Disability in Counselor Education: Perspectives from the United States

Abstract

This manuscript examines the US counseling profession’s long-standing curricular and institutional commitments around diversity and clinical excellence that pertain to disability as a multicultural identity. Specifically, the author situates training paucities, multidisciplinary contributions, and the recent emergence of disability-related counseling competencies to illuminate curricular and programmatic implications for counselor training in the US context.

Appendices

Multiculturalism in Professional Counseling

Several authors have situated the development of multicultural competencies as an imperative for counselor training programs in order to respond to client needs, professional standards, ethical responsibilities, and student development (Arredondo and Toporek 2004; Hill 2003; Ratts and Pedersen 2014). Additionally, in response to the documented counseling needs of marginalized communities (Chang et al. 2009), the promotion of culturally responsive behaviors by professional counselors has become an historical priority for the overall field and has manifested in multiple ways (Arredondo and Toporek 2004; Hill 2003).

First, the Association for Multicultural Counseling and Development (AMCD) was established in 1972 with the goal of including marginalized identities within counseling practice and discourse (Arredondo and Toporek 2004; Ratts and Pedersen 2014). From its foundation, the AMCD assumed leadership “to assist the mental health professions in recognizing the assets of culture, ethnicity, race, and other social identities as indelible dimensions of every human being” (Arredondo and Toporek 2004, p. 45), prompted largely by the antecedents of scientific racism seen to be inherent within counseling (Ratts and Pedersen 2014). Examples of scientific racism within counseling are the historical misrepresentation of minority identities in counseling research, counseling textbooks, clinical training, supervision, and leadership (Arredondo and Toporek 2004; Ratts and Pedersen 2014).

Second, throughout the last 30 years, multiculturalism has gained attention and recognition by scholars and leaders in the helping professions within the US (Pedersen 1991; Pieterse et al. 2009; Ratts and Pedersen 2014) and elsewhere (Contini de Gonzalez 2016; Georgiadou 2015). This change in the language and general discourse of the profession legitimized the need for social responsibility and appreciation of diversity within professional counseling practice, pedagogy, and research (Pieterse et al. 2009). For Pedersen (1991), multiculturalism referred to “a wide range of multiple groups without ranging, comparing, or ranking them as better or worse than one another and without denying the very distinct, complementary, or even contradictory perspectives that each group brings with it” (p. 4). Moreover, the counseling profession situated multiculturalism as a guiding force at the core of counselor professional identity to respond to the historical marginalization of individuals based on their ethnic, racial, cultural, and socioeconomic differences (Arredondo and Toporek 2004).

Third, following the creation of the AMCD, Sue et al. (1992) defined a set of multicultural competencies, which were operationalized by 1996 (Arredondo et al. 1996; Arredondo and Toporek 2004). With this set of professional standards, multiple identities, subcultures, and other factors of multiculturalism were provided as a reference to understand and embrace individual complexity within the counseling discourse (Arredondo et al. 1996). Since then, knowledge, awareness, and skills have been considered the preliminary multicultural trifecta to ground discussions of multiculturalism in the counseling profession (Pieterse et al. 2009) and to guide professional standards of practice and training. Additionally, the dynamism of multicultural development within the profession has served as a catalyst for innovative and culturally responsive initiatives by American counseling institutions, which have translated into the recent 2015 update of the Multicultural and Social Justice Counseling Competencies (Ratts et al. 2016).

Knowledge, Awareness, and Skills

The updated version of the Multicultural and Social Justice Counseling Competencies (Ratts et al. 2016) affords a complex enactment of diversity commitments while grounded on the triad of knowledge, awareness, and skills. This section examines literature pertaining to disability as a cultural identity that has been embraced in this triad. Multicultural knowledge relates to “the facts and information about cultures [that] are available in the people, the literature, and the products of each culture at the local, national, and regional levels” (Ratts and Pedersen 2014, p. 91). Disability knowledge is usually situated in the traditional rehabilitation discourse and medicalized models of disability (Reeve 2006; Smart and Smart 2006). Moreover, the multicultural knowledge related to disability competence is mainly delegated to specific lectures within multicultural courses (Pieterse et al. 2009) and elective (rather than required) classes in counselor training programs.

Multicultural awareness is the basis for counselors to accurately compare and contrast “alternative viewpoints, relate or translate priorities in a variety of cultural settings, identify constraints and opportunities in each cultural context, and have a clear understanding on one’s own limitations” (Ratts and Pedersen 2014, p. 91). In terms of disability awareness, studies have demonstrated the limited emphasis on counselors’ examination of able-bodied privilege and its potential impact on the counseling relationship (Reeve 2006; Watt et al. 2009). The documented counselors’ able-centrism reiterates the importance of addressing knowledge and attitudes towards disability in counselor training and professional practice.

