Effective Practices for Counselling People With Disabilities and Disorders

As a counsellor, you play an important role in your clients’ career-building process. Helping them take control, overcome challenges creatively, and access available supports can be critical to their success.

You also must keep current with developments in your field. Ever-changing labour market trends and requirements shape career-building practices. Advances in technology and support services, changing public perceptions of the capabilities of workers with disabling conditions, and a wider range of program alternatives all affect the career potential of people with disabilities.

Qualities of effective counsellors

Counsellors’ personal beliefs

Basic beliefs about people with disabilities and disorders influence how counsellors relate to clients. Reflect on your own values, beliefs, and assumptions about disability as part of social identity. Think, too, about the myths and stigma your clients may face in their lives.

As a counsellor, you can help address stereotypes in several ways:

• Re-examine your own views and confront any stereotypes you may have.
• Build relationships with hospital staff and community-based programs. Work with them to improve client services and raise public awareness.
• Share positive attitudes about clients with disabilities and disorders with colleagues and employers.

When career counselling people with disabilities and disorders, remember that we all have disabilities of some kind. Remind yourself to:

• Treat each person as unique, regardless of disability.
• Avoid labels whenever possible.
• Think of people in terms of their unique and limitless potential.
• Be creative about the many ways to accomplish the same task.
• Think of career growth as a vehicle for personal growth, regardless of disability.
• Examine how society defines success.
• Emphasize abilities, not disabilities.
• Consider how people can change or modify their jobs to focus on abilities and reduce the impact of disabilities or disorders.
• Consider how little most accommodations cost and how much they may benefit other employees as well.

Lifelong learning

Developing skills to counsel people with disabilities and disorders takes time. Consider some of these strategies:

• Examine your coping mechanisms.
• Explore all the skills you need to practise unconditional positive regard.
• Build awareness of your own style and approach.
• Read journal articles on different types of disabilities and disorders.
• Find out who is engaging in new developments and touch base with them.
• Use the internet to explore new research into disabilities and disorders.
• Attend symposia, seminars, workshops, and conferences on issues related to working with people with disabling conditions.

Advocacy skills

Many people, with and without disabling conditions, can benefit from developing or enhancing their self-advocacy skills. These skills can prove invaluable when discussing jobs with employers or learning accommodations with instructors.

In some situations, however, clients can benefit more by having an advocate speak on their behalf, especially if they are unable to speak or negotiate themselves. You can help clients determine:

• How and when to use an advocate
• What needs an advocate can meet on their behalf
• How to find an advocate

Communicating with clients

Some disabilities and disorders can impair a client’s communication skills. It is therefore important to communicate as clearly as possible. Consider these suggestions for adapting your communication strategies to each client’s unique needs:

• Ask clients how they would prefer to receive information from you—in writing, in person, over the phone, or in all these ways. Consider recording meetings so clients can review them at home.
• Use as many modalities as possible when meeting with clients. Show and If possible, let clients practise what you are telling them.
• Provide a structure for your meeting and for each step in the counselling process, particularly in cases where a client struggles with knowing where to begin.
• Use a step-by-step approach. Be patient and describe the details.
• Keep background noise to a minimum. Meet in a room with a door, if possible.
• Speak clearly, at a normal volume, and in a normal tone of voice. Normal conversation is very important when you are building rapport with clients.
• Be direct and specific. Divide what you have to say into small sections and pause between sections.
• Use plain language, both written and verbal, when communicating.
• If clients have trouble understanding, say the same thing in simpler or clearer words.
• Check often to ensure clients understand. Have them repeat information back to you to confirm their understanding.
• Show appreciation and be genuine.
• Make requests and suggestions positively, directly, and honestly.
• Refrain from expressing negative feelings. If you must express displeasure, be clear you are talking about a behaviour or action, not about the person.
• Convey belief in clients. Let them know you understand the impact of their disability or disorder and, at the same time, believe they can succeed.

