Models of Disability
When society talks about disability, there are two models that come to mind.
Healthcare professionals largely follow the medical model, which sees disability as a burden to be overcome.
In contrast, the social model views society as the issue. The real problems are the things that prohibit people with disabilities from living normally. These include buildings without ramps, or conferences without American Sign Language (ASL) interpreters. Only within recent years has psychology begun to consider disability through the social model.
Disability and Mental Health
Disability impacts approximately 26% of the American population. It affects many things, such as our ability to move, think, and communicate. It can appear as a physical challenges (Spina bifida) or a psychological struggle (bipolar disorder). A disability can be lifelong or temporary.
In mental health, disability as a topic receives less attention than subjects about any other minority group. Studies show that psychology students at both the undergraduate and graduate levels are not properly educated on how to best work with people who have disabilities. Nor do they receive guidance on how to make services more accessible. There are a few exceptions to this, such as coursework involving children with developmental disabilities.
Delivering Psychotherapy Services to People with Disabilities
Like the rest of the population, many people with disabilities have therapeutic needs. Therapists can work to deliver appropriate services to people with disabilities by engaging in culturally competent practices.
Oftentimes, it is a person’s misconceptions about disabilities that cause barriers to service. One of the most important things that therapists can do is build their critical awareness and knowledge. This goes beyond knowing the facts and encourages one to improve their knowledge by taking action.
Disability activists have advocated for the use of person-first language. This, for example, would encourage the phrase “person experiencing schizophrenia” rather than “schizophrenic.” Using this language emphasizes that the person’s disability does not define who they are. Small shifts in perspective can make a world of difference.
Disability-affirmative therapy can be helpful. This kind of treatment helps to put the disability of a client into focus without over-emphasizing the role that the it plays in their life.
In her book on Disability-Affirmative Therapy, Rhoda Olkin gives an example of how this modality was used with a client who had cerebral palsy. First, the therapist asked her client questions about her personal history. She then used the different models of disability to analyze the concerns that the client presented. Critically, the clinician tried to ensure that discussions about the client’s disability did not dominate the sessions unless that was what the client wanted. The client reported that this approach was impactful.
Though this study is helpful in understanding what disability-affirmative therapy looks like, it does not investigate the multiple identities that the patient might have had. Clinicians must explore the importance of what it is like to navigate multiple identities, commonly referred to as intersectionality.
Questions of intersectionality are important when looking at disability in any capacity. Intersectionality explains how multiple, overlapping aspects of our identity combine to create unique experiences of privilege and discrimination. Many people who have a disability also identify as a woman, a racial minority, and/or LGBTQA. What might therapy look like for a Latinx woman experiencing depression who also has a history of sexual violence? What if this woman also had vision problems; how does this complicate her care? And how would this differ from therapy for an economically-privileged white woman experiencing anxiety?
Because everyone experiences their disability in a different way, not everyone encounters the same obstacles and oppression. A woman with dyslexia might be able to “pass” as non-disabled, but a woman with a prosthetic leg cannot. These women might come from the same family background, receive the same level of education, and work the same job, but each woman’s life experience will be drastically different because of society’s immediate reaction to her appearance. A consideration such as this would be critical for a therapist to reflect on.
The stress of competing cultural demands is a prominent aspect of intersectionality. For example, a deaf woman of color needs to navigate both Deaf culture as well as racial oppression.
Clinicians need to be aware of the fact that deaf people do not see their deafness as a disability, but rather as a culture itself. Deaf women of color often report feeling forced to “choose” between their deaf identity and their racial identity. This can manifest in issues with support and level of involvement from the woman’s biological family. Such complications have important implications for how therapy would be carried out.
Clinicians should keep this in mind in order to provide clients with the most tailored and effective care possible.
The Age of Coronavirus
As intersectionality has a lasting impact on a person’s identity, so too will the current pandemic. Coronavirus has dramatically shifted American life. The lives of people with disabilities are no exception.
From the outset, members of the disability community are at significantly higher risk for contracting and dying from COVID-19. Hospitals across all of the states have been updating their medical rationing plans, many of which deny care to people with disabilities if someone with “better odds” is in need. If non-disabled, non-marginalized people are scared, people with disabilities are terrified.
