Barbara J. Palombi, PhD
Grand Valley State University
The internship provides an opportunity for IWD to develop the clinical, research, assessment, and consultation skills necessary to practice psychology as a competent professional.
In today’s world of professional psychology, obtaining an internship is an important step in becoming a psychologist. With increased competition for internships, securing an internship is considered a major career achievement and requires considerable perseverance, determination, and tenacity (Noonan, Gallor, Hensler-McGinnis, Fassinger, Wang, & Goodman, 2004); an ability to effectively present one’s skills and attributes to possible internship sites (Hauser, Maxwell- McCaw, Leigh, & Gutman, 2000), and an ability to identify the best match of an internship site to one’s professional interests and abilities (APPIC, 2002). Several articles have been written that identify the challenges faced by individuals with different types of disabilities with their internship experience and in employment settings. (Borg, 2005; Fassenger, 2008; Hauser et al., 2000; Lawn, 1989; Maggio, 2007; Noonan et al., 2004; Vande Kemp, Chen, Erickson, Friesen, 2003). This article will focus on specific challenges and stressors that interns with disabilities (IWD) may face during internships and professional employment settings including:
(a) added demands of daily living,
(b) determining the need for accommodations,
(c) maintaining personal health, and
(d) moving from internship to professional practice.
The internship provides an opportunity for IWD to develop the clinical, research, assessment, and consultation skills necessary to practice psychology as a competent professional (Fouad, Grus, Hatcher, Kaslow, Smith Hutchings, Madon, Collins, & Crossman, 2009). It also provides an opportunity for IWD to develop interpersonal skills to connect with faculty, staff, and colleagues that provide a foundation for their professional career. IWD may also face stressors not experienced by their internship colleagues. Iwasaki and Mactavish (2005) studied stress and persons with disabilities (PWD) and identified several areas of stress unique to PWD:
(a) added demands associated with daily living and the complications of disability,
(b) health concerns,
(c) interpersonal relationship and attitudes toward PWD, and
(d) issues regarding employment.
These areas of stress may become more pronounced and distressing for IWD during the internship and employment experiences.
Disability and the Added Demands Associated with Daily Living
Disability and the added demands associated with daily living serve as a constant reminder of how disability may affect an individual’s life (Iwasaki & Mactavish, 2005; Noonan et al., 2004). The demands of daily living may include finding accessible transportation to the internship site and the additional time needed to read files, learning how to navigate the internship site, becoming comfortable with new service providers (e.g. personal service provider, interpreters), and becoming familiar with the internship’s clinical demands. These demands may be of little concern for able- bodied colleagues, yet frequently require additional time, energy, and effort for IWD.
The added demands associated with a disability become more salient when considering the question of whether to disclose or not disclose information with the internship training staff. Some IWD fear that disclosure may impact their careers and prevent them from advancing within their place of employment (Goldberg et al., 2005; Noonan et al., 2004). For example, in a survey of college graduates with learning disabilities, 46% of the participants chose not to disclose a disability due to the fear of negative consequences (Madaus, Foley, McGuire, & Ruban, 2002).
IWD who have unapparent disabilities are especially challenged by the decision to disclose (Vande Kemp et al., 2003). In graduate school these interns may have completed their academic requirements without disclosing. Yet an internship contains unique demands and expectations that differ from academic and practicum experiences. For example, classes and practica are scheduled on specific days and at specific times. During the day there may be blocks of time to complete assignments, catch up on class reading, handle personal concerns, or to rest. With an internship, flexibility in one’s schedule may no longer be available. Every hour of the day may be scheduled with clinical activities, including psychotherapy with clients, completing clinical assessments, providing psycho-educational workshops, etc. No longer is there time to rest or recuperate from the daily demands of the internship.
