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    General 3

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    Susmita Dey

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    Application of Personality Theories and Counseling Strategies to Clients With Physical Disabilities HANOCH LIVNEH and ARDIS SHERWOOD This atile describes ow certain relevant theoretical concepts, inter- vention methods, and criteria for determining therapeutic change, thick are horrewed from several personality theories and counseling approaches, can be useful in counseling people with physical disabilities. The clinica utility ofeach discussed personality theory is explored in the context ofthe efforts directed at (a) gaining insight into the psy csacial impact of physical disability, b) counseling for personal sujstrnent tothe disability, ae (c) becoming familar with heory-spe- cific guidelines for assessing therapeutic changes. It is argued that counselors who serve clients with disabilities ought fo choose those interventions most congruent with their con theoretical orientation, cacdemie training, ork setting and nature ofthe disability condition A of information exists regarding the application of theinsighis gained from psychological theories of human personality and behavior to understanding the psychosor al impact of physical disability. Not surprisingly, theoretically derived intervention strategies to facilitate psychosocial adjust- ment o disability arealsasparsely encountered in thecounseling, and rehabilitation literature-Over the past fourdecades, assump: tions concerning the interdependence of physical illness and disability, and the process of psychosocial adjustment have un dergone fubstantial developments and modifications (see, for example, Duval, 1982; Shontz, 1971; Wright, 1983). Thesenotions, ranging from concepts that are embedded in intricate personality theories impressions that are portrayed through sketchy re ports, have the potential of occupying an essential role in the understating of adaptation to major traumatic events and the provision of rehabilitation care and service delivery to people ‘with disabilities. ‘To complicate things, adaptation to disability is not a static concept. tis a dynamic and often protracted process that is composed of several fluctuating and overlapping phases (Falek & Britton, 1974; Fink, 1967; Shontz, 1966). Various clinically “observed phase mexlels ofadaplation to disability were proposed in the past (Bray, 1978; Cohn, 1961; Weller & Miller, 1977). Briefly, the most commanly observed (or inferred) phases of adaptation totraumatic disability include the following: 1. Shock. The initial psychic numbness associated with the Impact ofa sudcien and severe physical impairment, 2. Anziely. A paniclike reaction of intial recognition of the ‘enormity ofthe traumatic event. 3, Denial. An attempt at mobilizing psychological defenses to ‘ward off the painful realization of the resultant condition. 4, Depression. An initial and fall realization ofthe loss of one's prior physical/sensory abilities (e,, mobility, sigh). 5, Internlized anger. A reaction of self-directed resentment accompanied by feelings of guilt and sel-blame. 6, Externalized hostility. A reaction of other-directed anger as a form of retaliation against imposed physical limitations, 7. Acknowledgement. Intellectual recognition of the im- plications of the disability and gradual acceptance ofits perma- ‘ence and resultant functional limitations 8. Adjustmient. Affective internalization of the functional im- plications of the disability along with behavioral adaptation to newly perceived life situation, ‘The psychosocial reactions experienced by a person with a disability at these various phasescall for differential intervention strategies specifically tailored to the individual's particular needs. Moreover, although the sequenceof theadaptation phases appears to be, at least partially, internally determined, appro- prlately timed external interventions (eg., psychosocial, behav- ioral, environmental) may havea decidedly pesitive effect upon the nature and duration of those phases and the ways of coping, ‘with them (Livneh, 1986), ‘The intent ofthis article is to assist the reader in exploring the substantive and clinical utilities of the most commonly used theories and intervention strategies for counseling people with disabilities. The theories selected for this review are notintended toconstutea complete set of theoriesapplicableto working with persons