Multicultural skills relate to the sensitive planning, conducting, and evaluating of the multicultural context by interacting, counseling, interviewing, advising, and managing multicultural tasks effectively (Ratts and Pedersen 2014). In terms of disability, counselors’ multicultural skills are evidenced by enhanced engagement skills, a non-judgmental approach, holism, active listening, and the empowerment of clients with disabilities (Swain et al. 2006). Further, Reeve (2006) stressed the need for counselors to develop the necessary skills to recognize and address the sociopolitical complexities of disability through the counseling relationship (Reeve 2006).

The United States Department of Health and Human Services’ (USDHHS) report (2005) and Matthews-Juarez and Juarez (2011) have situated increased responsibility on counselors for developing culturally competent and sensitive mental health services through their continual self-examination aimed at developing awareness of their own biases and stereotypes. Matthews-Juarez and Juarez (2011) also stressed the importance for counselors to understand the history and general knowledge about the dynamics pertaining to privileged legacies in the mental health system, and the need to gain multicultural skills to engage individuals and families based on their specific contextual background. Hence, disability-related competencies have been postulated as an urgent need for attention in the training and practice of counselors (Chapin et al. 2018; Smart and Smart 2006; Smith et al. 2008). These assertions align with the profession’s commitments for equity, inclusion, and multicultural sensitivity that have galvanized multidimensional conceptualizations of identity and have sparked a renewed emphasis on social justice advocacy within professional standards of teaching and practice (Ratts and Pedersen 2014; Vera and Speight 2003).

A Shift Towards Social Justice Advocacy

According to Chang et al. (2009), the increased awareness about the social inequalities that affect marginalized communities has led to the shift towards social advocacy as an important part of counselors’ training and responsibilities. The latest version of the multicultural competencies in counseling (Ratts et al. 2016) highlights the intersecting aspects of cultural identity, as well as the dynamic forces related to power, privilege, and oppression that impact the counseling relationship, along with advocacy interventions aimed to foster social change that can be applied to work with marginalized individuals, including clients with disabilities.

Social justice in counseling has been posed both as a goal and a process, and advocacy has been considered the vehicle for the enactment of values of justice and human dignity (Chang et al. 2010). Social justice advocacy is then positioned as an aptitude to be developed along with other multicultural competencies in counselor preparation. Furthermore, social justice advocacy is a furtherance of the initial Advocacy Competencies developed by Lewis, Arnold, House, and Toporek (2003), which offered specific strategies for counselors to help address the impact of systemic oppression, privilege, and discrimination, and to facilitate social change (Chang et al. 2009).

This advancement in the multicultural discourse represents meaningful potentialities for professional counselors to do what Reeve (2006), Smart and Smart (2006), and Swain et al. (2006) suggested as the need to incorporate psycho-emotional and political aspects of navigating a disabling society within counseling work. Thus, the counseling profession is growing in ways that respond to social commitments related to the lives of minority clients (Ratts and Pedersen 2014). This responsiveness is manifested through institutional initiatives that regulate practice and training in the US.

Institutional Initiatives that Influence Multicultural Preparation

Along with the demographic changes and the increased recognition of multiculturalism in the US, the counseling profession has grown in its response to the related needs of privileged and vulnerable populations engaged in mental health services (Leong 2008). Initiatives at the level of professional associations reify professional commitments to the wellbeing of minority communities as well as the expectation for professional counselors to be multiculturally skilled and competent in their work with marginalized communities, including clients with disabilities.

American Counseling Association (ACA)

The establishment of the counseling profession in America has been facilitated by the creation of the main professional organization and its sub-divisions. Formerly known as the American Personnel and Guidance Association, the American Counseling Association’s (ACA) main goal is the development and enhancement of the counseling profession through the establishment of ethical standards, as well as the promotion of accreditation, state licensure, and certification at the national level (Foster 2012). Moreover, with the endorsement of the ACA, the counseling profession has been a pioneer in developing a philosophical grounding and professional identity that orients away from medicalized views of mental health and leans towards a wellness-based approach informed by development and resilience, with an emphasis in education, prevention, and social justice (Chang et al. 2010). The ACA houses a variety of sub-divisions intended to focus on specific areas of the counseling profession. The American Rehabilitation Counseling Association (ARCA) is the ACA sub-division that focuses on rehabilitation issues for personal, career, and independent living goals through the counseling process.