Concealing a disability may affect a person’s affective, cognitive, and behavioral well-being (Pachankis, 2007). Also, those who choose not to disclose may be negatively affected by the threat of discovery (Pachankis, 2007), especially in situations such as internship or employment that challenge or question a person’s status or identity (Rosenthal, Chan, & Livneh, 2006). In a study focused on individuals with psychiatric disabilities and the decision of whether to disclose or not disclose, a variety of responses and reactions to this dilemma were reported. Some individuals believed it was a positive decision to disclose. They felt thatthe employer was aware of their disability, accommodations were made, and they were treated like other employees. Some individuals only disclosed the more socially accepted part of their disability. Another alternative was to “strategically time” disclosure after being in a position for a period of time. This method of disclosure allowed the PWD to develop mutual trust and support of staff and coworkers. Individuals who selected this response perceived themselves as being able to function without accommodations. Yet later it became apparent that accommodations would assist them with their work responsibilities. The Americans With Disabilities Act (ADA) permits individuals to forego disclosure until accommodations are necessary (Falender, Collins, & Shafrane, 2009; Foote, 2000; Vande Kemp et al., 2003).
The decision to disclose prior to internship may be based on the question “Would any of my clinical experiences, required tasks, or work environments during my internship be hampered by my disability?” If interns conclude that their disabilities would not affect their work performance, all clinical experiences would be available to them, and all environments accessible, there may be no need to disclose. If interns are unable to complete particular tasks, develop specific clinical competencies, or function in certain environments, such findings may necessitate disclosure.
Need for Accommodations
To invoke the right to seek an accommodation, a person must first disclose information regarding the disability to the employer (Falender et al., 2009; Foote, 2000; Vande Kemp et al., 2003). The possibility of considering reasonable accommodations requires an interactive process (Falender et al., 2009; Vande Kemp et al., 2003) and a mutual conversation between the employer and the employee to explore and identify possible accommodations (Falender et al., 2009). The intent of the ADA is for employers to make existing facilities usable for and accessible to PWD by restructuring or modifying work schedules, assignments, equipment, examinations, training materials, or policies. Adjustments to the work environment may range from allowing schedule flexibility to accommodating medication regimens to providing or permitting assistive equipment, like computers, to providing or permitting services such as sign language interpreters (Foote, 2000; Vande Kemp et al., 2003).
Employers regard the following requests as reasonable: “flexible scheduling, assistive/ adaptive equipment, special parking, physical change of office space, and temporary assignment of job duties to a co-worker to accommodate sick leave” (Roessler & Sumner, 1997 (p. 31)). The same employers regarded as unreasonable those “accommodations [that] include work at home, afternoon rest and nap periods, transportation to work and provision of a support person” (p. 33). Interns with unapparent disabilities are especially affected when requesting accommodations employers may perceive as unreasonable (Vande Kemp et al., 2003). Therefore, interns with invisible disabilities may be hesitant to share this information and may resort to invisible accommodations: working in the evening and on weekends to make up for lost time for rest and taking extra time required to complete work responsibilities, lowering their achievement goals, and spending personal money on ergonomic aids and assistive technology needed to perform internship responsibilities (Vande Kemp et al., 2003).
Interns with other types of disabilities also face unforeseen challenges. Olkin and Bourg (2001) surveyed 120 practicum/internship sites and found: 50% involved traveling to less-accessible secondary sites; nearly all sites had a floor not accessible by elevator; 20% lacked handicapped parking; 25% had no ramps; 81% had no automatic door openers; most had outside doorways at least 36” wide, but often inside doorways fewer than 32” inches wide. The investigators also found that access was particularly poor for trainees with sensory impairments. Of the sites responding to the survey, only 16% had Braille signage; 38% had emergency alarms with both visible and audible warnings; 12% provided no TTY (Telecommunication Device for the Deaf); even fewer listed TTY numbers on letterhead (Olkin & Bourg, 2001). Even though the ADA assures that PWD have the right to access and to employment, it is not specific in regard to the degree of architectural and sensory accessibility required (U. S. Equal Employment Opportunity Commission, 2008). To identify possible unforeseen challenges, IWD may want to assess the internship site and clinical training program to determine the degree of programmatic, architectural, and sensory accessibility prior to arriving on site.
Another means to determine if accommodations are necessary is to review the recently published Competency Benchmarks (Fouad et al., 2009). In this document the work group identified foundational competencies— the knowledge, skills, attitudes, and values that serve as the foundation for the functions a psychologist is expected to perform (e.g., an understanding of ethics and individual and cultural diversity issues, awareness, knowledge of the scientific foundations of psychology) and functional competencies—the major functions that a psychologist is expected to perform, each of which requires reflective integration of foundational competencies in problem identification and resolution (e.g., assessment, intervention, consultation, research). Reviewing this document may assist IWD in determining if they possess the competencies currently needed for internship and identify those required to enter practice. If the outlined competencies needed for practice prove to be difficult to achieve without accommodations, disclosure may be beneficial.
