It's likely that as a psychologist you will encounter people with disabilities in your practice, workplace and classroom.
People with disabilities constitute one of the largest minority groups in the United States, estimated at approximately 50 million people, or 15-20 percent of the population.
That percentage is likely to increase with the "graying of America," as the frequency of disability is higher among older people.
"Clinicians need to remember that people with disabilities are an enormously heterogeneous population," says Guy Guber, a sixth-year PsyD candidate at Alliant International University who is legally blind. "They include people who are born disabled or become disabled when they are older, as well as people with learning or mental disabilities."
Disability crosses gender, age, race and ethnicity, sexual identity and all economic and educational levels, he notes.
However, many graduate students don't receive formal training on how to work with people with disabilities. Disabilities are usually briefly mentioned as part of cultural competency or minority issues classes, says Greg Taliaferro, PhD, a private practitioner whohas cerebral palsy and a visual impairment.
"When disability is relegated to one class, it's like we can think about it in that one class, but we don't have to think about it in other courses," says Taliaferro. "And really, diversity needs to be in all classes so that it's at the forefront of people's minds."
However, students can tap that classroom experience and take further initiative to educate themselves about how to counsel clients with disabilities.
Some of the skills students may want to explore further include how to phrase their language when talking about people with disabilities, how to communicate effectively with people who are blind or hearing impaired and how to provide an accessible meeting area, say psychology disability experts.
WATCHING YOUR WORDS
How you work with a person who has a disability starts with your use of language, say experts. By carefully choosing your words, you can portray a person with a disability as actively engaged in life as opposed to perpetuating stereotypes of helplessness or tragedy, says Anju Khubchandani, APA's officer of disability issues.
Psychologists with disabilities recommend that students:
Use "person-first" language. Avoid referring to a client as a "disabled person." Instead, use "person with a disability," which forms an image of an ordinary person and then modifies it. The disability itself doesn't sit at the forefront of the description, explains Khubchandani.
That said, avoid euphemisms such as "physically challenged" or "differently abled." While these phrases have generated many jokes and parodies, they are not generally accepted among people with disabilities, experts say.
Avoid sensationalizing. Although it may be tempting to refer to people with disabilities as "superhuman," "incredible" or "extraordinary" because they generally overcome more obstacles to daily life than able-bodied people, such words create unfair expectations, say psychology experts. In the same vein, avoid phrases like "afflicted with," "struck by" or "a victim of" when referring to a person with a disability.
Notice your action verbs. Phrases like "Joaquin is in a wheelchair" paint a picture of a passive person sitting and doing nothing. However, phrasing such as "Joaquin uses a wheelchair" conjures a mental image of Joaquin as participatory and involved.
Don't make assumptions. It's quite possible that a person using a guide dog to navigate the subway is physically healthier than you are, says Tamar Heller, PhD, a professor and head of the department of disability and human development at the University of Illinois at Chicago. Just because a person has a disability doesn't mean that they have a disease, she notes.
And, unlike a disease, a disability is not something that needs to be "fixed," adds Nina Ghiselli, PsyD, director of disability services at Alliant International University. Ghiselli is a clinical psychologist with a learning disability who stutters. She says she's often been networking at a conference when someone asks if she's heard of a commercial device featured on "Oprah" that helped a woman stop stuttering--assuming that Ghiselli would want to be "cured."
"I know I have a disability. I've been in speech [therapy]. I choose not to spend my time in speech [therapy] and I choose to educate my environment instead," says Ghiselli.
Too often, she says, people assume a person who isn't able-bodied or a fluent speaker should want to be so.
Many people don't know how to communicate with a person who has a disability, especially one that affects hearing or sight. They might feel awkward using an interpreter, and feel that there is a "third-party" privilege to what should be a two-person discussion.
