Spirituality in Rehabilitation Counseling of Adults With Physical Disabilities: Views of Practitioners Across Countries

Abstract

The purpose of the study is to understand the views of practitioners across countries, on spirituality for rehabilitation counseling of adults with congenital and acquired disabilities. A survey of 1,269 practitioners in the field of disability across 15 countries was conducted. Results showed that practitioners had a favorable view of spirituality. Logistic regression results highlight several cross-country nuances in practitioners’ views toward spirituality for rehabilitation counseling, and more so, differentials in terms of adults with congenital and acquired physical disabilities. Practitioners who focused on a client-centered approach vis-à-vis those who diversified also into macro-level work of networking and advocacy, and specifically those who had high self-reported spirituality, proposed that for adults with congenital physical disabilities, spirituality enabled living with disabilities, as against a rationalization and justification of the disability. They favored mindfulness techniques as the modes of working with the clients and reported that by cultivating relational consciousness, spirituality enabled meeting the social goal of rehabilitation counseling. Furthermore, practitioners from affluent nations placed a premium on the deconstructing potential of spirituality and its facilitative role in enabling the clients themselves, and significant others, to transcend the ability/disability binary. The study foregrounds the importance of spiritually sensitive approaches in rehabilitation counseling.

Keywords

spirituality rehabilitation counseling disability practitioners

Introduction

Much has been written about spirituality and disability, where spirituality is seen as having a positive and protective influence in coping and living with disabilities (Wachholtz & Pearce, 2009; Zwingmann, Muller, Korber, & Murken, 2008). Among persons with chronic illness and disabilities, numerous researchers have reported clients’ desires to include their religious/spiritual beliefs in their healing process (Rippentrop, 2005). Findings highlight positive effects on healing, coping, and adjusting to disability, through spiritual beliefs and practices (Breslin & Lewis, 2008).

Kubler-Ross’s (1969) stages of grief/bereavement, of which communication with God is an integral part, have been modified to explain adjustment to a variety of personal losses, including illness or acquisition of disability (Maciejewski, Zhang, Block, & Prigerson, 2007). The idea is to focus on beliefs of clients with disability, their preferences, and develop adaptive worldviews (Rose, Westefeld, & Ansley, 2001). Spirituality is primarily seen as an important coping strategy, for mental health reasons, for persons with disabilities including spinal cord injuries, as a form of acquired disability (Johnstone, Glass, & Oliver, 2007; Matheis, Tulsky, & Matheis, 2006). Livneh (1991), in his description of the stages of adjustment to physical disability, described how some injured individuals and family members pray and attempt to “bargain” with God to be cured of the disability. Some recent models also point to a stage of bargaining with God for improvement or a cure through contingent prayerful interactions (Rodriguez, Glover-Graf, & Blanco, 2013). Subsequently, in the recovery process, some persons with disabilities are also reported to view their injury as punishment for having sinned; others believe they have been given their disability to serve some higher purpose (see also Kim, Lee, & Bezyak, 2016).

Post an acquired disability, McColl et al. (2000) explored changes in spiritual beliefs, finding a positive impact of spirituality. They noted that respondents expressed a greater awareness of self; a sense of purpose in life not present before their injury; a change in view of their own independence; a new understanding of trust; a greater appreciation and closeness with others, the world, or God; a sense of their own mortality and vulnerability, and a better understanding of other disadvantaged groups. The authors note how the 16 study participants had become spiritually wise, and had essentially developed positive coping strategies through their beliefs.

The spirituality of people with disabilities can thus be a valuable source of social and psychological support. Benefits of good quality spiritual care include improved relationships with self, others, and with God/creation/nature and a new sense of meaning, resulting in a reawakening of hope and peace of mind, enabling people to accept and live with problems not yet resolved (Narayanasamy & Owen, 2001; Zhang, 2010). According to Narayanasamy, Gates, and Swinton (2002), the spiritual aspect can be a vital source of meaning-making, friendship, acceptance, and self-worth, especially for persons with disabilities.