As previously mentioned, accommodations are a joint process of negotiation between the training director and the intern. When the training director is not informed about an intern’s disability, no accommodations either can or need to be made (Foote, 2000). Also, if aspects of the training experience are not accessible to IWD, the training staff may not be able to identify and/or develop alternative clinical experiences without prior information. Yet, the decision to disclose is always determined by the IWD.
Maintaining Personal Health
The clinical demands of the internship may affect a person’s physical and emotional health. Yet the person’s maintaining physical and emotional health is necessary to successfully complete the internship. Previous studies have demonstrated that poor health is detrimental to overall well-being and life quality (Janssen et al., 2002; Putnam et al., 2003) and has a behavioral and cognitive impact on persons with disabilities (Yorkston et al., 2003). Sherman and Thelen (1998) found that problems in close relationships and major personal illness/injury caused the most distress and impairment. Stratton, Kellaway, and Rottini (2007) related their experiences as graduate students struggling with issues related to death and illness. They recounted that fellow colleagues perceived them as being unapproachable and uptight. Their personal reactions to stress also contributed to further emotional and physical suffering (exhaustion, irritability, depression, anxiety, and emotional breakdowns in clinical/classroom situations).
When dealing with stressful life events, psychotherapists tend to feel less satisfied in their personal lives (Sherman & Thelen, 1998). In addition to feeling less satisfied, therapists also report canceling, being late, and missing therapy sessions with clients. Thus, psychotherapists’ ability to function adequately in terms of certain basic requirements of their role (e.g., promptness, availability, and conscientiousness) may be compromised when they experience significant stress. During times of increased stress and demands of the internship, IWD may determine personal self-care may be sacrificed. They may not attend to the physical aspects of their health— including diet, sleep, and regular exercise—or they may forego their emotional and personal needs—including sustaining or developing interpersonal relationships, expressing emotions, and spending time meditating, which are all aspects of self-care (Harrison & Westwood, 2009). Self-care provides balance and allows practitioners to be more present in both personal and professional relationships.
Competenc
y Benchmarks (Fouad et al., 2009) identifies self-care (attention to personal health and well-being to assure effective professional functioning) as a foundational competency. An essential component of this competency consists of interns monitoring issues with supervisors related to self-care and understanding the central role of self-care in effective practice. To be prepared for practice IWD must be able to self-monitor issues related to self-care and promptly respond with interventions when disruptions occur.
Lack of attention to self-care may increase IWD’s vulnerability to being labeled as “impaired” due to their inability to perform required skills (Falender et al., 2009). IWD’s sacrificing their physical and emotional health may also hinder supervisors and other members of the training staff from seeing IWD as competent professionals. It is important for IWD to consider their health as a priority.
Moving from Internship to Professional Practice
An important component of the internship is developing collegial relationships with faculty, staff, and fellow interns. These relationships often serve as the foundation for a person’s professional career. The ability to develop interpersonal relationships has been identified as a crucial clinical competency for successful practice as a psychologist (Fouad et al., 2009). Relationships have also been identified as a major source of stress for PWD (Iwasaki & Mactavish, 2005). PWD often have negative experiences that are directly attributable to misinformed public perceptions and culturally based stereotypes created and perpetuated by dominant majority groups without disabilities (Lenney & Sercombe, 2002; Noonan et al., 2004). PWD have identified the inability to navigate the social systems as being a major source of stress, including trying to get help, trying to get to work, and constantly being faced with a society that does not accommodate the needs of PWD.
Mental health practitioners have been trained to be sensitive to issues related to discrimination and prejudice regarding different aspects of diversity. Yet due to the lack of training mental health practitioners receive regarding prejudice and disabilities, IWD may be perceived with conflicting positive and negative emotions (Gill, 2001). Open devaluation of people with disabilities conflicts with society’s prevailing values of protection, charity, and nurturance. Consequently,
disability prejudice is seldom expressed overtly in the way racial bigotry or antigay views are often communicated (Hahn, 1997).
