Working with People with Disabilities

Disabilities primarily fall into three main categories—physical, intellectual, and the ones we in the mental health profession are most acquainted with, mental or emotional disorders. This is not to say that these disabilities don’t overlap. They frequently do, however, it’s important to clearly understand the differences and the unique qualities and psychosocial impact of each category. It’s imperative to point out here that any and all disabilities bring with them stigma and prejudgment, not unlike racial and ethnic stereotyping. Some common responses to people with disabilities include talking down to them, avoiding them, bullying, and other abusive behavior.

Disabilities come in all shapes and sizes. Many are quite visible, like people in wheelchairs who use walkers and people who are blind. And there are others without visible disabilities, like deaf people or those with heart or respiratory issues. Some disabilities are developmental, meaning that they are existent from birth or early childhood, like cerebral palsy or spinal-bifida, but others are traumatic, with later onset, such as spinal cord injuries, traumatic brain injuries, or amputees. People with physical disabilities are often misunderstood to have other intellectual or mental disabilities and are often judged unfairly to be incapable of being functioning social, adults.

Intellectual disabilities, or as it used to be called, mental retardation, can be related to a number of different causes, i.e. Down’s Syndrome, cerebral palsy or brain injury. People with these related disabilities have the most stereotypes put upon them in terms of being social outcasts, weirdos, or freaks.

Mental illness clearly carries with it plenty of stereotypic biases as well. People with bipolar disorder, schizophrenia, or personality or identity disorders, have tremendous social alienation issues to deal with as well. But those of us in the mental health field have greater familiarity with this particular population, and are, hopefully more accustomed and comfortable interacting respectfully with them than perhaps with those with other disabilities. This is largely due to the level of exposure to and education about these various disabilities.

I have been a psychotherapist for forty years, and I have had cerebral palsy all my life and have used a wheelchair for most of it. My life experiences have brought with them the dichotomy of being the stereotyped disabled person, with all the biases and social prejudice that comes with it—and as an educated, professional healer. The combined awareness brings me the opportunity to deepen my senses around human variation and my desire to broaden my respect for all.

 

Respect-Focused Therapy (RFT) is a foundation on which all modalities and techniques used in therapy can be strongly grounded, in order to produce sound, effective outcomes. This approach offers clients the opportunity to gain experiential understanding of being respected, possibly for the first time, from the therapeutic relationship and then be able to heal old wounds by creating more respect for self and others in the therapeutic process.

Remembering Edie Windsor

Ms. Windsor truly helped move the fight for LGBTQ rights forward in very significant ways. Her fight won a Supreme Court decision defeating the Defense of Marriage Act (DOMA), which paved the way for the legalization of gay and lesbian marriages in this country. Many of us never imagined this could happen in our lifetimes.

I’m old enough to remember a time, not really that long ago, actually, when the preferred course of therapy for gay people was “conversion therapy.” This was designed to make homosexual behavior appear to be so repulsive to the client that he or she would want to stop all related sexual behavior as well as the thoughts and feelings they were having toward people of the same sex. In other words, the message was unabashedly “stop being who you are because you’re perverted and society will never accept you!” Fortunately, this horrendous form of treatment is no longer supported by any professional board in the mental health field.

I was fortunate to be practicing a little later than when the peak of this trend was most prevalent, but it still was widely accepted as my practice was building. Homosexuality was clearly defined as a psychological disorder in the DSM until 1973 and remains stigmatized today, though thanks to activists like Ms. Windsor, we are moving in a more positive direction.

So how does this impact the work we do today and going forward with this community? I think it means to me continuing to look hard and deep at my own learned prejudices and discomfort with that which is different, even when I think that they no longer exist. And then it is about being open to, or reconsidering, new or different viewpoints in a way that fully honors the human sitting in front of me. In order to be able to give therapeutic benefit to anyone else, I must first open my heart and mind to the beauty of individual differences and the common bonds in expressions of love and intimacy.

