individuals disability

  please see attachment

Please have 3-5 references ( see textbook info below, please use) 

Please put citations on each slide

Your power point presentation must consist of at least 20 slides (not including reference list) and must include all of the following:

1. Introduction to the specific group – ex: maybe some stats on % of population in US, socioeconomic info., basic education facts etc.

2. Characteristics and Strengths – 

a. ethnic and racial identity; historical/sociopolitical background 

b. family structure (roles in family of children, parents, elders etc.)

c. kinship bonds with extended family and friends

d. spiritual and religious values

e. educational characteristics

f. cultural strengths/ specific challenges

3. Implications for clinical practice/ counseling and therapy (considering the above info.)

4. Summary 

References

Please

have 3-5 references ( see textbook info below, please use)

Please put citations on each slide

Your power point presentation must consist of at least 20 slides (not including reference list) and must include all of the following:

Introduction

to the specific group – ex: maybe some stats on % of population in US, socioeconomic info., basic education facts etc.

Characteristics and Strengths –

ethnic and racial identity; historical/sociopolitical background

family structure (roles in family of children, parents, elders etc.)

kinship bonds with extended family and friends

spiritual and religious values

educational characteristics

cultural strengths/ specific challenges

Implications for clinical practice/ counseling and therapy (considering the above info.)

Summary

References

Slides:

Title, Student

Introduction

Population

Socioeconomics

Education

Characteristics and Strengths: Ethnic and Racial Identity

Continue characteristics and strength: historical/sociopolitical background

Family structure(roles in family of children, parents, elders,etc.)

Family structure continue

Kinship bonds( with extended family and friends)

Kinship bonds continue

Spiritual and religious values

Spiritual and religious values continue

Educational characteristics

Educational characteristics continue

Cultural strengths/specific challenges

Cultural strengths/specific strengths continue

Implications for clinical practice/counseling and therapy (considering the above information)

Implications for clinical practice continue

Summary

Summary continue

References

The most important part of this project is the information you gather and convey about the group you are covering. A good power point slide doesn’t contain too much information but still highlights what you want the reader to remember.

It is fine to put some additional information about any particular slide in the section underneath for “Notes.” That is preferable to your cluttering the slide with too many things to read.

Information from the textbook

Textbook citation: Smith, D.W.S.D.S.H.A.N. L. (2019). Counseling the Culturally Diverse. [VitalSource Bookshelf]. Retrieved from https://online.vitalsource.com/#/books/9781119448280/

Group: Counseling Individuals with Disabilities

Chapter Objectives

1. Learn the demographics and characteristics of persons with disabilities.

2. Know the different types of disabilities and the models and myths regarding individuals with disabilities.

3. Identify counseling implications of the information provided for persons with disabilities.

4. Recognize strengths that are associated with persons with disabilities.

5. Know the special challenges faced by persons with disabilities.

6. Understand best practices for assessment and therapy with persons with disabilities.

I have experienced forced intimacy my entire life as a disabled child, youth and adult. I am always expected to do the work of opening myself up for others’ benefit, education, curiosity or benevolent oppression. (Mingus, 2017a)

Members of the deaf community view deafness not as a disability but as a difference in human experience. Many have a positive attitude towards deafness and generally do not consider it a condition that needs to be “fixed” and, therefore, may oppose technological innovations such as cochlear implants. (Konig, 2013)

A 77‐year‐old woman has been on kidney dialysis for 10 years; she also has seizures, arthritis, and significant hearing loss. Communication with the social worker is not going well due to the woman’s impaired hearing. The daughter explains that her mother has hearing aids but does not wear them because they hurt her ears. The social worker directs all her questions to the daughter, leaving the mother wondering what is being discussed. (Desselle & Proctor, 2000)

People often lack understanding and do not know how to respond to people with disabilities. Attitudes toward individuals with disabilities may be disdainful and dismissive, or overly protective or sympathetic. In the third vignette, the social worker was talking to the daughter as if the mother were not present. The daughter felt frustrated and responded,

You are not even trying to communicate with my mother … She can understand you if you look at her and speak slowly and clearly … Imagine how you would feel if you and your spouse went to the doctor to consult about a major surgery you were scheduled for and the doctor directed the conversation only to your spouse as if you were not intelligent enough to know what was being discussed. (Desselle & Proctor, 2000, p. 277)

There are an estimated 56.7 million Americans with some level of disability (physical or mental), of whom over half have a disability that severely affects daily functioning (Brault, 2012). Of the 72.3 million families in the United States, about 21 million have at least one member with a disability. Rates of disability are higher among African Americans (22.2%) and American Indian/Alaska Native groups (27%) compared with non‐Hispanic Whites (16.2%) (Cornish, Gorgens, Olkin, Palomibi, & Abels, 2008). Because of traumatic brain injuries incurred in the wars in Iraq and Afghanistan, the incidence of individuals with physical disabilities is increasing (Terrio, Nelson, Betthauser, Harwood, & Brenner, 2011).

