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Resource Guide for Graduate Psychology Students with Disabilities - Self-Care & Support
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Accomodating a Fatigue-based Disability in Graduate Training
By Kathleen Kendall-Tackett, PhD, & Hendrika Vande Kemp, PhD
Fatigue-based disabilities are common and stem from a wide range of conditions. Unfortunately, many of these conditions are invisible, and the needs of people with fatigue-based disabilities are often overlooked. The good news is that there are some steps that can be taken to offset the many barriers that those with fatigue-based disabilities encounter.
What Some Graduate Students Face
Life can be difficult when fatigue is not accommodated. Below are some examples of what students with fatigue-based disabilities face in their training programs. In the first story, a psychology intern describes how a full day would make her tired and sore. When she accommodated her disability, her relationship with her supervisor became strained.
"One difficulty came when I would sit for long periods in class or at work. For example, in doing assessments with kids. The full day of bending, sitting in little chairs, etc., made me sore. When possible, I would plan to spend the next morning working from my bed, using my laptop. However, my last rotation required seminars the morning after testing. I explained the difficulty to my supervisor and told her that I would likely miss some of these didactics when I had administered and scored extensive batteries, but that I would get notes and tapes from other students. At first she was very agreeable. However, when I actually missed some seminars, it strained our relationship and, I believe, colored her opinion of my overall abilities (e.g., she greatly overestimated the number of absences I had throughout the year and greatly underestimated the number of absences of the student who would get the notes for me. Apparently, she associated any absences with my leg pain, regardless of who they truly belonged to). "
Here are three additional examples gathered by one of the authors of this section from psychology students and interns living near in Southern California.
- A student currently undergoing chemotherapy treatments for cancer requests an accommodation in the assignment of her practicum site. The accommodation request is that she be assigned to a site in which services are delivered on site. The director of clinical training either ignores or overlooks this request and assigns the student to a program that delivers its services (to a geriatric population) primarily by means of home visits. The student grows increasingly frustrated by the stress of extra travel and the fact that no changes were made in the assignment even after she discussed it with her supervisor. Ultimately, this affects her evaluation in the area of "personal characteristics." The student is, of course, devastated. Eventually, the student was reassigned, midyear, to a practicum site closer to her home. The director of training acceded to this recommendation reluctantly, and it was up to the student to find a new site.
- A student with a chronic disability (childhood rheumatoid arthritis) has been granted the general accommodation of half-time status, as she suffers from considerable fatigue and has the usual difficulties with ordinary tasks of life (dressing herself, mobility, etc.). As the internship application process begins, it is clear that the options do not meet the criteria of the Americans With Disabilities Act, which dictates that she have as wide a range of opportunities as would a nondisabled student. There are, in fact, only two half-time slots available to her. Neither of them is APA-approved, and she sought out these sites herself. When another disabled student also wanted to try for a half-time slot, the two were in competition for the same two sites (the second student chose not to pursue the applications, as she did not want to compete with her friend).
- A student suffers from various effects of damaged disks in her neck. She is in constant pain. The nerve damage in her neck has led to weakness in her hands, and she has an authorized disabled parking sticker because she cannot carry books or other heavy objects. She is completing a pre-internship at a Los Angeles county site. She requests accommodations related to her inability to carry testing materials around the wards and her difficulty writing. She is, in fact, not even assigned her own desk or place to keep her materials. Her supervisor asks her to do extensive amounts of photocopying and asks her to copy by hand lengthy tables of figures related to psychometric qualities of a test they are using. When she consulted the office of student services about a need for accommodation, the staff felt that it was outside their range of responsibility.
What Types of Accommodations Help?
Carling (1994) describes some accommodations that are relevant for persons with fatigue-based disabilities. He recommends flexibility in scheduling, liberal leave policies, back-up coverage during leaves, working at home, flexible hours, self-paced work, and part-time options. The option for a part-time schedule is important, but fairly rare. Other scheduling 23 accommodations include rest periods during the day and the freedom to make scheduling adjustments (e.g., not having an early appointment following a late night, or not having too many clients in a row). Some other types of accommodations include having a parking space near the work site, not having to walk too far between appointments, and not having to carry heavy or bulky objects. Storage space in the work area is a must, as is a place to rest during the work day.
This student describes how her training program made the most of the accommodations that she required so that she could complete her training.
