Counseling interventions are considered a resource to support full functioning and participation of people with disabilities in their communities or specified environments of choice. The World Health Organization’s (WHO) International Classification of Functioning, Disability and Health (ICF) considers disability to result from a person with a health condition’s interaction with his or her environment where a person is restricted in his or her ability to engage in activities typical of others in the same or a similar environment. The functions of an individual with a disability are impaired by any disease, disorder, or health condition, and the severity of impairment contributes to the extent of disability or activity restrictions. The environment can enable or hamper participation. For example, an enabling environment for a person with mobility limitations would include access to mobility aids while, by contrast, environmental barriers would include inaccessible buildings. Additional limiting factors such as negative attitudes, stigma, and power relations arise from social environments, and these factors often influence the organization of and delivery of support services. Persons with disabilities are restricted from activities typically open to others by environmental restrictions more than by the objective qualities of their specific disability. This raises the question whether persons with disabilities need counseling, and if they do, (a) what the rationale is for providing counseling services, and (b) what would the counseling address.
Persons with disabilities are and have historically been denied recognition as a socioculturally oppressed minority due to the restrictions to activities and lifestyle ordinary to typically developing others. For instance, people with disabilities have limited access to basic social amenities compared to typically developing others because of negative social prejudice against them. They also tend to be socioculturally disadvantaged and ascribed negative characteristics because of their disability-related differences (e.g., incompetent, poor, suffering).
Historically, people with significant disabilities were detained in institutions for (a) cosmetic reasons because they were considered an unpleasant sight from which persons without disabilities should be protected, (b) political reasons in the sense of their being denied basic humanness and citizenship, and (c) cultural reasons in the sense that their life experiences and needs were regarded too different from those of ordinary persons to warrant social concern. Acts of genocide were also committed against persons with disabilities in that they could be castrated without their consent and be denied the right to marry or procreate. Persons with disabilities have also been treated as commodities by charitable organizations, some of which made fortunes for their founders and directors by marketing the unmet needs of persons with disabilities. Counseling was rarely an option for this population about which there was considerable ambivalence regarding their role and function in the community.
Influence of Disability Rights Movements
With the internationalization of civil rights for cultural minorities, persons with disabilities were perceived by the civic community, state, and federal governments to benefit from counseling that would enable their participation to the extent possible in typical activities and environments for others. Disability rights movements resulted in several national laws and international conventions to enable people with disabilities in their entitlement to equal and fair access to resources and a preferred life style. It may seem paradoxical that people with disabilities are regarded as in need of counseling when the evidence suggests that they are victims of societal oppression.
Counseling may enhance a sense of personal and environmental control in people with disabilities by helping them (a) identify the particular goals they seek to achieve and the methods of achieving them, (b) access the resources in the environment that they may need in order to achieve their self-selected goals, and (c) learn more effective self-management skills. Counseling approaches for people with disabilities need to consider that disability is not an intrinsic feature of the individual, but the result of interactions with his or her environment. There are no universal counseling needs or processes that will address the counseling needs of people with disabilities in their diversity. However, the WHO ICF provided guidelines on functioning with disability, including types of domains of activity restriction and participation in nine areas of health and well-being.
The WHO ICF guidelines enable identification of the disability-related type of activity or participation restriction, taking into account social and physical environmental factors. Some counseling professionals are of the view that the WHO ICF guidelines provide a practical framework for conceptualizing counseling needs in people with disabilities. For example, mental impairment from depression can restrict opportunities for beneficial interactions with others through self-isolation. Others may perceive self-isolation negatively, increasing the chances that the socially isolated person will be avoided or rejected in the social environment. The cycle of social isolation and social rejection could spiral into a more severe depression, anxiety, learned helplessness, and passivity for which counseling would be a resource.
The counseling needs of individuals with disabilities may also depend on the particular type of disability. A disability from a chronic, progressive condition such as renal failure presents unique counseling needs as compared to a stable disability like a healed and rehabilitated leg injury or amputation. The need for dialysis treatment associated with chronic renal failure often results in significant disruptions to routine or typical lifestyle and choices. Routine adds predictability to life by enhancing a sense of control over one’s environment. Some disabilities are associated with chronic health conditions with unpredictable symptom expression, which would pose significant challenges to the way individuals manage their lives. For example, people with psychiatric disability may experience acute phases of severe symptoms and/or persistent symptoms of mental illness, and these symptoms tend to disrupt most aspects of their lives. Many face the additional challenge that stigmatizing attitudes of society presents. By comparison, a stable disability such as a healed amputation may present different kind of challenges. Thus, counseling needs in people with disabilities depend on the (a) effects or product of the interaction between personal, environmental, and disability-related characteristics; and (b) the relative severity of the environmental, disability, and personal factors.
Counseling needs of people with disabilities are those whose resolution would enable them to have greater control over their lives. Specific counseling needs of individuals are influenced by the personal, disability type, and environmental characteristics, and often these characteristics are interrelated in their impact. The WHO ICF framework that considers disability in the context of personal, environmental, and disability type factors is particularly relevant to understanding counseling needs in people with disabilities.
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