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Specialized Approaches to Counselling People With Disabilities and Disorders

Effective counsellors adapt their approaches to the needs of each client—those who have and have not been diagnosed with disabilities, disorders, and other disabling conditions.

This article discusses specialized approaches that you may find helpful in your career counselling practice.

A comprehensive approach

The Achieving Career Balance model addresses recommendations from recent literature and focuses on building strengths. You may want to use this model to help clients move toward greater independence and self-satisfaction. Clients take control of their own career path while you support them in learning the skills to do so.

The model includes 3 components that provide a foundation for career work with people who have various disabilities or disorders.

1. The career-building process

Decisions about one’s career or life path are not separate events, but part of a process that continues throughout life.

In career counselling your clients, use a process that traces both the planned and unplanned steps they take. Assessing where people are in their life at given times allows them to begin moving toward future or enduring goals. As clients learn and have new experiences over time, specific needs or goals emerge. These contextual or immediate goals will lead to new experiences and learning. These in turn will require reassessing and possibly readjusting their future or enduring goals.

2. The personal profile

A personal profile helps career counsellors clearly and comprehensively assess clients’ needs and situations. Using structured 1-on-1 interviews, work with clients to complete a personal profile. This profile should include:

  • Needs and goals, both immediate and enduring
  • Interests and values
  • Skills and experiences
  • Background, training, and education
  • Work and lifestyle preferences
  • Challenges that might impede growth and development

Seeing the whole person — “Use good, solid communication and counselling skills and recognize the person as a whole person. In terms of strengths, the first thing is to find out what they like to do. Build confidence, work 1-on-1, consider peer support groups, share testimonials, and identify resources. Exchange materials that will be helpful to all parties involved and collaboratively seek solutions to problems. Give credit for their potential—the answers lie within them.”

3. Areas of competence

After you and your client have compiled their personal profile, focus on developing their competence in these 5 areas:

  1. Systemic supports, including work-site analysis and job analysis (see below)
  2. Personal supports
  3. Experience and learning
  4. Work search
  5. Lifestyle balance and job maintenance

The following section breaks down each of these 5 competencies into essential capabilities for a satisfying career path. Focus counselling on helping clients look at how their capabilities figure in their lives. Support them in making informed decisions based on needs they express at that time. Not all clients need, want, or can work on all competencies at once.

Systemic support competency

Employers’ willingness to hire people with disabilities and disorders often depends on the information, assistance, and incentives provided through:

  • Equity programs
  • Legislation on the duty to accommodate versus undue hardship
  • Education initiatives or partnerships
  • Formal mentorships
  • Persistent efforts by qualified individuals

Such programs and strategies increase career opportunities for clients and encourage employers to see them in a favourable light. To maximize client success, it’s important to analyze the systemic supports in both the work site and the job that the client will be entering.

Work-site analysis evaluates the work environment and helps clients determine their needs. The assessment could include:

  • Physical accessibility
  • The work roles that interest clients
  • Employer and employee education
  • Possibilities for movement within the organization

Job analysis seeks answers to the question “What will the employee do in the course of an average day?” Job analysis allows clients to:

  • Identify the requirements of the position
  • Determine how their strengths and abilities fit with the position
  • Determine the adaptations or accommodations they might need

Sample questions include:

  • What happens if the client performs the task incorrectly?
  • How does the employer measure success?
  • What knowledge does the client need?
  • What skills does the client need?
  • What environmental conditions should the client expect in the workplace?
  • How much problem solving, decision making, and attention to detail does the job require?
  • How much emotional exertion, such as stress and pressure, does the job involve?

Demonstrating competencies — “It is particularly important for people… to learn how to do their own job analysis and problem solving. Then the issue is not about the disability but about their knowledge and skill. If clients can show employers that they’ve thought these issues through, then that indicates that they will be more able to manage their work and life.”

After job analysis, you’ll work with clients—and, in some cases, the employer—to help clients creatively meet the challenges of the work role. You can provide the employer with information about reasonable job accommodations, such as adjustments to a task or workplace.

Personal support competency

A strong system of personal support can provide clients with:

  • Increased self-esteem and self-confidence
  • Emotional balance
  • Wider participation in the community
  • A sense of empowerment

Support systems might include family, professionals, informal mentors, allies, peers, and community resources. Understanding how to develop and maintain a support system is vital to staying on a satisfactory career path.

Mentoring and peer support programs help clients build support systems. Role models can ease the initial transition into the workforce and help with professional development and personal satisfaction once the client is working.

Your client needs to know how to build a support system on the job as well. Coworkers also need information about people with disabling conditions and should have the opportunity to share their perceptions and fears. And every new employee needs a thorough orientation that includes information about social and unwritten rules. Open and effective communication is the key to helping people feel accepted and valued on the job.

