“Seeing potential_ not disability”_August 2011 - Renovating with TLC

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					                                      Seeing potential, not disability
                                      Disabilities can alter a person’s life, but rehabilitation counselors work hard to put
                                      clients back in the driver’s seat

                                                                                                     By Lynne Shallcross

                                                      hen Chad Betters wants          assumption that rehabilitation counselors
                                                      his students to grasp what it   focus on one specific area, such as
                                                      means to have a disability,     substance abuse. But disability comes in a
                                      he shares the story of a former client. The     variety of forms, says Rollins, who is a past
                                      woman had been a nurse for 19 years but         president of ARCA.
                                      developed an allergy to latex as a result of       For example, she says, a rehabilitation
                                      her work.                                       counselor might help a student with a
                                         “By developing this condition, the           disability to get the accommodation he
                                      client not only had to adapt vocationally,      or she needs, whether that means taking
                                      given that she could not safely work in         a test in a quiet environment or using
                                      any health care environment due to the          a computer with voice capabilities. The
                                      utilization of latex in many of the medical     counselor’s role, Rollins explains, is to
                                      supplies present, but also had to make          take a physician’s or other evaluator’s
                                      drastic changes in her life, including          recommendation of what accommodation
                                      modifying her home, her vehicle and even        is necessary and to assist the school or
                                      her wardrobe due to the presence of latex       other institution in implementing that
                                      components. She also had to learn to be         accommodation for the client.
                                      mindful of her environment when out                According
                                      in public because sitting in a restaurant       to the ARCA
                                      with balloons in the vicinity could             scope of practice,
                                      trigger allergic symptoms,” says Betters,       “Rehabilitation
                                      an assistant professor of rehabilitation        counseling is a
                                      counseling at Winston-Salem State               systematic process
                                      University in North Carolina.                   which assists
                                         After working with Betters, the client       persons with
                                      was admitted into a legal training program      physical, mental,
                                      and found work as a paralegal. She had          developmental,
                                      learned how to manage her disability            cognitive and          Carolyn Rollins
                                      and became an advocate for health care          emotional
                                      professionals with latex allergies. “It’s a     disabilities
                                      story I share with my students, and it          to achieve their personal, career and
                                      tends to open their eyes to the magnitude       independent living goals in the most
                                      of the impact of a disability,” Betters says.   integrated settings possible through the
                                         Rehabilitation counseling is a well-         application of the counseling process.
                                      established but sometimes misunderstood         The counseling process involves
                                      part of the counseling profession.              communication, goal setting and beneficial
                                      “Everyone assumes we’re substance abuse         growth or change through self-advocacy,
                                      counselors,” says Betters, a member of the      psychological, vocational, social and
                                      American Counseling Association and             behavioral interventions.”
                                      the American Rehabilitation Counseling             Tyra Turner Whittaker, a professor
                                      Association, a division of ACA. “And while      of rehabilitation counseling at North
                                      we work with individuals with substance         Carolina A&T State University, notes that
                                      abuse issues because [they are] a disability,   the number of people with disabilities is
                                      we work with all disabilities across the        vastly increasing, particularly as the baby
                                      board.”                                         boomer generation ages and as more
                                         Carolyn Rollins, associate professor         veterans return home with disabilities
                                      in the Department of Counseling and             incurred during military conflicts.
                                      Educational Leadership at Albany State             Rollins adds that improvements in
                                      University in Georgia, has also heard the       medical care are allowing greater numbers