Disability literature now proactively takes a spiritually sensitive approach to practice (Hurst, 2008), beginning from the spiritual starting point of the client to build resilience (Clarke & Cardman, 2002), for their rehabilitation (Wrigley & Lagory, 2008) and wellness (Snook & Oliver, 2015). Rehabilitation counseling educators and researchers have emphasized the importance of educating aspiring rehabilitation practitioners about spirituality and religion as it pertains to adjustment to disability (Reyes-Ortiz, 2006). Marini and Glover-Graf (2010) reported that 73.4% persons with spinal cord injuries considered themselves to be religious/spiritual. Thus, the challenge for rehabilitation professionals is primarily to discover how individuals can benefit from existing spiritual beliefs and practices. This may include direct exploration of spiritual and religious beliefs with clients, although some may wish to keep their religious/spiritual beliefs private and prefer to work with family, ministers, rabbis, priests, or some other source (Bell et al., 2005).

With respect to rehabilitation counseling, attention is now being paid to training practitioners to build on clients’ religion and spirituality (Higashida, 2016; Oxhandler & Pargament, 2014). This makes a case for understanding whether and how professionals/practitioners view the role of spirituality in rehabilitation counseling of persons with disability. The focus here is on spirituality and rehabilitation counseling for adults with congenital and acquired physical disabilities. The spirituality literature has focused more on mental health and wellness, or coping (Meredith, Murray, Wilson, Mitchel, & Hutch, 2012; Naghi, Philip, Phan, Cleenewerck, & Schwarz, 2012). Fewer studies are available on those specifically with physical disabilities and spiritual interventions. Physical disabilities affect employment (Anderson, Dumont, Azzaria, Le Bourdais, & Noreau, 2007; Anderson & Vogel, 2002), education (Krause & Anson, 1997), and quality of life (Krause, Terza, & Dismuke, 2008; Marini & Glover-Graf, 2011).

The purpose of the study is to understand practitioners’ views across country contexts, on spirituality in rehabilitation counseling for adults with congenital and acquired physical disabilities. Based on the insights and views of diverse practitioners, implications for a nuanced and spiritually sensitive practice and rehabilitation counseling of persons with physical disability are explored.

Data and Method

The main objective of the study is to understand the views of practitioners on spirituality in rehabilitation counseling of adults with physical disabilities. The specific research questions are as follows:

Research Question 1: What are the practitioners’ views on spirituality and spiritual techniques for adults with congenital and acquired physical disabilities?

Research Question 2: How do practitioners view the role of spirituality and spiritual techniques in meeting the psychological, social, and vocational function goals of rehabilitation counseling for adults with congenital and acquired physical disabilities? More specifically, what role does spirituality play in meeting the psychological goals of well-being, social goals of better social adjustment, and vocational function goals of occupational/job satisfaction and attainment of adults with physical disabilities?

To address these specific research questions, a cross-country survey has been conducted.

Sampling

Sampling was conducted in two stages. At the first stage, 15 countries across the globe were selected and within each, social work/service organizations working with adults with physical disabilities were identified initially through the available databases from the nodal/apex bodies, and then after the initial contact via email, the list of organizations for the study were finalized based on permissions obtained from the organizational authorities as well as access to their staff/practitioners. The country-wise number of organizations identified was as follows: the United States (24), the United Kingdom (18), Australia (17), India (17), Canada (16), South Africa (14), Egypt (13), France (13), China (12), Germany (12), Japan (12), Singapore (12), Spain (12), New Zealand (8) and Czech Republic (7). Of the total 207 organization, majority (159) were urban-based and 48 organizations worked in both urban and rural or countryside areas of the countries. A majority (89%) of the organizations were faith-based (i.e., either church-based, congregation run or run by religious charities). From the 207 organizations, a list of 5,132 practitioners was obtained who were willing to participate in the study. An initial questionnaire was sent to all practitioners inquiring whether they would like to participate in a study on spirituality and rehabilitation counseling. Furthermore, the practitioners were given broad categories of congenital and acquired physical disabilities, and their perceived effect of spirituality in dealing with those was examined.