The ACA’s leadership within the profession has facilitated the emergence and legitimization of the multicultural discourse in different ways. From the time when the ACA supported and endorsed the creation of the Association for Multicultural Counseling and Development (AMCD) as a division focused on addressing racial issues in counseling (Arredondo and Toporek 2004), the ACA has consistently emphasized and advocated for the appreciation and affirmation of diversity as being a part of ethical practice within the profession (Arredondo and Toporek 2004; Pieterse et al. 2009). The ACA’s Code of Ethics stresses the importance for counselors to maintain awareness and sensitivity regarding cultural meanings of confidentiality (2014; B.1.a), diversity issues in diagnosis (E.5.b) and assessment (E.8), and the impact of multiculturalism and diversity in the supervision relationship (F.2.b). As a fundamental grounding of professional standards for training and practice, the ACA’s Code of Ethics (2014) defines multicultural counseling as a professional practice “that recognizes diversity and embraces approaches that support the worth, dignity, potential, and uniqueness of individuals within their historical, cultural, economic, political, and psychosocial contexts” (p. 20).

Throughout the ACA’s Code of Ethics (2014), disability is integrated as an identity within multiculturalism that requires counselors’ competence. For instance, in the Code document, disability is mentioned when highlighting counselors’ professional responsibility for non-discrimination (C.5), for diversity awareness in assessment (E.8), and for multicultural accommodations (H.5.d). The document stipulates concrete areas of diversity consciousness that inform the training of counselors as well as all other areas of the counseling profession.

The ACA’s 20/20 initiative delineated strategic areas for the advancement of the counseling profession in the US by 2020 (Kaplan and Gladding 2011). By coordinating and ensuring the participation of the majority of organizations within counseling, the ACA defined a long-term plan for the development of the profession that entailed efforts towards achieving a unified professional identity, license portability, and client welfare. The promotion of client welfare and advocacy for the populations served were positioned as the primary focus of the counseling profession, which have been consistently reiterated within accreditation standards for counselor training.

Council for Accreditation of Counseling and Related Educational Programs (CACREP)

The ACA’s ethical principles of professional practice also inform the standards for the accreditation of specialized counseling training in the US (Foster 2012; Leong 2008). Training programs that are accredited by CACREP follow intentional professional objectives and meet detailed requirements to guarantee the development of multicultural competencies in counselor preparation (Dodson 2013). The CACREP standards are periodically revised, with the last revision being released in 2016. These revisions help counselor education programs to stay current with societal demands and contextualized social dynamics that impact counseling practitioners as well as counselor educators (Foster 2012). In the 2016 CACREP standards, multiculturalism is positioned as the professional core disposition of social and cultural diversity within the curriculum. One of eight curricular core areas, this core area stresses the importance of learning objectives related to pluralistic characteristics within and among diverse groups, theories of identity development and social justice advocacy, the effect of power and privilege, the impact of counselors’ views, strategies for addressing barriers and oppression, as well as multicultural competencies (Council for Accreditation of Counseling & Related Educational Programs 2016; Standard 2.F.2).

Counseling standards situate multiculturalism as a foundational aspect of counselor education curricula (Pieterse et al. 2009). Hence, master’s and doctoral counseling programs applying for and renewing CACREP accreditation are explicitly required to provide evidence of learning objectives that emphasize training in diversity, as well as an understanding of the effects of social inequalities, oppression, and injustice that lead to specific mental health outcomes for marginalized communities (Chang et al. 2009; Pieterse et al. 2009). For instance, in the CACREP standards, and specifically after the merger with the Council on Rehabilitation Education (CACREP-CORE) finalized in July of 2017 (Council for Accreditation of Counseling & Related Educational Programs 2017), disability is framed as a cultural identity represented in the specific track of clinical rehabilitation counseling (5.D) and rehabilitation counselor education programs. In these programs, the emphasis is placed on the foundational aspects of rehabilitation counseling as well as the contextual dimensions of disability that define the social, legislative and cultural factors of this identity. Additionally, the CACREP standards compel counselor preparation programs to emphasize students’ self-exploration and awareness-building about potential personal values and perspectives that impact the counseling relationship (CACREP 2016). Thus, CACREP requirements for multicultural competence in professional standards of practice and research align with the counseling profession’s fundamental commitments for multiculturalism and diversity, which will have an impact on counselors practicing beyond graduation.

