Effective counsellors adjust their methods and approaches to meet the needs of individual clients. This article presents some strategies and practices to consider when working with people who have specific types of disabilities.
Before you begin, you may want to learn more about disabilities that fall into the following broad categories:
- Developmental disabilities
- Learning disabilities
- Mental health disabilities
- Physical and neurological disabilities
Counselling clients with developmental disabilities
What do I wish I’d known when I started working with persons with developmental disabilities?
“In general, in my education and experience, I was led to believe that the hopes, dreams, and aspirations of persons with developmental disabilities were different from everyone else… and that’s not true. We all want to have family involvement, to have loved ones in our lives, to have jobs and careers. I had to really look and think about things differently to ‘get’ this.”—Tim Weinkauf, Alberta Persons With Developmental Disabilities Program
Communicating with clients
Families and other supporters
Clients who struggle with traditional communication methods often rely on family members and other supporters to facilitate discussions. However, the client’s wishes, opinions, and voice should remain primary. Always secure clients’ permission before others share information on their behalf.
Autism spectrum disorders
When working with clients on the autism spectrum, you may find that pictures are often more effective than words. Consider using gestures, sign language, computer-aided visual communication tools, or established methods such as the Picture Exchange Communication System (PECS).
Fetal alcohol spectrum disorder
When working with clients with fetal alcohol spectrum disorder (FASD):
- Use a directive, action-oriented, situationally based approach.
- Model the behaviours you expect the client to demonstrate, such as being calm and focused.
- Provide a high degree of structure.
- Contact your local, provincial, or territorial substance abuse office for information on FASD support organizations.
Career counselling approaches for clients with developmental disabilities
Many people mistakenly assume that self-determination is not an option for this client group. However, having opportunities to make choices is a more significant factor in self-determination and autonomous functioning than intellectual capacity.
The following counselling approaches work well with this client group:
- Establish a warm, supportive, trusting environment.
- Avoid anxiety-producing situations, such as testing conditions.
- Provide encouragement, positive reinforcement, patience, and support.
- Build recognition, praise, progress charts, and special rewards into activities.
- Work frequently with clients over a period of time.
- Provide group experiences as opportunities to practise verbal expression, explore occupational interests, and discuss personal concerns.
- Show pictures and visit businesses and industries to expose clients to job and workplace information and other life roles.
- Adapt or modify material as necessary and use a range of resources.
- Be creative and don’t be afraid to experiment.
- Consider a person-centred planning approach to increase decision-making autonomy.
Begin by gathering information about the client’s strengths, hopes for the future, likes, dislikes, and needs. Family, support workers, and former teachers are good resources for this information, particularly for clients who do not communicate in a traditional way. At this point, details about required disability-related supports and financial support are important.
Referrals for assessment
Assessments may be required to confirm whether a client has a developmental disability or another type of disability for funding or training eligibility.
Some clients will already have been assessed or diagnosed by professionals. Because assessment or testing may be intimidating or cause discomfort, first check to see if the client has an appropriate assessment already available or on file. If you feel further assessment is required or would be helpful, refer the client to the appropriate agency.
As family members tend to be over-involved in their loved ones’ lives, their presence can skew responses. With the client’s permission, a non-family support person, such as a friend, peer, co-worker, or neighbour, may be better able to contribute observations to inform the assessment.
Inclusive post-secondary education
Inclusive schooling now extends to the post-secondary level. Adults labelled severely, profoundly, and multiply disabled successfully participate in these programs.
High School Students With a Dream: Exploring Strengths, Interests, and Possibilities (8:42)
Although Chavo has a disability, he is surrounded by people who see his strengths. He enjoys cooking, which could become a career option for him. As they plan for his transition from high school, Chavo and his family continue to explore a range of possible careers that will make use of his abilities and prove fulfilling.
Inclusive post-secondary education for people with developmental disabilities lays the foundation for transition into the community and the competitive workforce.
The programs provide the following advantages:
- The means and experiences to develop career-related skills and aptitudes
- Life-enriching experiences that help in transitioning to adulthood and community life
- Natural paths to accessing experts and optimum learning environments
- Practicum experiences that can lead to employment opportunities
- Increased self-confidence and social skills
- Decreased need for paid support workers
Counselling clients with learning disabilities
What do I wish I’d known when I started working with persons with learning disabilities?
“I wish that I had known about the issue of diverse presentations. Sometimes we get ‘pigeonholed’ thinking that all people with learning disabilities are the same. And they’re not, not at all. Everyone is so different. The issue of behavioural presentation can be very confusing. I learned about learning disabilities through working with people.”—Brian Mader, Career and Employment Consultant, Government of Alberta
Communicating with clients who have non-verbal learning disorders
When working with clients with non-verbal learning disorders:
- Clearly state your expectations.
- Use computers as a tool when appropriate.
- Follow consistent scheduling.
- Arrange facilitated group activity.
- Encourage or introduce mentorship opportunities.