Of the 5,132 practitioners, 4,998 practitioners replied in the affirmative, to this first email. Using systematic sampling (k = 4), a sample of 1,296 practitioners was identified, keeping in view time and cost considerations. As the participation was voluntary, though no formal incentive was provided, all the respondents were sent appreciation notes after completing the questionnaire.

Method

An email questionnaire was administered. The English version was considered primary. The questionnaire was also translated into French, German, Mandarin, Spanish, and Japanese using the method of translation, back translation, and retranslation. Services of the official translators were used. Majority (87%) of the respondents answered the English version. The questionnaire comprised basic background profile questions on the practitioners and two scales to measure their self-reported spiritual experiences: The Daily Spiritual Experiences Scale (DSES) and the Spiritual Experiences Index–Revised (SEI-R). The DSES, developed by Underwood and Teresi (2002) is 16-item self-report measure designed to assess ordinary experiences of connection with the transcendent in daily life. The first 15 items of the questionnaire are measured on a 6-point Likert-type scale. Item 16, which is about feeling of closeness to God, is measured on a 4-point scale. The crude total score is 16 to 94; however, mean scores are considered as more useful for analysis (Underwood, 2011; Cronbach’s α = .84; item-scale inter correlation = .93; Pearson’s r = .91).

The SEI-R developed by Genia (1997) is a 23-item scale that measures faith and spiritual journey, aiming to not impose any particular faith as part of the questions. It contains two subscales: Spiritual Support (13 questions) and Spiritual Openness (10 questions) on 6-point ratings. Four items in the Spiritual Openness subscale are reverse-scored. Each subscale is scored separately. For the Spiritual Support subscale, the score ranges from 13 to 88 (Cronbach’s α = .95; item-scale inter correlation = .88; Pearson’s r = .93). For the Spiritual Openness subscale, the score ranges from 10 to 60 (Cronbach’s α = .92; item-scale inter correlation = .86; Pearson’s r = .93). The scales were checked for cross-country validity and reliability.

Instruments

In relating to the core study objectives, the questionnaire comprised 10 semi-open-ended questions on practitioners’ views on spirituality for adults with physical disabilities, spiritual techniques, and views on spirituality in meeting psychological, social, and vocational training goals of adults with physical disabilities. Based on the available conceptual and empirical literature, the following categorizations of responses were offered in the questions. For adults with congenital physical disabilities, spirituality could enable living with disabilities or rationalize and justify the disabling conditions (Abraido-Lanza, Vasquez, & Echeverria, 2004; Glover & Blankenship, 2007; Glover-Graf, Marini, Baker, & Buck, 2007). For those with acquired disabilities, spirituality could be a means to cope with and accept the reality and also sublimate (Marini & Glover-Graf, 2010; Ming-Yi & Fong, 2007). Mindfulness techniques and focus on building a relational consciousness could work as spiritual techniques for persons with congenital physical disabilities (Boero et al., 2005; Schalock & Verdugo Alonso, 2002). For those with acquired disabilities, the focus on letting go and building strength and resilience are critical (Brennan, 2002; Selway & Ashman, 1998).

Empirical literature has discussed how spirituality can meet the psychological goals of rehabilitation counseling for persons with disability by facilitating self-acceptance, positive negotiation, adjustment, well-being, peace, and wellness (DiLorenzo, Becker-Feigeles, Halper, & Picone, 2008; Revheim, Greenberg, & Citrome, 2010; Wirth & Bussing, 2015). Conceptually, spirituality can meet social goals of rehabilitation counseling by cultivating a relational consciousness (i.e., positive and enabling relationships with self and others; Conner, 2010; Picard, 2009; Reinders, 2008; Skar, Folkestad, Smedal, & Grytten, 2014) and deconstructing notions of disability by transcending the ability/disability binaries (Boswell, Knight, & Hamer, 2001; Yong, 2007). This then extends to vocational goals in terms of negotiating for equal access and opportunities, equity, and repositioned vocational goals (Higashida, 2016; Muscott & Melloy, 2001; Selway & Ashman, 1998).

Analysis

Data were analyzed using the STATA 13 computer package. Themes emerging from the semi-open-ended questions have been manually coded and the response categories have been accordingly organized, fitted into the given conceptual categorizations.

