International Journal for the Advancement of Counselling 7:99-103 (1984). © Martinus Nijhoff Publishers, The Hague. Printed in the Netherlands.

COUNSELING PERSONS WITH DISABILITIES THROUGH TEAMWORK

S. NORMAN FEINGOLD and MARIE FEINGOLD

National Career and Counseling Services, Washington, D.C. and Vocational Rehabilitation Services Administration, Washington, D.C.

I. Definition

' In American rehabilitation nomenclature, disability means a long term or chronic condition medically defined as a physiological, anatomical, mental, or emotional impairment resulting from disease or illness, inherited or congenital defect, trauma, or other insult (including environmental) to mind or body. ' (George N. Wright, 1980, p. 68). A handicap is created when the environment creates obstacles or barriers to daily living for the disabled person. Nevertheless, disability and handicap are generally used interchangeably.

II. Premise

Our premise in this brief presentation is that the attitude of disabled persons is of paramount importance in their establishing goals and directing self toward meeting them. If they are not motivated to take responsibility for their lives, there is little that can be accomplished. The challenge to the counselor is develop- ing potential strategies and skills to assist clients to move toward accepting re- sponsibility for their lives.

Rehabilitation demands hard work on the part of the client, the family and the counselor. There are no easy, quick methods. Time, high energy expenditure, and goal directedness are demanded.

Whether the individual is born with or acquires a disability, or the body deteriorates as it ages, or is traumatized in an accident, the concepts and actions discussed in this paper apply.

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III. Team approach

Awareness of a disability may be made by the teacher in school, the parent, the family physician, the employer, the hospital. The kind of disability, the age of the person with the disability, the functional limitations created by the disability will vary from individual to individual. Once the existence of the disability is con- firmed, an interdisciplinary team should be established.

Everyone will not require the services of all team members. Others will require the services of different team members at different stages of their rehabilitation. The settings in which the rehabilitation services are provided will vary with the disability and with the stage of the rehabilitation process. Team members are likely to work out of many different physical and administrative settings.

The two most important team members are the client or person with a disabili- ty; and the family or family substitutes of the individual with a disability. Other team members are client/patient advocate or ombudsman; nurses, nurses aides, orderlies, licensed practical nurses, personal care attendants, all the staff that provide daily care; occupational therapist; physical therapist; physician or physi- cians; placement specialist; psychiatrist; psychologist; rehabilitation counselor; rehabilitation engineer; rehabilitation nurse; social worker; speech therapist; and team leader.

Professional team members must be knowledgeable and maintain up-to-date information about their own area of expertise as well as being able to share infor- mation and ideas with other team members. Success and failure belong to the team not to individual members of the team.

Team conferences need to be conducted on a regular basis and in response to the specific needs of the individual. The newly traumatized in the hospital require staff conferences on a more frequent basis than do disabled individuals who are working and carrying on the tasks normal for their age.

The family as a unit and the individual members often need counseling as much or more than does the family member with a disability. All members of the nuclear family and many members of the extended family are affected by the changes in family constellation caused by the disability of a member, who can too easily fill the family's victim role. The disabled family member can be isolated from the total family in various behavioral ways. The rest of the family may 'use' the disabled member to solidify their positions and to lessen their anx- ieties and frustrations. They become more cohesive by assuming the victim, the disabled family member, is the primary source of major difficulties that beset the family as a system.

Counseling not only assists the family to better understand the changing family relationships but also improvement in any part of the family system has positive effects on the disabled family member. Family members can assist in recovery and adaptation or they can sabotage the work of the professionals with all degrees of self-defeating behavior in between.

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The family too may require assurance that their needs are legitimate and can not be ignored. This is particularly so when the family member with a handicap requires constant and on-going supervision and care over a lengthy period of time. Respite care is a growing concept. Respite care permits the family and the member with a disability to have a vacation from each other. Trained individuals live at the home and care for the disabled member while the other family members are away or the individual with a disability lives at a group home or nursing home for the 'vacation' period.

A psychiatrist has an exceptionally important role in the hospital or rehabilita- tion center setting to identify the coping mechanisms of clients and to help the team develop strategies that encourage adaptive coping rather than maladaptive coping. Additionally, the anger that accompanies sudden and traumatic injury is usually vented on the daily caretakers, nurses, orderlies, therapists, etc. The psychiatrist or psychologist as a team member also provides a safety valve to these team members.

IV. Some skills that counselors should have

Counseling individuals with disabilities requires that counselors be futurists, net- workers, information givers, and have creative problem solving skills as well as empathy and unconditional regard. Limit setting and 'can do and can succeed expectations' are equally as important.

Counselors must be cognizant of new technologies and how they will enable the individual to circumvent the limitations imposed by the disability. Talking computers, for example, widen the options of the blind and speechless.

The principles of counseling, testing and evaluation apply equally to the disabled and non-disabled. The disability is an issue only in so far as it requires functional accommodation of the evaluating instruments. For the person with low vision, completing a paper and pencil test may require either large print or more time. For the computer terminal operator with limited range of motion of the upper extremities, the keyboard will have to be repositioned from the 'nor- mal' position to one that meets her physical parameters.

Community resources include consumer support groups. Counselors need to know the groups in the community and if they provide positive outreach. Self- help with peer counseling, advocacy, housing and transportation coordinators is a growing trend in the United States.

Counselors of the disabled must be willing to make home visits. A home visit is like a picture; worth a thousand words.

Counselors must be advocates/ombudsmen for their clients.

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V. Ethical dilemmas

Medical advances keep alive people who formerly died. Many become severely disabled. Technologically it is possible to improve the quality of their lives. The financial cost is often extremely high. In the United States, funding is being reduced. With limited budgets, what criteria do we use to determine who will benefit from the technology?

Additionally, vocational rehabilitation funds in the United States are to be used to enable recipients to return to work or to engage in work for the first time. Work is defined as competitive full-time, competitive part-time, homebound, sheltered or self-employment. If working is not possible, is the quality of life not to be improved?

What does the counselor do when the law is such that by working, the client loses medical and social service benefits that are far in excess of what he/she will have by working?

Aside from monetary concerns, professional staff has to be willing to adapt their routines to those that maximize opportunities for clients/patients. It may be easier for staff to have a dialysis schedule that prevents a 14-year old from attending school but this is a disservice to the patient. When high school gradua- tion occurs, despite at least average native intelligence and good adjustment to the disability, the client lacks the information/education and social skills of his or her peers. Home tutors twice a week are not a substitute for a week in school. Attainable jobs are then at a lower level than if the dialysis schedule had permit- ted school attendance. This is an example of how, through dialysis we have saved a life and through rigidity, we have lowered the quality of the life we have saved.

VI. Conclusion

The rehabilitation process, to be meaningful, requires large expenditures of ef- fort by individuals with disabilities and by counselors. Empathy, creativity, team work, networking, and communication skills in addition to professional counselor training are required of the rehabilitation counselor.

This paper briefly presents the framework through which we envision maxi- mizing the assets and minimizing the limitations of counselee and counselor. We hope we have presented ideas that will be useful to readers.

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