Towards a social model approach to counselling disabled clients

The social model of disability has emerged over the past 30 years in Britain to challenge the dominant individual, particularly medical and tragedy, models. This social model is borne from the experiences of disabled people and essentially defines disability as the discrimination faced by people with impairments. This paper explores the possible conflicts between some counselling approaches that can individualise and personalise problems and disability as a political issue. Drawing on research with counsellors and disabled clients, we illustrate the social construction of disability as an individualised problem within the counselling process. Considering the implications for counselling practice, we argue for an approach to counselling which recognises the social model of disability as the basis for social change.     

On the need for structurally competent counselling and psychotherapy: Neoliberal ideology,disability and the psy disciplines

This article highlights and problematises the psy disciplines' articulations with neoliberalism, with a particular focus upon disability and upon counselling and psychotherapy. Recent years have witnessed burgeoning scholarly interest in the potential complicities of the psy professions in a neoliberal agenda of individualisation, pathologisation and responsibilisation of human suffering. Such complicities are, in state therapy settings, driven by a growing need for these professions to offer cost-effective, evidence-based interventions to secure funding in an increasingly competitive market. Whilst the entwining of neoliberal ideology with therapy practices may be innocuous for some, it is contended that disabled people may be at particular risk of harm. A case is then made for training and practice to foreground structural competency, an awareness of how therapy encounters and client concerns are shaped by socio-structural factors, including, but not limited to, politics and political ideology. This would require not only an appreciation of the sociopolitical context in which therapy unfolds and its indubitable shaping of subjectivities, but also greater recognition of disability as a source of social inequity and oppression, as opposed to an individual phenomenon. Moreover, structural competency would require theoretical and demographic diversity in training and practice, which, in turn, would necessitate identifying and addressing barriers to inclusion for disabled people. Points raised are deemed of particular importance given the emergence of long COVID.     

Toward a feminist theory of disability

We need a feminist theory of disability, both because 16 percent of women are disabled, and because the oppression of disabled people is closely linked to the cultural oppression of the body. Disability is not a biological given; like gender, it is socially constructed from biological reality. Our culture idealizes the body and demands that we control it. Thus, although most people will be disabled at some time in their lives, the disabled are made "the other," who symbolize failure of control and the threat of pain, limitation, dependency, and death. If disabled people and their knowledge were fully integrated into society, everyone's relation to her/his real body would be liberated.     

Disablism,Identity and Self: Discrimination as a Traumatic Assault on Subjectivity

The international disability movement has favoured a political strategy which relies on historical materialism, eschewing subjective aspects of disability. From this perspective, rehabilitationist and psychological constructions of the subjectivities of disabled people are rejected as victim‐blaming pathologisation. Recently, feminist work has begun to explore psychological aspects of the lives of disabled people, within various paradigms. Drawing loosely on ideas from psychoanalysis, this paper explores the impressions left on subjectivity by symbolic assaults often associated with the disabled identity, thus connecting intra‐psychic and socio‐political arenas. The conceptual ideas employed emerged from psychoanalytically oriented group psychotherapy with severely physically impaired adults performed by the first author. The authors argue that the ongoing nature of socially engendered trauma suffered by disabled persons perpetuates marginality, through internalization of self‐punitive psychological defences, which corrode the entitlement necessary for an assertive political movement. Surviving in a world which continually questions one's belonging, leaves little personal resources for debunking oppressive social phenomena. Material as well as discursive changes are essential if internal narratives are to be reclaimed, overcoming the subjective imprints of ongoing social trauma. Copyright © 2015 John Wiley & Sons, Ltd.     

Anger - the hidden destroyer A psychodynamic approach with the physically disabled

