Definitions and Frameworks

We use the term disability to refer to a physical or mental condition that results in significant limitations in one or more major life activity. Limitations could be difficulties in mobility, communication, sensory processing, cognitive processing, and many others. This definition is consistent with the concept of disability used in the Americans With Disabilities Act of 1990 (ADA), a critically important disability civil rights law passed in 1990. However, it is important to emphasize that this definition is not intended to convey the notion that a disability is a deficit.

We subscribe to the disability model that frames disability as an interaction between the physical or mental condition of the individual with a disability and the attitudes, policies, and contexts that create limitations. In other words, disability is a socially constructed concept. The disability rights movement in the United Kingdom uses the term disabled “to denote someone who is disabled by society's inability to accommodate all of its inhabitants” (Disabled-World.com, 2016, ¶13). There are many types of disabilities, including mobility or physical impairments, spinal cord injuries (SCIs), vision or hearing disabilities, psychological disorders, and cognitive or learning disabilities. Some disabilities are readily apparent to others, whereas others are invisible (such as epilepsy or diabetes). We include this definition because members of groups may bring up the social discrimination they experience, and because their own view of the limitations associated with their particular disability (or disabilities) may become issues to be addressed in treatment.

We also choose to use “person-first language” (Dunn & Andrews, 2015, p. 256) in the title and throughout the book not only to be consistent with the American Psychological Association publication style guidelines but also because we want to convey that the disability is one aspect of a multifaceted person. A useful guideline for using person-first language can be found at http://www.cdc.gov/ncbddd/disabilityandhealth/pdf/disabilityposter_photos.pdf.

However, we recognize that there is an opposing viewpoint that prefers “identity-first” language. From this perspective, for some people, the disability is the focus of their identity. For example, Emily Ladau (2015) believes that person-first language separates the person from his or her disability and “implies that ‘disability’ or ‘disabled’ are negative, derogatory words. . . . [Person-first language] essentially buys into the stigma it claims to be fighting” (¶ 7). She points out that when referring to the racial or ethnic identity of someone, we do not say, “a person who is Latina” or “a person who is Jewish,” we say, “She's Latina” or “He's Jewish.” She feels that saying “She's disabled” is equivalent. However, though we acknowledge this position, we use “person with a disability” rather than “disabled person” in this book, recognizing that this is not a universally accepted choice.

We use the term group or group work to include all types of groups: task, psychoeducational, counseling, and therapy. The needs and concerns of persons with disabilities exist in all of those formats and in all settings (schools, community mental health facilities, hospitals, rehabilitation centers) in which groups may be offered, and we provide material that will generally be applicable to all contexts and formats. Although the distinctions between types of groups and settings are important, we believe that the concerns related to disabilities transcend those distinctions. In those cases in which the material is specific to a type of group or setting, we make that clear.

Client Rights

The passage of the ADA in 1990 was an important step toward ensuring the rights of people with disabilities (see http://www.ada.gov and http://aaidd.org/home for additional information). B. Brown (1995), in the spirit of that legislation, proposed a “Bill of Rights” (p. 71), which provides a foundation for this book. We include below those rights that are most pertinent and urge readers to view the original article for the complete list:

• The right not to be discriminated against on the basis of a disability when being referred to or requesting participation in group work.
• The right not to be discriminated against on the basis of being regarded as a person with a disability.
• The right of individuals to be judged for inclusion in group work on their own merits.
• The right to request and to be provided with reasonable accommodation that is not an undue hardship.
• The right not to be disqualified from group membership on the basis of the inability to perform nonessential role functions.
• The right not to be discriminated against as a direct threat to the safety or health of others, unless certain standards are met.

B. Brown (1995) also highlighted rights that focus on the prospective group member:

• You have the right and responsibility to initiate discussion with the facilitator about any accommodation needs.
• You have the right to reveal a disabling condition to the group leader and to members without being discriminated against.
• You have the right to expect the development of group norms that recognize the value of diversity within the group. (pp. 72–75)

With these rights in mind, we draw on a model proposed by Merchant (2013) for multicultural groups to provide a framework for this endeavor. She proposed that groups might be culture specific, which in the case of disabilities would mean that membership in the group would be restricted to persons with a specific disability (e.g., deafness, AIDS, cerebral palsy, SCIs), with the goals of providing support, information, and resources for persons with that disability and of helping members accept themselves and their lives with the disability. A second type of group would be one designed to increase understanding of, and sensitivity toward, persons with disabilities in a group comprising a mixture of persons with and without disabilities (or with different disabilities). We do not focus on such groups in most of this book, although we touch on them in the training and resources sections. Finally, there are groups for a variety of issues (e.g., family violence, substance abuse, grief and loss) in which persons with disabilities participate although the focus is on the issue rather than the disability. In each of these types of groups, the facilitator must be knowledgeable about the particular challenges of including persons with disabilities as contributing members of the group. These challenges may be related directly to the disability, but they also may include other health issues, relationship difficulties, family-of-origin issues, abuse, and so on. Facilitators must also have a basic understanding of the disabilities to anticipate and prepare for the needs of those members while helping all members have a positive experience in the group and a deeper appreciation of the psychosocial context of the member (or members) with disabilities. Finally, it may be that the group facilitator is a person with a disability; the nature of the disability and the composition of the group may present unique leadership issues whether or not the members have disabilities as well (Bauman & Thorbergson, 2011).

