Not Dumb, Just Disabled

In my early years as a counselor in private practice, I was eager to take on new clients as quickly as I could. I conducted a quick telephone assessment before scheduling a client that was planning on coming in the next day. Later, I realized a big piece of information was missing from the assessment. I am sharing my story to bring awareness to other counselors who, like me, take our physical abilities for granted which is a form of ableist oppression.

The next day, as I waited for my client to arrive, I noticed that he was running late. This is not completely unusual, but I called him anyway. He answered and said that he was not able to come up to my office because it was located on the second level and there was no wheelchair accessibility. Not only was I unable to accommodate him for the session, I also contributed to more oppression by not thinking to ask if he was able to come up a flight of stairs. This fostered more shame not only for my client but also for me. If I had the awareness to inquire about his accessibility needs, I would have been able to offer a phone or video session eliminating wasted time and further embarrassment for the client. This error has led to an increased interest in advocating and bringing awareness of the needs of individuals with a disability and in particular people who use wheelchairs.

The Facts

According to the World Health Organization, over a billion people are estimated to live with some form of disability. Impairments associated with being in a wheelchair are not limited to immobility. It affects work occupational impairment, self-care, communication skills, and typically includes social impairment due to isolation. For this reason, I want to share some common misconceptions that the general public may have about people who use wheelchairs. My hope in writing this is to encourage other therapists to become more sensitive to the setup of their offices, their intake procedures, and whether they are or are not handicap accessible. Furthermore, I hope to encourage therapists to take the following information into account when working with someone in a wheelchair and be knowledgeable about the types of generalizations and oppressions that these individuals face day-to-day. Lastly, I want to encourage therapists to find a way to use their new knowledge in helping other people that may exercise the same ableist ignorance that I was blinded by early in my counseling career.

The following are a few examples of ableist oppression towards people who use wheelchairs:

  1. Specific micro-aggressions
    1. Speaking loudly to a person within a wheelchair.
    2. Assuming that a person who uses a wheelchair has no sexual desire.
    3. There is a common misperception that people with disabilities do not possess. Intellectual capacity or any independent living skills.
    4. Poor early detection of mental health illness or missed diagnosis.
    5. Assuming that that reasons for entering therapy are connected to the disability (Smith, Foley, & Chaney, 2008).
  2. Silence is also a form of oppression (it’s ok to acknowledge it).
  3. Verbal and physical aggression.

This list is not meant to be exhaustive, but to set a foundation for further learning and self-reflection.

Ableist Oppression

I work in an office building that is in a small shopping center. During the holiday season, the parking lot is packed. Just imagine, because we have all seen it, a person not living with a disability getting into his/her car that’s parked in a disabled parking spot because it was more convenient for them to park closer to the store they wanted to visit. This may not seem like a big deal to most; however, that minor action can create a critical inconvenience for my clients trying to come in for their therapy appointment. They may or may not find a spot to park due to the limited amount of disabled parking and it may cause them to be late to their appointment. This creates a huge hassle and may further anxiety that they may already feel when coming in for their session.

Those with disabilities also encounter a range of barriers when they attempt to access healthcare services. The World Health Organization (2016) reports that people in wheelchairs are four times more likely to report being treated badly by healthcare providers and nearly three times more likely to report being denied care altogether. Counselors can make a difference by becoming competent to the needs of people in wheelchairs. This task can be as simple as being kind. What we can do is provide a broad range of modifications and adjustments (reasonable accommodation) to facilitate access to healthcare services.

Access to health care is another hassle for people with disabilities. Affordability being one of the leading factors of reasons they don’t seek out healthcare services. For instance, It is often difficult to gain employment when applying for a job. This then creates lower income due to lack of job opportunities. Transportation is another issues because it sometimes creates an added inconvenience.

Due to cultural shame, people who use wheelchairs also tend to withdrawal and be hidden away. The prevention of people leaving the house can lead to a distinct cohort of psychosocial stressors. Included but not limited to, experiencing the loss of things that they used to be able to do, but now cannot. As counselors, we can encourage these individuals to increase their activities of daily living, so that they can be out in the environment more which could help treat depressive symptoms.

Agent of Social Change

Counselors are able to make a difference by educating themselves and others to the needs of those who use wheelchairs. Building relationships with legislators and policy-makers can bring awareness and improve access to quality, and affordable health care services. As a counselor advocate, if you live in an area where you have the ability to petition for access or at the very least begin a conversation about the lack of access, it may help in creating the reform that this population needs.

We can also advocate for facilitating data collection and dissemination of disability-related data and information. We can develop normative tools, including guidelines to strengthen health care. For example, changing the physical layout of clinics to provide access for people with mobility difficulties or identify alternative modes of service delivery models, such as in-home care, telemedicine or video conferencing.

We have to realize that aside from the physical impairment other psychosocial stressors continue to create additional aggravations such as negative attitudes or silence, inaccessible buildings or offices, no transportation, and limited social support. People with disabilities have the same general health care needs as everyone else and they are one of the most vulnerable groups, yet they are the ones to receive the least access to competent care (WHO, 2016).

Another consideration for building equity is to integrate disability education into undergraduate, graduate, and continuing education. We can train oncoming counselors so that they can play a role in preventive health care services. We can exercise competent clinical or supervisory skills in evidence-based guidelines for assessment and treatment with this population.

Lastly, let’s get real about the negative things that people say about individuals who use a wheelchair. Here’s some examples of oppressive language that I have heard: lame, cripple, cretin, gimp, gimpy, invalid. If you don’t know what to say or how to refer to individuals who use wheelchairs, here’s the answer: Always come from person first. What does this mean? This means that you use the person then the qualifier, or the person then the description. For example, “person with a disability,” as opposed to “disabled person.” It is not sensitive to say “the disabled,” but instead say “persons living with a disability.” Imagine this sounding like your identifying someone that has a distinguishable difference but no oppressive ties such as: a person living with an accent, or a person who lives with glasses. It doesn’t use language that limits a person to be identified from one struggle, as we all have struggles.

In summary, this was written to provide new information to counselors who do not realize the oppression that people with a disability experience on a day-to-day basis, in particular those who use wheelchairs. By maintaining a posture of openness and being committed to self-examination, counselors are able to be more sensitive to the needs of others. The awareness of needs also strengthens advocacy efforts and allows counselor to become agents of change.

References

ADA National Network. (2013). The Americans with Disabilities Act questions and answers.

Retrieved from https://adata.org/learn-a bout-ada

Goodman, L. A., Liang, B., Helms, J. E., Latta, R. E., Sparks, E., & Weintraub, S. R. (2004).

Training counseling psychologists as social justice agents: Feminist and multicultural principles in action. The Counseling Psychologist, 32(6), 793-836.

Smith, L., Foley, P. F., & Chaney, M. P. (2008). Addressing classism, ableism, and heterosexism

in counselor education. Journal of Counseling & Development, 86(3), 303-309.

The World Health Organization. (2016). Disability and health. Retrieved from http://www.who.int/mediacentre /factsheets/fs352/en