Experience and learning competency

Building connections to the world of work — “The transition from a post-secondary institution into the workplace can be difficult for anyone. It takes confidence in your abilities, initiative, and persistence. Students with disabilities can ease that transition by pursuing relevant volunteer experience, job shadow opportunities, and internships while they are still attending school... If they are able to build practical connections with the world of work while they are in post-secondary, it is much more likely that they will find and retain meaningful employment after graduation.”

Part of your role is to help clients integrate what they are learning or have learned about themselves, and then relate their experiences and learning to their career options.

Experience and learning include formal academic coursework, school, and research. They also include less formal opportunities to develop skills and explore ideas. Relevant activities include:

  • Volunteering
  • Job shadowing
  • Information interviews with people working in a field
  • Work experience, such as on-the-job training, internships, and co-op educational experiences
  • Personal research

Work experience opportunities can be especially valuable for clients with disabilities and disorders. You can help clients obtain this experience by:

  • Helping them identify suitable and interested employers
  • Profiling the targeted positions and comparing these to clients’ personal profiles to identify gaps
  • Using the gaps to help employers and clients devise an individualized training program
  • Negotiating a time frame and strategy to gain work experience

Lifestyle balance and job maintenance competency

Lifestyle balance is a major factor in predicting career success and satisfaction for anyone, but it is perhaps a larger factor for people living with disabling conditions. It’s a key element in job maintenance competency, which includes:

  • Knowledge of self
  • Involvement in community
  • Exploration of interests
  • Lifestyle options
  • Self-management skills (for example, communication, time management, self-esteem, goal setting)
  • Accommodation
  • Skills that support successful job maintenance

The choose-get-keep approach

The choose-get-keep approach to career counselling has been used widely for several decades and works well in employment services for people with disabilities and disorders. The approach follows the usual process in career counselling with adaptations for clients living with disabling conditions.

1. The choose phase

The goal of the choose phase is for clients to select an employment goal that matches their values and qualifications.

Begin by making sure the client wants to work by surveying the risks and benefits of taking a job. Examples of risks and benefits are outlined in Important Context for Counselling People with Disabilities and Disorders.

The next step is employment goal setting. Follow these guidelines:

  • Assess interests, values, education, training, and skills.
  • Take extreme care to objectify personal values. They must be observable and provide criteria for making an informed career choice.
  • Use personal criteria and qualifications to identify the type of work, the work environment, and the number of hours to be worked.

Example of a goal: Within 2 months, I want to work as a library assistant in a small art or music library for 20 hours a week.

In the decision-making step, when the client has chosen a goal and is deciding which jobs to apply for, you may encourage them to involve significant others (family, professionals, friends) who can support their goal.

Making a choice is not always comfortable for clients, so this first phase may take longer than expected. Clients may feel discouraged. Engage them by building a close, trusting relationship. Allot time to teach them to improve their decision-making skills with less professional support in the future.

Allow clients to repeat this phase if necessary, even after reaching the get and keep phases. Efforts to educate employers and coworkers will contribute to client success.

2. The get phase

The get phase begins with job search and closes with accepting a job offer. You will teach job search skills both to engage clients and prepare them to apply for other positions or promotions when they’re ready. You will also do placement planning.

This phase includes these steps:

  • Matching the client’s social, mental, and physical qualifications with the requirements of the job
  • Identifying tasks needed to secure the job
  • Identifying accommodations that might be required

Direct placement may be part of this approach. This involves presenting the client to a potential employer, particularly if the client has good work potential but may not present well in an interview. You will need to know and apply a variety of strategies to overcome employers’ potential perception of the client’s liabilities.

Placement support involves helping clients gain the skills and resources they need to get the job independently. This includes teaching the client strategies to address any liability the employer might perceive.

3. The keep phase

In the keep phase, the focus is on helping clients do the job and function in the workplace successfully. Depending on the nature of the disability, this may mean reinforcing and building on interpersonal and intrapersonal skills demanded in the workplace.

Activities in the keep phase include:

  • Helping clients do functional and resource assessments of the skills and supports they need to achieve job satisfaction and success
  • Planning the interventions needed to address any skill and resource deficits
  • Planning skill development
  • Coordinating services and training
  • Modifying the work environment and arranging job accommodations if needed

Strength-based approach

How do you focus on strengths? — “Assume that people are bright and have capabilities. Ask them, ‘How have you gotten to where you’re at? What do you think your strengths are?’ Often people have lots of strengths and it’s best to find out their competencies 1-on-1.”

Your challenge as a counsellor is to help clients understand their strengths and abilities/disabilities in relationship to the employment they are considering. You must help them assess their strengths and limitations and then identify and explore employment options.

Strength-based interview strategies:

  • Establish a client-focused, collaborative process with clients
  • Empower clients by facilitating self-identification of strengths
  • Reinforce client autonomy

The following types of interview questions help clients identify their strengths:

  • Survival questions—Given what you have gone through in your life, how have you managed so far?
  • Support questions—What people have given you special understanding, support, or guidance?
  • Possibility questions—What are your hopes, visions, and aspirations?
  • Esteem questions—When people say good things about you, what are they likely to say?
  • Exception questions—When things were going well in your life, what was different?