Importance of Groups for Persons With Disabilities

On a very basic level, groups provide a social support network for members. For those with disabilities, this may provide a necessary ingredient for growth. The skills that form relationships in the group can be applied to social settings outside the group with the confidence that one has been successful using those skills in the protected context of the group. Groups provide a safe and supportive environment in which members can gain deeper self-understanding and develop a more nuanced understanding and appreciation of others. The well-known therapeutic factors in groups (Yalom & Leszcz, 2005) can be particularly powerful in the case of groups with persons with disabilities (Ellis, Simpson, Rose, & Plotner, 2015).

One of those factors is universality, which refers to the recognition in the group that one is not alone in her or his situation. For persons with disabilities, being in a group with others who have the same challenges can reduce the sense of isolation that often accompanies such circumstances. This phenomenon is powerful in groups for parents who have children with disabilities (Seligman, 1993). Parents may struggle to adjust their parenting to meet the needs of the child with a disability and may experience negative reactions from others in the community; sharing and learning from others who share these challenges can be very therapeutic. In groups with others who do not have disabilities, the person with disabilities may find he or she shares feelings and struggles with others regardless of their disability status, which is also a vehicle to reduce the feelings of loneliness and disconnection from others. In such groups, the person with disabilities may find that experience facilitates the transition into other settings (e.g., work, social activities) with nondisabled persons. Groups provide an opportunity to exchange ideas about common problems (Livneh, Wilson, & Pullo, 2004), often generating new perspectives on perceived challenges.

In a group, the opportunity to be helpful to others, or altruism, can increase the members' feelings of self-worth. When others in the group acknowledge or appreciate a member's contribution to the group or to individual members, he or she feels valued and important, essential ingredients for self-esteem. When members encounter others at different stages of dealing with an issue, they may develop a sense of hope that they, too, can make progress and feel more satisfied and fulfilled. For those whose disability may limit their opportunities to join with others, the feeling of cohesiveness that develops in groups can provide that sense of belonging that is so essential for optimal human functioning.

Groups also provide a place where members can express their emotions without fear of judgment, a process known as catharsis. This experience often precipitates feelings of relief from the effort to bottle up strong emotions, and it allows members to shed feelings of shame and guilt that are frequently associated with those emotions. Groups also provide a context in which one can learn from others, by giving and receiving feedback, modeling the behavior of other members, and exploring existential issues of freedom and responsibility, mortality, and loneliness. Although these factors are present to some degree in all effective groups, the potential for profiting from these therapeutic factors may be enhanced among those with disabilities, particularly those disabilities that may be associated with social isolation or that are particularly heavily stigmatized.

In groups led by a professional, the leader has the opportunity to observe and assess the client's interpersonal style. In individual therapy, the counselor must rely on the client's self-report; in the group, the clinician can observe and assess the psychosocial needs of the client directly, which provides much more authentic data.

Organization of This Book

The book is organized into sections to facilitate the location of pertinent information. All chapters include a section on Key Terms and Recommendations for Practice. References are in a separate section at the end of the book.

Key Terms

1. Disability: a condition that limits a person's ability to engage in one or more major life activity (school, work, travel and movement, recreation). Disability is a social construction, because the attitudes, policies, and lack of accommodations in the environment create the limitations rather than the disability creating them per se.
2. First-person language and disability-first language: When referring to someone who has a disability, there are two competing beliefs about the most respectful and appropriate way to do so. One camp uses a phrase that first notes the person and then the disability (person-first language, e.g., person with a hearing loss), and the other prefers to acknowledge the centrality of the disability by saying “deaf person” or “hearing-impaired person.”
3. Group dynamics: patterns of interaction among and between members and between members and the leader.
4. Group work: a generic term that includes all types of groups, primarily task groups, psychoeducational groups, counseling groups, and therapeutic groups. Classroom groups and athletic teams are sometimes studied as examples of task groups, as are committees in the workplace. The dynamics of interactions are similar in all groups.
5. Therapeutic factors: Also known as curative factors, this concept originated with the work of Irvin Yalom and refers to characteristics of groups that promote beneficial outcomes in members.

Recommendations for Practice

1. Locate a copy of a well-validated measure of attitudes toward persons with disabilities. Take the inventory honestly, and evaluate your own performance. If it is not what you would like, consider how to get additional experience to become more accepting of this population. One such measure is available online at https://implicit.harvard.edu/implicit/. Log in as a guest and take the disability measure.
2. You may wish to ask clients whether they prefer person-first or identity-first language as part of establishing norms at the beginning of the group.
3. A discussion of what the term disability means to you (and members) can be very enlightening.
4. Be sure to explain why groups are the treatment of choice for this population.
5. Be conscious of the meeting space and ensure that it can accommodate persons with a variety of disabilities.
6. Observe or survey your groups to determine which therapeutic factors are most prevalent. Reflect on how you can maximize these experiences to enhance the growth of group members.