Women are more likely to experience a physical disability than men; further, women with a physical disability are much more likely to experience depression than women in the general population (Brown, 2014) and are at risk for abuse (Robinson‐Whelen et al., 2010). In children, disability is more common in boys and in children from low‐income families (Sullivan, 2009). Children with disabilities are more likely to be subjected to maltreatment, including neglect; physical, sexual, or emotional abuse; and bullying (Jones et al., 2012; Zablotsky, Bradshaw, Anderson, & Law, 2014). Individuals with severe disability have high unemployment and poverty rates (U.S. Census Bureau, 2010). As estimated by the Census Bureau’s American Community Survey, only 32% of those with disabilities are employed, versus 73% of those without (Office of Disability Employment Policy, n.d.).

Individuals with disabilities have significantly lower rates of college completion compared to those without (Barber, 2012). Up to 90% of individuals with psychiatric disabilities are unemployed—the highest unemployment of all disability groups (Larson et al., 2011).

In the following sections, we offer background information about individuals with disabilities, discuss the challenges often faced by these individuals, and consider their implications in treatment. Remember that disabilities vary greatly in terms of severity as well as the specific condition involved, and that people with disabilities constitute a diverse community with multifaceted racial‐ethnic backgrounds, cultural identifications, and religious practices. This overview, therefore, provides generalizations about a diverse group of people, the applicability of which always needs to be assessed with regard to individual clients.

CHARACTERISTICS AND STRENGTHS

In this section, we will consider the Americans with Disabilities Act (ADA), myths regarding individuals with disabilities, models of disabilities, and characteristics and strengths associated with this population.

The Americans with Disabilities Act (ADA) The ADA, signed into law in 1990, prohibits discrimination against people with disabilities in employment, transportation, public accommodation, communications, and governmental activities and ensures that buildings, facilities, and transit vehicles are accessible and usable by people with disabilities. Its passage was speeded up when hundreds of individuals with disabilities demonstrated in front of the Capitol Building in Washington, D.C. To demonstrate the barriers they faced, dozens left their wheelchairs and crawled up the 83 steps to the building (Michaels, 2015).

The ADA defines disability as “a physical or mental impairment that substantially limits one or more of the major life activities of such individual.” It protects individuals with intellectual impairment, hearing or vision impairment, orthopedic conditions, learning disabilities, speech impairment, HIV/AIDS, and other health or physical conditions. Psychiatric disorders covered include major depression, bipolar disorder, panic and obsessive‐compulsive disorders, some personality disorders, schizophrenia, and rehabilitation from drug addiction.

Under the ADA, employers are allowed to inquire about candidates’ ability to perform the job but not about their disability. Employers are not allowed to discriminate against an individual with a disability during the person’s employment or in regard to promotion if the individual is otherwise qualified; similarly, employers cannot use tests that will cause individuals to be screened out because of a disability. Additionally, employers are required to make reasonable accommodations for people with disabilities.

Although the ADA has improved opportunities for employment by individuals with disabilities, the law has been whittled away by court decisions that have supported businesses rather than people with disabilities. For these reasons, the National Council on Disability has indicated a need to “restore the original intent” of the ADA (American Association of People with Disabilities, 2006).

Implications

Mental health professionals should keep abreast of federal and state disability laws, including statutes affecting the rights of individuals with disabilities in school and work settings. It is important for therapists to make sure that they do not provide unequal service or deny treatment to clients with disabilities; if an individual requires treatment outside your area of specialization, you can help facilitate a referral to a more qualified provider. Also, be alert for criteria that may screen out or disadvantage clients with disabilities, such as requiring a driver’s license for payment by check. Policies, practices, and procedures in your office can be modified to take into consideration those with disabilities, such as ensuring that service animals are permitted in your building. You may need to provide auxiliary aids and services, such as readers, sign‐language interpreters, braille materials, large‐print materials, and videotapes or audiotapes to facilitate communication with some clients. Evaluate your office for structural and architectural barriers that prevent individuals from getting the services they need. Evaluate the accessibility of your office, including the availability of ramps, parking spaces, reachable elevator control buttons, and wide doorways.

