«Reeve, D. (2002) 'Oppression within the counselling room', Counselling and Psychotherapy Research 2(1): 11-19. This is the corrected version ...»
Donna Reeve Oppression within the counselling room 1
Reeve, D. (2002) 'Oppression within the counselling room', Counselling and Psychotherapy
Research 2(1): 11-19.
This is the corrected version incorporating reviewer comments and has been
paginated to match the published version (as the page does not fit in Word I have
indicated the start of new pages in square brackets). Small typographical differences
may therefore exist between this and the published version.
[Start page 11] Oppression Within the Counselling Room DONNA REEVE Department of Applied Social Science, Lancaster University, Lancaster, LA1 4YL UK
This paper suggests that the oppression experienced by disabled people in society is sometimes replayed in the counselling room by counsellors who are unaware of their own disablist attitudes and prejudices. Whilst the provision of Disability Equality Training (DET) within counselling courses would ameliorate the problem, I believe that disabled people would be most empowered by a counselling approach which recognises the potential for oppression within the counsellor–client relationship. One solution may be the creation of a new counselling approach, disability counselling, which includes the social model of disability as one of the foundations. An alternative solution may be found within the emerging counselling approaches that treat counselling as a social and political process and place emphasis on developing comprehensive anti-discriminatory practice.
Introduction This paper examines closely the counselling relationship between a counsellor and their disabled client, and considers the nature of the power in that relationship. My own personal experiences as a disabled client and counsellor have led me to question the nature of that relationship, and to try and place it in context with the relationship between disabled people and a disabling society.
Counsellors are subject to the same negative images and stereotypes of disabled people as the rest of society. The attitudes and prejudices of counsellors towards disabled people can adversely affect the nature of the client–counsellor relationship when the client is a disabled person - there is sometimes oppression within the counselling room. Whilst counsellors are aware of the need to challenge their racist and sexist attitudes, I will suggest that many counsellors are unaware of their disablist attitudes which remain unrecognised and unchallenged. This is due to the fact that Disability Equality Training (DET) is missing from most counselling courses and to the dearth of disabled people training as counsellors. Disability is not present as an issue on these courses in the same way that race and gender are.
Whilst the provision of DET would make counsellors aware of disability as a social construction, rather than individual tragedy, I do not see that it can go far enough in providing counselling which is empowering for disabled people. I suggest two possible solutions that recognise the potentially oppressive nature of counselling and seek to redress the power imbalance. The first solution builds upon transcultural counselling creating a new counselling approach called disability counselling that recognises oppression within the counselling room and incorporates the social model of disability as a cornerstone. The second solution draws attention to new counselling approaches which adopt a social and political, rather than a psychological stance.
These new approaches aim to achieve comprehensive anti-oppressive practices that Donna Reeve Oppression within the counselling room 2 offer empowering counselling for all people, irrespective of race, gender, religion, class or disability.
Background The most common psychological theories designed to explain personal responses to disability are based on the assumption that there will be psychological adjustment as the individual comes to terms with their impairment. This assumption has been added to by various grief and stage theories (Oliver, 1995), which predict that disabled people are expected to grieve, mourn and express feelings of anger and denial, before they can [start page 12] become psychologically whole again (Lenny, 1993). There have been many criticisms of these ‘loss’ theories that attempt to explain how people respond to disability (Lenny, 1993; Oliver, 1995). The suggestion that disabled people will inevitably need to adjust to this change leads to the assumption that becoming disabled is psychologically devastating and that such a personal tragedy can only be resolved by grieving the loss (French, 1994). These assumptions are the product of the ‘psychological imagination’ constructed upon a bedrock of ‘nondisabled’ assumptions of what it is like to experience impairment (Oliver, 1996: 21) and arise from the medical model of disability in which impairment is seen as the cause of disability and posits disability as an individual tragedy (Bury, 1997).
These ‘loss’ theories have been heavily criticised for not taking into account the social dimension of disability by assuming that the only response will be one of personal loss (Oliver, 1990). When a person acquires an impairment or becomes chronically ill then their lives will be changed in some way; for some people, the experience of impairment can cause feelings of loss in areas such as changes in bodily function or future life choices, and so a bereavement or ‘loss’ theory might be appropriate in this case. For most disabled people, the real problems, such as losses within work or social life, come from living in a disabling environment, rather than the experience of impairment (Oliver, 1995). This fact supports the social model of disability in which disability is caused by ‘externally imposed disadvantage and social restriction’ (Oliver and Barnes, 1998: 18), rather than impairment. The ‘loss’ theories which claim to explain personal responses to disability do not explain the emotional distress experienced by disabled people living within a disabling environment.
The assumption that becoming disabled is psychologically devastating also implies that all disabled people will therefore need counselling to come to terms with their ‘losses’ (Lenny, 1993). This is given credence by the negative stereotypes of disabled people as bitter and self-pitying because of an individual failure to ‘accept’ their disability (Oliver, 1990). Whilst there is limited evidence for the validity of these ‘loss’ theories (Robertson, 1992), they are still presented in the counselling literature as the only way that people respond psychologically to disability. Not all disabled people want counselling (Lenny, 1993), but those that do decide to seek counselling want access to counselling services which meet their perceived needs (McKenzie, 1992); person-centred counselling with its lack of assumptions about how people respond to disability is seen by some to be the least intrusive counselling approach, when compared with psychodynamic and behavioural approaches (Lenny, 1993).