with disabilities, nor should they be regarded as being, held in higher professional estoem than are the theories that are not included. The decision rule used for theory adaptation was ‘twofold. First, theories were selected based on their familiarity to ‘most readers (ie, their inclusion in popular text books such as Corey [1986], Corsini & Wedding [1989], and Patterson [1986). AAnc! second, only theory-driven intervention strategies that have been previously successfully adapted to counseling clients with disabilities were selected. in addition, the principles, concepts, and constructs selected for discussion from each theory should rot be construed as an attempt to provide the reader with an exhaustive ist ofthe theory’s constructs. Rather, these should be viewed asan effortat describing aselected, albeit highly relevant JOURNAL OF COUNSELING & DEVELOPMENT - JULY/AUGUST 1991 = VOL. 69 525 Copyright © 2001. All Rights Reseved. Livneh and sherwood setof concepts from personality theories that have direct applica- tion to the rehabilitation of clients with disabilities, ‘The theoriesslated for discussion arearranged largely accord ing to their historical importance in the counseling field. The analysis includes theories that (a) emphasize psychodynarnt: motivational mechanisms (eg., Psychoanalysis, Individual Psy chology), (b) focus on the humanistic-abiective perspective (Person-Centered Therapy, Gestalt Therapy), (¢ eoncentrate on cognitive issues Rational-Emotive Therapy, Cognitive Therapy, Reality Therapy), and (@) are concemed with the behavioral domain (Operant, Classica Behavioral Therapy). The eviclecon- cludes with an examination of the Somatopsychological ap- proach, a model that uniquely addresses the psychosocial ex perience of people with physical disabities The discussion of each approach is organized into four pars First, the most relevant concepts of the theory that are related te the understanding of the dynamics underlying adaptation to Uisability are presented. These are fellowes! by discussion of the general intervention stratogics thet seem most appropriate to counseling people with disabilities. The intent of the second section (general intervention strategies) & to (a) acquaint the reader with ateas of congruency betwveea the most salient goals ‘of each theory and those appropriate for counseling people wit disabilities and (b) provide the reader with a genoral under- standing ofthe application of rack theory's primaty intervention ‘modalities to rehabilitation settings. The third portion focuses on ‘specific counseling procedures that are associated with the pro: ‘ess of adaption to physical disability. Disabilities differ along severaldimensions(eg,, sensory versus physical, congenital ver susadventitious, time of oaset, level of severity), and this section examines those counseling, interventions that are generally regarded as more appropriate within the context ofthe temporal process of psychosocial adaptation to disability (Dunn, 1975; Halligan, 1983; Hohmann, 1973) ‘The eight phases of adaptation to disability previously de Tineated are used as benchmatks for discussion, To assist the reader further in gaining a better insight into the nattre and adaptation to physical disability, the discussion provides refer ‘ences to spinal cord injury, a disability ofa sudden andl traumatic nature that typically occurs is early adulthood. Fiaally, criteria for therapeutic change assessment are briesly delineated. Where lever feasible, the assesement of change in zehabilitation setting= is related to those outcome criteria that are more frequently advocated by practitioners from each theoretical orientation Prior efforts to highlight the application of personality theo- ries to persons with disabilities (Le, Duval, 1982; English, 1971; MeDaniel, 1976; Riggar, Maki, & Wolf, 1986, Thomas, Butler, & Parker, 1987) have differed considerably from this discussion. The focus of Duval (1982), English (1971), and McDaniel (976) was on a Limited number of the more traditional personality theories (eg, Psychoanalytic, Body Image, Individual Psycho* (ogy), with the intention of providing the reader with a generat appreciation of the role played by the most salient person ality construcis in understanding the psychology of physical disability ‘The more recent work of Riggar eta. (1986) and Thowas tl (1987) shares more commonalities with this discussion, Theit ‘work, however, provides amore generic treatment of porsonality and counseling theories aod