Abstract
This comprehensive text from Marini, Glover-Graf, and Millington makes a unique and valuable contribution to the growing number of textbooks published in recent years that have as their focus the psychosocial aspects of chronic illness and disability. Among the factors that distinguish this text are its scope and its deliberate incorporation of the voices of rehabilitation consumers. This latter aspect begins in the Preface, with a personal account of the disability-related experiences of the lead author, and is maintained throughout with the inclusion of a different personal narrative of disability experience at the end of each chapter. These “insider perspective” accounts were solicited by the authors through advertisements and word of mouth. Although not necessarily directly related to the topic of the chapter that they follow, these stories have the effect of making the content, and the work of rehabilitation professionals, real and relevant, and in some cases imperative. With respect to the scope of the text, the authors take a broad view of the domain of “psychosocial aspects.” In the Preface, Marini identifies disability as a social construct, conceived from a minority-model perspective. He further states that, “Historically, persons with disabilities have been marginalized and dehumanized and thus not considered worthy of equal status” (p. xiv), and demonstrates this perspective emphatically in the first chapter. Thus, although there is not a discussion or definition of the term “psychosocial,” the authors’ framework for exploration is clearly established as including both a broad sociological view and a highly personal perspective on disability and rehabilitation.
The book contains 16 chapters, organized into four sections, including Part One: Disability from a sociological perspective, Part Two: The psychology of disability surrounding the individual and family, Part Three: Pertinent topics concerning psychosocial issues of disability, and Part Four: Counseling strategies and insights for working with persons with disabilities. The text begins with a relatively brief review of the history of the treatment of persons with disabilities in society between 500 B.C. and the present, and features a very interesting discussion of the historical and modern perspectives on eugenics. The chapter concludes with a discussion of key disability and rehabilitation legislation. In the 22 pages of this chapter, it would be difficult to do justice to the details and complexities of the changing social attitudes toward disability over the time span addressed while providing a comprehensive description of current legislation associated with vocational rehabilitation services, independent living, and the Americans With Disabilities Act. Marini does manage, however, to provide through his compelling narrative sufficient information that readers will appreciate the key elements.
In the second chapter, Marini provides a comprehensive and informative review of the research concerning the formation and expression of attitudes about disability and toward persons with disabilities. Millington’s subsequent chapter explores disability-related attitudes and experiences from the perspectives of several different ethnic groups, including Hispanic Americans, African Americans, Asian Americans, and Native Americans. Although the format of the discussion emphasizes between-group differences, and the chapter lacks a discussion of the within-group, between-group distinction, this informative chapter will certainly prove very helpful to students and professionals. The historical review associated with each ethnic group is particularly helpful. The first section of chapters concludes with a very interesting review of the disability-related attitudes and perspectives of various professional groups, including teachers, attorneys, counselors, and psychologists among others, and various industries or special interest groups, including the health insurance industry, nonprofit disability organizations, and political groups. The analysis is original, informative, well supported with current research, and comprehensive in its scope.
The focus of Part Two is the individual and family psychology of disability, and this section includes chapters on theories of adaptation and adjustment, family adaptation, sexuality and disability, and the psychosocial experience of injured workers. Following an introduction in which the process, terminology, and contexts for understanding the adaptation process are discussed, the initial chapter in this section provides a relatively brief summary of seven theories of adaptation to disability, including well-established and more recent perspectives. The concluding discourse, described as a synthesis, raises a number of thought-provoking questions concerning the current state of adjustment and adaptation research. This chapter provides an introductory-level coverage of extant theories of adaptation, but gives relatively little attention to coping and related research.
Glover-Graf’s subsequent chapter on family adaptation explores the historical and current realities of the changing conceptions and definitions of family, and very effectively presents current research on family adaptation. This chapter introduces and addresses a range of important issues that may be faced by families of different types and from different ethnic and cultural backgrounds. In the subsequent chapter, Glover-Graf explores the too often–neglected topic of sexuality and disability. The chapter includes a wide range of important questions and topics for consideration by rehabilitation counseling and other health professionals, including an exploration of the interaction of gender, social roles, and disability, and an informative analysis of issues that may arise for persons with specific disabilities or chronic illnesses (e.g., learning disabilities, cognitive disability, and psychiatric disability). In short, this chapter provides an excellent overview and an in-depth analysis of a refreshingly broad array of important issues that too frequently are ignored and underrepresented. This well-researched chapter will prove helpful to students and readers at all levels of professional development. The final chapter in this section is notable for Marini’s attention to chronic pain, including a discussion of the theoretical models and personal implications of chronic pain. Marini also explores the impact of a vocational injury on families and the cultural influences on the experience of injured workers.