28 | Counseling Today | August 2011
of people to                                                           one in four is employed full time. “You                 whether the
survive life-                                                          can imagine what that does to a yearly                  individuals are
threatening                                                            income,” Sales says.                                    dealing with a
situations, but                                                           Carrie Wilde, president of ARCA and                  disability they
many times,                                                            former chair of the Counselor Education                 were born with
these individuals                                                      Department at Argosy University in                      or one they
are left with                                                          Tampa, Fla., says although the roots of                 experienced
disabilities. It’s                                                     rehabilitation counseling are in helping                later in life,
no surprise then                                                       clients find employment, that isn’t the sole             Wilde says.
that the role of                                                       focus. “Now counselors are taking a more                She previously
                      Tyra Turner Whittaker                                                                                                           Amos Sales
rehabilitation                                                         holistic approach,” she says. “How are                  worked with
counselors is                                                          clients doing socially, educationally, how is           clients who had
growing ever more crucial, Rollins says. “A                            [a disability] affecting their relationships?           brain injuries, using a holistic approach
person’s ability to function independently                             It’s not just vocational.”                              that encompassed working through the
can be enhanced by the knowledge of                                       Whittaker, a member of ACA, adds to                  clients’ perceptions of themselves with
rehab counselors.”                                                     that point. “In the past, unfortunately,                the disability, adjusting to the disability,
                                                                       what happened in the field of counseling                 improving their self-confidence and
Employment … and much more                                             [was that] people tended to view rehab                  becoming more socially comfortable.
   One of the primary goals of                                         counselors as just employment specialists               Wilde says a holistic approach to
rehabilitation counseling is to help                                   [rather than] counselors who have an                    rehabilitation counseling can also include
clients become gainfully employed, says                                expertise in employment,” she says. “For                working with the client’s family members,
Amos Sales, professor in the Department                                the most part, rehabilitation counselors                friends and other support systems.
of Disability and Psychoeducational                                    share the core counseling training that                    The issues clients bring with them to
Studies at the University of Arizona. As                               most counseling students have, along with               rehabilitation counseling are wide ranging,
a minority group, 13 percent of people                                 additional training in employment and in                Sales says. In many cases, clients are still
with disabilities live at or below the                                 the medical and psychosocial aspects of                 working through personal and emotional
poverty line, and two-thirds of people with                            disabilities.”                                          issues related to having a disability, he says,
disabilities are unemployed, according to                                 Rehabilitation counselors assist clients             so a counselor’s training in establishing a
Sales. Of those who are employed, only                                 with reintegrating into the community,                  relationship while demonstrating empathy

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and positive                                         Rehabilitation counselors often work          counselors providing vocational counseling
regard is crucial.                                with potential employers or the client’s         to rehabilitation clients. “Truly listen to
   On the                                         coworkers as well, she adds, helping to          the client’s story — where they’ve been and
employment                                        set up accommodations for the client             where they hope to go,” she says. Clients
end, counselors                                   in the workplace. The counselor’s level          often want to share their backgrounds
might work                                        of involvement in the workplace largely          as well as their future aspirations, she
collaboratively                                   depends on the client’s ability to articulate    explains, and counselors should show
with the client                                   his or her needs to the employer, Wilde          the patience to first listen before assisting
to investigate                                    says. “We as rehabilitation counselors do        clients in meeting those goals.
what he or she                                    not want to add to the stigma that may
                         Carrie Wilde                                                              Returning power to the client
wants to do, Sales                                already be associated with a disability,” she
says, possibly                                    says. “The more we can have clients do for         Sales views people with disabilities as
by administering a personal interest test.        themselves, the less disruptive it is.”          an oppressed minority group — a group
If it becomes evident the client needs               In working with an employer, the              that “experiences a particular need to feel
retraining or additional education to             rehabilitation counselor’s goal is to find        more power in their lives.” Giving power
obtain employment, he says those services         out what can be changed in the client’s          back to individuals with disabilities is such
can be provided through the state-federal         environment or support system to allow           a passionate topic for Sales that in 2007
vocational rehabilitation services program,       the individual to do the work, Wilde says.       he wrote a book about it: Rehabilitation
which was set up through the federal              For example, if an employee was injured          Counseling: An Empowerment Perspective,
Rehabilitation Act.                               and can no longer handle heavy lifting, a        published by ProEd and available through
   Employment services with rehabilitation        rehabilitation counselor might work with         ACA.
counseling clients might begin with an            the employer to modify the person’s job            “They have been denied power
assessment, which may be administered             description. Wilde had one client who            throughout their lives,” Sales says of clients
by the counselor or by someone else,              couldn’t bend well because of a disability,      with disabilities. “They have dealt with the
depending on the scope of practice in             so she collaborated with his employer to         medical model all their lives where they’ve
the counselor’s workplace, Wilde says.            make adjustments to the equipment with           been told what they can do and cannot do.
After reviewing the assessment of the             which the client worked.                         Because of mobility issues, they’ve been
client’s abilities, she says the rehabilitation      The economy remains a complicating            denied access. All of those things feed into
counselor might offer the client                  factor, Betters says. “Individuals without       being in a lower power position. They
employment services, such as working              disabilities are having trouble finding           come to counseling with a need to be
on interview skills, or send the client to        employment,” he says. “When there are            more empowered.”
another agency for additional training or         disabilities, that just compounds it.”             Ironically, the field of rehabilitation
services.                                            Whittaker offers a recommendation to          counseling had very paternalistic