National Board of Certified Counselors (NBCC)

Counselor certification entails the verification of “rigorous standards for training, specialized knowledge, and supervised experience” (Foster 2012, p. 45) that seeks to bring nationwide uniformity to the profession (Foster 2012). The most relevant counseling credential in the US is the National Certified Counselor (NCC) body, which is administered by the NBCC through the standardized National Counselor Examination (NCE), which also functions as the licensure exam for several states across the country. Another test administered by the NBCC is the Counselor Preparation Comprehensive Examination (CPCE). This test is a comprehensive culminating exam that offers an objective assessment of students’ knowledge in relation to the eight core training areas. The NCE and the CPCE assess specific content areas related to social and cultural diversity. Disability as an aspect of cultural diversity is reflected in the assessment of multicultural knowledge in these tests.

Commission on Rehabilitation Counselor Certification (CRCC)

Another widely recognized counseling national certification is the Certified Rehabilitation Counselor (CRC) credential offered by the CRCC. The CRC is the main certification related to disability assessment, policy, and occupational aspects, as well as in regard to the foundational counseling principles of professional practice (Foster 2012). This certification requires multicultural knowledge in social and cultural issues related to disability identity. Counseling training programs formerly accredited by the Council of Rehabilitation Education (CORE) and currently embraced by CACREP, concentrate within education and experience on rehabilitation counseling and disability issues, and prepare students to attain licensure after completing supervised practice post-graduation (Foster 2012).

American Association of State Counseling Boards (AASCB)

Counseling state licensure is regulated by the AASCB and usually requires counselors to hold at least a master’s degree, the accrual of supervised hours, and a passing score in a performance examination (Foster 2012; Leong 2008). Licensure represents the most comprehensive step in the professionalization of counselors in the US (Foster 2012), which guarantees the accrual of supervised practice and a robust knowledge-base in preparation to serve the complex needs of privileged and minority clients. Furthermore, in order to maintain state licensure, professional counselors are required to engage in ongoing demonstrated professional development and ethical practice, which entails the continual enactment of multicultural competence.

In summary, the most recognized institutional bodies in the counseling profession work in alignment with fundamental commitments of specialized counseling knowledge and multicultural competence and sensitivity. These institutional initiatives create professional synergies that inform the multicultural preparation and practice of professional counselors in the US within training and beyond graduation. Moreover, given the professional expectations of multicultural competence that are enacted by these institutional initiatives, counselor education programs have the responsibility to infuse issues of multiculturalism throughout the counselor curriculum.

Disability Training in Counselor Curricular Design

Traditionally, counselors in the US have received limited training in issues related to disability and rehabilitation (Pledger 2003). In instances where such issues have been addressed within counselor preparation, clients’ lives have typically been examined from a deficit-oriented lens (Goodley and Lawthom 2006; McCarthy 2003; Olkin and Pledger 2003). Moreover, despite the counseling profession’s endeavors for the enhancement of multiculturalism in training and practice, disability’s psychological and socio-political aspects have been rarely addressed in the counseling discourse (Olkin and Pledger 2003; Swain et al. 2006).

Moreover, disability remains largely absent in the training of counselors and marginalized in the multicultural discourse in the US (Olkin and Pledger 2003; Reeve 2006; Rivas and Hill 2018; Smart and Smart 2006; Smith et al. 2008). Some authors have identified reasons for this absence. For instance, disability has been traditionally understood as the result of biological differences that result in clients having “exceptional” needs (Olkin and Pledger 2003, p. 297). When clients with disabilities experience a variety of social, financial, and legal implications, these are seen as inevitable aspects of disablement. The absence of disability as a multicultural concern within counseling is in reciprocal relation to the absence of disability in counselor curricula, recruitment, retention, and research (Olkin and Pledger 2003). Olkin (1999) and Olkin and Pledger (2003) further asserted that disability, as a cultural identity, is largely absent in the mainstream counseling curriculum and scholarship. Specifically in the preparation of counselors, clinical courses can be the first opportunity for students to address the services to persons with disabilities, and therefore, be challenged in relation to their perceived competence in working with these clients (Pledger 2003; Rivas and Hill 2018). Additionally, the lack of representation of disabled communities (as subjects of study and in research) in the production of knowledge has been considered counterproductive, further marginalizing, and being overtly oppressive (Charlton 1998). Thus, the lack of disability emphasis in the training of counselors is incongruent with anti-oppression scholarship that highlights the importance of inclusion of disabled people’s accounts in the making of everyday life (Charlton 1998).