their assumptions, main constrict, goals, and techniques but only limited discussion of specific 526 JOURNAL. OF COUNSELING & DEVELOPMENT + JULY/AUGUST 1951 » counseling interventions dirccted at people with physical de abilities. Two inte are (a) assiting the reader in paining @ greaice understanding of the relationship. between specific counscling steatugies and particutas paychoss: ) offering the reader a brief exposure to client outssie criteria advected by rehabilitation practitioners of vacicuscousseling porstne 1m this respect, this aricie may be mogarded ae ar extension and refinement of the prior work initiated by English andl McDaniel almost 20 years ago, cuhninated by the tevent contributions of Riggar et al. 0986) and Thomas etal. (1987). ‘THE PSYCHOANALYTIC APPROACH Concepts The most relevant concepts a the orthodox paychosnalytic ap ppovach to understanding the paychosscia lmplcsticns of phys {al disatlity are (2) the ego's defense mechanisms, (8) body Image, (© mourning and grel, ard (2) the importance of ea:!y developmental stages. ‘Te ogo's defence mechanisms (eg, repression segrrssion. rea Lion formation, projection, rationaizatin, denial) are regarded by poychoanalylictheory as unconscious percessesinthrsrevice df the ego, whose major goal is warding off anxiety throngh the distortion or denial of certain internal and external realities. In this capacity, defense mechanisms serve peopin with disabaitie in their stiemptto cope with the adversity generated hy the onse™ ‘of a physically disabling condition. Insnfar ax psythoanalyic cof the porson'sacceptascr et © disability, successhal adaptation 1 re § only when the porcan with lsabiityscisor! {edges sor he limitations and minienzestheuseo! maladaptive defenses (Duval, 1882), Chiof among these malodaptive defense rmechanisins are the following: (a) dent. which is viowed asa efensive retreat from paint realization ofthe smprations oF the condition; 4b) rojestion,vehich is asiocited with the exter rolizationof hostility toward people objects, ant enviranmenta! conditions (eg. blaming others progrens and (c) taming ogpnet the self or intersalizaticn {whichis manifested through the displacement of anger tows c's set invarinbly leading to fovings of self Bdsm, gait 2nd possible selFinjurious episodes (Cull & Hardy, 2975) Bally nage may be viewed asthe uneonseirus mental repre sentation of the bady Gchilder, 1950). Tho hoy image is forme elatvely early in ie But is ecestantly changing ae ares of information zeceived by way'of visual and spats st tural and tactile impressions and internal servations. Chronic diseases, physical taumar, ans disabling conditions provoke abnormal Sensations that enerfere with the ianage: of an antart body. Likewise, disability may produce egevesion that rekindle childhood condlicte soled t0 body. perception (Meniinger 1955). These sensations readily Become a par! af the total ex perience of the individual, an, consequently, the pesson exhibit inappropriate reactors (eg, anxiety, gull, anges to the impairowent (McDonie}, 1976), Because the primary causes cf behavior are regarded by psychoanalytic forSislations a inter nally determined ond because the loss of physical integrity is theorized tokave a negative impacton the body ona attitudes toward oneselfand others are also adversely inflseaced Copyright © 2001. All Rights Reseved. Application of Personailty Theories and Counseling Strategies to Cllonts With Physica! Disabilties [Mourning and depression (melancholia) were frst explored by Abraham (1916/1648) and Freud (1917/1950) in the context of orthodox psychoanalytic object relations theory. According to this theory, the loss of a loved object (eg., person, body part, country) ss seen as triggering what Freud (1917/1950) termed the ‘work of mourning” and viewed as a process that, when com: pleted, results in a free and uninhibited ego. During the inital phases of his process, however, depression is explained in terms fof an aggfession-rurned-inward mechanism. This model argues ‘that thestrong ambivalence toward thelostobjectcanberesolved only by turning against oneself (.e, internalization) the hostility felt towand that object In other words, in the case of a physical disability; theaggressive tendencies orginally engendered by the Joss of body part or function and directed toward itean only be abated by internalizing them and blaming oneself for the onset of the condition. Shontz (1971), in contrast, maintained that re gression in the service of the ego may actually