Abstract

A basic challenge in the psychodynamic counselling of the physically disabled is the engagement of anger in relation to the patient's disability. Regardless of a patient's age at the onset of disability, they will exhibit anger, resentment and frustration for losses they may have, or perceive themselves to have, endured. Healthy physical and psychological adaptation requires the disabled patient to ‘cope’ with their anger. Feelings of anger may impede, obstruct or even derail the impetus towards healthy psychological and behavioural functioning. The manner in which we learn to negotiate the vicissitudes of daily life is linked to our selfobject development. This development does not end when we become adolescents or young adults, but continues throughout our life span. The normative, healthy psychological maturation required for adaptive behaviour is vulnerable to a wide range of impediments acquired at any point along the individual's developmental continuum. As clinicians we need to keep in mind that the self-regulation of internalized emotional states is transacted through a complex set of characterological and personality traits that may be impaired, or wanting, eventually leading to maladjusted psychopathological states. The therapeutic function of the clinician is to redress those ego deficits that stand in the way of a fully creative and productive life. The intended aim of this paper is to illustrate the manner in which I engage with those physically disabled persons presenting anger. I shall consider the use of counter-transference responses as behavioural in modifying various forms of anger formation manifested by disabled clients. It is my position that a positive shift in a disabled person's ego ideal through empathic transference will help to alleviate their underlying hostility and other forms of anger. The paper commences with a brief review of the experience of the disabled in Western society. I shall then turn to an examination of the psychotherapeutic approach underpinning my work with disabled clients. The third section will describe and illustrate, through case material, the clinician's use of self in the dyadic transaction with disabled clients.

The power of a positive therapeutic outcome lies in the clinician's ability to engage with the client despite emotional content, clinical aptitude or specific approach. Empathic attunement brings into operation those mechanisms underpinning the dynamic process integral to the approach used in the above cases. Countertransference issues sometimes intervene in the unconstrained flow of therapy. Regardless, those issues that are salient to the client and are incorrectly handled by the clinician will appear recurrently until satisfactorily addressed. Further, even when errors are made in sessions, outcomes may be positive.

Whatever the initial purpose that brings a physically disabled person to therapy there will eventually be a need to address issues around their condition. It is not enough to ignore or accept a client's earliest statement that their disability Ms not a problem'. They may initially not have come into therapy for problems concerning their disability; however, the particular disability will ultimately play an important role as to how and what the person feels, thinks and believes about him or herself. In general, psychodynamic counselling with the physically disabled requires knowledge of disability issues as well as of counselling procedures. Those working with the disabled need to understand their own personal issues through analytic work and continued supervision. Working with the physically disabled can be overwhelming, frustrating and exhausting, but in the end is most rewarding.     

Representing disability in charity promotions

Social psychological research in relation to charity advertising in the area of disability has attempted to distinguish between ‘positive’ and ‘negative’ images and the way in which these are related to their fundraising potential. In the light of the critique of charity advertising offered by a number of disability theorists, it is suggested that this perspective would be enhanced by consideration of the attitudes of disabled people to charity advertisements. A study is reported that compares the attitudes of disabled and non‐disabled people to two charity advertisements. Differences between these two groups are reported and in the light of the nature of these it is suggested that what are considered to constitute ‘positive images’ is unlikely to be consensual. Copyright © 1999 John Wiley & Sons, Ltd.     

Social justice and remembering “the personal is political” in counselling and psychotherapy: So,what can therapists do?

This brief contribution argues for the importance of a social justice perspective in counselling and psychotherapy, particularly within the current international socio‐political context. Much has been said about social justice over recent years in the fields of psychology, psychotherapy and counselling. Professionals and academics have expressed some concerns about what it might actually mean, or how difficult it might be in practice to engage with this perspective. In this paper, the activist phrase “the personal is political” (Hanisch, 1970) is used to illustrate the way in which a social justice approach to counselling and psychotherapy does not need to be complicated, but rather a foregrounding of a particular understanding of well‐being and the people we work with. Following this, some concrete and straightforward suggestions for how therapists might begin to act on their social justice values are made.     

Disability and countertransference in group psychotherapy: connecting social oppression with the clinical frame

Psychoanalysis has paid limited attention to disability, and at times the approach has lacked political awareness. Over recent decades the international disability rights movement has argued that disabled people constitute an oppressed, systemically disadvantaged minority. Lately, a critical psychoanalytic view has connected disablist discrimination to universal unconscious conflicts evoked by impairment. Corresponding evocations emerge in the therapeutic frame, producing countertransference responses to the impaired body. Drawing on psychoanalytically oriented group psychotherapy with severely physically impaired adults, countertransference phenomena were studied in developing discussion on disability-related clinical work. The complex, uncertain role of psychoanalytic practice in combating oppression was also examined. Key issues include challenges to the traditional frame, the crossing of psychic boundaries, anxieties relating to not knowing, and the role of unconscious factors in marginalizing disabled experience.     