Also, given the diversification of counseling specialties in the US, disability components have been mainly associated with rehabilitation counseling (Smart and Smart 2006), resulting in decreased opportunities for disability representation in the training of counselors of other specialties (Smith et al. 2008). However, Smith et al. (2008) asserted the increasing need for disability-related counselor competence that moves beyond the realm of rehabilitation notions of different abilities and extends to the work related to supporting families and parents of people with disabilities, school counseling, career decisions and employment counseling, mental health counseling, and self-advocacy to be used in the navigation of a disabling society.

When disability is present in counselor education curricula, it is typically in the form of a one-off lecture in a multicultural course and in isolation from other identities (Lewis et al. 2009; Pieterse et al. 2009). Thus, the integration of disability content in the multicultural class represents different challenges and opportunities. In a content analysis of 54 multicultural and diversity-related course syllabi from counseling and counseling psychology programs accredited by CACREP and the American Psychological Association (APA), Pieterse et al. (2009) identified several themes that account for the representation of some minority identities as well as issues in the curricular enactment of the profession’s multicultural commitments of social justice advocacy. With a relatively low response rate of 37%, the authors received multicultural syllabi from masters (n = 25, 46%) and doctoral (n = 29, 52%) programs from all regions of the country.

The authors found that the coverage of varied identities and their contextual variables was enacted in an inconsistent manner in the multicultural education of counselors. For instance, within the category of special populations, “disabled” (p. 103) was identified in 12 syllabi as a particular population of study, which represented 29% of the documents reviewed. In other words, disability is documented in syllabi as a learning objective in only about a third of the syllabi obtained. Moreover, ableism as being a type of discrimination that perpetuates oppression and marginalization of differently-abled clients was documented in only 7% of the syllabi reviewed (Pieterse et al. 2009). One of the limitations of Pieterse et al.’s (2009) study indicated that the examined syllabi might not have fully captured the richness of the discussions in the multicultural class, where disability issues might have been present. However, there is an undeniable underrepresentation of disability-related content documented in the syllabi reviewed and, therefore, decreased opportunities for disability competence development in counselor multicultural training.

Disability cultural competence has also been examined in the multicultural curriculum of rehabilitation education programs. Lewis et al. (2009) stressed the need to offer more direction for rehabilitation educators on how to integrate cultural competency throughout the program of study and not to restrict it to just a required course in multicultural counseling. Lewis et al. (2009) also emphasized the need to move from a model that fosters single lectures for each identity to an infusion approach that weaves multicultural content throughout the rehabilitation counseling curriculum, accreditation standards, professional practice, and research.

Manifestations of the Lack of Disability Competence

The absence or the inadequate representation of disability in counselor training has significant implications for the professional practice of counselors and other mental health professionals (Olkin and Pledger 2003; Reeve 2006; Smart and Smart 2006), and can represent a variety of reactions and relational dynamics that can further marginalize disabled clients if counselors do not understand this identity as being a legitimate dimension of diversity (Pledger 2003; Rivas and Hill 2018). Olkin and Pledger (2003) contributed a conceptual article that described how medicalized conceptualizations of disability in psychology and other mental health professions can impact the way clinicians engage with clients with disabilities. Along with documenting the presence of deficit narratives of disability (Davis 2013), Olkin and Pledger noted the absence of disability training and lack of self-examination of biases as fundamental factors leading to a lack of disability competence in students. Moreover, different authors have also documented how clinicians’ lack of awareness can impact their ability to work with clients with disabilities (Reeve 2006; Smart and Smart 2006; Smith et al. 2008).

In a 3-year qualitative study that examined nine master’s-level students’ reactions to difficult dialogues in the classroom, Watt et al. (2009) analyzed student journal entries and reaction papers and identified eight typical student reactions to dialogues about cultural differences. The authors documented disability as a cultural identity that typically triggers reactions of false envy in counseling students, which were expressed in the form of admiration and inspirational attributions that are problematic biases impacting the lives of people with disabilities (Linton 1998; Reeve 2006). These inspirational views of disability are problematic inasmuch as they perpetuate objectifying, reductionist, dehumanizing explanations of disabled experiences.

Furthermore, Sheaffer et al. (2008) conducted an exploratory study to examine the influence of students’ socio-cognitive development on attitudes toward people with disabilities, as measured by preferred social distance. The authors surveyed 102 master’s-level students in health programs and found increased preferred social distance in inverse relationship to students’ socio-cognitive development. Along with the ability for enhanced self-reflection in later stages of developmental maturity, Sheaffer et al. (2009) stressed the importance of providing opportunities for counselors to develop heightened empathy, openness to experience, and cognitive complexity in their work with clients with disabilities.