- Provide clients with logical explanations for change.
- Have clients consider organizational skills coaching.
- Suggest that clients undertake social skills training.
- Accompany visual material with verbal explanation.
Career planning approaches
In working with clients with learning disabilities:
- Take the time to get to know your clients. Ask them about their whole life, from birth to present. Pay attention to education experiences, medical background, and social experiences.
- If possible, involve significant people in clients’ lives in the process, including partners, family members, employers, and co-workers. This provides a broader perspective on issues and demonstrates a collaborative, co-operative approach.
- Gather all available documentation on clients. Everyone comes with a history, and getting to know clients’ history helps you understand their perspective.
- Help clients with learning disabilities become aware of and acknowledge their disabilities and the related difficulties. Learning disabilities are forever. They don’t go away. Understanding a disability allows people to plan strategies to compensate.
- Help clients identify and build on their strengths.
Successful people with learning disabilities seek—and gain—control of their lives. That requires wanting to succeed and knowing how to set goals. It also means reframing the experience of having a learning disability into a more positive experience. The key problem is not the disability itself, but the challenges of living with and overcoming the disability.
Learned creativity is a critical factor in predicting employment success. As career counsellor Jayne Greene-Black puts it, getting through school with a learning disability can be “a pretty good business boot camp.” It teaches risk taking, problem solving, and resilience.
Part of feeling in control is having self-determination. For people with learning disabilities, self-determination requires personally adaptive approaches to meeting demands, both in the community and at work. They are often able to rely on strengths in one area to bypass weaknesses in another. For example, a client might use checklists to compensate for poor memory.
Ultimately, success is related to people’s ability to develop compensatory strategies. You can help by promoting self-awareness and self-understanding.
When to refer for assessment
“Trust your intuition. If you think it [a learning disability] is there, it quite likely is. Diagnosis is really important. For many adults, diagnosis is a huge relief.”—Brian Mader, Career and Employment Consultant, Government of Alberta
Often an important first step in the career planning process for clients in this population is having a professional assessment completed.
Psychologist John Vavrik writes, “Learning disabilities should be formally diagnosed by a registered psychologist with advanced training in the learning disabilities field.” Based on a comprehensive psychoeducational assessment, the psychologist will determine the nature and extent of academic difficulties. The assessment also aims to identify, as closely as possible, the specific brain mechanism responsible for these difficulties.
A valid learning disability assessment includes:
- A medical history (for example, head injuries, exposure to environmental toxins)
- A developmental history (for example, onset of developmental milestones, such as walking and talking)
- An educational history (for example, school grades, type of remedial instruction provided)
- Performance on measures of specific mental processes (for example, auditory discrimination)
- Performance on measures of academic achievement (for example, reading comprehension)
The assessment also needs to take into account the fact that most adults have been out of school for years. In many cases, they never received adequate schooling in the first place. This is a reason why assessing learning disabilities in adults is more challenging than in school-aged children.
Benefits of assessment
There are many benefits to conducting an assessment for clients with learning disabilities:
- Clients enjoy a sense of relief and reassurance when a cause of difficulty is identified.
- Clients’ self-esteem can benefit from discovering unexpected strengths and talents that have been unrecognized or undervalued.
- The focus shifts from hiding problems to identifying ways to address them.
- Identifying a profile of specific strengths and challenges makes it easier to plan interventions.
- Counsellors and clients can determine eligibility for related funding, programming, training, and testing accommodations.
Referrals for assessment
For information on referrals for assessment, consult the local learning disabilities association in your area or the national office of the Learning Disabilities Association of Canada. Ensure that the assessment is completed by a professional experienced in dealing with the client’s age group. Psychologists who have worked extensively with children with learning disabilities may have limited experience working with adults with the same condition.
Education options for clients with learning disabilities
As a result of the diagnostic and remedial services offered to children with learning disabilities, a growing number of adults with learning disabilities have complete, or almost complete, secondary school credentials. While young adults with learning disabilities are typically less likely than their peers to attend post-secondary institutions, the numbers of those attending are rising.
Still, many young adults with learning disabilities do not succeed in the education system. They may have passed through or left the system before special programs were in place to help them deal with their disabilities. As a result, they may be inadequately trained.
These adults tend to be vulnerable in the labour market. Many are undiagnosed. Though they are likely aware of their difficulties, they cannot identify the cause. Many are represented in literacy and basic education programs.
Reports on people with learning disabilities who complete post-secondary education show that their employment rates are comparable to those of their peers. Some rates exceed those of peers who have not completed post-secondary training. In addition, the reported salaries of post-secondary graduates with learning disabilities exceed reported salaries of adults with learning disabilities who are not graduates of post-secondary programs.
Upgrading, training, and retraining may all be within the reach of clients with learning disabilities. Check with the adult education programs in your area.
Counselling clients with mental health disabilities
What do I wish I’d known when I first started working with people diagnosed with a mental illness?