Myths Regarding Individuals with Disabilities

There are many myths associated with people with disabilities (e.g., Center for Workplace Preparation, n.d.; LSU Office of Disability Services, 2011; National Service Inclusion Project, n.d.): Most people with disabilities are in wheelchairs. Among the millions of people with disabilities, a small proportion use wheelchairs, crutches, or walkers. Most have more invisible disabilities, such as cardiovascular problems, arthritis and rheumatism, back and spine problems, hearing impairment, asthma, epilepsy, neurodevelopmental disorders (e.g., academic or intellectual impairment), and mental illness. People with disabilities are a drain on the economy. It is true that many individuals of working age with disabilities are not working. However, the majority of those who are unemployed want to work. Discrimination often hampers their efforts to join the workforce. Employees with disabilities have a higher absentee rate than employees without disabilities. Studies have found that employees with disabilities are not absent from work more than nondisabled employees. The greatest barriers to people with disabilities are physical ones. In actuality, negative attitudes and stereotypes are the greatest impediments and the most difficult to change. People with disabilities are brave and courageous. Individuals with disabilities react to situations like anyone else does. They demonstrate a variety of emotional reactions in adapting to their condition. Some adapt relatively quickly, whereas others have more difficulty coping. As mentioned previously, not all disabilities are apparent. Individuals with “invisible” disabilities (e.g., many mental disorders or physical conditions such as traumatic brain injury) may be responded to with frustration and resentment from friends, family members, and employers. When an individual looks healthy, others may not believe they have a disability and may blame them for the difficulties that they display. With a visible disability, prejudice and discrimination can occur, but accommodations are more likely to be made. With a less visible disabling condition, such as a traumatic brain injury, misattributions are common (e.g., blaming difficulties in recovery on the individual’s personality or unwillingness to cooperate). There may also be unrealistic hopes for full recovery. Invisible disabilities can be assessed by consulting with family and friends about the client’s preinjury behaviors, abilities, personality, and attitudes to determine whether there have been any changes in these characteristics due to the injury. If this is the case, the counselor can educate family members about the nature of the condition and explain how unrealistic expectations sometimes develop with unobservable injuries (McClure, 2011).

Models of Disability

There are three models of disability, each influencing societal perceptions of disabling conditions and possible treatment strategies (Artman & Daniels, 2010; Olkin, 1999). First, the moral model focuses on the “defect” as representing some form of sin or moral lapse. The disability may be perceived as a punishment or a test of faith. The individual or family members may respond with feelings of shame and responsibility. In some cultures, disabilities are believed to result from such factors as evil spirits, curses, or retribution from unhappy ancestors. Second, the medical model regards disability as a defect or loss of function that resides in the individual. Action is taken to cure or rehabilitate the condition. In some cultural groups, intervention targets rebalancing mind–body disharmony. The medical model has been responsible for many technological advances and treatments targeting a variety of conditions. Additionally, this approach dismisses the notion that moral issues have caused the disability. Third, the minority model views disability as an external problem involving an environment that is filled with negative societal attitudes and that fails to accommodate the needs of individuals with special needs. This perspective emphasizes the oppression, prejudice, and discrimination encountered by individuals who are disabled—experiences very similar to those of other minority groups.

Implications

Much research indicates that empowering individuals and caregivers increases life satisfaction. Unfortunately, the stress and prejudice associated with disabilities increase the risk for psychiatric or substance abuse problems (Turner, Lloyd, & Taylor, 2006). If mental health issues appear to be related to the disability, it is important to identify the way the disability is viewed by the client and by family members; such information may influence problem definition and intervention strategies. If the disability is seen as a moral issue (e.g., a test of faith), religious support may be an important component of the treatment process. Goals might include reducing guilt, giving meaning to the experience, generating support from the religious community, and developing problem‐solving approaches. From the medical model perspective, the client or family members may want to focus on improving the client’s condition, using technology or other interventions to help “normalize” functioning. Mental health professionals can not only help clients and family members obtain technological resources but also enhance clients’ independent living skills and advocate for appropriate accommodations in school or work environments. Incorporating perspectives from the minority model can be useful; counselors can emphasize how societal attitudes play a large role in the problems faced by individuals with disabilities and focus on environmental supports directed at maximizing the potential of the client. An emphasis on self‐empowerment and self‐advocacy can help inoculate clients against societal prejudices and discrimination and protect their self‐esteem.