Two cycles or levels of coding have been done with the qualitative data, by the researcher. At the first level, descriptive coding was done, which entailed summarizing in a word or phrase, the basic topic of a qualitative passage. At the second level, pattern coding was done, which meant deriving explanatory or inferential codes, which identified an emergent theme, configuration, or explanation (Saldana, 2009). Based on the existing conceptual categories and the descriptive codes, material was pulled together into parsimonious units of analyses or metacodes so as to develop binary thematic codes for the binary logistic regression analyses.

Ten logistic regression models have been developed to determine practitioner profile predictors of their views on spirituality for adults with congenital and acquired disabilities, spiritual techniques, and role of spirituality in meeting psychological, social, and vocational function goals in rehabilitation counseling of adults with physical disabilities (congenital and acquired). For all the log regression models, nominal/categorical predictor variables were suitably translated into binary/dummy variables for the analysis. The following binaries were created of the predictor variables: domicile country (European countries, the United States, the United Kingdom, Canada, Australia, Asian, and African countries), age (31–50 years, 51–60 years), gender (women, men), religion (Christians, others), educational qualifications (master’s degree in rehabilitation counseling, master’s degree in social work), duration of service (more than 10 years, up to 10 years), work profile (client-centered work, client-centered work and macro networking and advocacy), and DSES, Spiritual Support, and Spiritual Openness subscale scores of SEI-R (above mean scores, below mean scores).

The purpose of the analytical trajectory is twofold: to understand cross-country views of disability practitioners on spirituality in rehabilitation counseling, and based on those views, to understand nuances of how spiritual interventions can be used with the said clientele.

Practitioner Profiles

Of the 1,296 practitioners, the country-wise distribution was as follows: India (14%), the United States (13%), Australia (7%), China (7%), South Africa (7%), Canada (6%), France (6%), Germany (6%), Japan (6%), Singapore (6%), the United Kingdom (6%), Egypt (5%), Czech Republic (4%), Spain (4%), and New Zealand (3%). Roughly 36% of the practitioners were in the age group 31 to 40 years, 28% were in the age group 41 to 50 years, and 36% were in the age group 51 to 60 years. Approximately 68% were women and 32% were men. Approximately 61% were Christians, 11% were Hindus, 8% were Buddhists, 6% were Jews, and 14% were Muslims. Majority (78%) had a master’s degree in rehabilitation counseling. Roughly 22% had a master’s degree in social work with either a specialization or a minor in disability studies/disability practice. Those who had a master’s degree in rehabilitation counseling were trained in countries that had rehabilitation counseling programs located either in schools/departments of education, special education, educational psychology, or social work. Those who had a master’s degree in social work either specialized in disability studies/practice through selection of disability specific coursework and field work in the second year of the master’s program or minored in disability practice by selecting minimum six credits/three courses in the entire 2-year-program duration (usually of 56–78 credits).

An estimated 33% had up to 10 years of service experience in the field. Approximately 67% had more than 10 years of service experience in the field of social work in disability and rehabilitation. All the practitioners worked as rehabilitation counselors (i.e., this was their work title as per the official records and payrolls, in the respective organizations). Majority (61%) of the practitioners focused on client-centered work in rehabilitation counseling. This means that they used a combination of person-centered and Rogerian counseling techniques. Roughly 39% also engaged in macro-level networking and advocacy work in the area of disability and rehabilitation counseling.

Results

Practitioners’ Self-Reported Spirituality Scores

The average DSES score was 52.89 (SD = 6.32). Approximately 36% of the practitioners had scores below the mean score and 64% of them had scores above mean score. The average score on the Spiritual Support subscale of SEI-R was 79.87 (SD = 9.95). Approximately 44% of the practitioners had scores below mean scores on the Spiritual Support subscale and 56% had above mean level scores. The average score on the Spiritual Openness subscale of the SEI-R was 37.43 (SD = 6.03). Approximately 31% of the practitioners had scores below mean scores on the Spiritual Openness subscale and 69% of them had scores above mean scores. Roughly 28% of the practitioners reported that spirituality meant transcendence and mysticism.