"I'm a grad student with a disability (severe chronic pain, seizure disorder, neurological problems). I know I will be unable to work a full 8-hour day or even more than 3 hours consecutively in a single day, and I am not sure how likely it will be that internships will accommodate me. As far as my practicum (3rd year in clinical PhD track), they were quite accommodating in terms of allowing me to take a leave of absence when I needed neurosurgery, allowing me to determine when I would return and to schedule the hours and activities I would be doing. It turns out that I was unable to sit and look at someone and nod my head for an hour at a time, so they let me do more child therapy for a while, where I was able to move around and shift my position often, and the child did not notice as much. I also was allowed to schedule my appointments so that I never saw two clients back-to-back, which was fortunate because after a session, I almost always was in so much pain I needed to lie down. The bad part is they did not buy me an ergonomic chair as my neurosurgeon said they should (and I couldn't afford for myself). But that's my only complaint. They said my program at school should foot the bill for that. My program said my practicum should pay, or the state department of rehabilitation. It still has never been resolved."
Negotiating for Accommodations
There is much work to be done in terms of making accommodations for fatigue-based disabilities in graduate training, internships, and jobs. Students with fatigue-based disabilities may indeed be the first ones in their department to ask for accommodations. While these accommodations may not always be easy to get, it is possible to arrange for them. Below are some suggestions to help students get started.
Develop a plan. Students with disabilities should assume that they will have to take the initiative in developing a plan that will accommodate their disability. Research all the options, and know the advantages and disadvantages of each approach. Students should try to anticipate the concerns of prospective supervisors or employers, and tell them how those concerns will be addressed.
Be positive. Confidence is contagious. Students with disabilities should project this to prospective programs and employers, even if it has to be faked at first. They should not have to apologize for wanting "special" arrangements. Students with disabilities should be confident in the unique skills that they can offer, and experience with disability can be an asset to clients, fellow students/interns, and supervisors. It is best to be honest about needs and limitations and present a positive plan for how they will be dealt with. Realize, too, that not everyone will be willing to make these types of accommodations. If they aren't, go elsewhere, especially if there is concern about endangering your health.
Don't justify your arrangements. One of the difficulties of having an unusual working arrangement is that students with disabilities can be perceived as less serious about their work, or even lazy. The average work week is increasing, and those who want, or need, to work less than full time are often perceived as not pulling their weight. This will be particularly true of those with invisible disabilities who are often perceived as not having a disability. These types of misunderstandings can be hurtful. When appropriate, students with disabilities should educate others about their disability. It is advantageous to develop some nondefensive responses to people's questions and comments, such as "that's what works best for me." But bottom line: Avoid feeling the need to explain arrangements to others.
In conclusion, people with fatigue-based disabilities have something to offer to people in their respective programs, to clients, and to the research that they conduct. Although you may be pioneers in your departments, you should know that others have been able to arrange for appropriate accommodations. We are confident that you can, too.
References
Carling, P. J. (1994). Reasonable accommodations in the workplace for individuals with psychiatric disabilities. In S. M. Bruyere & J. O'Keeffe (Eds.), Implications of the Americans With Disabilities Act for psychology. Washington, DC: American Psychological Association.
Vande Kemp, H., Shiomi Chen, J., Erickson, G. N., & Friesen, N. L. (2002). ADA accommodation of therapists with disabilities in clinical training. Women and Therapy (special issue: visible and invisible disabilities), 26, numbers 1, 2.
Further Reading Related to Accommodating Fatigue
Friedberg, F. (1995). Coping with chronic fatigue syndrome. Oakland, CA: New Harbinger.
Goldberg, B. (1998). Chronic fatigue, fibromyalgia, and environmental illness: 26 doctors show you how they reverse these conditions with clinically proven alternative therapies. Tiburon, CA: Future Medicine Press.
Kendall-Tackett, K. A. (2001). The hidden feelings of motherhood: Coping with mothering stress, depression, and burnout. Oakland, CA: New Harbinger. (Especially Chapter 7: So Tired!)
Kendall-Tackett, K. A., Marshall, R., & Ness, K. E. (2002). Chronic pain syndromes and violence against women. Women and Therapy (special issue: visible and invisible disabilities), 26, numbers 1, 2.
Kendall-Tackett, K. A. (2000). Physiological correlates of childhood abuse: Chronic hyperarousal in PTSD, depression, and irritable bowel syndrome. Invited review. Child Abuse & Neglect, 24, 799-810.
Starlanyl, D. J., & Copeland, M. E. (1998). Fibromyalgia and chronic myofascial pain syndrome:A survival manual. Oakland, CA: New Harbinger.
Teitelbaum, J. (1996). From fatigued to fantastic. Garden City Park, NY:Avery
Vande Kemp, H. (2001).The patient-philosopher evaluates the scientist-practitioner: A case study. In B. D. Slife, R. N. Williams, & S. H. Barlow (Eds.), Critical issues in psychotherapy: Translating new ideas into practice (pp. 171-191). Newbury Park, CA: Sage.
Vande Kemp, H. (1997). Personal reflections on trauma and head injury. AFTA Newsletter, Spring, 38-41.
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