Life Satisfaction

I should have picked up the pieces and made the adjustment, and not dwell on it … The problem is the rest of the world is dwelling on it … this place won’t hire you and this company won’t insure you and that potential lover won’t look at you … So that reopens the wound maybe twenty times a day and yet you’re supposed to have made the adjustment. (Noonan et al., 2004, p. 72) Because of an auto accident, Gary Talbot went from being an “able‐bodied man to able‐bodied wheelchair user.” He evaluates his life this way: “I don’t like the fact that I can’t walk down the street or go jogging or climb a hill or ride a bike. [But] there’s so much I can do and that I’ve been able to do that I just wouldn’t change anything about my life.” (Rosenbaum, 2010) Ratings of life satisfaction among individuals with disabilities tend to be lower than among those without disabilities. However, this depends on the type of disability and the timing of the rating. Some individuals adjust well, whereas others remain chronically distressed. In one study of the life satisfaction of people with traumatic spinal cord injuries, 37% indicated they were “very satisfied” and 31% “somewhat satisfied” with their lives. This compares to 50% “very satisfied” and 40% “somewhat satisfied” among the general population. An interesting aspect of the study was that those who perceived themselves as “in control” reported the greatest satisfaction (Chase, Cornille, & English, 2000). Similarly, in a longitudinal study of 307 individuals who were “severely” handicapped, with a reduced capacity to work, life satisfaction was reduced in the first year but rose to preinjury levels by the fourth year. Those who were most likely to improve had the personality characteristic of “agreeableness,” an attribute associated with the ability to access and cultivate social support. Thus, helping clients develop or maximize social skills may enhance recovery (Boyce & Wood, 2011). Having close social relationships and paid employment are also associated with increased life satisfaction (Crompton, 2010). Individuals with disabilities often rate activities such as communication, thinking, and relating socially as more important than being able to walk or to dress oneself. Unfortunately, many health professionals display a negative attitude toward disability. Only 18% of physicians and nurses imagined that they would be glad to be alive if they had a high‐level spinal cord injury; in sharp contrast, 92% of those with this condition reported satisfaction with their lives (Gerhart, Koziol‐McLain, Lowenstein, & Whiteneck, 1994).

Implications

Mental health and health care providers often underestimate the potential quality of life for individuals with disabilities. They may accept signs of depression or suicidal thoughts as normal because of their low expectations regarding life opportunities for this population. The research seems to show that many individuals with disabilities feel satisfied with their lives and that increasing their sense of control is important. Self‐efficacy can be enhanced by encouraging as much personal control and decision making as possible. If depressive or suicidal thoughts or wishes surface, they should be addressed. Some support the right of individuals with disabilities to engage in assisted suicide. However, other organizations argue that individuals with disabilities are an oppressed group and express concern that they may be coerced to end their lives (Coleman, 2015).

Sexuality and Reproduction

In response to intrusive questions regarding her intimate experiences, poet Kelsey Warren, who uses a wheelchair, replied “Cripple copulation may be slightly more complicated, but it is always climactic.” (Zeilinger, 2015) Men and women with disabilities often express concerns over sexual functioning and reproduction. They worry about their sexual attractiveness and how to relate to or find a partner. Some may not know whether it is possible to have children or may have questions about the genetic implications of procreating. Mental health professionals who are uncomfortable with these topics may minimize or overlook these areas of concern.

Implications

Clearly, both clients and therapists need to be educated on these subjects as they relate to specific disabilities. Many individuals who have a disability receive the societal message that they should not be sexual or that they are sexually unattractive. This concern should be addressed and assessed both individually and, where applicable, for couples. Therapists can emphasize that sexual relationships are based on communication and emotional responsiveness and can help individuals or couples develop new ways of achieving sexual satisfaction. Prior perspectives regarding sexuality may have to be replaced with new ones. Sexual pleasure is possible even with the loss of sensation in the genitals that occurs with spinal cord injuries. Among men with spinal cord injuries, some are able to attain an erection and ejaculate, although they may have to learn new forms of stimulation (Craig Hospital, 2015). Many women with spinal cord injuries are still capable of orgasms and sexual pleasure from stimulation of the genitals or other parts of the body (Perrouin‐Verbe, Courtois, Charvier, & Giuliano, 2013). Such injury also does not preclude the ability to become pregnant or deliver a child.