Additionally, Rivas and Hill (2018) examined the lived experiences of ten counseling interns receiving multicultural education to assist clients with disabilities. Along with previous studies, the authors also found students’ perceptions of disability content absence, inconsistent exposure to disability content, amplified negative reactions (e.g., frustration, anxiety, feelings of inadequacy, pity) and competence issues when working with disabled clients in their internship. The authors emphasized the need for counselor preparation that embraces a consistent focus on disability issues, moves beyond a single lecture stance and integrates it throughout the curriculum (Rivas and Hill 2018; Smart and Smart 2006). These changes could not only enhance the overall multicultural education of counselors, but they are also promising for counselors’ development of disability competence.

Disciplinary Forces in the Disability Discourse

Along with the paucities in disability training within the multicultural education of counselors in the US, medicalized and deficit-focused narratives of disability have been prevalent in traditional psychology (Olkin and Pledger 2003) and counseling (Rivas and Hill 2018; Smart and Smart 2006). These narratives have typically situated disability as a biological inferiority, with pathological descriptions, and as a sign of abnormality (Davis 2013; Shakespeare 2013; Smart and Smart 2006), and have fueled institutional and systemic dynamics leading to inferior or inadequate service provision from counselors (Smart and Smart 2006). Moreover, there are disciplinary forces that have shaped or could inform the disability discourse in counseling in the US.

Contemporary Rehabilitation Counseling

In rehabilitation counseling, the discourse around disability has on the whole shifted from a medicalized emphasis to approaches that recognize the social dimensions that impact clients with disabilities (Pledger 2003). Moreover, in alignment with more contemporary models of disability, which conceptualize disability as a social, cultural, and political experience (Linton 1998; Shakespeare 2013), rehabilitation counseling has increasingly positioned persons with disabilities as an historically marginalized group, as vulnerable to bias and discrimination as any other minority group based on race, ethnicity, social class, sexual orientation, or religion/spirituality (O’Brien 2011; Pledger 2003). From this lens, the aim is not to change or fix the individual, but to understand the person’s interplay of cultural factors that explains psychological experiences in a disabling society (Reeve 2006; Smart and Smart 2006).

For instance, Smith et al. (2008) emphasized the need to address ableism in counseling. These authors described ableism as “a form of discrimination or prejudice against [people with disabilities] that is characterized by the belief that these individuals need to be fixed or cannot function as full members of society” (p. 86). Smith et al. (2008) explained the negative effect of ableism in society and further positioned rehabilitation counseling as a venue to address these issues in the provision of counseling services. Additionally, Smart and Smart (2006) described the different models that have shaped the conceptualizations of disability within counseling, and strongly advocated for the integration of disability models that account for the environmental and sociopolitical realities faced by people with disabilities.

Thus, even though rehabilitation was initially conceptualized as “the process by which physical, sensory, and mental capacities are restored or developed in people with disabling conditions” (Brandt and Pope 1997, p. 24), this focus on deficit has shifted to “a strength-based approach that recognizes the capacity of individuals with disabilities to perform when optimal conditions exist within the environment” (Pledger 2003, p. 281). Moreover, “clients are seen as being able to act and make decisions for themselves, as having agency or the capacity for control over themselves and their lives, if facilitated in a non-judgmental way, within a supportive context” (Swain et al. 2006, p. 165). In short, the shift in rehabilitation approaches have further aligned with affirmative and multicultural counseling commitments, which highlight social responsibility, client agency, and human dignity.

Disability Studies

Being a discipline emerging largely from the disability rights movement in the United Kingdom and the US (Charlton 1998; Davis 2013), disability studies discourse links the sociological, historical, anthropologic, political, legal, and literary aspects of disability (Olkin and Pledger 2003) and organizes a knowledge-base in the US that offers a socially grounded understanding of disability within multiculturalism (Linton 1998). This approach places a greater emphasis on power, oppression, community identity, and civil rights (Olkin and Pledger 2003) and situates disability as a public concern and a political act (Smart and Smart 2006). Informed by socially just and culturally responsive views of differently abled persons, social views of disability have helped reorient counseling service provision and training (Olkin and Pledger 2003; Smart and Smart 2006). In other words, the field of disability studies is a key factor influencing the shifts in the disability discourse within counseling.

