Rehabilitation Counseling

Rehabilitation counseling is a pragmatic, strengthbased approach to counseling persons with disabilities. It shares similarities with certain aspects of a number of related disciplines, including physical rehabilitation and occupational therapy, psychiatry, psychology, nursing, and social work. Rehabilitation counseling is most commonly provided to individuals newly disabled by a physical event or injury or to those with a serious mental health or substance abuse problem. What makes rehabilitation counseling distinct from other disciplines is that it is activity focused, involving learning by doing within real-world contexts. Other disciplines tend to be therapy focused, usually occurring in institutional settings. The evaluation component of rehabilitation counseling typically involves the assessment of a client's problems or goals and the formulation of a treatment plan. The counseling component may seek to assist clients across a wide range of life domains, including activities of daily living, vocational functioning, social functioning, advocacy and resource acquisition, coping, and lifestyle change. The central aim of rehabilitation counseling is to empower clients to live more independently and satisfactorily while also advocating for clients' rights, needs, and hopes. Rehabilitation counselors help to reduce the cultural stigma that persons with disabilities experience. Generally, society views persons with disabilities as flawed and needy. This cultural milieu promotes feelings of dependence and inadequacy in persons with disabilities. Rehabilitation counselors counter these attitudes by helping persons with disabilities to function and excel in real-world educational, vocational, domestic, and familial contexts.

One of the hallmarks of rehabilitation counseling is that it is a pragmatic approach that facilitates rehabilitation through the use of techniques found across multiple fields. Frances Reynolds (1999) distinguishes it from other approaches to physical rehabilitation in that it may borrow techniques from a variety of orientations to facilitate adaptation and adjustment to a disability. For example, rehabilitation counselors such as Richard Hardy, Warren Rule, and John Cull have described using various psychodynamic approaches in rehabilitation counseling contexts. Hardy (1999) has also described the use of Gestalt therapy and hypnosis, while Joseph Ososkie (1998) has described existential perspectives, and Gerald Gandy (Gandy, Martin, and Hardy 1999) and a number of others have used cognitive-behavioral therapy and integrative techniques to facilitate a person's acceptance and adjustment to a disability. Nancy [Page 1362]Crewe (1997) has contributed a number of articles on functional assessment and outcomes rehabilitation counseling for individuals with spinal cord injury and traumatic brain injury that have provided valuable insight into the lives of persons with disabilities. Brian McMahon has written a number of articles about rehabilitation counseling and supported employment for individuals with a wide range of disabilities, including traumatic brain injuries that have moved the field toward a more empowerment-focused ideology (e.g., McMahon and Shaw 1996). In sum, the field of rehabilitation counseling can be characterized by a wide variety of approaches that are drawn from the distinctive psychological issues facing people with disabilities and from the theory, research, and practice of general counseling and psychotherapy. To an important extent, these approaches are framed by the goal of a person retaking his or her full potential and ability after the onset of a disability.

...