Approximately 47% of the practitioners reported that spirituality was about a relational consciousness (i.e., having and maintaining harmonious relationships between self, others, and the Absolute). Approximately 25% of the practitioners reported that spirituality was about unity, peace, equity, mindfulness, and unconditional love and forgiveness.

Practitioners’ Views on Spirituality for Adults With Congenital Physical Disabilities

Approximately 68% of the practitioners reported that for adults with congenital physical disabilities, spirituality enabled living with disabilities. Roughly 32% of them indicated that spirituality enabled rationalization and justification of disabling conditions. The logistic regression model indicates that the predictors as a set reliably distinguished between practitioners who reported that spirituality enabled adults with congenital disabilities to live with peculiarities vis-à-vis those who indicated that spirituality enabled rationalization and justification of their disabling conditions, likelihood ratio (LR)χ²(9) = 38.02, Prob. > χ² = .0001. Prediction success was 36.02% (pseudo R² = .3602). The odds ratio of the predictors work profile, DSES scores, and Spiritual Openness subscale scores is greater than one. This means that practitioners focusing on client-centered work, those having higher DSES scores and higher Spiritual Openness subscale scores, were more likely to say that for adults with congenital physical disabilities, spirituality enabled living with disabilities.

Practitioners’ Views on Spirituality for Adults With Acquired Physical Disabilities

Roughly 61% of the practitioners reported that for adults with acquired disabilities, spirituality enabled affirmative acceptance of the situation/condition. Approximately 39% of them reported that spirituality for adults with acquired disabilities enabled sublimating undesirable realities. The logistic regression model indicates that the predictors as a set reliably distinguished between practitioners who indicated that spirituality enabled adults with acquired disabilities to affirmatively accept the situation/condition vis-à-vis those who reported that spirituality enabled sublimating undesirable realities, LRχ²(9) = 72.13, Prob. > χ² = .0001. Prediction success was 34.12% (pseudo R² = .3412). The odds ratio of the predictors country, service duration, work profile, and Spiritual Openness subscale scores is greater than one. This means that practitioners from European countries, the United States, the United Kingdom, Canada, Australia, and New Zealand; those who had more than 10 years of service in the field; those who did client-centered work; and those who had higher scores on the Spiritual Openness subscale were more likely to say that for adults with acquired physical disabilities, spirituality enabled accepting the situation/condition in an affirmative manner.

Views on Spiritual Techniques for Adults With Congenital Physical Disabilities

Roughly 54% of the practitioners reported that the core spiritual technique to work with adults having congenital physical disabilities is mindfulness. Approximately 46% of them reported that the core technique was proactive building of a meaningful relational consciousness. The logistic regression model indicates that the predictors as a set reliably distinguished between practitioners who favored mindfulness vis-à-vis those who proposed the core technique as proactive building of relational consciousness, LRχ²(9) = 68.19, Prob. > χ² = .0001. Prediction success was 28.16% (pseudo R² = .2816). The odds ratio of the predictors DSES scores, Spiritual Support subscale score, and Spiritual Openness subscale score is greater than one. This means that those practitioners who had higher scores on self-reported Spiritual Experiences scale, Spiritual Openness, and Spiritual Support subscales were more likely to support for mindfulness as the core spiritual technique in working with adults having congenital physical disabilities.

Views on Spiritual Techniques for Adults With Acquired Physical Disabilities

Approximately 56% of the practitioners reported that the core spiritual technique of working with adults having acquired physical disabilities is building inner strength and resilience. An estimated 44% of them reported that the core technique should comprise letting go, forgiveness, and sublimation. The logistic regression model indicates that the predictors as a set reliably distinguished between those practitioners who argued for building inner strength and resilience as the core technique vis-à-vis those who reported that the core technique should be letting go, forgiveness, and sublimation, LRχ²(9) = 78.12, Prob. > χ² = .0001. Prediction success was 31.17% (pseudo R² = .3117). The odds ratio of the predictors country, religion, work profile, DSES scores, and Spiritual Openness subscale scores is greater than one. This means that practitioners from European countries, the United States, the United Kingdom, Canada, Australia, and New Zealand, Christians; those who focused on client-centered work; and those who had higher scores on the DSES and Spiritual Openness subscale of SEI-R were more likely to support for building inner strength and resilience as the core spiritual technique in working with adults having acquired physical disabilities.