Or, in an effort to avoid embarrassing either themselves or the person with a disability, they often don't make any effort to communicate at all. The end result, says Sybille Ulrike, a fifth-year student working toward her PsyD at Alliant International University who is deaf, is that people with disabilities often feel socially isolated. In reality, it's easy to communicate with a person with a disability, once you know a few basics, she and others say.
Start out by asking a person with a hearing or visual impairment what communication method they prefer. A person with a hearing impairment might use an interpreter, write messages back and forth, read lips or even combine a few techniques.
Next, pay attention to your surroundings and body language.
Make sure that if you are talking to someone who reads lips, for example, that the room you are talking in is light enough for them to see your face clearly. Face the person directly, and avoid covering your mouth or looking away if you are taking notes.
IN THE THERAPY ROOM
It's a good idea to ask every potential client if they might have accessibility issues before their first appointment, says Heller, as she recounts the difficulty her sister, who has cerebral palsy, had trying to get her wheelchair into a psychiatrist's office. Ghiselli says her local grocery store sets a good model: "They ask you on your way out, 'Do you need help with your bags?' and they ask that of everyone--an elderly person, a young mother with children, or even a young, apparently able-bodied person. They don't make assumptions based on only what they can see."
Here are some tips experts offer for working with people with various kinds of disabilities:
People with hearing impairments. If you are using an interpreter, address the interpreter as if they embody your client. If your client is named Mack, say "Mack, how have you been feeling lately?" as opposed to saying to the interpreter, "Could you ask Mack how he is feeling lately?"
"Sometimes people talk to the interpreter and not to me," says Ulrike, "but the interpreter just serves as my voice."
In fact, APA's Ethics Code offers psychologists guidance on how to use interpreters, notes Stephen Behnke, PhD, JD, director of APA's Ethics Office. "Standard 2.05 addresses the importance of ensuring that an interpreter provides a competent service and is free from any problematic multiple relationships," he notes.
Group therapy also has its own set of challenges. When several people are talking at once, a person with a hearing impairment may struggle to follow the conversation. It helps if you enforce a rule that one person speaks at a time and visually signals their intent to talk, advises Ulrike.
People with visual impairments. Orient a person to the area in which you are meeting. Explain where large furniture is, and where doors are located. If you rearrange your office during the course of working with a client who has a visual impairment, let them know the changes in furniture position. Keep your doors fully open or closed. If you are guiding a person, let them hold you by your arm just above the elbow and give them explicit instructions like "this is a step up," as opposed to "this is a step." Also, refer to the position of obstacles by using the positions of clock hands. For example, Khubchandani suggests that you say "My desk is at your 2:00," instead of "My desk is over there."
If you require your patients to fill out forms, have them available in alternative formats, or offer to read them out loud.
If your client uses a guide dog, remember that no matter how cute the animal is, it is a working partner that your client relies on for safety as well as navigational support. Don't pet or play with the animal without first asking permission, advises Khubchandani.
People with impaired mobility. Remember that for a person who uses a wheelchair or crutches, those implements are an extension of their body. Don't touch or remove them without their consent, advises Ghiselli. Just as you wouldn't put your feet up in a stranger's lap, don't use a client's wheelchair as a footrest.
If you are talking to someone in a wheelchair for more than a few moments, crouch or kneel down to be at eye level with them. This saves them from straining their neck to look up at you, and it's more respectful to be on the same physical level.
Finally, "It's important to understand where a person with a disability stands on the continuum of disability identity," says Heller. Some clients might not want to talk about their disability, some might have issues stemming from their disability that they'd like to discuss and still other clients who are disabled don't view their disability in a negative way whatsoever.
Indeed, says Ulrike, clients with disabilities seek treatment for many of the same reasons able-bodied clients do, including issues relating to family, relationships, intimacy, anxiety or stress.
Allow your client to express how much they identify with being a person who has a disability, Heller advises, and let that guide your interaction.
For more information on working with people with disabilities, visit www.apa.org/pi/disability/homepage.html.