Spirituality and Religiosity

Spirituality and religious beliefs can be a source of inner strength and support. One woman with a disability wrote, “It sort of helps me to identify myself, thinking I am a woman created by God and I am so precious and I am so loved and I have so much beauty inside of me” (Nosek & Hughes, 2001, p. 23). Religion and spirituality (connection to a higher power) are associated with increased life satisfaction and functional ability for individuals with traumatic brain injuries (Waldron‐Perrine et al., 2011).

Implications

The mental health professional should determine the role, if any, that religious beliefs or spirituality play in the life of a client with a disability. The spirituality of the woman in the quoted example enhanced her sense of self. Such beliefs can be a source of support for clients and their caregivers. Therapists can ask clients about their religious or spiritual beliefs and how their beliefs help them confront challenges; they can then incorporate these beliefs into treatment (Waldron‐Perrine et al., 2011). In some cases, individuals may believe that their disability is a punishment from God or may blame God for not preventing the injury. These issues should also be addressed and resolved. Therapists can consult with or refer to religious leaders when working with clients who are attempting to come to terms with a disability.

Strengths

Many individuals with disabilities who have lived through natural disasters show resiliency and adaptation. Instead of responding, “Where were they when we needed them?” they were more likely to think, “What are my possibilities? What options do I have?” (Fox, White, Rooney, & Cahill, 2010, p. 237) Because of the variety of disabilities and because individuals with disabilities can come from any population, we will focus on personal characteristics that enhance daily living and satisfaction with life. Individuals with traumatic brain injuries who feel a connection to a higher power show greater life satisfaction and functional ability. Among those with spinal cord injuries, coping strategies, hope, and optimism are associated with a higher quality of life (Kortte, Gilbert, Gorman, & Wegener, 2010). Qualities such as creativity, resilience, self‐control, self‐advocacy and the ability to make positive connections with others and find meaning in life are strengths that can be tapped in the therapy process (Wehmeyer, 2014). Many individuals already possess these strengths; however, they can also be developed or enhanced in counseling by focusing on changing the client’s and the client’s significant others’ perceptions of the disability. Outcome is enhanced by improving self‐confidence and finding and developing ways to empower the client (Shallcross, 2011) and encourage active decision making (Artman & Daniels, 2010). For some, the development of a “disability identity” or a positive affirmation about the disability may enhance self‐image. This might include association with the disability community, confronting discrimination and prejudice, and advocacy to reduce constraints—for example, by eliminating physical barriers that hamper access. Those with a disability identity often adapt to and view their disability as a valuable experience rather than a decrement. This perspective has been associated with lower distress levels among individuals with multiple sclerosis (Bogart, 2015). Others can have a positive self‐identity even in the absence of an emotional and social connection to the disability community. Counselors must listen to what their clients need rather than force them into a specific direction in relation to their disability (Dunn & Burcaw, 2013). In general, finding meaning in one’s experience is associated with better adjustment and cognitive adaptation. Individuals facing a life‐changing disability benefit when they embrace the opportunity to develop a new perspective on life, or view their changed life circumstances as a signal to slow down or change their life for the better. In contrast, some individuals do not search for meaning in their experiences, yet still make a good adjustment to life. If a client is engaged in the search for meaning, the counselor can help with the process. However, attempting to encourage such inquiry in a client who is not searching for meaning may be counterproductive (Davis & Novoa, 2013).

SPECIFIC CHALLENGES

In the following sections, we consider challenges faced by individuals with disabilities and their implications in treatment. Remember that these are generalizations and that their applicability needs to be assessed for each client.