facilitate ego irowth, when sack regression follows successful coping with the ‘mourning necessitated by the bodily loss. Early developmextal stages are considered by psychoanalytic thinking to be crucial in the development of adult personality traits. In fact, personality is believed tobe formed during the first 5 t0 6 years of childhockd. Because each of the postulated early psychosexual stages (i.e, oral receptive, oral sadistic, anal sadis- tic, anal retentive, and phallic) hasa particular conflict that must be resolved before the individual can pass on to the next stage, any diffcuities in passing from one stage to the next would have implications for future personality development. More specifi- cally, frastration of needs, overindulgence of needs, and traumatic events may cach lead to fixation at that particular developmental sage. Hence, disablement, especially when oc ‘curring if early childhood, has an adverse impact on later per- sonality formation and often paves the way to immature and passive-agressive behaviors English, 1971) Likewise, parental ‘overprotection ofthe infant whois disabled (e.g, overindulgence of needs) might result in adults who exhibit dependent, un- motivated, and narcissistic personalities. The parallelism betwoen physical disability and symbolic castratiog, a potentially useful concept for understanding the paychology of disability, has been suggested by psychoanalytic thinking, yet has failed to be adequately explored. Castration anxiety may be rekindled by a wide array of analogous and symbolic losses including losses of extremities, vision, and inter- nal ongans. Freudian theory, accordingly, would postulate that such losses in adult life are capable of triggering the archaic esdipal taboo and its associated fear of castration. Similarly, boul losses may be unconsciously perceived. the punishment inflicted spon oneself because of certain sexual transgressions (Cubbage & Thomas, 1989; Wright, 1983). General Intervention Strategies Applications of psychoanalytic intervention to rehabilitation set tings are virtually nonexistent, This is obviously a manifestation ofthe protracted duration of treatment required, the necessity for advanced professional training, and the financial burden in volved. Yet, understanding of psychoanalytic concepts and methods may assist the counselor in better appreciating the ‘complexity ofthe personality, especially as it strives to adjust to. the real and symbolic losses of physical functioning (Thurer, 1985), ‘The process of rehabilitation and physical restoration often. rekindles conflicts associated with body image (McDowell, Coven, & Eash, 1979). Kolb and Weldt (1976), for example, in a modified analytic-gestalt procedure, advocates assisting the per- son with disability fist to contact his or her physique through fantasy exercises 5elfexploration, and psychodramaby focusing ‘on those regions where bodily sensation is hindered (eg., para- lyzed or amputated extremities) and, second, to contact other people through mutual body exploration and nonverbal com- munication, s0 as to exchange sensory and affective experiences. Adaptation to Disability Related Interventions ‘The extensive training required for psychoanalytic practitioners, ‘the expense of therapy, and the prolonged style of treatment make itdifficultto incorporate tis therspeuticapproach into the phase model of adaptation to disability. In addition, psychoanalytic. ‘oriented practitioners seek to reconstruct one's personality struc tureand, accordingly, concentrate most of thei efforts on clients ‘with psychopathological reactions that require uncovering carly developmental issues. Conversely, clients with physical disabil- Ities more typically require adaptive or ameliorative interven tions, which are targeted directly atthe functional loss at hand, Despite the obvious discrepancies in philosophy and goal setting between the rehabilitation approach and orthodox ps cchoanalysis, psychoanalytic-based methods may assist clients ‘who have successfully come to terms with their disability, its permanence, and its induced functional limitations (clientsin the acknowledgement and adjustment phases) sothat they may gain a better insight into their needs, motivations, and aspirations. Understanding the personal meaning the client attaches to the affected body parts and functions and the defense mechanisms sed to ward off anxiety and other unpleasant emotions can be instrumental in assisting the client on his or her road torecovery. Criteria