Views on Spirituality in Meeting Psychological Goals of Rehabilitation Counseling for Adults With Congenital Physical Disabilities

Approximately 53% of the practitioners reported that spirituality facilitated meeting the psychological goals of rehabilitation counseling of persons with congenital physical disabilities by focusing on their acceptance of own distinctive self and proactive negotiation through this selfhood. Roughly 47% of them reported that spirituality played a role in rehabilitation counseling for positive psychological adjustment and psychological well-being of persons with congenital physical disabilities. The logistic regression model (see Table 1) indicates that the predictors as a set reliably distinguished between practitioners who reported that spirituality in rehabilitation counseling of persons with congenital physical disabilities facilitated distinctive self acceptance-proactive negotiation vis-à-vis those who reported that it meant psychological adjustment and well-being, LRχ²(9) = 69.02, Prob. > χ² = .0001. Prediction success was 23.18% (pseudo R² = .2318). The odds ratio of the predictors country, religion, and DSES scores is greater than one. This means that practitioners from European countries, the United Kingdom, the United States, Canada, Australia, and New Zealand; Christians, and those who had higher DSES scores were more likely to say that spirituality facilitated meeting the psychological goals of rehabilitation counseling for persons with congenital physical disabilities by focusing on their distinctive self-acceptance and proactive negotiation of this selfhood.

Table 1.

Logistic Regression—Predictors of Practitioners’ Views on Spirituality in Meeting Psychological Goals of Rehabilitation Counseling for Adults With Congenital Physical Disabilities (Accepting the Distinctive Self and Proactive Negotiation = 1, Positive Adjustment and Well-Being = 0).

Views on spirituality in meeting psychological goals of rehabilitation counseling for adults with congenital physical disabilities (accepting-negotiation = 1, adjustment-well-being = 0)	Odds ratio	SE	t	P > \|t\|	95% CI
Constant	7.18	.3729	3.17	.03	4.5629	8.1987
Country	1.18	.6729	2.38	.02	0.6783	6.7092
Age	0.98	.4782	3.19	.07	0.1498	2.1139
Gender	0.97	.3894	2.11	.08	0.1973	3.0964
Religion	1.09	.7329	3.96	.03	0.1972	4.1396
Education	0.93	.3894	2.19	.18	0.1139	3.0976
Service duration	0.94	.3289	2.23	.91	0.4892	4.1139
Work profile	0.91	.8983	3.39	.71	0.8939	3.1198
DSES scores	1.02	.1627	4.01	.02	0.8172	6.1526
SEI-R SS subscale scores	0.98	.2336	2.38	.29	0.8713	8.9913
SEI-R SO subscale scores	0.93	.6152	1.89	.18	0.8723	3.1156

Note. CI = confidence interval; DSES = Daily Spiritual Experiences Scale; SEI-R = Spiritual Experiences Index–Revised; SS = Spiritual Support; SO = Spiritual Openness.

Views on Spirituality in Meeting Psychological Goals of Rehabilitation Counseling for Adults With Acquired Physical Disabilities

Approximately 62% of the practitioners saw spirituality’s role in meeting the psychological goals of rehabilitation counseling for adults with acquired disability as affirmative acceptance and letting go. Roughly 38% of them indicated that for adults with acquired disability, spirituality could be used in rehabilitation counseling for meeting the goal of cultivating peace and wellness. The logistic regression model (see Table 2) indicates that the predictors as a set reliably distinguished between practitioners who indicated that the role of spirituality in meeting psychological goals of rehabilitation counseling for adults with acquired disability was to facilitate affirmative acceptance and letting go vis-à-vis cultivating peace and wellness, LRχ²(9) = 57.18, Prob. > χ² = .0001. Prediction success was 24.19% (pseudo R² = .2419). The odds ratio of the predictors religion, work profile, and DSES scores is greater than one. This means that Christian practitioners, practitioners who focused on client-centered work, and those who had higher DSES scores were more likely to see the role of spirituality in meeting the psychological goals of rehabilitation counseling for adults as facilitating affirmative acceptance of the disability/disabling condition and letting go.