Supervisors and colleagues may be reluctant to provide IWD with honest feedback about their interactions with others and how these interactions are perceived (Gill, 2001). Borg (2005) shared his experience supervising an intern with a visual disability. At the internship site, it was the customary practice to hire interns as permanent staff members. During the deliberation process, staff members indicated that the intern had troublesome ways of subtly pulling for help from other staff members. Without directly asking, the intern would have other staff complete her paperwork, guide her from room to room, and usher her patients into session. The consensus was that her presence in the clinic was disruptive and taxing.
When these types of situations occur, IWD may be labeled as “problematic peers.” The disruptive behaviors associated with problematic peers were inadequate social skills, deficient interpersonal skills, supervision difficulties, unprofessional demeanor, personality disorders, emotional problems, and academic dishonesty (Rosenberg, Getzelman, Arcinue, & Oren, 2005). Other students/interns experience problematic peers as affecting (a) class functioning, (b) cohesion in group supervision, (c) the individual’s learning process, (d) ability to work collaboratively or participate in class discussions, and (e) the willingness to self-disclose. Reponses to problematic peers by other students/interns include (a) gossip among themselves, (b) consultation with each other, and (c) withdrawal from the problematic peer (Rosenberg et al., 2005). These responses to problematic behavior may leave their peer feeling socially isolated and alienated (Gill, 2001; Iwasaki & Mactavish, 2005).
Research indicates that persons with disabilities may not receive optimal assignments/jobs and are more likely to have reduced hours or have a position
terminated (Fassinger, 2008).
Being a member of the work force poses challenges for IWD. Research indicates that persons with disabilities may not receive optimal assignments/jobs and are more likely to have reduced hours or have a position terminated (Fassinger, 2008). PWD may also be subject to internal barriers, such as underestimation of capabilities, poor self- efficacy expectations, and low outcome expectations. A group of high-achieving women with sensory and physical disabilities identified challenges faced in the work environment (Noonan et al., 2004). The women reported experiences of disability prejudice, including stupid, hostile, and condescending attitudes and behaviors. These experiences of prejudice also included: (a) restricted educational opportunities, (b) discrimination in hiring, (c) biased performance evaluation, (d) job tracking, (e) pay inequities, (f) lack of support and mentoring, (g) negative attitudes and chilly workplace climate, (h) lack of accommodations, and (i) general discouragement. IWD have to develop an awareness of ableism attitudes in the work environment. Depending on the nature of the disability, IWD may or may not have dealt with these attitudes. These attitudes may not be as apparent during the internship, but may arise in different work environments. It is easy for IWD to become negative and cynical regarding these attitudes. It is important to develop strategies to address these challenges. The group of high-achieving women (Noonan et al., 2004) discussed strategies used to address the challenges of ableism including: (a) ignoring it as much as possible; (b) getting support from each other; (c) internally reaffirming their goals and worth; (d) using humor to de-escalate hostility and put others at ease; (e) challenging it personally, collectively, and legally; and (f) working actively toward social change (Noonan et al., 2004).
Attitudinal and response styles that may enhance the employment opportunities of IWD, include: (a) confidence regarding the skills offered to employees, (b) enthusiasm about learning new tasks, (c) enjoyment in helping others, (d) focus on what they enjoy rather than what they cannot do, and (e) regarding work as enhancing self-esteem and a strong positive influence on psychological well-being (Chapin & Kewman, 2001).
One of the most salient factors identified that separated those who were employed from those who were unemployed was optimism—viewing disability from a positive perspective; setting goals, embracing change, and being satisfied with supervisors. Optimism also had a positive effect on the number of job offers received (Chapin & Kewman, 2001). Individuals who made a concerted effort to locate employment were successful. Interns with disabilities who want to secure professional employment need to possess the necessary clinical skills and competencies, but also be aware of the moderating variables (e.g. confidence, enthusiasm, optimism, etc.) that may influence employment decisions.
Concluding Comments
The move from internship to professional practice challenges interns with disabilities to be cognizant of their disability; possible accommodations; maintaining physical and
mental health as priorities; focusing on personal impact with colleagues, supervisors, and peers; and developing a positive attitude in clinical competencies. In reviewing these challenges, it may seem overwhelming for people to focus on their clinical responsibilities in the present and also be concerned with future ramifications. Being able to focus on the present and the future will provide IWD both the foundational and fundamental competencies required for professional practice.
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