 

Respect-Focused Therapy (RFT) is a foundation on which all modalities and techniques used in therapy can be strongly grounded, in order to produce sound, effective outcomes. This approach offers clients the opportunity to gain experiential understanding of being respected, possibly for the first time, from the therapeutic relationship and then be able to heal old wounds by creating more respect for self and others in the therapeutic process.

Believing in our common good

In a recent blog, John Sommers-Flanagan, quoted Adler:

“An incalculable amount of tension and useless effort would be spared in this world if we realized that cooperation and love can never be won by force.” (Adler, 1931, p. 132).

It seems to be obvious on first glance that “force” can never win over the spirit of love or cooperation. Yet, the evidence that entangles our world and everyday lives demonstrates how intensely we as human beings try to hold on to the erroneous belief that we can “make” people love and respect us.

This tends to get us in a lot of trouble. We see this all the time, particularly in the lives of our clients. Couples who have to engage in an argument to its last breath in order to be proven right, adolescents who engage in risky behaviors such as using drugs or running away in order to get parental attention, or the parents who demand respect from their children through intimidation, if not abuse.

The core issue here, as I see it, is that we tend to treat respect as an asymmetrical phenomenon. That is, there is often an  assumption that one person deserves or receives more respect than the other. Therefore, the relationship remains static in its inequality (i.e. a male dominates a sexual relationship or a power struggle is ongoing because there is always competition for who should be the winner for the most respect).

When one steps back to consider this dilemma, the obvious conclusion is that the premise of necessary inequality is false. Parents, teachers, employers, law enforcers, and even therapists can easily fall into the trap of assuming that authority means demanding more respect than one in that position must give to those under such authority.

This way of thinking is toxic, particularly as the concept extends beyond clear lines of established authority or power. The common good of all evaporates when others are belittled, marginalized, or discriminated against.

As therapists, I believe that we have a critical responsibility to demonstrate and advocate for genuine and equitable conveyed expressions of respect in the therapy room and beyond. To do so requires our diligent exercise in practicing for the good of all.

Respect-Focused Therapy (RFT) is a foundation on which all modalities and techniques used in therapy can be strongly grounded, in order to produce sound, effective outcomes. This approach offers clients the opportunity to gain experiential understanding of being respected, possibly for the first time, from the therapeutic relationship and then be able to heal old wounds by creating more respect for self and others in the therapeutic process.

Disasters and Mental Health

I live in Austin, Texas, and we just got our toes dipped in a small part of Hurricane Harvey, but we also watched from the sidelines as our friends and family in Houston and coastal areas were slammed by the terror of the possibility, if not the reality, of losing everything—homes, cars, and belongings, along with memories and a sense of security and safety.

It is this latter concept of losing security and safety which I think is the hardest to cope with psychologically. Having experienced such devastation in such short order is clearly and literally “having the rug pulled out from beneath your feet.” To have this done in such a large scale is further disorientating and catastrophic. Fear and shock dominate the psyche. Knowing where, or having the capacity, to begin to move forward is blocked by the enormity of insecurity.

Will life move on? Of course. But it will not look or feel the same for a very long time. That’s where mental health professionals come in. The trauma endured by so many in these circumstances is much more indelible, beyond the first few weeks or months. PTSD will be prevalent for many for years to come.

Recovery mentally will be a much slower process than regaining physical and financial losses. Feeling safe again is the struggle. The job for therapists, therefore, is to begin the process of recreating safety and security for our clients who have had such trauma.

It is my belief that we can best do that by honoring them as full human beings who have lost so much, rather than just “refugees.” The differentiation I’m making here at first glance may seem subtle, but categorization and labeling is an easy pitfall. This is even more pronounced when we are working with the poor or indigent. Human nature can often trick us into the trap of stereotyping, albeit unwittingly. But intentional acceptance and focusing on a respectful framework allows us to move in a way that can create safety for everyone we serve.

Respect-Focused Therapy (RFT) is a foundation on which all modalities and techniques used in therapy can be strongly grounded, in order to produce sound, effective outcomes. This approach offers clients the opportunity to gain experiential understanding of being respected, possibly for the first time, from the therapeutic relationship and then be able to heal old wounds by creating more respect for self and others in the therapeutic process.