Disability sport and activist identities: A qualitative study of narratives of activism among elite athletes’ with impairment

ObjectivesSport and exercise psychology has recently expanded into how it can be utilized to enable social missions like activism. No research, however, has examined activist identities among disabled, elite athletes. This article is the first to engage with this new and complex issue by examining narratives of activism amongst elite athletes with impairment and their adoption/rejection of various activist identities.MethodsThirty-six people were recruited using maximum variation and criterion-based purposive sampling strategies. Data was collected using interviews and fieldwork observations (e.g., observation and social media material). The large data set was rigorously analyzed using a narrative thematic analysis.ResultsAll participants adopted an athletic identity and an athletic activist identity. A small group also adopted a political activist identity that was concerned with challenging disablism. The athletes’ reasons for adopting or eschewing activist identities are identified and connections made to organizational stressors, interpellation, feeling, emotional regulation, narrative, habitus, health and wellbeing. Also revealed is the impact that sporting retirement had on activist identity construction.ConclusionsThe article makes a novel research contribution by revealing two different activist identities within the context of disability sport and what social functions each identity might serve. It also significantly develops knowledge by revealing various organizational stressors experienced by disabled athletes, the importance of embodied feelings and emotional regulation in activist identity construction, the damage that social oppression can have on wellbeing following sporting retirement, and the positive possibilities retiring may have for developing different identities. Practical suggestions are as well offered.     

The Anomalous Wellbeing of Disabled People: A Response

Disabled people frequently find themselves in situations where their quality of life and wellbeing is being measured or judged by others, whether in decisions about health care provision or assessments for social supports. Recent debates about wellbeing and how it might be assessed (through subjective and/or objective measures) have prompted a renewed focus on disabled people’s wellbeing because of its seemingly ‘anomalous’ nature; that is, whilst to external (objective) observers the wellbeing of disabled people appears poor, based on subjective assessments, people with disabilities report a good quality of life. In this paper, I examine an article by the philosopher Dan Moller in which he seeks to explain this ‘disability paradox’. Despite agreeing with his analysis that there is more to what people value than happiness, his explanation reflects some of the difficulties presented in philosophical accounts which seek to understand the lives of disabled people: this includes an analysis which fails to problematise definitions of wellbeing and who has the ‘voice’ to do the defining; which negates the multiple identities and subject positions that disabled people occupy; and which lacks recognition of the social contexts which mediate disabled people’s lives. I suggest that there is a need to incorporate disabled people’s voices into research which deepens our empirical knowledge about the relationship between impairment and wellbeing, including the social circumstances that shape disabled people’s agency.     

Motivation as a predictor of outcomes in school‐based humanistic counselling

Background: Recent years have seen a growth in the provision of counselling within UK secondary schools, and research indicates that it is associated with significant reductions in psychological distress. However, little is known about the moderators and mediators of positive therapeutic benefit. In the field of adult mental health, motivation has been found to be one of the strongest predictors of therapeutic outcomes, and it was hypothesised that this may also be a predictor of outcomes for young people in school‐based counselling services. Aims: To assess the relationship between young people's motivation for counselling and its effectiveness within a secondary school setting. Sample: Eighty‐one young people (12–17 years old) who attended school‐based humanistic counselling services in Scotland. Method: Clients completed a measure of motivation for counselling at the commencement of their therapeutic work and a measure of psychological wellbeing at the commencement and termination of counselling. Results: Motivation for counselling was not found to be significantly related to outcomes. Discussion: The results indicate that the association between motivation and outcomes may be weaker in young people as compared with adults. However, a number of design factors may also account for the non‐significant findings: insufficient participants, marginal reliability of the motivation measure and social desirability effects.     

Navigating the Relational Psychic Economy of Disability: The Case of M

This paper presents a theoretically-informed psychosocial analysis of the case of M, a physically disabled man from South Africa. We use M’s account as a platform from which to consider projection, melancholic suspension and grief, as these are played out in the negotiation of dependency in relationships for disabled people. Making use of a case study methodology, we examine the various strategies through which M manages those disability stereotypes which are ascribed to him, creating a picture of how identity is negotiated in the face of interpersonal dependency as well as disablist prejudice. A central proposition is that, for M, upholding relationships which bring much-needed assistance means caring for the emotional lives of his carers, in a manner which leaves him more vulnerable to internalizing identity insults, and less able to resist his own oppression. Employing a psychoanalytic frame, we suggest that the “melancholic suspension” which some disabled people may be subject to, may lead to the necessity to “take on” certain projections, in the process of accessing much-needed care. As shall be seen, M maneuvers creatively through this relational realm by engaging in trade-offs between positive identity and physical need, employing strategies which include self-deprecation, the performance of mastery, playing with gender, and humor. With these and other techniques, he navigates the relational and psychic economy of his dependency.     