Specifically, disability studies offer several theoretical claims that have contributed to shifting views of disability in counseling. For instance, disability studies have disarticulated the presentation of disability as a problem that creates significant limitations in the person’s life (Linton 1998; Shakespeare 2013). This shift promotes more human, contextualized, and socially just conceptualizations of disability within counseling. Furthermore, in congruence with the disability rights battlecry “Nothing About Us Without Us” (Charlton 1998), disability studies highlight the importance of disability subjectivities by recognizing the uniqueness of cultural experiences related to disability and by including first-hand account narratives from people pertaining to this minority (Charlton 1998; Linton 1998; Shakespeare 2013). Issues of representation of disability identity in admission and retention (Shin et al. 2011), and in research and scholarship still remain in counseling in the US (Olkin and Pledger 2003). Hence, highlighting and representing individuals with disabilities through all realms of the profession aligns with espoused values of multiculturalism and social justice.

Additionally, the tendency to objectify and essentialize disability still persists in the counseling discourse (Reeve 2006; Smart and Smart 2006) even though the multicultural discourse has advanced to acknowledge and embrace intersectional views that underscore the interplay of multiple social markers in people’s lives (Ratts and Pedersen 2014). Disability studies focuses on the social response to disability as an organizing experience that determines psychological, social, political, academic, occupational, relational, and material consequences for disabled clients (Shakespeare 2013). Ergo, a disability studies approach to the lives of people with disabilities is congruent with the current version of the multicultural and social justice advocacy counseling competencies (Ratts et al. 2016) in that it seeks to address the intersectional and the social rather than the individual. Lastly, given that disability has traditionally been associated with rehabilitation counseling (Smart and Smart 2006) and is not consistently infused across the general counselor education curriculum (Pieterse et al. 2009; Reeve 2006; Smart and Smart 2006; Smith et al. 2008), disability studies’ conceptualization of disability as a visible identity throughout the multicultural education of counselors seamlessly aligns with professional values of affirmation of diversity and social justice.

Disability Cultural Competence

The literature and constructs emerging from rehabilitation and disability studies parallel the domains of the recently developed Disability-Related Counseling Competencies (Chapin et al. 2018) that were endorsed by the American Rehabilitation Counseling Association’s Board of Directors in 2018 and by the American Counseling Association’s Governing Council in 2019. This document is organized into five sections that focus on different environments and roles played by professional counselors working with disabled clients.

The first and third sections, Understanding and Accommodating the Disability Experience and the Counseling Process and Relationship, account for knowledge, awareness, skills, and advocacy surrounding the work with disabled clients, and present strong synergy with the domains of the multicultural and social justice advocacy competencies (Ratts et al. 2016). Specifically, the disability-related competencies highlight the understanding of the disability experience circumscribed in the context of society and with an affirmative approach that debunks pathological explanations of functioning. This attention to contextual and sociopolitical aspects of disability is congruent with Linton (1998), Pledger (2003), Reeve (2006), Shakespeare (2013), and Smart and Smart (2006). Moreover, these sections of the disability-related competencies call for attention to the discriminatory and oppressive dynamics enacted in healthcare environments in the US. In congruence with the views of Reeve (2006), Rivas and Hill (2018) and Smith et al. (2008), the presence of discriminatory biases and negative counselor reactions have a direct impact in the counseling relationship.

The second section of the disability-related competencies focuses on Advocacy for people with disabilities and support for their self-advocacy. This approach highlights the necessity to turn to and empower people with disabilities to amplify their power for self-advocacy and agency through appropriate supports. This is congruent with authors who have highlighted the importance of recognizing the uniqueness of disability subjectivities (Charlton 1998; Reeve 2006; Shakespeare 2013; Swain et al. 2006) and the need to consistently integrate them into counselor education curricula, programs, and scholarship (Olkin and Pledger 2003; Rivas and Hill 2018; Shin et al. 2011).

The fourth and fifth sections of the disability-related counseling competencies document focus on the considerations and competencies surrounding the evaluative role of counselors conducting testing and assessment in the work with disabled clients, as well as the counseling work in clinical and community settings. Counselor are called on to move beyond deficit-oriented views and to exercise caution around procedures and interpretation of assessments that pertain to diagnosing and treatment recommendations for counseling people with disabilities (Pledger 2003; Smart and Smart 2006). Furthermore, the disability-related competencies underscore the need for counselors to gain clarity around issues of accommodations and equal access that move beyond the counseling room and extend into these clients’ communities (Pledger 2003; Smith et al. 2008).

