Inclusive counselling and psychotherapy: discussion between UWE staff, students and Disabled Women Take Action (DWTA)
‘I was amazed by how psychotherapy and counselling can feel an unsafe environment for disabled people’
By Eva Fragkiadaki, Senior Lecturer in Counselling Psychology and Programme Leader
It has been a great pleasure to collaborate with Helen and Cora from the DWTA community over the last few months. Our discussions started by focusing on the psychotherapy and counselling service provision available for disabled people. Our enquiries revolved around if and how disability and the social model of disability are supported by the training we provide in the Professional Doctorate Programme in Counselling Psychology at UWE.
I presented what we were doing already, as well as areas of development we could incorporate into our training. Everyone was excited by the potential and Cora and Shruthi from DWTA joined our final year students for a fruitful and stimulating conversation in which we shared experiences, concerns, thoughts and reflections.
I was amazed by how psychotherapy and counselling can feel an unsafe environment for disabled people. Practitioners need to make considerable adaptations not only in our formulations and techniques, but also in the way we think about, understand and conceptualise disability. Challenging our beliefs and biases is key to providing inclusive psychotherapy and hopefully therapeutic relationships that are characterised by trust and safety.
Our students learned a lot from the discussion with Cora and Shruthi. Two of them, Emma and Kieta, have offered their reflections:
“From our ‘working with disability’ lecture and experiential discussions with Cora and Shruthi, it was my understanding that there are both practical and relational/interpersonal components to counselling disabled people and people with chronic conditions. The practicalities begin with the referral process, ensuring that there are multiple ways to refer (by phone, email, online form) which include an opportunity for people with known impairments to state these, and whether they have additional access or support needs. It was posed that a simple question could be included if a disability or support need is identified such as, “Do you have any comments on how we might best support you?”. As well as considering accessibility in terms of access to the counselling itself (wheelchair access etc), it was discussed that individuals might not know what they need straight away but may value an invitation from the therapist that the dialogue remains open. Another practical aspect that was mentioned was the responsibility of the therapist to attend training and be open to learning about conditions that affect individuals we work with. It can also be acknowledged and shared with the client that it would be impossible to learn everything and that we recognise that people can experience health conditions differently, though are willing to learn from them.
Counselling with disabled people was also discussed from a relational/interpersonal perspective. It was discussed that therapists must be aware of their own feelings, biases, and attitudes in relation to disability, and be able to acknowledge these and bracket them during counselling. To identify ‘our stuff’ is useful, because by acknowledging that we are afraid that we might get it wrong, we can own this as ‘our stuff’ and put it aside to be present for the person and their experiences. It was said that the disabled person may or may not want to talk about their experiences of disability in counselling and it can be helpful to let them know it’s safe to do this whilst also not assuming that their impairment is the primary concern. In counselling it was said that a person wants to be seen as a whole person, encompassing multiple identities and parts. Yes, one of their identities may be a ‘disabled person’ but their other identities such as their culture, family and interests may be as important and relevant for them to discuss in counselling.
Most psychological interventions were developed for non-disabled individuals in Western societies; therefore, therapists have a responsibility to adapt these to the needs of an individual. It can be helpful then to hold the person in mind and ask for their collaboration in what would be the best approach. The individualised approach and learning about the social perspective of disability which theorises that disability is socially and societally constructed was important for further understanding. Sensitivity to context was also discussed as important for counselling disabled people. This sensitivity is an extension of holding the person in mind when assessing the way in which we present ourselves as therapists and how we behave.”
“I thought it was an excellent session. It made me so much more aware of the adaptations that we need to consider when working with clients who have such a wide range of sensitive topics and very different abilities.
I think this type of training needs to be much more widely available because even with a group of Counselling Psychology students, most of whom had attended the discussion just a week earlier, I don’t think people were necessarily holding this in the front of their minds.
I think the main point I took away was to check this out with people rather than making assumptions and be willing to adapt at short notice if needed.”
We hope this is just the beginning of a long-term collaboration. Our training becomes richer and hopefully we can contribute to the discussion with further research and practice on working with disability in psychological settings.
Shruthi also shared some thoughts about the session:
As a woman with vision disability, I had various difficulties in accessing the counselling support for my mental wellbeing. I have met with various counselling therapists both in India and in Bristol and I had difficult experiences in both places. The therapists failed to comprehend my intersectional experience of being a disabled and as well as a woman seeking support for sensitive issues. Personally, I found that there is a huge gap in the common mental health practices where disabled women often find it complicated to open up and talk about violence and abuse and also about sexuality concerns.
I felt that the discussion with the group at UWE was promising and constructive. Some of my concerns in terms of non-inclusive practices was received well and the group was able to relate to their own experiences. I felt happy when the group shared that they had some learning and would incorporate their learning into their practice.