INTELLECTUAL DISABILITY AND MYSTICAL UNKNOWING: CONTEMPORARY INSIGHTS FROM MEDIEVAL SOURCES

Intellectual disabilities make people vulnerable to marginalization in churches and social spaces, but theology has not sufficiently attended to the topic and promoted the flourishing of people who have cognitive impairments. This article responds to theology's inadequate attention to intellectual disability and historical resources for reflection on the topic by reading medieval sources with intellectual disability in mind. I argue that Bonaventure's Itinerarium Mentis in Deum provides a model for imagining intellectually disabled and nondisabled people sharing the journey into God and that Eckhart's view of intellect as the uncreated element in the soul includes people who are intellectually disabled among those who may be united with God.     

(Re)placing multiculturalism in counselling and psychotherapy

Since multiculturalism is not fully theorised it has created much confusion in counselling and psychotherapy. It has been criticised for ignoring questions of power relations, and for emphasising the cultural differences of ethnic minority groups rather than focus on their similar predicaments of racism, sexism, misogyny, homophobia and economic oppression. Furthermore, it has not provided clinically useful information within which therapists can conduct assessments and diagnosis, understand clients' subjective distress and cure seeking expectations. This paper explores this issue by highlighting the magical (non)sense of multiculturalism and its racialised forms, and argues that multiculturalism is untenable if it restricts itself to a few marginalised ethno-cultural client groups, rejects gays and lesbians, patronises indigenous forms of healing, and maintains a fixed racialised 'black-white' paradigm of practice. It suggests that a point of departure for multiculturalism from an ethno-culturalism-centred philosophy to one that is pluralistic and reflexive of the needs of all clients (irrespective of ethnicised, racialised, gendered, and sexualised subjective identities) is critical if it is to be useful psychologically. To arrive at this critical juncture, multiculturalism would need to be (re)placed, not disavowed but re-centred in the practice of counselling and psychotherapy to embrace diversity and difference across and beyond the current categories that constitute itself. Replacing multiculturalism in a 'third space', an 'in-between space'—a critical multicultural space—where dominant hegemonic cultural meanings could be reinscribed and where racism, sexism, misogyny, homophobia and other 'representations of patriarchal terror' could be critically interrogated to empower marginalised voices. The paper explores three strategies for creating a 'third space' in multicultural counselling and psychotherapy: the inclusion of white people as clients; the converging of race, gender, sexual orientation, class and disability issues; and the integration of indigenous and traditional healing practices. Bringing it all together under the umbrella of diversity or critical multiculturalism will ensure an ethical and clinical practice commensurate with our current understanding of the complexity and sophistication within which clients construct their subjectivity.     

Disability as Abject: Kristeva,Disability, and Resistance

In this essay, I develop an account of disability exclusion that, though inspired by Julia Kristeva, diverges from her account in several important ways. I first offer a brief interpretation of Kristeva's essays “Liberty, Equality, Fraternity and … Vulnerability” and “A Tragedy and a Dream: Disability Revisited” and, using this interpretation, I assess certain criticisms of Kristeva's position made by Jan Grue in his “Rhetorics of Difference: Julia Kristeva and Disability.” I then argue that Kristeva's concept of abjection, especially as developed by Sara Ahmed and Tina Chanter, offers important insights into disability oppression; Ahmed's and Chanter's contributions improve upon Kristeva's account. Understanding disability as abject helps to explain both resistances to interacting with disabled others and ways to resist disability oppression. Finally, I argue that understanding disability as abject is preferable to recent deployments of Lacanian theory in disability studies and that this account is compatible with social models of disability.     

Class Dismissed: Putting Social Class on the Critical Psychological Agenda

Despite persuasive arguments pertaining to the importance of social class in the shaping of human life, this has and continues to be neglected within psychological research. Using primarily a UK focus, we begin by outlining some of the ways in which ‘mainstream’ psychology typically conceptualises class (e.g. socio‐economic status) and argue that such an approach has a number of detrimental implications, for example, neglecting structural inequalities and oppression and ‘othering’ the working class. We then present a selection of ‘critical’ and feminist‐informed research on social class which, we argue, offers a more holistic and sophisticated understanding of class and, in particular, draws attention to the complexities involved in how people experience, understand and construct class, classed identities and class transitions. Further, such work provides insight into the many ways in which people reproduce, re‐work and resist classed discourse in everyday contexts such as the home, work place and beyond. However, we acknowledge the need for investigation into how those with more economic power justify class privilege and discursively protect and maintain their status.     