Part Three explores three “pertinent topics” concerning psychosocial issues of disability: quality of life (QOL), social support and caregiving, and thriving versus succumbing. The section begins with Glover-Graf’s unique and very effective approach to exploring QOL and disability by describing the developmental impact of disability on QOL from infancy through later adulthood. Although statements concerning the relationship between specific types of disability and QOL outcomes warrant supporting comparative research, the chapter provides a comprehensive review of the relevant research on the QOL impact of psychiatric, developmental, physical, and sensory disabilities and other chronic conditions. In Chapter 10, Marini presents an extensive exploration of the psychosocial implications of caregiving, a topic with significant current relevance that has as yet received far too little attention in rehabilitation counseling. This chapter very effectively details the research on general and disability-specific issues faced by caregivers for people with spinal cord injury, traumatic brain injury, psychiatric and neuromuscular disabilities, and Alzheimer’s disease. An exploration of the process and impact of the difficult decision to transfer a loved one to a long-term care facility concludes this timely and important chapter. In the concluding chapter of this section, Marini returns to a question he identified in the preface as being central to this text, concerning individual differences in psychosocial outcomes among persons with disabilities, and updates the thriving versus succumbing analysis with a review of the factors, conditions, and personal traits of persons who thrive with a disability. Included in this discussion are reviews of key concepts and theories associated with positive psychology, posttraumatic growth, and related topics.
The final section of the text addresses counseling strategies and insights for working with persons with disabilities. In Chapter 12, Millington presents a brief overview of counseling theories and their application in rehabilitation contexts. He reviews theories typically covered in such a chapter (e.g., psychodynamic, humanistic, cognitive-behavioral, and Reality Therapy), as well as several counseling approaches that are less frequently identified but that certainly have relevance and growing application in rehabilitation counseling practice. These include positive psychology, solution-focused counseling, and motivational interviewing. Career counseling theories and psychosocial rehabilitation concepts are also briefly discussed. Although the title of the chapter (“Which counseling theories and techniques work best with different disability populations and why”) is incongruent with its contents, Millington provides an effective and helpful introductory-level overview, including, for each theory, a sampling of relevant rehabilitation research concerning the theory’s application in practice. In the subsequent chapter on counseling families, Millington deftly identifies the significant structural and professional challenges to the inclusion of the family in rehabilitation counseling, and the importance and benefit of such inclusion. His exploration goes further than these frequently made observations, however, and in the course of his review of family counseling theories and techniques, he identifies specific steps that should be taken to ameliorate this disjunction, including revisions to counselor training and the application of emerging counseling approaches. This chapter will prove an excellent introduction to family counseling theory and rehabilitation issues.
In Chapter 14, Glover-Graf explores ethical responsibilities in working with persons with disabilities. Students and educators will find this a most helpful and informative analysis that goes beyond the typically identified ethical issues for rehabilitation counselors. For example, Glover-Graf discusses not only ethical decision-making and frequently occurring rehabilitation counseling ethical questions/dilemmas but also several very relevant and emerging disability issues, such as biotechnology, end-of-life counseling and assisted suicide, AIDS/HIV and the duty to warn, and reproductive technologies. Glover-Graf’s discussion in this chapter, as in her chapter on sexuality and disability, is notable for its introduction of critically important issues and questions that have not received sufficient prior attention. Chapter 15 is a highly practical and aptly titled review of “Basic do’s and don’ts in counseling persons with disabilities,” which includes a current annotation of Beatrice Wright’s value-laden principles, and what will be a very helpful review of disability etiquette. The text concludes with a call for rehabilitation professionals to provide a holistic approach to their work, and for increased professional attention to several underemphasized areas of research and practice, including social justice, advocacy, and participatory action research.
In summary, the authors have produced a text that will prove an informative and thought-provoking introduction or review of the psychosocial aspects of disability, useful for students and professionals in rehabilitation counseling and other health professions. This volume is notable for its scope and its expansive perspective on the topics that fall under the broad “psychosocial” umbrella. For introducing and exploring a number of issues that have very real implications for persons with disabilities, but that received too little attention in the literature, the authors are to be applauded. Furthermore, the innovative approach of incorporating first-person accounts proves a very effective mechanism for bridging the gap between the realm of professional discourse and the lived experience of disability and rehabilitation.
As noted above, unlike several of the recent psychosocial texts that provide a more focused and in-depth analysis of the topics of psychosocial adaptation/adjustment and coping, the content in these areas is limited. The analysis of that critical psychosocial question—why do some people experience more positive outcomes than others—which is identified in the preface as a central concern of the authors, does not receive explicit attention again until the latter half of the book. However, the scope of the present volume is decidedly broad and comprehensive, and aspects of psychosocial experience are explored here that are not addressed in other psychosocial texts. In terms of considerations for revisions in the future editions that I fully expect will be forthcoming, there are a few passages in the text that would benefit from additional editing, and the titles of several chapters could be either more representative of the content or more descriptive. These are minor observations, however, in what is a very positive overall impression of this original, informative, and thoughtfully produced addition to the body of psychosocial aspects of disability literature.