De-escalation of volatile situations

In case you need to defuse a volatile situation, be prepared to use these strategies:

• Slow the situation down. What’s causing the volatility? Remove the person or object that’s the focus of frustration. Let the client talk.
• Be aware of the client’s personal space. If you are within it, the client might feel attacked. Give the client more space than normal. Keep listening.
• Ask the client “What would you like to do?” or “What would help you?” Ask if intervention is needed.
• Don’t appeal to logic. Don’t try to talk the client out of anything or argue.
• Don’t bring up emotionally charged topics or concerns.
• When you have something to say, speak slowly and in a non-confrontational manner. Agree with the client when appropriate. Say something positive.
• Use body language that conveys calmness. Don’t move suddenly or speak in an authoritarian tone.
• As soon as possible, encourage the client to make some choices. This strategy helps the client regain some control over the situation and decreases the danger of the volatility continuing.
• Be aware that the situation might worsen. Be prepared to get help.

Helping clients with life skills

People with disabilities and disorders often report struggles with daily living activities. Many say that a physical or mental condition or other health problem reduces how much they can take part in society.

Ask how your clients are coping in daily life. This will help you build trust and learn how they deal with practical challenges.

In helping a client with life skills:

• Listen to the client’s whole story about a problem or concern. Take notes. Summarize the story and check it with the client.
• Ask what the client would like you to do. If the client asks you not to take action, respect this request.
• Don’t do more than the client asks. Your task is to support them and provide reliable information. If they decide you can help with a particular issue, keep them informed of each step you take. Stop when and if they ask you to do so.
• Don’t offer advice in areas beyond your expertise.
• Recognize your limitations. Don’t say you’ll do something you can’t deliver on.
• Be sure the client takes an active role in clarifying the problem, finding an advocate, and seeking information.
• Meet with third parties that you contact on the client’s behalf with the client present. Support the client, but don’t take over.
• Remember that a client’s frustration may stem from an inability to communicate acceptably. Help the client rebuild communication skills.
• A client may have concerns about taking an issue to a higher authority. Let them know that senior people may be positioned to act on their concern. Help them prepare to present the problem effectively.
• Keep your supervisor informed about your activities and let your client know that you are doing so.
• Encourage your client to share the problem with others in similar situations. Mutual support and common action can often overcome feelings of isolation.

It may be helpful to gather information about clients by:

• Interviewing them and their family members or group home workers
• Observing them in different environments
• Reviewing records and evaluations of previous experiences
• Visiting them repeatedly and communicating with them and their families in familiar surroundings
• Offering short-term assessment and trial work experiences
• Arranging onsite visits to different businesses in the community

Helping clients set goals

To address many of the challenges your clients face, it is important not to separate personal and work-related issues. Instead, focus on what is important to the client. If their top 5 goals don’t involve work at this time, then choose a goal that might build knowledge or skills transferable to work and other situations.

For example, if a client wants to learn how to use email to communicate with relatives in another part of the world, help the client achieve that goal. This will allow the client to gain transferable computer-based communication skills.

To help clients set realistic goals:

• Listen to their ideas about their goals.
• Find out how they have been using their skills.
• Explore what is meaningful to them.
• Provide honest, non-judgmental feedback.
• Help clients examine alternatives, options, and different ways of doing work.
• Help them recognize the demands and requirements of specific career goals.
• Teach them skills for setting goals and planning actions.

When supporting clients with disabilities and disorders, adapt the popular SMART acronym for goal setting by adding another “S” at the end. Encourage clients to set goals that are:

• Specific
• Measurable
• Achievable
• Realistic
• Time-limited
• Supported

A newer twist on the SMART acronym is SMARTER goals, where the extra letters stand for:

• Evaluate
• Readjust

Trial and error can discourage anyone, but you can help clients see errors in a positive light, as learning opportunities. Starting out with SMARTS goals and progressing to SMARTER goals can help them frame trial and error as a normal part of everyone’s goal-setting process.