Many of the issues which disabled people might seek counselling for are common to all people in society - marriage problems, stress, childhood traumas, etc. However, disabled people may also have additional difficulties which they may try to resolve Donna Reeve Oppression within the counselling room 3 through counselling such as experience of the medical profession (Oliver, 1995), living with pain and exhaustion (Crow, 1996), internalised oppression (Keith, 1996) and the experience of living in a disabling society. It is very important to be clear about what counselling can achieve and what it cannot. Counselling cannot fix disability because disability is a problem created by society and not the individual, although it can help someone to explore the ways in which they are being disabled and how they feel about it (Lonsdale, 1990).
I also want to recognise that disabled people who do decide to seek counselling have less choice than is available to non-disabled people. Some charities such as the Multiple Sclerosis Society (Lewis, 1999) and Spinal Injuries Association (SIA, 1998) provide free face-to-face and telephone counselling to people with these specific impairments. However, lack of accessibility in the built environment generally, together with the fact that disabled people are a financially disadvantaged group within society (Barnes, 1991) means that counselling is not available to many disabled people. My personal experience indicates that counsellors in private practice or within agencies which are not related to disability, do not see many disabled clients. As a result, the mistaken conclusion is made that disabled people do not want to use their services and little effort is made to meet the access needs of this particular client group.
The rest of this paper will consider more closely the nature of the relationship between a disabled person and the counsellor (non-disabled or disabled). I will explore how the experience of living within a disabling society can be replayed within the counselling room and suggest two solutions to this problem. Corker (1995) writes about counselling from the perspective of both a deaf person and a counsellor; her comments about oppression within the counselling room together with my own personal experiences as a disabled person, both client and counsellor, are the starting point for the ideas I will now present.
Oppression in the Counselling Room The British Association for Counselling (BAC), which is the largest counselling
organisation in the UK, describes counselling as:
an opportunity for the client to work towards living in a way he or she experiences as more satisfying and resourceful … the counsellor’s role is to facilitate the client’s work in ways which [start page 13] respect the client’s values, personal resources and capacity for choice within his or her cultural context. (BAC, 1998: 8).
The question I now want to consider is whether or not disabled people have access to counselling that meets this description - is the experience of counselling empowering or oppressive?
The Counsellor–Client Relationship Within counselling the ‘core conditions’ offered by the counsellor - empathic understanding, unconditional acceptance and genuineness - are considered to be the essential minimum for a working alliance between the counsellor and client (NelsonJones, 1982). A healthy counselling relationship occurs when the counsellor–client relationship is one of partnership and equality (Corker, 1995). This requires the counsellor to be aware of, and work with the inherent power imbalance between the ‘trained’ counsellor and ‘vulnerable’ client. Counsellors who follow the BAC Code of Practice are reminded that they have Donna Reeve Oppression within the counselling room 4 a responsibility to consider and address their own prejudices and stereotyping attitudes and behaviour and particularly to consider ways in which these may be affecting the counselling relationship and influencing their responses.
(BAC, 1998: 10).
Counsellors, like all other people in society, are fed a stream of negative images and stereotypes of disabled people from a very early age, which contributes to the continued discrimination and exclusion of disabled people within society (Shakespeare, 1994). Whilst counsellors understand the need to address their own sexist and racist attitudes, I believe that many of them fail to consider their own prejudices and assumptions about disabled people. As a result these counsellors themselves are part of an oppressive culture (Corker, 1995) and such counsellors who are unaware of their disablist attitudes may further oppress their disabled clients within the counselling room. A similar process has been observed in a study of GPs and the way in which they oppressed their disabled patients because they had not tackled their own negative attitudes towards disabled people (Begum, 1996). My personal experience of being a disabled client, together with anecdotal evidence from disabled friends who have also experienced counselling, has led me to conclude that this oppression can be a reality in some (but not all) counsellor–client relationships where the counsellor is non-disabled. Examples of oppression include assumptions by the counsellor that relationship problems are totally caused by the presence of impairment, disbelief that a disabled client would consider refusing surgical intervention to be ‘normalised’, as well as relocating a counselling session to an inaccessible room (Withers, 1996).
I would like to consider two reasons why counsellors may be unaware of their own prejudices and stereotypes of disabled people. The first reason is that basic counselling training courses are primarily designed to teach counselling skills and theory (Lago and Thompson, 1996). As a result very little time, for example 1 day in a 2 year Diploma course, is spent making counsellors aware of equal opportunities and how it should inform their practice. Whether or not disability equality is included within this area is a moot point - even BAC accredited courses only have to comply with the requirement that courses include reference to the effect of factors such as ‘race, culture, gender, sexuality, politics, religion, ethics and class’ (BAC, 1996: 8) disability is missing from the list. I believe that it is vital that all counsellors (from trainee to supervisor and tutor) have Disability Equality Training (DET) to raise their awareness of how their own attitudes can disable people. A request for a disability component in counselling training was also raised by all of the participating counsellors in the study by Oliver (1995). Unfortunately, my personal experience is that some counsellors believe that they already ‘unconditionally accept all people’ and therefore don’t need DET (a feedback comment from a DET course I gave to counselling students). It is important that counsellors understand disability as a social construct and the ways in which disabled people are systematically excluded from participating in everyday life.
If counsellors can move away from the viewpoint of disability as an individual ‘problem’ with the assumption that it has a negative impact on that person’s life (medical model perspective), then other benefits for disabled clients would follow.