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beginnings, Sales says, with counselors       actually oppress clients is by making          process for persons with disabilities, Sales
viewed as the “experts” who would             decisions for them, by moving them more        offers several recommendations, including
determine vocational goals for clients.       toward the counselor’s own thoughts and        responding to the individual instead of
Thankfully, times have changed, he says,      opinions,” he says.                            the disability and using the Rogerian
and today there is a greater push toward        If the counselor acts as the expert, Sales   approach of empathy, congruence and
client empowerment.                           warns, clients are more likely to make         positive regard. Try to put as much
   The first step rehabilitation counselors    choices on the basis of what they think the    power as possible back into the clients’
can take in empowering clients is to          counselor wants them to do rather than         hands, he advises counselors, and support
assume the role of partner rather than of     on what they believe would be in their         clients in assuming more power over
expert, Sales says. That’s a paradox in the   own best interests. “If they’re comfortable    their own personal change as well as over
counseling profession, he says, because       with you and they are seeking advice, that’s   their environment. Depending on the
counseling students work hard to become       good,” he says. “But if you move them too      individual issues and needs of each client,
knowledgeable about all sorts of emotional    quickly based on your thinking and expert      rehabilitation counselors can use a wide
issues and how to overcome them. “But         knowledge, that’s not good.”                   range of effective counseling theories
where you subtly cause problems and             To create a more empowering counseling       and approaches, but Sales says feminist
                                                                                             theory pairs particularly well with an
                                                                                             empowerment approach.
   Branching out                                                                                Rollins is also an advocate of
                                                                                             empowering clients. “Rehabilitation
     Employment isn’t an issue only for       the claimant’s future earning capacity,”
                                                                                             counseling is a profession in which we
  rehabilitation clients — it’s also an       Whittaker says.                                strongly believe in the autonomy of the
  issue for rehabilitation counselors. To        5) Addictions counseling is another         client, and the client’s role in the process
  help new rehabilitation counseling          option for counselors trained in               is very important,” she says. “The client
  professionals looking for work              rehabilitation counseling, Whittaker           ought to be able to have a role in the
  or even seasoned professionals              says, although rehabilitation                  outcomes of the treatment and to define
  seeking something new, Tyra Turner          counselors might need additional               [his or her] own needs.” Clients should
  Whittaker, a professor of rehabilitation    licensure and/or training in addictions        be actively involved in the rehabilitation
  counseling at North Carolina A&T            counseling depending on their                  process, Rollins says, and counselors
  State University, offers a rundown of       state’s requirements. North Carolina           should work from a strengths-based
  job opportunities for those trained in      A&T offers a certificate program                model, with the counseling relationship
  rehabilitation counseling.                  in rehabilitation counseling and               building on the assets the client brings to
     1) One major employment option,          behavioral addictions. The program             the table.
  Whittaker says, is working for a state      provides specialized training to                  Earlier in her career, Wilde remembers
  agency, whether it’s a state vocational     rehabilitation counselors in the areas         empowering a 32-year-old client who
  rehabilitation agency or a state agency     of alcohol and drug abuse, gambling            was rebuilding his life after a self-inflicted
  for the blind or deaf and hard of                                                          gunshot wound to the head. The client
                                              addiction, sex addiction, eating
  hearing.                                                                                   was living in a nursing home when
                                              disorders and criminal behavior.
     2) Look into opportunities with the                                                     Wilde began working with him, but after
                                                 6) Life-care planning is yet another
  Department of Veterans Affairs.                                                            approximately two years of rehabilitation
                                              option. “This is an area of specialty in
     3) Because rehabilitation counselors                                                    counseling, the man found employment
                                              rehabilitation in which the counselor
  have special expertise in career and                                                       and began living on his own again. “It
                                              works with people with catastrophic
  employment counseling, they can                                                            was the belief that he could do more for
  consider working as a career counselor      injuries or illnesses,” Whittaker says.
                                              The counselor’s role would be to               himself that got him out of the nursing
  or employment specialist, Whittaker                                                        home,” Wilde says. “Empowering
  says. “You can use that knowledge and       develop a care plan that delineates
                                              every specific need the individual has          clients to do more for themselves and
  skill set to help individuals find careers                                                  feel good about themselves is central to
  or assist companies in executing their      or will have, along with the cost of
                                              those needs from the point of injury           rehabilitation counseling.”
  employment development programs,
  which are desirable services in this        through the remainder of the client/           A complicating factor
  current economic climate.”                  claimant’s life.                                 For about three years, Betters has been
     4) Work as a vocational expert              7) Finally, Whittaker points to             researching the relationship between
  on behalf of insurers, defendant            disability management as a rewarding           disability and obesity. The nation’s
  or plaintiff attorneys, or through          employment option. Rehabilitation              waistline is growing, and that can
  the Social Security Administration.         counselors would have the opportunity          complicate the situation for people with
  “Similar to medical experts utilized        to work with an employer in the                disabilities, he says. “As our country is
  in the legal system, vocational experts     areas of disability intervention and           becoming more and more a victim of the
  offer vocational professional expertise     prevention within the workplace.               obesity epidemic, we are going to have
  on the impact of a personal injury on                              — Lynne Shallcross      to accommodate this in what we do as
                                                                                             rehabilitation counselors because it is

