Psychologist’s Perspecitve
on Living with a Disability
by Danielle Engle
Living
life with a disability presents unique
mental health challenges and needs, according Karen Larson-Hahn
of the Courage Center. Larson-Hahn is a licensed psychologist
with 20 years experience as a therapist, most of it in health
and rehabilitation psychology. During a recent interview, Larson-Hahn
offered her perspective on a range of mental health-related issues.
According to Larson-Hahn, acquired disabilities and congenital
disabilities can present very different mental health issues.
Individuals with Acquired
Disabilities
An acquired disability
is one that results from an external cause such as an accident
or illness. She cites the work of Robert Marinelli and Arthur Dell
Orto, who discuss the adjustment phases for individuals with acquired
disabilities. The first phase is reassessment, the process of acknowledging
that the change [disability] cannot be reversed. Reevaluation is
the next phase, whereby the person’s identity
and life structure are reexamined. What is the impact of the disability
on future work, parenting and other life areas? Reintegration is
the final adjustment, where the individual looks to the future and
considers new roles in work, family and other life areas.
With acquired disabilities,
both the individual and their family have to adjust to a sudden
change. A person who was functioning well in mainstream society
suddenly has an accident or illness. It disrupts the individual’s life as well as the family’s
life. If this person was the breadwinner, they may lose the ability
to work. This change can be very stressful for families. Likewise,
if this person is a parent taking care of children, the parenting
role may change as a result of physical or cognitive changes. The
early phase of hospitalization and rehabilitation is the most likely
time for family members to be involved. One advantage of a program
like Courage Center is that clients are regularly evaluated for
mental health needs.
Individuals with Congenital
Disabilities
A congenital disability is one that is present at or shortly after
birth. When a child has a disability, there are many potential mental
health issues to consider. The developmental tasks that occur during
the formative years present additional mental health challenges for
children with some types of disabilities. Several life areas may
be impacted by the disability, including play activity, participation
in sports, school and vocational choices, and goals and dreams related
to marriage, family and children. Visible physiological and sensory
differences may pose mental health issues during those times when
peer acceptance and a sense of belonging are especially critical.
Children with disabilities may also have dependency challenges that
prevent them from having the same autonomy as their peers.
Siblings may have their own set of mental health issues. For siblings,
it is difficult to adjust to having their parents spending a lot
of time away from home. Siblings may feel left out with their parents
spending so much time in the rehabilitation and hospital setting.
Often, children with disabilities need more and different kinds of
attention. The siblings may not get the same level of attention as
their sister or brother with the disability.
Likewise, the parents
may feel torn in several directions, balancing between the needs
of one child and the needs of other children, work, home and other
responsibilities. In her work with children, Larson-Hahn’s
experience has always included the child’s parents in any therapy.
Clearly, there are benefits of having a range of support services
available to families. Rehabilitation centers such as Courage Center
work with families from outside of the metropolitan area and from
other states as well. However, this distance, coupled with work and
other responsibilities, makes it difficult for some families to participate
in all the available support services.
Advantages of a Multi-Disciplinary
Treatment Setting
Larson-Hahn stressed the benefits of housing mental health services
in the same facility as other rehabilitative services. Such settings
provide staff the ability to coordinate and collaborate in treatment
planning. They also facilitate a consistent approach across a continuum
of services, which may include therapies (speech, occupational, physical,
aquatic, recreational and mental health), support groups (e.g. traumatic
brain injury programs) and consultation (e.g. assistive technology
training).
Another benefit of the multi-disciplinary approach is the option
of including psychiatric treatment. In the case of Courage Center,
a neuropsychologist evaluates how an individual is functioning at
a cognitive level. This evaluation is used to shape the rehabilitation
program and strategies for working effectively with a person. There
are also consulting psychiatrists available to prescribe psychotropic
medications for clients as well as consulting services for staff.
Likewise, mental health
therapists benefit from collaborating with speech therapists. With
clients who have speech and language problems, a speech therapist
can assist with communication. If the client uses an assistive
technology communication device and something goes wrong with the
device, once again a speech therapist can play a vital role. Individuals
with speech difficulties may get parts of a word or sentence out
but not the rest. “You want to be respectful and have the
communication be as least stressful as possible,” said Larson-Hahn. “If
filling in the gaps is more frustrating for the person, I don’t
want to do that... The speech therapist may have ideas for how to
facilitate the communication more smo-othly and efficiently and to
give you some direction as the therapist.”
The benefit of having professionals from many disciplines involved
goes both ways. If, for example, a client misdirects anger toward
a speech or other therapist, the mental health therapist can step
in and reframes the focus on what is really happening. The person
can then be assisted in dealing with the anger and frustration of
having a disability.
Looking to the Future
In looking to the future,
Larson-Hahn sees education of everyone as a critical need. Often,
clients are still dealing with misunderstandings or stigma from
the people with whom they interact in the community. Clients with
visible disabilities are sometimes assumed to have cognitive impairments.
Individuals who use a cane or wheelchair may live independently,
yet while attending a social event, these same individuals may be
approached by people asking where their care attendants are. When
asked how clients deal with these attitude barriers, Larson-Hahn
said, “It is an ongoing challenge for some people. Some people
are able to put it in perspective and move on. Others require some
emotional support through their therapist, support group, or church.”
Larson-Hahn believes
schools are an obvious place to start the education process. “I think at a very basic level in schools, we need
to focus on inclusion versus exclusion. Lots of times kids with disabilities
are separated out - put in special education or adaptive physical
education classes. Sometimes they have different needs; yet, this
[exclusion] also facilitates the feeling that they’re different.”
When asked how people
can be taught to have compassion concerning these and other issues,
Larson-Hahn said, “I don’t know
that we always do a good job of teaching kids about disability, helping
them to understand what it means to have a disability, and helping
them to welcome kids with disabilities into their social circle and
those kinds of things. I think part of the challenge is for the disability
community to raise that awareness, legislatively or otherwise. I
also think supporting candidates who are aware of these issues is
huge.”
In closing, Larson-Hahn
encouraged individuals and family members to check credentials
and make inquiries regarding a mental health therapist’s
experience in working with individuals with disabilities. Traumatic
brain injury, stroke, spinal cord injury and a host of other disabilities
create a range of mental health challenges that may require the
expertise of psychologists specializing in health and rehabilitation
services.
