Disability Distraction: What Counselors Get Wrong When Treating Clients with Disabilities, Chronic Illness, and Chronic Pain
I am very uncomfortable writing the following post. Nobody likes it when someone with little experience calls out an entire community for an error they claim to not make. Nobody likes that person. that person is self-righteous and arrogant and probably needs to take a log out of their own eye.
Well, today, that person is me. I have been an ALC for just over a year, but that is not the qualification I’m leaning on today. I am a woman with a disability. I have been a woman with a disability for over thirty years, and now I am a counselor with a disability. I don’t make this mistake because it’s been made on me too many times. But I know many of you are making this mistake because I hear about your mistakes from my friends among Huntsville and Madison’s denizens with disabilities.
We’ve all read blog posts and taken trainings on how not to get fixated on a diagnostic label. We can debate the pros and cons of diagnoses for days and still come up with a “well, it depends on the situation” kind of answer. But we usually mean “mental health diagnoses’ in these debates. Today I’d like to draw your attention to the dangers of becoming hyper-fixated on a physical diagnosis in mental healthcare.
What It Feels Like
I have been a healthcare consumer with a disability for decades. Whenever I meet a new doctor, dentist, chiropractor, or counselor I have to find a way to communicate my unique needs as a blind woman, but then I usually have to work hard to steer the fascinated provider back onto the topic that originally brought me into the office. And I do mean work hard. It’s not easy to tell someone with the kind of expert authority a doctor wields that they’re running down a rabbit hole, especially when I’m the one who pointed out the hole’s existence in the first place.
It impacts my care but is not the cause of my need.
It gets worse when I have to do this multiple times in a session, or throughout my relationship with a given provider. It feels like trying to get a toddler off a string of “whys” and “what ifs?” And each time I have to do this I wonder if they’ve even heard anything I said after the word “blind.” Will they take my other concerns seriously? Will I receive the help I need to deal with whatever sickness, injury, or distress has prompted the appointment?
I am afraid that my health, if not my life, will be endangered by a doctor’s inordinate fixation on my blindness.
Of course, counselors don’t usually hold that kind of power over a client’s physical well-being, right? No, but we do have the ability to help a client enhance themselves, or to reduce them to the most clinically shiny term on their chart. This is, as we all know, called dehumanization.
What I’ve Heard
Statistics demonstrate a higher rate of mental health issues among people with disabilities, chronic pain, and chronic illness. this is so well-known that when I talk with new acquaintances among these populations they always list mental health diagnoses among their menu of life complications. If you don’t live with this, then introducing yourself with a medical profile might sound weird, but we do it as a means of setting expectations and boundaries with each other and to communicate a wealth of shared expe
riences. Of course, when I admit to being a counselor, I usually get a response like this.
“oh, I tried going to counseling once, but it didn’t really work for me.”
When I’ve eliminated financial burden and transportation as likely barriers to mental health care, the most common explanation for this failure of care is that the counselor wanted to relate everything to the disability, when the client had come in to work on trauma, ADHD, or relationship problems.
Now, in an effort to become more disability-informed, most of us have read or trained on material that correlates higher rates of mental illness and trauma, and loneliness with long-term health issues. But here we run the risk of equating correlation with causation. I, for example, struggled with depression and anxiety for years, issues that were deeply rooted in a family culture of toxic perfectionism. Did my blindness complicate things? Certainly. But it didn’t cause the intergenerational extended family dynamics that caused my friendly local Inner Critic to initiate a hostile take-over of my sense of self-worth.
The Difference Between Reduction and Inclusion
By organizing a client’s entire experience around a central theme of disability counselors continue the harmful medicalization of persons with disabilities, chronic illness, and pain. The therapy room becomes just another exam room where symptoms, progress, and frustration are measured and documented. We spend enough time experiencing this as it is. Yet even across populations of chronically ill and permanently disabled clients studies show that the therapeutic relationship has a greater impact on positive outcomes than all the inclusivity and disability-informed training in the world.
We really don’t care how much you know about our unique disability diagnoses — we have medical experts for that. But we do care that you see us as whole people because that is a battle we’ve been fighting for centuries.
Terrible things happen to us. Parents die, or are abusive. We move to new cities with no social support structure. Joblessness, divorce, anxiety about the news, personality disorders and chemical dependence, and harmful rage are just as much a part of our lives as our diagnoses. But who else wants to hear about all that mundane hardship?
Who else will allow us to drop the “heartwarming differently-abled facade” many of us feel compelled by reductive media presentation to project?
The answer should be you.