32 | Counseling Today | August 2011
multiplying,                                    and when someone has a disability, lack                     including those aspects at least in the
compounding                                     of activity, dietary changes from a tighter                 discussions if it’s relevant.”
and increasing                                  budget and mental anxiety only increase                        Does Betters recommend that
the magnitude                                   the likelihood of the person becoming                       rehabilitation counselors address the
of disability                                   obese.                                                      issue of weight with clients, even though
that clients are                                   The implication for rehabilitation                       it remains something of a taboo topic?
bringing to the                                 counselors, Betters says, is that job                       “If it’s going to prohibit or limit their
table.”                                         placement for the client becomes even                       employability, my position is yes,” Betters
   Advancements                                 more difficult. The more limitations a                       says. “It should be treated as any other
in health care                                  person has related to obesity — such as                     issue, concern or obstacle in the client’s
                      Chad Betters
have helped                                     fatigue, taking diabetes medication or                      return-to-work process.”
minimize                                        dealing with orthopedic pain because of                        Although rehabilitation counselors
obesity’s effect on mortality, which is         weight — the harder it becomes to find                       aren’t experts in diet and nutrition, Betters
positive, Betters says, but the flip side        a suitable employment match. Betters                        suggests opening the discussion by asking
of the coin is that obesity is increasing       adds that individuals who are obese also                    clients how obesity might be impacting
morbidity, making it more of an issue           face greater employment discrimination.                     their disability. Rehabilitation counselors
within rehabilitation counseling. Obesity       “Obesity’s implications compound                            may also be able to assist clients by
can complicate rehabilitation after a           everything,” he says.                                       making appropriate referrals. For example,
person suffers a disability, and it can also       The obesity epidemic isn’t going to                      although it isn’t the norm, Betters says
stem from incurring a disability.               drastically diminish anytime soon, Betters                  some workers’ compensation systems are
   Betters points to research showing that      tells rehabilitation counselors. In fact,                   providing gym memberships to clients to
people who enter workers’ compensation          data points to it getting worse. “As rehab                  assist them with weight-loss efforts.
programs after an injury come out with          counselors, we can’t expect clients to come
higher body-mass indexes than before            in the door with a game plan that they’re                   Working together
they began. “Those individuals are then         going to take responsibility to manage                        All counselors, regardless of specialty, can
at a greater likelihood of sustaining a         [their weight] or have an action plan                       benefit from understanding the work of
re-injury,” Betters says. “It’s almost a        during rehab,” he says. “Rehab counselors                   rehabilitation counselors, Whittaker says.
downward spiral.” The American lifestyle        didn’t sign up to work as nutritionists                     “All counselors will encounter individuals
already promotes obesity, Betters says,         or exercise trainers, but we need to start                  with disabilities at some point, whether