Prejudice and Discrimination

Ableism is an all‐too‐common discriminatory practice in which individuals without disabilities are favored or given preferential treatment, with the implication that those with a disability are somehow inferior (Keller & Galgay, 2010). Of course, people with disabilities always have additional racial, ethnic, and gender‐related identities, and as a result, they may experience ableist attitudes in concert with other forms of bias. In fact, the operations of intersectionality in the lives of people with disabilities have not received extensive attention from counseling researchers; a recent study found disability to be one of the two least studied social identities within intersectional research (with the other being social class) (Shin et al., 2017). Additionally, individuals who have disabilities may be evaluated based on an insidious deficit perspective (i.e., a belief that something is wrong with them). For example, employers believe that individuals with physical disabilities are less competent than individuals without a disability (Wang, Barron, & Hebl, 2010). Rohmer and Louvet (2009) make the point that “visible disability can be considered a superordinate social category” (p. 76); that is, disability appears to be a highly salient characteristic. For example, individuals with observable physical disabilities are often referred to using language such as “confined to a wheelchair” or “wheelchair bound” (Artman & Daniels, 2010). Prejudicial terms such as retarded, lame, and crazy are also used without conscious awareness of their impact on individuals with disabilities. Other reactions may be a result of not understanding the nature of specific disabilities. For example, most people without hearing loss do not understand that hearing aids can amplify all sounds, resulting in jumbled hearing, which is why individuals with hearing impairment may choose not to wear them. The public often has low expectations for individuals with disabilities and assumes that disability in one area affects skills in other areas. Additionally, able‐bodied individuals often do not consider the structural and psychological barriers that individuals with disabilities have to face.

Implications

It is important for counselors to understand that individuals with disabilities are people first; like members of any group, they may demonstrate a wide range of functional difficulties, as well as varying accomplishments. Mental health professionals need to actively assist individuals with disabilities to maximize their educational and employment opportunities. Approximately 9% of students enrolled in postsecondary educational institutions have some form of disability (Haller, 2006). Mental health professionals can prepare these students for success at the college level by teaching them to be self‐advocates—encouraging them to alert their professors to their disability status and request course accommodations, if needed. The greatest prejudice may occur with hidden disabilities, such as psychiatric conditions. As a person with schizophrenia stated, “I don’t want to tell anybody, because people who aren’t ill, they do have a tendency sometimes to treat you different … We’ve got to disguise ourselves a lot” (Goldberg, Killeen, & O’Day, 2005, p. 463). Educating employers and workplace colleagues about specific conditions can sometimes allay fears (Law, 2011), as well as address false stereotypes associated with disabilities (Mizrahi, 2014). Independence for individuals with intellectual disabilities or severe mental health issues can be encouraged by teaching them skills such as interviewing for jobs, managing money, doing laundry, and performing other daily living tasks (Ericksen‐Radtke & Beale, 2001). Mental health professionals need to recognize that they are also subject to disability prejudice and address any discomfort they may have with disabilities. Several suggestions are helpful (American Psychological Association, 2001; Landsberger & Diaz, 2010): Instead of thinking about a “disabled person,” change the focus and use the phrase “person living with a disability.” This emphasizes the individual rather than the limitation. Do not sensationalize disability by referring to the achievements of well‐known individuals with disabilities as “superhuman” or “extraordinary.” Such references create unfair expectations. Most individuals with disabilities have the same range of skills as those without. Avoid the use of phrases that evoke pity and conjure up a nonfunctional status, such as “afflicted with,” “suffering from,” and “a victim of.” Respond to individuals with a disability according to their skills, personality, and other personal attributes, rather than their disability. Increase your understanding of an individual’s specific condition and related resources, but take care not to assume that the disability is a primary concern. See Table 22.1 for additional suggestions about working with clients with various disabilities. TABLE 22.1 Things to Remember When Interacting with Individuals with Disabilities Source: Adapted from United Cerebral Palsy (2001) and New York State Department of Health (2009).

People with physical disabilities: Ask if assistance is required before providing it; if your offer is accepted, ask for instructions on how to help and then follow them. Do not use or move items such as wheelchairs, crutches, and canes without permission. They are considered part of the individual’s personal space. Address the individual directly; it is important to attend to the client rather than to someone who might have accompanied him or her. Sit at eye level to facilitate comfort in communication. Make certain there is easy access to your office.

People with vision loss: Identify yourself and anyone else who is present when greeting the client. If the individual does not extend a hand, offer a verbal welcome. Offer the use of your arm to guide—rather than steer or push—the individual. Give verbal instructions to facilitate navigation. If a service dog is present, do not pet or play with it. Ask about the individual’s preference regarding presentation of information (e.g., large print, braille, audiotapes). Let the individual know if you are moving about or if the conversation is to end. Give verbal cues when offering a seat. Place the individual’s hand on the back of the chair and he or she will not need further help.