Canadian Occupational Performance Measure

Certified occupational therapists may choose to use the Canadian Occupational Performance Measure (COPM) with clients to facilitate goal setting in areas of self-care, leisure, and productivity. The COPM is an individualized outcome measure designed to detect change in a client’s self-perception of occupational performance. People with disabling conditions report that they like being able to assess their own progress as opposed to having health professionals make that judgment. The Canadian Association of Occupational Therapists provides additional research into the uses of the COPM.

Post-secondary training

Many post-secondary institutions in Alberta, including all publicly funded schools, have a Disability Services Office that can provide students with information, accommodations, services, and supports in accessing funding. Available solutions may include:

• Volunteers to make audio recordings of written work or books
• Volunteers to edit written work
• Access to appropriate technical aids
• Information about assessments
• Accommodations for completing exams

The National Educational Association of Disabled Students provides further information about services and programs available to students with disabilities and disorders at Canadian post-secondary institutions.

Career planning approaches

The process of career counselling people with disabilities is no different than career counselling people without disabilities. However, the issues for those with disabilities may be wider in scope. Each disability and disorder has its own literature related to personal, employment, and career counselling.

Some clients may present as feeling dominated by concerns about their symptoms, medication, stress levels, daily habits, access to specific services, or other factors not directly related to career planning. The person helping them can easily forget to focus on the client’s talents, abilities, strengths, and interests.

Your task as a counsellor is to help your clients increase their chances for gaining and maintaining satisfying work. You can do this by helping them to:

• Identify their strengths and special skills
• Identify their preferred future, including preferred work choices
• Recognize their disabilities or disorders (if they do not already)
• Understand their condition and how it might affect work situations
• Identify any coping strategies they have developed to address challenges they face at work
• Identify assistive devices and other strategies to address work challenges
• Make attainable work choices that relate to their preferred future

As you work with clients who have different disabilities and are at different points in their career journeys, you will likely need to draw from a variety of career planning approaches. The next section describes approaches that have proven successful for clients with disabilities.

General career counselling approaches

Consider the following models for working with clients with disabilities and disorders:

• Develop a 3-way partnership between employers, counsellors, and clients.
• Use a systematic approach that exposes the client to a variety of experiences early on, develops decision-making skills, uses supportive counselling, and helps with accessing other services.
• Help clients get to know themselves well and develop positive attitudes. Clients benefit from taking control of their career development.
• Adapt existing services to assist your clients and stress the importance of clearly defined goals.
• Contact community organizations that serve people with various disabling conditions in your local area. Meet informally with service providers. Ask them about the issues faced by people they serve.
• Learn from your clients. Follow up regularly to find out about their progress. If needed, hold case conferences with the agencies they’re involved with. Too often people fall between the cracks. By staying current, you can better assess what your clients need and select timely and useful referrals.

Some models emphasize the needs of people with disabilities and disorders, including:

• How people approach decision making and lifestyle options
• How life experiences and self-concept influence career choices
• How environmental factors influence people with disabilities and disorders
• How counsellors can help people shift their focus from job search to career development

A client’s belief system is also a critical factor in determining the success of an employment action plan. According to the theory of learned helplessness, some clients believe they are powerless to change outcomes.

There is a key difference between this client group and those clients who seem more competent: the latter group acknowledge the challenges and barriers they face in gaining employment and achieving promotions. Rather than seeing outcomes as beyond their control, they attribute their successes and failures to the effort they invest.

Reframing to see one’s disability or disorder in a more positive way is a critical skill. The process of reframing includes:

• Recognizing the disabling condition
• Understanding one’s own strengths and weaknesses
• Accepting these abilities and limitations
• Setting a plan of action toward reaching goals

Consider these other ideas when counselling clients:

• Generate discussion on their interests, hopes, and dreams.
• Never make assumptions about clients.
• Explore clients’ presenting limitations and solutions to problems.
• Talk with them about general employment information, such as jobs available and training required.
• Focus on clients’ skills and interests to direct them to job possibilities.
• Arrange job trials for them.
• Explore reworking or trading job duties to accommodate clients and co-workers.
• Explore win-win scenarios.