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the disability is physical, cognitive, mental    client in addressing those issues to reduce           Wilde’s most valuable lesson learned as
or developmental in nature. My suggestion        their impact in successfully resolving the         a rehabilitation counselor was to let clients
would be to have compassion. Often due           counseling issues.”                                take the lead. “My clients have taught me
to burnout or dealing with our own life             Counselors who don’t specialize in              so much,” she says. “They are the experts
issues as counselors, the level of empathy       rehabilitation counseling would also               on their experiences, so I take my lead
toward others can be adversely impacted.         benefit from understanding the state-               from there. I’m there to challenge them
It is vital for all counselors to fight for       federal vocational rehabilitation services         and support them, but it’s looking at what
[clients’] opportunities as you would fight       system to properly prepare to help                 the client has to offer, seeing beyond the
for your own children or parents.”               clients with disabilities who are seeking          disability and seeing the potential for what
   Whittaker thinks all counselors should        employment and other supports, Betters             they’re able to do. It’s a privilege to work
have at least one course that focuses on         says. Many counselors don’t realize the vast       alongside clients as they go through that
disability issues but also believes that each    amount of resources within the system,             process.”
counselor should operate within his or           he says. If the issue is related to finding,
her own scope of practice. “If a private         maintaining or advancing in employment,
practitioner has a client with a disability      the system can provide assistance                    To order a copy of Sales’ Rehabilitation
who presents with issues beyond their            with medical concerns, education,                  Counseling: An Empowerment Perspective
scope of practice, I would definitely say         transportation, retraining and much more.          (order #72868), visit the ACA online
refer the client to a qualified rehabilitation       Above all else, Betters says, it’s important    bookstore at or
counselor,” Whittaker says.                      to recognize clients as individuals with           call 800.422.2648 ext. 222. The cost is
   If a mental health counselor is working       disabilities, not disabled individuals.            $39.95 for ACA members and $49.95 for
with a client who has an identified               “They’re capable of doing almost                   nonmembers.
disability and isn’t progressing as well as he   anything if they have the appropriate
or she should and the reasons why aren’t         accommodations,” he says.                            Lynne Shallcross is a senior writer
apparent, Rollins recommends consulting             Sales agrees. “You can become more                for Counseling Today. Contact her
with a rehabilitation counselor. “Rehab                                                               at
                                                 preoccupied in understanding the
counselors and mental health counselors
                                                 disability than in understanding the                 Letters to the editor:
work well together,” she says. “They can
                                                 person,” he says. “Be very cautious to not 
work on a plan to advance the client’s
                                                 address the individual as their disability.”
goals. The rehab counselor also might
be able to come up with other sources of
support for that person.”
   Other counselors may also find a
rehabilitation counselor’s expertise
particularly helpful when trying to
determine if a disability exists. Although
certain physical disabilities are easy
to discern because of the presence of
                                                                                                    9 12         Oklahoma City, OK
wheelchairs or crutches, Rollins says                                                               16 19        Hartford, CT
many clients struggle with “invisible”                                                              16 19        San Diego, CA
disabilities that counselors might                                                                  23–26        Sherman Oaks, CA
not readily identify in the absence of
client disclosure. “Consequently, some                                                              14–17        Chicago, IL
dimensions of the client’s behavior                                                                 21–24        Atlanta, GA
or issues may be unclear and remain                                                                 28–31        Portland, OR
unexplored,” she says. “The counselor
may view the client as being unmotivated                                                            4–7          Denver, CO
                                                                                                    4–7          Elizabeth, NJ
or uncommitted to treatment, lazy or                                                                18–21        Sherman Oaks, CA
unwilling to fully engage. Some disabilities
may be undiagnosed, or the social stigma                                                            2–5          Houston, TX
attached to some disabilities can affect a                                                          2–5          Phoenix, AZ
client’s willingness to disclose disability.
A rehabilitation counselor will identify
clues from the client’s history, as well as
behaviors that may suggest the presence
of a disability, even though the client
has not disclosed. … The rehabilitation
counselor will then explore the impact
of the disability issues and assist the

                                                                                                   August 2011 | Counseling Today | 35

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