Difference between Rehabilitation counseling and other types of Counseling
Rehabilitation counselling focus on serving individuals with disabilities provides a clear cut conceptual distinction for differentiating rehabilitation practice from the practice of other counselling specialties. Rehabilitation stresses re-education of disabled individuals who have previously lived independent lives; habilitation focuses on educating clients who have been disabled from early life and have never been self sufficient. Rehabilitation counsellors also distinguish between having a disability and being handicapped. Official definitions of what constitutes a disability are crucial in the work of the rehabilitation counsellor. A person with a disability has either a physical or a mental condition that limits that person’s activities or functioning. When describing this population, counsellors must avoid language “that portrays people with disabilities in imprecise, stereotypical, or devaluing ways”.
Such language is demeaning and places these persons in a negative light. A handicap, which is linked to but distinct from a disability, is “an observable or discernible limitation that is made so by the presence of various barriers”. It is the cumulative result of obstacles that disabilities interpose between persons and their maximum level of functioning. An example of a disabled person with a handicap is a quadriplegic assigned to a third-floor apartment in a building without an elevator or a partially deaf person being given instructions mainly through verbal means. Rehabilitation counsellors help clients in these and similar situations overcome handicaps and effectively cope with their disabilities.
An interesting aspect of rehabilitation counselling distinguishes it from other forms of counselling: its historical link with the medical model of delivering services. The prominence of the medical model is easy to understand when one recalls how closely rehabilitation professionals are involved with the physically challenged. “Rehabilitation counselling practice requires knowledge in areas of medical terminology, diagnosis, prognosis, vocational evaluation of disability-related limitations and job placement in the context of a socioeconomic system”. Although the medical model originally dominated this counselling specialty, more pragmatic models of helping seem to be emerging. For instance, the minority model assumes that persons with disabilities are a minority group rather than people with pathologies. The peer-counsellor model assumes that people with direct experience with disabilities are best able to help those who have recently acquired disabilities.
Stone lists three ways in which rehabilitation counselling differs from other types of counselling. First, there are differences in the nature of clients served. Rehabilitation counsellors work with a much more impaired population than do other counsellors.
Most rehabilitation clients are found to have physical, mental, or behavioral disorders. Second, rehabilitation counsellors are responsible for providing clients with educational information and remedial and therapeutic treatment. Third, clients expect rehabilitation counsellors to be professionals who provide a wide range of services, especially those connected with disabilities and employment. Unlike other counsellors, rehabilitation counsellors traditionally focus their efforts on helping clients obtain employment.
Rehabilitation counsellors use a wide variety of counselling theories and techniques. Almost all of the affective, behavioral, and cognitive theories reviewed in this text are employed by those who work in this field. Recently, there have been emphases on social-systems theories in rehabilitation practice. The actual theories and techniques used in rehabilitation counselling are dictated by the education and style of counsellors as well as the needs of clients, For example, a disabled client with sexual feelings may need permission, information, and suggestions on how to handle these emotions while another disabled client who is depressed may need other forms of attention and input.
Ideally, theories and techniques are chosen with regard to specific situations and are aimed at enhancing the overall functioning of clients. This approach is in keeping with Rusalem’s observation that one of the main tasks of rehabilitation counsellors is to help their clients accept and adjust to disabilities and the attitudes and reactions of society at large. Livneh and Evans point out that rehabilitation clients who have physical disabilities.
for example, blindness or spinal cord injuries, go through 12 phases of adjustment: shock, anxiety, bargaining, denial, mourning, depression, withdrawal, internalized anger, externalized aggression, acknowledgment, acceptance, and adjustment/ adaptation.
Livneh and Evans believe that there are behavioral correlates that accompany each phases and intervention strategies appropriate for each one. For example the client who is in a state of shock may be immobilized and cognitively disorganized. Intervention strategies most helpful during this time include comforting the person, listening and attending, offering support and reassurance, allowing the person to ventilate feelings and referring the person to institutional care if appropriate.
Affective and insight strategies are appropriate for the early phases of the adjustment process and that action and rational orientations work best in later phases. They also contend that disabled clients with low intelligence or low levels of energy may best be served by more direct, action – oriented counselling theories and techniques Rehabilitation counsellors use more action-oriented approaches, such as those generated by behavioral and Gestalt theories. Coven believes that Gestalt psychodrama can be especially powerful in helping rehabilitation clients become more involved in the counselling process and accept responsibility for their lives. Techniques such as role paying, fantasy enactment and psychodrama can be learned and used by clients to help in adjustment. A few examples will illustrate some specific ways in which rehabilitation counsellors provide services. Hendrick points out that physical injury such as spinal cord damage produce a major loss for an individual and consequently have a tremendous physical and emotional impact. Rehabilitation in such case requires concentration on both the client’s and the family’s adjustment to the situation.
Everyone involved needs help working through the mourning process, and all need to be included in developing detailed medical, social, and psychological evaluations. A long-time counsellor’s commitment involves carefully timed supportive counselling, crisis intervention, confrontation, life-planning activities, sex counselling, and group counselling.
In short, the rehabilitation counsellor must help the person with injured spinal cord develop an internal locus of control for accepting responsibility for his or her life. In addition to serving as a counsellor, a professional who works with the physically disabled must be an advocate, a consultant, and an educator. The task is comprehensive and involves a complex relationship. Some children with disabilities are also mentally limited.
In these cases, the counsellor’s tasks and techniques may be similar to those employed with a physically disabled adult or adolescent (supportive counselling and life-planning activities). But young clients with mental deficiencies require more and different activities.
Norton advocates that counsellors who work with this population, first work through personal feelings about the children. Only then can counsellors begin to be helpful. Huber asserts that counsellors must also help parents assess feelings, ideally in a group setting. While working with adolescents who have mental difficulties due to head injuries, a counsellor must address social issues as well as therapeutic activities.