Cover Story

Rehabilitation psychology rose to prominence after World War II as psychologists began to work with injured veterans who needed help adjusting to life with physical disabilities and psychological trauma.

"Unfortunately, we find at the 50th anniversary of the division that rehabilitation psychology is still really relevant because we have a lot of people returning from the Iraq and Afghanistan wars with disabilities and injuries," says Div. 22 (Rehabilitation) President William Stiers, PhD, a Johns Hopkins University physical medicine and rehabilitation psychologist. Some of the division's approximately 1,200 members work with active-duty military personnel and their families, conduct cognitive retraining with injured veterans and provide psychological treatment. They also help educate hospital staff on how best to work with brain-injured and disabled patients-skills that are critical for soldiers returning from service in Iraq or Afghanistan.

In fact, the U.S. Department of Defense reported in May that more than 10,000 military personnel deployed in the Afghanistan and Iraq wars have suffered traumatic brain injury, blindness, amputations and other disabilities.

But rehabilitation psychologists do more than provide care to veterans and active-duty personnel. In fact, rehabilitation psychologists have broadened their reach to include individuals with a wide range of chronic health conditions across the lifespan, including those with neurodevelopmental disabilities such as cerebral palsy, those who have been disabled by injury or age, and people with chronic illnesses such as diabetes and cancer.

Division members also play a leading role in preventative care, caregiver support and health-care policy issues.

Whatever their specialty, a defining characteristic of rehabilitation psychologists is their focus on the positive.

"Although many aspects of disability and chronic health conditions may be viewed as negative, rehabilitation psychology focuses on hope, life and celebration, even in the face of true adversity," says Stiers.

Rehabilitation and the military

Div. 22 got its start as an APA special interest group in 1949. At that time, the group's members helped injured World War II veterans find jobs, says founding member Beatrice Wright, PhD, who also served as 1962 division president. "In the file of the United States Employment Service, these people were unemployable," she says. But with the proper equipment, such as workstations that accommodated wheelchairs, they were able to hold jobs.

Based on this experience, Wright published "Physical Disability: A Psychological Approach," (APA, 1960)-which was used in classrooms worldwide and included by APA in its canon of classic psychology books.

"The scientific literature [at the time] focused on the limitations of people with disabilities, ignoring their strengths and assets," she says. "This emphasis on the negative contributed to the devaluation and stigma of having a disability."

Also, studies typically compared people with disabilities on tests that were standardized on or otherwise geared to so-called normal or nondisabled people, she adds. The field of rehabilitation psychology got another boost in the 1960s by the disability rights movement (which ultimately led to the 1990 Americans with Disabilities Act) and by the return of some deeply scarred Vietnam and Korean war veterans.

Division member Michael E. Dunn, PhD, estimates that about a quarter of Div. 22's members see active-duty military. Dunn spent 35 years working in Veteran's Affairs Spinal Cord Injury Centers. He recalls that his patients didn't like being in the hospital against their wills.

"They were concerned about their bodies and didn't want to consider that something might be wrong with their minds, [which was] their conception of psychology," he says. "So I had to develop more subtle, less intrusive...more casual ways of intervening. I saw few people in my office for formal "sessions," but wandered around, saw people for short periods, frequently, on the ward, in their rooms, halls and PT clinic."

Dunn not only helped veterans come to terms with their new bodies, but also helped the medical staff understand how best to work with people with disabilities.

This team-based approach has grown to become another hallmark of rehabilitation psychology, one that the field's practitioners have widely used in hospitals, inpatient and outpatient rehabilitation centers, nursing homes and sports-injury centers-long before psychologists were regularly involved in the health-care environment, adds Stiers.

The team-based approach also extends to patients' homes and communities, adds Harriet Zeiner, PhD, who works in the Palo Alto VA health-care system and is a Stanford University assistant clinical professor in physical medicine and rehabilitation. In 2006, the VA's four Polytrauma Rehabilitation Centers mandated psychological treatment not only for veterans and active-duty military personnel who were injured, but also for their families, she says.

"My belief is that if you can get an alliance going between the therapist, the patient and the family all triangulating against 'demon brain injury,' that's the optimum environment for rehab," she says. "My hope is that it will become the model for the civilian sector."

Taking the lead in chronic care

Although the future for Div. 22 members will undoubtedly include caring for injured soldiers, the bulk of their work will be caring for civilians with disabilities.

"Today, in current contemporary society, health-care systems are simply overwhelmed with the number of people who are now living with chronic health problems," says Timothy R. Elliott, PhD, the editor of Rehabilitation Psychology and professor in the department of educational psychology at Texas A&M University.

He estimates that almost 50 percent of the population lives with at least one chronic diagnosable health problem. Meanwhile, the 2000 Census reported that 42 percent of Americans over age 65 lives with a disability.

Because rehabilitation psychologists have traditionally counseled individuals about their personal health and their social and vocational needs, Elliott feels they are a natural choice to develop community-based interventions,public health programs and to identify those most at risk for secondary complications of chronic illness-before their conditions necessitate expensive emergency room visits or surgical interventions.

"All of the outcomes following the diagnosis of a chronic health-care problem are mediated by behavioral and social pathways," he says. "These things we know, but we haven't addressed them in meaningful policies to help people live well at home within their communities. The needs are great, but rehabilitation psychology is in a great position to take the lead."

Further Reading

Div. 22 AT A GLANCE

Div. 22 (Rehabilitation) seeks to bring together APA members interested in the psychological aspects of disability and rehabilitation, to educate the public on issues related to disability and rehabilitation and to develop high standards and practices for professional psychologists who work in this field. Members may be involved in clinical service, research, teaching or administration. The division publishes a quarterly journal, Rehabilitation Psychology, and a quarterly newsletter, Rehabilitation Psychology News. For more information on Div. 22, visit www.div22.org.