Table 2.

Logistic Regression—Predictors of Practitioners’ Views on Spirituality in Meeting Psychological Goals of Rehabilitation Counseling for Adults With Acquired Physical Disabilities (Affirmative Acceptance and Letting Go = 1, Cultivating Peace and Wellness = 0).

Views on spirituality in meeting psychological goals of rehabilitation counseling for adults with acquired physical disabilities (affirmative acceptance-letting go = 1, cultivating peace and wellness = 0)	Odds ratio	SE	t	P > \|t\|	95% CI
Constant	6.32	.1238	3.18	.04	4.5892	9.0094
Country	0.93	.4382	2.29	.12	0.6893	11.7543
Age	0.97	.4763	3.15	.08	0.1238	4.7182
Gender	0.98	.3718	2.89	.09	0.8923	3.1186
Religion	1.04	.7902	3.14	.03	0.2396	4.6239
Education	0.96	.3653	2.78	.99	0.3196	3.0452
Service duration	0.93	.3774	2.38	.32	0.2186	4.1289
Work profile	1.08	.8905	3.12	.01	−1.0954	4.3027
DSES scores	1.12	.6152	4.05	.02	1.0162	6.0281
SEI-R SS subscale scores	0.98	.2172	3.17	.18	0.9172	6.1143
SEI-R SO subscale scores	0.96	.1173	4.16	.23	0.8172	3.1562

Note. CI = confidence interval; DSES = Daily Spiritual Experiences Scale; SEI-R = Spiritual Experiences Index–Revised; SS = Spiritual Support; SO = Spiritual Openness.

Views on Spirituality in Meeting Social Goals of Rehabilitation Counseling for Adults With Congenital Physical Disabilities

Approximately 67% of the practitioners reported that the spirituality could be deployed in meeting the social goals of rehabilitation counseling for adults with congenital physical disabilities by cultivating a relational consciousness for the client. Roughly 33% of them reported that spirituality met the social goals of rehabilitation counseling for the said group by deconstructing the idea of clients’ disability for significant others and society. The logistic regression model (see Table 3) indicated that the predictors as a set reliably distinguished between those who indicated that spirituality met the social goals by cultivating relational consciousness vis-à-vis those who favored its potential for deconstruction, LRχ²(9) = 86.17, Prob. > χ² = .0001. Prediction success was 34.16% (pseudo R² = .3416). The odds ratio of the predictors country, service duration, work profile, DSES scores, and Spiritual Openness subscale scores is greater than one. This, along with t values, means that practitioners with more than 10 years of service, those focusing on client-centered approach to work, and with higher DSES and Spiritual Openness subscale scores were more likely to propose that spirituality met social goals of rehabilitation counseling for adults with congenital physical disabilities by cultivating a relational consciousness. Practitioners from European countries, the United States, the United Kingdom, Canada, Australia, and New Zealand were more likely to attest that spirituality deconstructed the idea of client’s disability for significant others and society, and hence facilitated the social goals of rehabilitation counseling.

Table 3.

Logistic Regression—Predictors of Practitioners’ Views on Spirituality in Meeting Social Goals of Rehabilitation Counseling for Adults With Congenital Physical Disabilities (Cultivating Relational Consciousness for the Client = 1, Deconstructing the Idea of Clients’ Disabilities for Significant Others and Society = 0).

