Sensory Disability and Psychotherapy Training: A Call for Inclusion

The American Psychological Association acknowledges disability as one of many cultural identities or individual differences (https://www.apa.org/about/policy/multicultural-guidelines.pdf). Nevertheless, in applied psychology training, discussions of disability remain noticeably limited within multicultural initiatives. Wilbur et al. (5), in a study of psychologists supervising practicum trainees with disabilities, found that the supervisors lacked formal training, awareness of disability issues, and understanding of ways to maintain an equitable environment for their students. These findings echo my personal experiences as a student; some supervisors know little about how to accommodate my compromised visual acuity, let alone how to facilitate discussion of disability as it pertains to the therapeutic process and multiculturalism. In fact, during the multicultural training I have undergone throughout my education, disability was rarely on the curriculum. I do not fault my faculty or supervisors for this failure. Instead, this deficiency likely reflects wider systemic barriers within psychotherapy training that impede development of competencies related to working with individuals with disabilities.

The scant literature on disability in psychotherapy training has historically been—and remains—grounded within rehabilitation counseling and accommodation (4). Although it is likely useful that the field of rehabilitation counseling extends the medical model to the treatment of people with new or recent disabilities, such as via the development of person-specific accommodations and evidence-based treatments (4), I argue that a focus on disabilities as deficits or abnormalities requiring treatment, which excludes multicultural and contextual factors pertaining to disability, is not appropriate for most trainees or clients with disabilities, nor is it wholly representative of the greater community of people with disabilities. Instead, the “social model” (4) views disability as a product of environment and policy, thus placing the focus on systemic factors that privilege persons without disabilities and do not allow for accommodation of others. Although the medical and social models can coexist, the literature is replete with labels that define disability as an abnormality or weakness (4). The medical lens of disability contrasts starkly with the views of some in the disability community (e.g., the deaf community) who do not view their disability identity as having a weakness in need of fixing. In 2019, the American Psychological Association’s Division for Rehabilitation Psychology published a special issue concerning social justice, diversity, and health disparities relating to disability as an identity (6), reflecting the recent movement toward positioning disability as a social construct and highlighting the systems of discrimination and oppression that hinder the community of people with disabilities.

Ableism, or the preference and privilege toward persons without disabilities, is a far-reaching and multifaceted issue pervading the structure of academic and health care institutions (7, 8). Despite the pervasiveness of ableism, training programs can employ certain steps to better foster an inclusive and accommodating training environment, in addition to the accommodations covered within the Americans With Disabilities Act and section 504 of the Rehabilitation Act. Lund and colleagues (9) conducted a qualitative study to determine the resource-related needs trainees sought within their training programs. Accommodations, mentoring and peer support, disability-related services, and disability training for persons without disabilities were among the most widely noted suggestions but, ironically, also the least accessible to trainee clinicians. I personally appreciated those peers and supervisors who brought thoughtful attention to how accommodations could facilitate a more equitable learning environment, as well as to how ability status shapes professional development.

The American Psychological Association facilitates a mentorship program for students and early-career psychologists who have disabilities. The program’s purpose is to facilitate connections and networking among peers and to provide a mutually supportive space in which to discuss disability-related issues (https://www.apa.org/pi/disability/resources/mentoring). Despite the scarcity of faculty and practitioners who openly identify as having a disability, psychotherapy training programs may consider adopting similar mentorship models to better facilitate inclusivity, community, and support. Pearlstein and colleagues (10) have published training guidelines for clinician trainees with sensory disabilities, highlighting specific and practical steps training programs and faculty can take to facilitate an inclusive environment. Examples of faculty actions include acting as advocates for accommodation and social change for trainees, incorporating disability identity within culturally competent supervision, and helping clients to navigate self-disclosure and disability-related topics. Finally, training programs and professional organizations and associations may encourage trainees, supervisors, and clients alike to connect and engage with disability advocacy groups, such as the National Association of the Deaf or the American Foundation for the Blind. Such connection and engagement would enhance education on disability issues and culture for those without disabilities and would relieve the burden on trainees with disabilities to educate their colleagues and mentors.

As a person with a disability, my experiences within my psychotherapy training have been challenging, but I would be remiss if I did not acknowledge that my disability has shaped who I am today. I am confident that I would not be an effective psychotherapist were it not for my lived experience and integration of my disability identity. I am not who or where I am today despite my disability but because of it. My hope is that within training institutions and programs, the focus shifts toward accessibility and inclusion of people with disabilities and a celebration of the diversity and unique experiences these persons bring to the field.