Tae Hart, Ph.D., C.Psych.
In 2022, the American Psychological Association published Guidelines for Assessment and Intervention with Persons with Disabilities. Disability was not a topic I had received training in during graduate school, on internship, or beyond. Until recently, the topic wasn’t well-integrated into the graduate courses that I have taught. In fact, I have to admit before the Guidelines were published in 2022 I hadn’t given it much thought. What’s ironic about this is that I am a clinical psychologist with a progressive, chronic medical condition that affects my ability to walk and stand.
In 2022, the American Psychological Association published Guidelines for Assessment and Intervention with Persons with Disabilities. Disability was not a topic I had received training in during graduate school, on internship, or beyond. Until recently, the topic wasn’t well-integrated into the graduate courses that I have taught. In fact, I have to admit before the Guidelines were published in 2022 I hadn’t given it much thought. What’s ironic about this is that I am a clinical psychologist with a progressive, chronic medical condition that affects my ability to walk and stand.
I came across the APA Disability Guidelines while I was working on revisions to my graduate course in Professional Ethics, which is a required course in our clinical psychology program. It’s a very lengthy read, so it might be helpful for you to first review the shorter 2023 Executive Summary for the Guidelines (Hanson, Bruyere, Forber-Pratt, Reesman, & Sung, 2023). Both the Guidelines and Executive Summary provide excellent learning about disability as well as some very practical points to implement into our clinical assessments and interventions.
While I have had a strong sense of myself as a disabled person for the last many years, I realized that there were some concrete ways to make my own clinical practice more accessible to other disabled people. There are 23 specific guidelines, which are beyond this scope of this brief article. However, I want to share a couple of the guidelines that I began using right away in my clinical practice.
Guideline 1 states “Psychologists Strive to Learn About Various Disability Paradigms and Models and Their Implications for Service Provision.” Guideline 1 provides an overview of common disability paradigms and models and helped me identify that much of what I understood about disability came from the medical model, of which “the focus is on the person’s deficits and elimination of the pathology or restoration of functional capacity.” This contrasts quite a bit from other disability models, such as the social model, in which psychologists help service users to develop “positive disability identity and self-advocacy skills, and/or consult with others to ensure that the client has opportunities for participation, a voice in decision-making, and adequate accommodations.” One practice I implemented right away is the addition of several questions about disability into my initial assessment, so that I understand how the service user views their disability (“models”). This helps to strengthen the working alliance without assumptions, and to establish service user-centered therapy goals.
Guideline 5 states “Psychologists Strive to Provide Barrier-Free Physical and Communication Environments in Which Clients With Disabilities Access Psychological Services.” As a person who has primarily an orthopedic disability, I had considered some environmental factors as barriers to psychotherapy (e.g., the extent to which the office and restrooms were wheelchair accessible), but had not considered other points of accessibility such as sight, sound and communication. For example, was my consent form accessible for service users with vision impairments? Was the platform I used for virtual sessions adaptive enough for service users with hearing impairments? Could closed-captioning be utilized? I also realized the importance of assessment questions regarding specific needs for accessibility for any given service user (not just physical and communication needs, but also length of sessions, needs for rescheduling sessions). Asking these questions at the outset of therapy can build a more positive environment for service users with disabilities.
Of course, a service user may identify as disabled (or not) for a number of reasons: psychological, intellectual, physical, learning, pain, memory, and several others. Indeed, the 2022 Canadian Survey on Disability reported 27% of people over the age of 15 identify as having some type of disability; these statistics are even higher for women and older adults. Our common goal as psychology professionals is to provide the most effective and compassionate services possible. With that in mind, I invite you to review the APA Disability Guidelines and Executive Summary and to spend some time considering your own practice improvement for disabled service users.
References
American Psychological Association, APA Task Force on Guidelines for Assessment and Intervention with Persons with Disabilities. (2022). Guidelines for Assessment and Intervention with Persons with Disabilities. Retrieved from https://www.apa.org/about/policy/guidelines-assessment-intervention-disabilities.pdf.
Hanson, S. L., Bruyere, S., Forber-Pratt, A., Reesman, J., & Sung, C. (2023). Guidelines for assessment and intervention with persons with disabilities: An executive summary. American Psychologist, 78(8), 995–1009. https://doi.org/10.1037/amp0001150