With the widespread fear that the Coronavirus has instilled, more people than ever are turning to therapy. And with the growth of social distancing, teletherapy is rising in popularity.
Though teletherapy lacks the intimacy of in-person treatment, it has many benefits. Some people might view their mental health concern as disabling in some way, associating it with stigmas about needing care. If they are apprehensive about receiving therapy as a result, they might feel more comfortable reaching out for services if they are able to receive them without leaving their home. Additionally, people who are physically disabled might otherwise have trouble transporting themselves to a therapy center. Teletherapy allows people with physical disabilities to receive therapy in their place of residence without the worry of finding accessible transportation. This can also be helpful for people with weather-related and seasonal conditions.
Outreach and Implementation
During the COVID-19 pandemic, The Viva Center has accommodated clients by offering teletherapy services that make every effort to match in-person therapy. Additionally, as a programmed response to the pandemic, The Viva Center has implemented Healing Through Connection (HTC) , a short-term, low-cost supportive crisis counseling service.
But what else can Viva and other centers do to make their services more accessible?
Steps Towards Accessible Care
The first step to accessible care has to do with recruitment. Oftentimes, print ads are not accessible to people with reading disorders and/or low vision. Because of this, website accessibility is critical, as it can be a platform that, when formatted correctly, is accessible to many people.
Simple fonts allow for the use of assistive technology such as screen readers, and text descriptions for visual information is helpful for people with vision problems. This would be especially helpful for the previously mentioned woman with depression and vision problems.
Once clients have been recruited, the consent process should be made accessible as well. Large font size (16-18 pt.) and dark lettering on light backgrounds provide easy ways for people with visual problems to access material. Recorded versions of such materials can also be helpful, especially for people with reading disabilities. A center that goes above and beyond would also include an in-house version of documents and information on a disk that a person could take home with them and use with their assistive technology. Intake forms should also attempt to address concerns about multiple identities as this has implications for future care.
After the wake of this pandemic has settled, a center might consider keeping teletherapy as an option for people with both physical and mental disabilities. During therapy sessions themselves (whether in-person or not), the client should be invited to make use of the space in a way that is most comfortable to them. This might include lying on the ground, sitting against a wall, turning off the lights, or stimming. Such actions give consideration to people who have issues with mobility, light sensitivity, or motor control.
Finally, disability advocacy is just as important as the aforementioned suggestions. Addressing accessibility issues and finding ways to limit barriers to access are done best when everyone comes together to brainstorm. Centers can host events led by disability advocates and professionals that teach about best practices for accessibility and cultural competence. At this event, clinicians could role play with one another to practice disability-affirmative techniques. Such an event would also be a good place for clinicians to discuss how the center as a whole can improve accessibility on the ground.
“Nothing about us without us” is a popular phrase that was chanted and written on signs during the Disability Rights Movement in the 1960s. 80 years later, the same sentiment should remain true. Incorporating a disability studies perspective into therapy practices is critical for best supporting people with disabilities, which can be done through a disability-affirmative approach.
Regardless of the kind of therapy being used, concerns about intersectionality should never be overlooked. Especially during the Coronavirus pandemic, marginalized communities are in need of care that addresses all aspects of their identity.
In times of crisis, it is easy for us to recede into darkness. Whether you identify as disabled or not, as having multiple intersections or not, we all share at least one thing in common during these troubling times: the ability to reach out to one another. Extending a helping hand – or prosthetic arm – can bring light back to the darkest of places. If we can learn anything from the Coronavirus, it’s how to be there for one another in ways that are meaningful . And hopefully, this is a lesson that can extend beyond the current health crisis and into the years to come.
Meredith, a former clinical intern at Viva, is a recent graduate of Georgetown University where she majored in psychology with minors in disability studies & english. She is beginning a master’s program in the fall at the University of Pennsylvania where she will be studying counseling and mental health services. She hopes to work in a field that emphasizes childhood mental health and social-emotional competence among children in school systems.