for Change Change, in psychoanalytic theory, is judged subjectively by the client (eg, restored feelings of well-being) and, clinically, by the ‘therapist (eg, an achieved balance between internal impulses and social restrictions, and degree of sll-insight achieved by the client). Knight (1941) proposed a more specific set of criteria, three of which seem tobe relevantin rehabilitation settings. These criteria include (a) increased productiveness, (D) improved intes- personal relationships, and (c) the ability to handle ordinary psychological conflicts and reasonable reality stress. The last Criterion has obvious implications for assessing the client's suc- cess in coping with the ordinary barriers and frustrations im- posed by the disability ‘THE INDIVIDUAL APPROACH Concepts ‘The most commonly used concepts of Adler's (1917/1927) In- dividual Therapy for understanding the impact of physical dis ability on personality are (a) inferiority (or organ inferiority), (b)compensation,(c)the striving for superiority and (@) life-style. Inferirity feelings may result from either organ fie. ,congenital or early acquired structural or functional anomalies of physical ‘or mental nature}orstatusinferiorty (ie. infantsare born feeling, weak, incomplete, and unfulfilled, especially in comparison to JOURNAL OF COUNSELING & DEVELOPMENT JULY/AUGUST 1991 + VOL. 69 ser Copyright © 2001. All Rights Reseved. Livneh and sherwood adults). Compersatinn, a8 a pacticular innate defense ouechastsm, acts to overcome these real or imagined inferiority feelings by attempting to strengthen one’s ability in the seme (direct oF primary compensation oradifferent(indimet or secondary com pensation) area, Strivine for superiority an innate dive to attain ive sliving is guided by social interest ana recognition of others’ npods. Nonadaplive striving is discerne’ by pathologicaland fatse feeling of power couplestwith ignoring ‘other people's needs. McDaniel (1976) further suggested that tb: ‘exemptionsand privileges of disability. along with themanipula tion of others, may offer a substitute for the oxigival goal of superiority, The lle-tyle, or plan of life, gradually emecgs during the fist yearsoflife.Yhissel-consistent unity represents the individual's organisenic ideas and goals and socks toachieve superiority out of early experienced inioviorty feelings. Ibis the overriding unigue mental pattern that dicects the person's fee! ings, cognitions, and behaviors in relation to life's tasks (Adler, 1917/1927; Dreikurs, 1967; Rule, 1987), According to Adler (1917/ 1927), thee major facts thatiead toabnormalinjesiority feelings and falty life stytes area child's ‘experiencing early physical deformities (og, imperfect organs, chronicchildihood diseoses), pampering the bild by ovexprotec!. ing him or ber or paying him of her too much attention, and neglecting oF rejecting the child by ot paying encnagh attentio this or her needs. If disability eccurs during early chitdianod, it ‘would likely factor inthe clevelopment of the life-siye. I, haw ever, the onset of disability slater inlife, the individual's slroady Formed lifestyle should exert a strong influence on the perce tion and the process of adjustment to disability (ule, 1984), General Intervention Strategies ‘The oversiding goal of Adlerian Thorapy is assisting clients to develop thetr life-style so thal they will Be able to directa mere socially useful and produetivestyle oflife. Accordingly. fifc-style ‘counseling, as applied toa client with disability, weeks 0 enabh the client to move from a position of nonceping, (ie, fel i {eririty) to that of coping tLe, overcorning inferieity) through striving towaed a subjectively determined sease of significance (Rule, 1987). In this capacity, life-style Information afte: broadens the counselor's understanding of hans che client aight ‘cope with physical disability. The counselor feats hore the client's life-style notions and goals (how the client's personat ‘meaning isattachaa tothe disability) areconsiloatinyg to (theough compensation) or undermining (through despair a retroat the acceptance of, and adjustment to the disability (ole, 1984) The Adlevian lifestyle counseling process is composed of Foxit phases (Dreikurs, 1967; Mosak, 1977). The application of the therapeutic plan to counseling clients vith disabilities and th facilitation ofthe acceptance and adjustment to the disability is described by Rule (1984, 1987) a flan: 1 Establishing and maintaining w velationship ih the lint. "Che