselors
• 5 Ethical Considerations and General Practice Guidelines
• 6 Understanding the Experience of Disability: Counseling Practice Guidelines
• 7 Integrating Counseling Practices with Societal Issues
• 8 Understanding the Individual’s Response to Disability: Counseling Practice Guidelines
• 9 Understanding Social Role Demands of Individuals With Disabilities: Counseling Practice Guidelines
• 10 Responding to Some Unique Demands of Disability: Counseling Practice Guidelines
• 11 New Horizons for the Counseling Professions
• Case Studies
• Index