Issues Treated in Therapy:
Note: This page pertains primarily to physical and sensory disabilities (such as paralysis and visual impairment). If you are interested in learning more about developmental disorders, you can visit our Autism / Asperger's page.
The issue of disability is oddly treated in our society and in our families; therefore, people with disabilities, whether life-long or new-onset in nature, may develop psychological problems related to living with a disability. These problems often (but not always) manifest themselves as anxiety, depression, and/or relationship issues, and the person with the disability may, at first, not be aware that the disability, and how it is treated in society, is the underlying cause of his/her psychological concerns.
A disability may result from an illness (i.e., difficulty walking resulting from Multiple Sclerosis), but a disability is not, psychologically, the same as an illness. Having a disability in a society that does not value people with disabilities can be an identity issue; a disability requires of the disabled person that he/she take a stance--whether conscious or unconscious--regarding his/her disability. Will he/she deny it or ignore it? Will he/she attempt to “overcome” it, no matter what the personal cost? Will he/she be proud of being a person with a disability? Will he/she fight for equal rights for people with disabilities? Will he/she try to “pass” as able-bodied? Will he/she believe her family’s message that he/she will “never amount to much” and give up on their dreams?
A myriad of difficult life questions arise for people with disabilities, for example:
Children and adolescents with disabilities are often ostracized or humiliated by peers at school. They often feel insecure among their peers (although they may do very well in adult company) and are confused by the clash between the messages they receive from peers and those that they receive at home. If they cope well with their disabilities and/or their disabilities are “invisible,” they may assume that there is something else “wrong” or “shameful” about them that makes them unappealing to their peers. By the time they reach adulthood, the fact that they have a disability may have been compartmentalized to the point that they cannot make realistic decisions for themselves that take their disability and other life circumstances proportionately into account.
Thus, young adults with lifelong disabilities often appear in therapy complaining that they feel anxious and/or depressed, cannot move forward in their lives, and do not understand why. A therapist who understands the implications of having developed psychologically with a disability can help these clients re-story their lives to date, develop and diversify their self-esteem, and make practical, satisfying plans.
A whole other set of psychological issues is triggered by the development of a disability in adulthood. People who acquire disabilities through war, industrial, auto or other accidents, crime, or illness suddenly have to cope with the loss of one or more body parts or some or all of those parts’ functionality. Additionally, their customary ways of thinking about themselves, their existence, and the world may just have been shattered. This is a huge blow to the psychological system. Unfortunately, it is also a shock to the newly disabled person’s support system. Often friends and family members will either flee the scene or remain supportive but act overly cheerful, insisting that the person with the new disability will soon “overcome” his or her new circumstances.
Newly disabled people sometimes feel so pressured to “pick themselves up and move on” that they do not have adequate time to grieve their significant losses and re-evaluate their lives. They may become depressed and their depression may remain undiagnosed by medical professionals assisting with their physical rehabilitation. Additionally, depending on the circumstances which caused a person to become disabled, that person may be suffering from posttraumatic stress.
A counselor familiar with the psychological processes that often occur after the onset of a new disability can help the newly disabled client account and work through his/her many losses (which may include such life-changing losses as losing her profession or other previously highly valued life roles). Ultimately, the counselor can help the client to make practical, emotional, intellectual, and spiritual changes that will allow him/her to live his/her new life with satisfaction. ~ Page content provided by Wendy Smith, wendysmithcounseling.com
A 25-year-old female graduate student with a history of spectacular academic achievement comes into a psychotherapist’s office and states that she has been anxious and depressed for over a year but does not know why. She talks about a wide range of problems, worries and concerns for most of an hour, mentioning, as an aside, that she has been visually-impaired since infancy. At the end of the hour, the psychotherapist states that she has a hunch that the young woman’s anxiety and depression are related to her disability. The client thanks the therapist, leaves, and does not reappear for three months. When she does come in again, she tells the therapist that she needed time to digest her comment; she had always thought of her visual impairment as a “separate issue” that had nothing to do with the rest of her life. The two begin a process of several years, which involves the young woman’s reevaluating her values and priorities, working through a lifelong need to “prove herself,” integrating her disability into a new sense of self, and learning to make decisions for herself that take her whole life, including her disability, into account. The client’s depression disappears completely within the first six months. She and the therapist continue to work on ways of managing her anxiety, including understanding its root causes. Based on her new values and understanding of herself, the client changes careers, stops overachieving, and, instead, develops volunteer, recreational and social interests from which she derives new satisfaction and which balance out her work-life.
Change of Identity After Loss of Mobility - Case Example
Bill, a 50-year-old man who uses a wheelchair, is referred by his county crisis line to a counselor who specializes in working with people with new-onset disabilities. Bill called the crisis line because he was feeling suicidally depressed but knew deep down that he didn’t want to kill himself. A year and a half ago, the counselor learns, Bill, who loves the outdoors, was seriously injured in a boating accident and lost mobility and sensation from the waist down. He had previously been a successful businessman who worked hard during the week, played hard on the weekends, and didn’t spare much time for the meaning of life. Now that he has mastered the details of self-care as a person with paralysis and completed a physical rehabilitation program, his life seems meaningless to him. He could go back to work at his old company if he wanted to but he can no longer see the point in making sales. According to Bill, all he does is work out at home with his weights and watch depressing news programs on TV or depressing scenes out the window of his new accessible urban apartment; he knows a lot about “what’s wrong with this messed up world.” In the course of their sessions, the counselor helps Bill become aware of, and express, a lot of grief and rage with regard to his disability and all that he has lost because of it—and, as it turns out, with regard to plenty of social issues as well. The counselor encourages Bill to take “field trips” to different places around the city and take notes on what he observes and learns—especially about himself. Bill begins to report on some of these trips with interest and insight. He’s looking at people, birds, trash, everything, in ways that he never took the time to do before. One of his field trips is to a local community center where some elementary school boys are playing basketball. Bill eventually becomes their coach. ~ Case Examples provided by Wendy Smith, wendysmithcounseling.com
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Last updated: 09-16-2013