Counseling a client with a disability
Recognizing and Addressing Ableism in Therapeutic Practice
Counseling a Client with a Disability
My definition of ableism is a societal bias that favors individuals without disabilities, often resulting in the marginalization and discrimination of those with disabilities. This prejudice can manifest in various forms, including physical barriers, negative stereotypes, and systemic inequities in accessibility and opportunity. It is often an unconscious form of discrimination involving harmful assumptions about capability, autonomy, and value. It creates an “inferior” status for those with disabilities, viewing them as less than others. I see it as similar to other biases, such as racism or sexism, but focused on ability.
Disability prejudice refers specifically to the negative attitudes and beliefs individuals hold toward people with disabilities. It is often a direct product of ableism, as it arises from societal standards and narratives that position disability as an undesirable condition.
Ableism can be unintentionally reflected in counseling through language, assumptions, and treatment approaches. Using terminology that is derogatory or outdated can diminish a client’s dignity. Terms like “handicapped” or “the disabled” can reinforce negative views. Counselors might assume that individuals with disabilities are less capable or less knowledgeable regarding their own experiences and needs. These assumptions can lead to dismissive attitudes in therapy sessions. Customizing treatment plans without fully considering the uniqueness of each individual’s experience may overlook essential aspects of their lives, thereby minimizing their agency.
When ableism is identified in counseling practices—whether through microaggressions, assumptions about quality of life, or structural barriers—the counselor must immediately engage in self-reflection, apologize if necessary, and shift toward an anti-ableist, disability-affirmative approach. Counselors should validate the client’s experience, educate themselves, adopt a disability-justice framework, and adjust their approach to be more respectful and inclusive. This helps foster a more nuanced and empathetic understanding (Atkins et al., 2023; Longhurst & Full, 2023).
If I realize I have reflected ableism in a session, I believe it is my ethical duty to reflect, seek supervision, and directly address the misstep with humility. Practicing “disability humility,” which involves ongoing self-reflection and a willingness to learn, is key (Atkins et al., 2023).
Counselors should use person-first or identity-first language according to the client’s preference (“person with a disability” versus “disabled person”) and consistently check in with clients about those preferences.
Counselors should also encourage clients to share their experiences and insights, emphasizing that they are the experts on their own lives. In addition, counselors should regularly seek supervision and feedback from colleagues regarding biases or assumptions that may arise in practice.
Counselors and therapists may experience discomfort around clients with disabilities due to societal stigma, lack of exposure, and personal biases. This discomfort can stem from fears of inadequacy or concerns about saying or doing the wrong thing. Counselors may have had limited exposure to individuals with disabilities, leading to unfamiliarity. Many people, including counselors, feel discomfort around individuals with disabilities because of internalized societal messages that frame disability as tragic or abnormal. Often, people have not been taught how to discuss disability respectfully or inclusively, which creates awkwardness or fear of “saying the wrong thing” (Atkins et al., 2023).
Another consideration involves historical prejudices and social narratives surrounding disability, which can create bias. Errors of omission and commission are common concerns in disability counseling.
Errors of omission are things counselors fail to do. For example, not asking how a disability affects a client’s mental health or failing to address accessibility needs during intake can make clients feel invisible or misunderstood (Longhurst & Full, 2023).
Errors of commission occur when counselors say or do harmful things, such as using offensive language or making inaccurate assumptions. To avoid these errors, counselors should listen carefully, use inclusive tools, and continue learning through client experiences and professional training. Errors of commission may also include using deficit-based language, making assumptions about a client’s abilities, or focusing solely on pathology (Rivas & Hill, 2023). Another common example is using a purely medicalized approach without considering environmental and societal barriers, which can reinforce ableist perspectives.
In answer to the question of whether I would view or interact with people from this population differently if I perceived them as having an “adaptive need” rather than a “disability,” my answer is yes. Thinking in terms of “adaptive needs” instead of “disability” helps me focus on the client’s strengths and on how I can better support them. It shifts the focus from what is “wrong” to what adjustments or tools may help them succeed, which is both more respectful and more empowering.
Viewing a client as someone with adaptive needs shifts my perspective from seeing them as “limited” to seeing them as an individual who navigates the world in unique ways. This perspective emphasizes empowerment and potential rather than deficits. Using this approach helps me remain client-centered and strengths-based. Instead of asking, “What’s wrong?” I ask, “What support or changes does this person need to thrive?”
By focusing on adaptive needs, I am better able to respect the client’s autonomy and individuality. It also helps me advocate for changes in the environment or systems rather than expecting the client to change who they are.
Sometimes, even well-meaning therapists may over-accommodate or under-challenge clients with disabilities, which can unintentionally limit growth or reinforce feelings of inadequacy (Rivas & Hill, 2023).
A final point worth considering is that, under laws such as the Americans with Disabilities Act (ADA), neurodivergent individuals may qualify as having a disability if their condition substantially limits major life activities, allowing them to request accommodations.
Do you think counseling a neurodivergent client is the same as counseling a person with a visible physical impairment? Or do you believe neurodivergent clients may benefit from counselors with specialized knowledge of the unique challenges they face?
References
American Counseling Association (ACA). (2020). ACA Code of Ethics (2020). ACA.
Atkins, K. M., Bell, T., Roy-White, T., & Page, M. (2023). Recognizing ableism and practicing disability humility: Conceptualizing disability across the lifespan. Adultspan Journal, 22(1), Article 4. https://doi.org/10.33470/2161-0029.1151
Longhurst, P., & Full, W. (2023). Disabled people's perceptions and experiences of accessing and receiving counseling and psychotherapy: A scoping review protocol. BMJ Open, 13, e069204. https://doi.org/10.1136/bmjopen-2022-069204
Rivas, M., & Hill, N. R. (2023). A grounded theory of counselors' post-graduation development of disability counseling effectiveness. Journal of Counselor Preparation and Supervision, 17(1), Article 7. https://research.library.kutztown.edu/jcps/vol17/iss1/7