Elements of a counter‐exhibition: Excavating and countering a Canadian history and legacy of eugenics

Into the Light, a recently mounted collectively curated museum exhibition, exposed and countered histories and legacies of 20th‐century “race betterment” pedagogies taught in Ontario's postsecondary institutions that targeted some groups of people, including Anishinaabe, Black, and other racialized populations, and disabled and poor people, with dehumanizing ideas and practices. This article advances understandings of the transformative potential of centralizing marginalized stories in accessible and creative ways to disrupt, counter, and draw critical attention to the brutal impacts of oppressive knowledge. The “counter‐exhibition” prioritized stories of groups unevenly targeted by such oppression to contest and defy singular narratives circulating in institutional knowledge systems of what it means to be human. The authors draw on feminist, decolonial and disability scholarship to analyze the exhibition's curation for the ways it collectively and creatively: (1) brought the past to the present through materializing history and memory in ways that challenged archival silences; and (2) engaged community collaboration using accessible, multisensory, multimedia storytelling to “speak the hard truths of colonialism” (Lonetree) while constructing a new methodology for curating disability and access (Cachia). The authors show how the exhibition used several elements, including counter‐stories, to end legacies of colonial eugenic violence and to proliferate accounts that build solidarity across differences implicated in and impacted by uneven power (Gaztambide‐Fernández).     

Disabilities and impairments: strategies for workplace integration

This article argues that disabilities are, within many of the U.S. debates, best understood as certain kinds of impairment affecting a person's capabilities to perform socially defined roles and functions within specific environments. We also argue that it is not the impairments per se that lead to claims about what we ought to do or ought not do for people with disabilities. Rather, it is only within the context of capabilities being linked to the concept of freedom--almost universally valued in the current U.S. socio-political environment--that disability issues take on an ethical tenor. Additionally, we link the notion of disability to that of social capital. In particular, we argue that any social organization that discriminates against people with disabilities by attenuating their opportunities within that environment also decreases the social cohesion that exists within that organization. Such corporate climates promote organizational structures and processes that fail to optimize facilitation of the mutual benefits of the members. Finally, we discuss three different kinds of accommodation strategy: assistive technologies, systemic personal change, and universal design. We suggest a case-based (casuistic) approach to problems caused by disabilities. Using methods from both philosophy and public policy, we then build policies for accommodations incrementally, based on an application of those methods to the cases, and resulting in a more nuanced process enabling the creation of policies that take account of the experiences of both disabled and non-disabled people.     

Resilience: A Disability Studies and Community Psychology Approach

This paper contests traditional psychological understandings of resilience through reference to a research project exploring resilience in the lives of disabled people. The paper briefly historically locates individualistic accounts of resilience (which have often been unhelpful in the lives of disabled people) and then moves into more recent social constructionist theories of this phenomenon. This latter perspective necessarily locates resilience in a network of resources including material resources, relationships, identity, bodies and minds, power and control, community participation, community cohesion and social justice. We argue that the recognition of resilience as a relational product is important and in tune with attempts to make psychology less an individualistic encounter and more a community intervention. However, disabled people, their politics and the development of critical disability studies, contest and challenge normative ideas of what it means to live with a resilient network of resources. In this sense disability offers new and exciting ways of addressing resilience.     

Disability and Life Satisfaction in Italy

During the last decades, the socio-economic policy agenda has devoted an increasing attention to the inclusion of disabled people into society. It follows that understanding the drivers of life outcomes and conditions of disabled people is essential to analyze the sources of disadvantaged positions.This paper brings evidence on the predictors of life satisfaction of disabled people in Italy, focusing on four specific dimensions (relations with relatives and friends, economic conditions, and leisure time) and analyzing information on people with functional limitations and health problems, as provided by the 2011 ISTAT survey.Estimation results show that household structure, health and disability status affect life satisfaction more significantly than personal and income variables. Education attainments significantly affect satisfaction with the economic conditions. In addition, support in daily activities may increase satisfaction with economic conditions and leisure time, suggesting that providing non-monetary support would be effective in increasing life satisfaction, especially in those domains requiring freedom of movement. Finally, we find that older disabled people are, on average, more satisfied than younger disabled people, while gender is relevant when interacted with the household type.