counselor seeks to gain insight inte theetent's frame ot reference and encourage the client 10 explor the implications of the dis. ability. Specific information op the dient's medi a ‘current status is also gathened 2. Investigating the elivt’s if stole. The counselor obtains re evant information to explore with the client how he oF sie is ‘urrently functioning in the three areas of social living, worl Cor school), and interpersonal relationships. In this phase, the client Is often asked, “What would be differenti yous vrere vol (able 528 JOURNAL OF COUNSELING & BL bodied) or ifthe protien ddl act exit?" Binally, the counse! obtains from the bered ehildhond experiences and ely nce of aly mem= in Adierias: Therapy is well documented. These select emotes sor the swost mean ingful conchistons, gents, and expectations crystallizes during this early period and shed fightor theclien*'s presisablity st cof lfesty'e formation within the peychoscia} content of fasts 3 laterpreting selor cation velien's lifestyle probes to identity style notions, goals, and expectations, and enéecvors to convey these impressions ko the client. The gos! othe client fo {gain insight, expecially as i relates 10 ‘will promote aceeptanice of the disabitty. 1 couraged to exstume responsibility for idertifving Th boven the life-style information ond daily situs! ticular emphasis upon disability-assoriated issu. 4. Resvienting and rostucaty The foous during the Final phase is on behavior change Clients are Relpes! to terol Uilfieulties ara formelate futures ing this pose, the aun clingt's heteark of fife ted toward alternative ways of understanding aad valving themselves. The guiding principle sremovaleslitestylebaerier to acceptance of, and adjustntent to disability. how bovtier bflen include inferiority foelings stemesing from comprises With able-bodied peuple, flings of sucia isolation, cavt fell dependency. the counsel thevefore, shoud Ing the client's feelings of inferiority other-compurison? and increasing eelings of social blongingness (Dreikurs, 1967; Rule 1988), son decree Adaptation to Disability-Related Interventions The application uf Adtevian therayectic methoxls to the diferent phasosof the processof adaptation indisabilitys.tosame exten affected by some nf the same limitations previously ise tunder psychoanalytic methods (e.g, durstion of thetap phasis nearly recollections, and reronstraction of te Ie Nevertheless, Adlerinn Therapy hasits pecoter impast wher frst uscd dusing the Vent s experiencing of depressiveand i ives anger reactions. During this time, ¢he counsel f9cuses or he client's noncoping behaviors fie, fecling ings depres lective strategies for cop a sense of personal sigsifieence and zocial belo 1987) In the later phases of scknowledgement and adjestment, the ‘counselor strives to help the client view the dissbllty sithin the broadle=contextof his orherlife-stylegoats anc aspirations. More specifically, cherapeutic goats are directed toward (a) enabling, the sient to gain a beter insight igo the parsonal meaning he o sho associates with the disability; (b failitating the client's» eeptance ofthe nevely eveated havens imposed hy the disobii d incorporating these Eutations into bis or he likesty!2 on futuro guls;and @)reccticating tse dient behaviors! change in the aren of pnaland vovational Adaplation ‘coed injury whe manifests signs of an extensiad deppeesvion ra take the following form. Theelie-w’s depressinn is frst (ie. investigated) within 15 life-style perspect aval attaling, ess ke LOPMENT « JULYIAUGUST 1991 + VOI. 68 Copyright.@.2001. All Rights. Reseved. Application of Personality Theories and Cour cause depression is often associated with feelings of infesiority land the latter, in tum, aze based on assessment o comparison. With others or one's prior situation, the focus then becomes reorienting and educating the client to relinguish these com: parisons, In addition, clientsare assisted in developinga sense of socal usefulness and coping skills required to function inde: pendently and successfully in the community. Criteria for Change ‘Change is typically assessed through the clients attained soc usefulness. No objective measures are used to judge this out- ‘come, Agreement by an outside observer (e.g. significant other, temployen, the counselor, and the client's introspective self report, however, can be jointly used to estimate the degree of disability acceptance as processassessmentindicator) and social "usefulness (as outcome assessment indicator). ‘THE