People who are deaf or hard of hearing: Ask about the individual’s preferred communication (some use American Sign Language and identify culturally with the deaf community, whereas others may prefer to communicate orally, read lips, or rely on residual hearing). Address the individual directly, rather than a person accompanying them. Realize that talking very loud may not enhance communication. To get attention, call the person by name. If there is no response, lightly touch them on the arm or shoulder. Do not pretend to understand if you do not. Use certified interpreters to facilitate communication; their role is to relay information. Try to avoid using family members as interpreters. Make direct eye contact, and keep your face and mouth visible.

People with speech impediments: Allow the individual to finish speaking before you speak. Realize that communication may take longer, and plan accordingly. Do not rush. Face the individual, and give full eye contact. Address the individual directly. Do not pretend to understand if you do not. When appropriate, use yes‐or‐no questions. Check with the individual, if needed, to ensure understanding. Remember that a speech impediment does not mean the individual has limited intelligence. Select this link to open an interactive version of Table 22.1 Supports for Individuals with Disabilities In the past, programs for persons with neurodevelopmental disabilities (e.g., autism, intellectual impairment, learning disabilities) were limited to efforts at “rehabilitation” rather than assistance in maximizing potential and developing independent living skills. There has been gradual recognition that deficiencies in experiences and opportunities can significantly limit an individual’s development and that services are most effective when they enable independence, self‐determination, and productive participation in society. To accomplish this task, it is important to support students with disabilities in completing school and learning job skills. Many school‐to‐work transition programs, including those that provide students with disabilities the opportunity to learn work‐related skills through local employment opportunities, have shown promising results (e.g., see DC Partners in Transition at www.dctransition.org). Some programs for individuals with moderate to severe intellectual or physical disabilities provide prevocational orientations for both the family and the student. Information on job preparation and job expectations is provided, followed by skills training and then an internship in a local business, where employers give feedback on the individual’s performance. Such programs have been successful both in helping youth with disabilities make the transition to employment or further education and in opening doors in the business community. Mentors can also play an important role in helping college students with disabilities achieve academic success. Many graduates attribute their academic success to significant relationships with a faculty member or special services staff member (Barber, 2012). With regard to educational settings themselves, college students with disabilities have been found to report more distress related to academic performance than other students, as well as higher rates of anxiety and suicidal ideation. Support personnel throughout campus communities—including counselors, faculty, residence hall staff, and offices of disability services—should coordinate their efforts to reach out to these students as early as possible in their college careers (Coduti, Hayes, Locke, & Youn, 2016).

Implications

There has been a shift in the orientation of programs for people with disabilities from remediation or “making them as normal as possible” to identifying and strengthening interests and skills. Mental health professionals working with individuals with disabilities should be aware of programs offering educational and employment assistance. For example, the ParentCenterHub.org website is a repository of different resources for individuals with disabilities, such as Organizations and Agencies in Your State, Employment, Postsecondary Education, Recreation, Independent Living, Assistive Technology, and Disability Living Online. Media such as Ability Magazine, Disability Scoop, e‐Bility, and New Mobility (a magazine for active wheelchair users) also provide useful information and support for individuals with disabilities. It is important for mental health professionals to be aware of the ways current technology is enhancing quality of life and employment opportunities for many individuals with disabilities. Vocational and support group information is easily accessible via the Internet. Counseling Issues with Individuals with Disabilities

I want to say unequivocally that disabled people are everywhere. We are one of the largest oppressed groups on the planet. We are part of political movements, even if you don’t know or don’t acknowledge that we are. No matter what community you’re working with, you are working with disabled people. (Mingus, 2017b) Helping professionals often display the same attitude as the general public toward individuals with disabilities and may feel uncomfortable or experience guilt or pity when working with this population. As when working with other oppressed groups, counselors must examine their own views in regard to clients with disabilities and identify and question any prejudicial assumptions. A client’s disability should not be the sole focus of counseling. However, environmental contributions to the problems a client is experiencing (e.g., frustrations with architectural barriers or with negative stereotypes or prejudices) should be identified and addressed in counseling.