“I wish I had known how deeply disabling in terms of confidence and one’s sense of competency mental illness can be. I don’t think any of us grasp the depth of despair that individuals who suffer from mental health disabilities experience, and the amazing ways in which they cope.”—Sandra Taylor, Alberta Health Services
Decisions, problems, and tasks
People diagnosed with a mental illness may have little experience in making genuine choices or accepting responsibility for decisions they have made. Sometimes their support system does not expect them to make their own decisions. Therefore, their responses to the decision-making process may include:
- Impulsive decision making
- A fatalistic approach
- An intuitive approach, regardless of appropriateness
- Agonized indecision
Similarly, people with mental health disabilities may struggle with problem solving and organization.
Helping clients build their skills
You can help your clients with these issues by modelling performance of a task and then encouraging them to perform the task while:
- Listening to your instructions
- Whispering the instructions
- Just thinking the instructions
Help clients think through problems and processes in a structured way:
- Use a checklist system for tasks and objectives.
- Help clients visualize events using timelines and pictures.
- Begin by discussing just a few possible options, solutions, or steps. Progress to more options when the client is ready.
- Provide constant feedback.
Counselling clients with physical or neurological disabilities
What do I wish I’d known when I first started working with persons with physical and neurological disabilities?
“I wish I’d known more about what people with disabilities say and how they feel about their disabilities... People are along a continuum, from sensory or mobility disability since birth to learning to live with a newly acquired disability... Many don’t feel that they have a disability; rather, their disability is part of who they are as a person or they’re in transition learning and adjusting to who the new person is.”—Patricia Sears, Specialized Support and Disability Services, University of Alberta
Clients with certain physical and neurological disabilities have distinct communication needs beyond what may be required for people with other disabilities.
Communicating with clients who have hearing disabilities
In working with clients with hearing disabilities, consider these suggestions:
- Look directly at lip-reading clients to allow for a clear view of your mouth.
- Face people with the light on your own face, if possible.
- Keep your hands away from your mouth.
- Speak a little more slowly and distinctly, but try not to exaggerate your words. Use common language.
- Use a normal tone of voice and pitch. Increase your volume naturally only when the client asks you to.
- Tell clients if they are speaking too loudly or too softly.
- Be patient if clients want to sit closer.
- Allow clients who have difficulty speaking or pronouncing words the extra time it takes to express themselves. Avoid interrupting or completing sentences for them.
- Ask clients who have speech disabilities to repeat or rephrase conversation that is unclear to you.
- Write out explanations for clarification. Allow your clients time to read and respond. Encourage them to discuss these written explanations further with their significant others.
- Look directly at the client when using a sign language interpreter.
Communicating with clients who have sight disabilities
In working with clients who have sight disabilities, consider these suggestions:
- Address people directly by name to ensure that you have their attention.
- Let clients know what is happening. Tell them when you are entering or leaving a room or performing a task.
- Describe the contents of forms or other material you are using with clients. If possible, duplicate the material in a preferred mode, such as large type, braille, or audio recording.
- Ask clients if they need help to get around. When you act as a guide, allow people to hold your elbow, and walk at a normal pace. Describe where you are going and point out objects, doors, etc. When you help clients sit down, place their hand on the back of the chair so they can seat themselves.
- When speaking with people who are visually impaired, use normal figures of speech, such as “It’s good to see you” or “We’ll have to see how that turns out.”
- Respect the guide dog. The animal is on duty and is a vital tool for clients who are blind. Treat the dog as you would any third party there to assist clients. Do not pet a dog when it is on duty without first asking permission.
- When discussing an object, place it in clients’ hands and let them examine it.
Communicating with clients who have mobility disabilities
In working with clients who have mobility disabilities, consider these suggestions:
- Sit down on a chair so that you are the same height as clients in wheelchairs.
- Arrange your office space before the need arises. Ensure that traffic areas are wide enough for wheelchair access.
- Meet in a conference room or larger space if your office doesn’t accommodate a wheelchair.
- Check with clients who use wheelchairs before helping them enter or exit a room.
- Respect that wheelchairs are part of the personal space of people with mobility disabilities.
- “Person who uses a wheelchair” says all that is necessary when you are referring to such a client.
Counselling clients who have attention deficit hyperactivity disorder
In addition to other adaptations, you may want to suggest that clients with attention deficit hyperactivity disorder (ADHD) use some of the following strategies:
- Learn about and understand ADHD.
- Follow medical treatment plans that may include prescription medication and lifestyle changes.
- Follow a healthy lifestyle, including plenty of rest, exercise, a balanced diet, and a structured routine.
- Use lists, day planners, and files to organize activities.
- Break large chores into smaller, easier-to-handle tasks.
- Plan rewards for completed tasks.
- Disclose ADHD in order to receive job accommodations tailored to specific needs.
- Get help in determining why certain activities are difficult and identifying solutions.
- Keep a sense of humour.