Implications

The presence of multiculturalism in counseling has fostered socially grounded descriptions of identity and social justice advocacy for minority clients (Ratts and Pedersen 2014). Specifically, the advancements in the multicultural and social justice discourse within counseling have facilitated an increasing acknowledgement of counselor self-awareness, client worldviews, relational dimensions, and advocacy interventions in the counseling work with marginalized communities (Ratts et al. 2016). Moreover, the dynamism of multiculturalism in the counseling profession offers promising potential for re-shaping disability identity conceptualizations in counselor training (Rivas and Hill 2018).

Even though the professional practice of counseling in the US has historically engaged in medical and rehabilitative views of disability (Pledger 2003; Smart and Smart 2006; Smith et al. 2008), an emerging and more promising discourse around disability has begun to influence the counseling profession. This is evident through amplified institutional attention to multicultural issues (ACA 2014; CACREP 2016; Ratts et al. 2016; Ratts and Pedersen 2014), the examination of disability in counselor training, admission, retention, and scholarship (Olkin and Pledger 2003; Pieterse et al. 2009; Rivas and Hill 2018; Shin et al. 2011; Smart and Smart 2006), and the launching of disability-related counseling competencies (Chapin et al. 2018). However, several implications can be delineated to strengthen the impact of disability initiatives in counselor training in the US.

One implication highlights the need to further examine and adjust disability training across counseling curricula (Olkin and Pledger 2003; Pledger 2003; Reeve 2006; Rivas and Hill 2018; Smart and Smart 2006). For instance, Pledger (2003) suggested the infusion of “theoretical foundations, historical perspectives, conceptual frameworks, terminology, and criteria for defining disability” (p. 279), which could facilitate a more contextualized understanding of disability, and increase disability competence in counselors. Having a more robust knowledge-base regarding disability could facilitate a more effective enactment of disability-related counseling competencies by practicing counselors (Chapin et al. 2018).

Additionally, Reeve (2006) emphasized the need for counselors’ disability training to include classes and lectures that cover the psycho-emotional dimensions of disability and the full impact of living in a disabling environment. According to Rivas and Hill (2018), when counseling interns worked with disabled clients, counselors hardly focused on the psychological aspects of navigating disabling environments and handling discrimination and lack of access. Reeve (2006) further asserted that psycho-emotional disabling results from helpers’ unexamined biases and attitudes that influence the therapeutic relationship. An implication emerging from this present article is the urgent call for curricula adjustments that amplify counselor self-awareness into dynamics of power and privilege that influence the counseling relationship. Hence, through the examination of privileged/marginalized client and counselor dynamics, counselors can gain sensitivity to identify and address personal biases and conduct assessments and diagnostics while embracing the impact of navigating unwelcoming and oppressive environments (Chapin et al. 2018; Smart and Smart 2006).

Smart and Smart (2006) suggested the curricular integration of additional models and disciplines to conceptualize disability beyond medicalized descriptions and the need to incorporate social and political aspects of identity. Deepening disability studies’ precepts in counselor training could further inform counselors’ multicultural practices by facilitating the recognition of the elusive psychological elements of disablement, and deconstructing and promoting socially grounded knowledge about disabled identities. This knowledge can stimulate multicultural activism through professional practice, the acknowledgement of the interplay of intersecting identities, the transformation of mental health institutions, and the promotion of socially just counseling practices (Goodley and Lawthom 2006).

Lastly, Shin et al. (2011) recommended increasing the representation of persons with disabilities and other marginalized identities in counseling programs. Reeve (2006) advocated for the active and intentional inclusion of counselors with disabilities in the profession. A programmatic implication from this examination entails the systematic and intentional inclusion of disability in advertisements, admission, and retention processes of counselor education programs, as well as disability representation among faculty.

Given the current standing of the disability discourse in counselor education in the US, future research can focus on understanding the developmental complexities that define counselors’ enactment of multicultural and disability-related competencies. Also, qualitative research could examine the experiences of disabled clients served by counselors who enact these competencies. Lastly, quantitative research could focus on the development of instruments to measure disability-related competencies within clinical practice.

Conclusion

The need for the infusion of disability content in counselor training has been largely emphasized in the counseling literature (Olkin and Pledger 2003; Reeve 2006; Rivas and Hill 2018; Smart and Smart 2006; Smith et al. 2008). At the same time, the counseling profession has maintained growing commitments for social responsibility by repositioning multiculturalism at the core of counseling pedagogy, practice, and research (Ratts and Pedersen 2014). The goal of this article is to highlight the potential of the current professional and institutional climate in the counseling profession for furthering and deepening a disability discourse that signifies enhanced opportunities for counselor disability-related competence, inclusive training policies, and human dignity throughout behavioral healthcare services in the US.