Implications As with all clients, comprehensive, nonbiased assessment is essential for those who have disabilities. Kemp and Mallinckrodt (1996) point out some of the errors that can occur in assessment and counseling relationships with individuals with disabilities. First, errors of omission may be made. The counselor may fail to ask questions about critical aspects of the client’s life because they assume that the issue is unimportant due to the presence of the disability. For example, sexuality and relationship issues may be ignored because of the belief that the individual lacks the ability to pursue—or interest in pursuing—these intimacies. Affective issues may also be avoided, because the counselor is uncomfortable addressing the impact of the disability on the client. The counselor may display lowered expectations of the client’s capabilities. Second, errors of commission may occur. In such cases, counselors make the unjustified assumption that certain issues should be important because of the disability, when, in fact, they are not important for the client. Further, a therapist might inaccurately assume that personal problems faced by the client result from the disability. Career and academic counseling may become a focus even when it is not what the client wants to discuss. Therapists also make errors by not addressing the disability at all, encouraging dependency and the “sick” role, or failing to confront countertransference issues (e.g., wanting to “rescue” the client). It is generally appropriate to ask a client about the disability, including any related concerns. The therapist can also ask if there are ways that the disability is part of the presenting problem. Such an approach allows the therapist to address the disability directly. In doing so, it is important not to succumb to the “spread” phenomenon that often exists with disabilities: believing that the disability encompasses unrelated aspects of the individual. If the disability is of recent origin, factors such as coping strategies, recent challenges, the possibility of self‐blame for the injury, and the amount of social support available can be assessed. Family Counseling

Family caregivers now operate as integral parts of the health care system and provide services that were once performed by professional health care providers. It is, therefore, important to help reduce the impact of stressors on caregivers and other family members. Additionally, emotional issues, such as distress, guilt, self‐punishment, and anger, may need to be considered. Family members may feel angry about their caretaking responsibilities or somehow feel responsible for the disabling condition (Resch et al., 2010).

Implications Clients with a disability and their family members can work together to create positive changes that enhance both client well‐being and family functioning. Among family caregivers, attributes such as positive problem‐solving skills, positive problem orientation, and coping strategies are associated with greater satisfaction for themselves and the individual with the disability (Elliot, Shewchuk, & Richards, 1999). One effective approach employed by caregivers is using problem‐solving strategies when encountering difficulties; such caretakers learn to define the problem, generate and evaluate alternatives, implement solutions, and assess outcomes. This approach helps increase self‐efficacy among family members and improves their ability to cope with stress.

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 physical disabilities and the problems faced by individuals with “invisible” disabilities. Assess the impact of multiple sources of discrimination on ethnic minorities and other diverse populations with disabilities (Dispenza, Varney, & Golubovic, 2017). Redirect internalized self‐blame for the disability to societal attitudes. Employ necessary modifications to enhance communication, and address the client directly rather than through conversation with an accompanying individual. Determine whether the disability is related to the presenting problem and, if so, identify whether the client adheres to the moral model (disability results from a moral lapse), medical model (disability is a physical limitation), or minority model (disability results from societal failure to accommodate individual differences). Determine whether the disability will influence assessment or treatment strategies. If this is not an issue, continue with your usual methods of assessment and case conceptualization. If formal tests are employed, provide appropriate accommodations. Interpret the results with care, since standardization does not take into account various physical disabilities. Recognize that family members and other social supports are important. When possible, include them in your assessment, case conceptualization, goal formation, and selection of techniques, but try not to use family members as interpreters for those with communication difficulties. Be aware that family members may not fully understand psychiatric issues or may be part of the problem (Ali, 2012). Identify environmental changes or accommodations that may be needed, and assist the client or family with the planning necessary to implement them. Help family members reframe the problem so that family and client strengths can be identified. Focus on and reinforce the positive attributes of the client and family members. Help both the client and family members develop self‐advocacy skills. Realize that mental health professionals may need to serve as advocates or consultants to initiate changes in academic and work settings. Be aware of Web resources and provide links to disability‐related products such as computer accessibility, clothing, augmentative communication devices, legal and advocacy resources, job training, and educational resources. Video Lecture: Can You Hold the Door for Me? Including Disability in Diversity by Rhoda Olkin

SUMMARY

There are approximately 56.7 million Americans with some level of disability (physical or mental); among this group, over half have a disability that severely affects daily functioning. People often lack understanding and do not know how to respond to people with disabilities. Attitudes vary from being disdainful and dismissive to being overly protective or sympathetic. Ableism is an all too common discriminatory practice in which individuals without disabilities are favored or given preferential treatment, thereby implying that those with a disability are somehow inferior. The 1990 ADA extended the federal mandate of nondiscrimination to individuals with disabilities and to state and local governments and the private sector. Because of the number of myths and beliefs about those with disabilities, counselors need to be informed in areas such as sexuality and reproduction, worker capabilities, resource availability, and especially their own feelings of discomfort or bias around those with disabilities. Fourteen clinical implications for counselor practice are identified.