Many people with disabilities and disorders have developed their own adaptations and accommodations without being fully aware of them. Use questions such as these to identify what accommodations clients have developed on their own:

  • What has worked for you before?
  • What’s happening right now?
  • What have you been thinking about as far as work goes?
  • How do you resolve different challenges in your work or daily life?
  • If you could take pictures of your future, what would you like to see in them?

Strength-based strategies are most effective when they are woven through all interactions with clients. They are not stand-alone strategies, but part of the larger process of building a career.

Consider the following ways to build on clients’ strengths:

  • Interact with clients as individuals and see their abilities rather than their disabilities.
  • Encourage clients’ autonomy while providing, or helping them access, the supports they need.
  • Help clients identify and acquire personal and professional skills they can transfer to real work situations.
  • Help clients determine how to apply their strengths to a variety of work situations.
  • Involve as many partners as possible, including employers and other community agencies.

Person-centred planning approach

The Yang-Tan Institute on Employment and Disability at Cornell University advises that “person-centred planning is a process-oriented approach to empowering people with disability labels. It focuses on the people and their needs by putting them in charge of defining the direction for their lives, not on the systems that may or may not be available to serve them. This ultimately leads to greater inclusion as valued members of both community and society.”

6 key factors influence the effective implementation of person-centred processes:

  1. Clearly defined roles
  2. A personal relationship with the focus person
  3. Desire for change
  4. Creation of a personal vision
  5. Commitment to planning and follow-up
  6. Flexibility of resources

Helping to change lives — “Good plans reflect the perceptions of the focus person and those who know and care about him or her. Learning how people want to live is just the beginning, the foundation. Helping people have their own lives requires changing how we think, how we are organized, and how we act.”

When using person-centred planning:

  • Look past where people are today and explore the potential for what they might become.
  • Take the time to get to know the client, including their abilities, dreams, and needs.
  • Develop plans that clients find meaningful and that reflect their language and goals.
  • Consider this process a “vision-quest” experience. Get to know people and their vocational aspirations. Don’t discount their dreams. Be creative in finding ways of helping them become involved in those areas.
  • Avoid placing personal limits on what people can do. Find out what attracts people to the area they are choosing and look for ways to help them become involved.

Person-centred planning for people with developmental disabilities

PCP gives clients more autonomy in making choices. This benefit is particularly significant for clients with developmental disorders, as they have not always been offered this right.

Essential lifestyle planning approach

The essential lifestyle-planning approach is a guided process for exploring how someone wants to live and then building a plan to help the person get there. This approach builds on PCP, introducing additional terms and concepts, including:

  • Personal futures planning
  • Pre-vocational assessment, treatment, and habilitation
  • Individual service design
  • 24-hour planning and whole-life planning

Developmental approach

Traditional employment counselling focuses on assessment, followed by helping clients prepare conduct a job search on their own. For people with disabilities and disorders, an incremental developmental approach helps in building toward employment goals.

Do not confuse a developmental approach to counselling with an approach to counselling people with developmental disorders. In this case, it’s the approach that’s developmental and it can be used with any career counselling client, including those with a wide variety of disabilities and disorders.

To help with a client’s career development, begin with these questions:

  • How does the client learn best?
  • Who are the members of the client’s support system in the community? These may include doctors, hospital workers, family members, friends, therapists, and staff of other community agencies. See yourself as part of that team.
  • What can the people in the client’s support system tell you about the client that applies to the client’s goals?
  • What is the impact of the client’s disabling condition on their work and life aspirations? What are the client’s dreams?
  • What other community agencies, programs, and services might be of use to the client?
  • Where can you refer each client?

Behavioural approach

A behavioural approach may work well with some clients who have a mental health disorder. This approach focuses on observable and clearly defined behaviours. A behaviour might be researching volunteer opportunities in an area of interest or making a phone call to inquire about an information interview. Accountability is built into this approach since the research, phone calls, or other actions show whether the client has followed through with the planned behaviour.

The first step in applying a behavioural technique is to define the problem:

  • What happens just before the client behaves (or not) a certain way? That is, what was going on at the time they did or didn’t follow through on a plan?
  • Where, how often, and for how long does the behaviour occur? In other words, what circumstances seem to either support or hinder their follow through with a planned action?
  • What happens after the behaviour occurs? What is the consequence? For example, do they feel good about doing what they planned and do more? Or do they feel bad about not following through and fall into depression?

The second step is to construct a baseline or standard against which to measure change. This process involves observing the individual over a period of time and recording the frequency of the desired behaviour (or its absence).

The third step is to choose a technique with which to change the behaviour. For instance, systematic desensitization can use mock interviews to help the client overcome fear and nervousness in a job interview setting. Aversion therapy, which teaches the client to associate pleasant but unhealthy triggers with negative experiences, can help them overcome a destructive tendency to gossip about coworkers.

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