PERSON-CENTERED APPROACH Concepts ‘Thecentral constructs of Rogers's (1951) Person-Centered theory that soem to be wseful in understanding the psychological im= plications of physical clisability to the individual are (a) the salience of the phenomenological field, (b) the self-concept, and (the denial and distortion of threatening experiences. The concept af counselor produced facilitative conditions is also of significantimportance, Person-Centered proponents argue that individuals are capable of experiencing reality (ie, the extemal and internal environments) only asitis filtered through their penomenstogial field, or subjective perception. The sell-concept, itis further claimed, is the difterentiated and organized portion ofthis fel, which is composed of a series of perceptions, values, and at~ tituces commonly referred to as “1” or “me” (Ford & Urban, 1963; Rogers, 1951). "What one wottld like to be,” on the other hand, is referred to as the ideal self, When a discrepancy exists ‘vetween'the deal self and the self-concept or when incor is experienced between the organismic experience (the innate actualizing tendency) andone'sself-concepl, thisisfeltasa threat ‘and may consequently evoke anvlety ‘As related to the impact of disability on the individual, advo- cetes of Person-Centerad counseling argue that it is not the disability per sethat psychologically affects the person but rather the subjective meaning and personal attitudes associated with it (the phetiomer ological perception). Disability representsa threat to the self-concept, and it may ultimately result in lowered self esteem Roessler & Bolton, 1978) It also acts to widen the gap between the actual and ideal elves. To cope with this threat and ward off anxiety, the individual might deny the existence of impact of the disability or distort reality, for example, by mis: construing the permanence or degree of severity associated with the disability (Cook, 1987) ‘General Intervention Strategies There are important limitations to the traditional Person: Centered! approach to counseling clients with disabilities. Ale though most experts would undoubtedly agree on the value of the counselor's providing and communicating early facilitative conditions, such as empathic understanding, respect, genuine ‘ling Stategies to Clents With Physical Dsobilies ness, warmth, and positive regard, to assist the client sith a disability to establish a more positive self-concept, itis the need fora more active and direct approach, in the latter phases of the ‘counseling process, that soems to limit the applicability of the Person Centered approach to rehabilitation settings (Cook, 1957; “Thomas, Butler, & Parker, 987). See (1985) provided alist of the discrepancies between classical Person-Centored Therapy and the requirements of rehabilitation counseling and described the Jimitations of the use ofthis approach in rehabilitation setings. Among, these deficiencies are the Person-Centered approach’s (a) reluctance to set specific goals (apart from self-actualization), ()aversion tadiagnosisand evaluation, (c)questions concerning, the value of advise giving, (d) lack of concern with the external environment, (@) nature of being process oriented rather than. ‘outcome oriented, and (Dtendency not tofocuson cent behavior ‘oF skill development. Yet, Person-Centered counseling is not without its merits for ‘counseling people with disabilities, CHents may stil profit, espe- cially early in the counseling encounter, rom gaining nsightinto their perceptions and feelings of being disabled, and come to accept their disability emotionally without devaluing themselves lr resorting to defensive maneuvers concerning the existence of theircondition, Adaptation to Disability-Related Interventions Rogerian methods, or more appropriately, therapeutic condi- tions, are most useful during the early and intermediate phases ofadaptation todisability. During thistime,clientsoften manifest feelings of anxiety, confusion, depression, and self-blame, and the Person-Centered counselor can provide the client with salubrious reassurance, support, and physical comfort (Walters, 1931), The counselor encourages the recently injured client to express feelings that are associated with the traumatic foss and ‘when appropriate clarifies them to theclient (Herman, Manning, & Teitelman, 1971), During thse phases, the counselor's ability to listen and attend empathetically to the client's fears and con-

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