Views on spirituality in meeting social goals of rehabilitation counseling for adults with congenital physical disabilities (relational consciousness = 1, deconstruction = 0)	Odds ratio	SE	t	P > \|t\|	95% CI
Constant	3.04	.2381	3.19	.03	2.1562	5.298
Country	1.02	.3218	−2.13	.02	−1.1146	11.1290
Age	0.88	.1375	2.38	.07	0.1395	3.4529
Gender	0.93	.1678	3.09	.08	0.1673	5.1296
Religion	0.96	.1387	2.89	.19	0.1128	4.1906
Education	0.99	.8943	3.22	.08	0.1389	3.4486
Service duration	1.19	.3128	4.18	.02	0.1486	4.1389
Work profile	1.09	.6729	4.33	.03	0.1386	5.1139
DSES scores	1.09	.2186	3.12	.02	0.1185	6.1396
SEI-R SS subscale scores	0.93	.3186	2.38	.42	0.1386	6.3329
SEI-R SO subscale scores	1.12	.1241	2.09	.01	0.0812	9.1723

Note. CI = confidence interval; DSES = Daily Spiritual Experiences Scale; SEI-R = Spiritual Experiences Index–Revised; SS = Spiritual Support; SO = Spiritual Openness.

Views on Spirituality in Meeting Social Goals of Rehabilitation Counseling for Adults With Acquired Physical Disabilities

Approximately 64% of the practitioners reported that for adults with acquired disability, spirituality could meet the social goals of rehabilitation counseling by restructuring their relational consciousness, redefining their social relationships with significant others and society. Approximately 36% of them indicated that spirituality could be socially enabling for persons with acquired disability by building client’s potential to enable self and significant others to transcend the ability/disability binary and in effect renegotiate their own social space. The logistic regression model (see Table 4) indicates that the predictors as a set reliably distinguished between practitioners who reported that spirituality restructured their relational consciousness vis-à-vis those who reported that it enabled potential building for clients to transcend the ability/disability binary for self and others, LRχ²(9) = 56.12, Prob. > χ² = .0001. Prediction success was 31.18% (pseudo R² = .3118). The odds ratio of the predictors country, service duration, work profile, DSES scores, and Spiritual Openness subscale scores is greater than one. This, along with t values, means that practitioners with more than 10 years of service and those with higher DSES Spiritual Openness subscale scores were more likely to say that for adults with acquired disabilities, spirituality met the social goals of rehabilitation counseling by restructuring their relational consciousness and redefining their social relationships. Practitioners from European countries, the United States, the United Kingdom, Canada, Australia, and New Zealand, and those who worked primarily with a client-centered approach were more likely to say that spirituality could build their potential to enable self and significant others to transcend the ability/disability binary.

Table 4.

Logistic Regression—Predictors of Practitioners’ Views on Spirituality in Meeting Social Goals of Rehabilitation Counseling for Adults With Acquired Physical Disabilities (Restructuring Relational Consciousness = 1, Building Clients’ Potential to Enable Self and Significant Others to Transcend the Ability/Disability Binary = 0).

Views on spirituality in meeting social goals of rehabilitation counseling for adults with acquired disability (restructuring relational consciousness = 1, transcending binaries = 0)	Odds ratio	SE	t	P > \|t\|	95% CI
Constant	3.14	.3278	2.13	.03	1.1568	5.1129
Country	1.09	.2138	−2.89	.01	−4.1269	4.1138
Age	0.93	.3186	2.33	.09	0.1148	3.0976
Gender	0.93	.2138	3.18	.08	0.1489	4.0927
Religion	0.88	.3291	4.12	.27	0.1823	3.0976
Education	0.93	.4287	3.87	.85	0.1896	2.1138
Service duration	1.10	.1367	3.18	.03	0.1378	5.1137
Work profile	1.05	.1268	−3.12	.02	−4.1286	3.1187
DSES scores	1.08	.2386	3.22	.01	1.0469	6.9067
SEI-R SS subscale scores	0.92	.3419	4.18	.08	0.1732	5.1196
SEI-R SO subscale scores	1.12	.1426	5.12	.03	1.0816	3.7712

Note. CI = confidence interval; DSES = Daily Spiritual Experiences Scale; SEI-R = Spiritual Experiences Index–Revised; SS = Spiritual Support; SO = Spiritual Openness.

Views on Spirituality in Meeting Vocational Function Goals of Rehabilitation Counseling for Adults With Congenital Physical Disabilities

Majority (76%) of the practitioners indicated that spirituality enabled meeting the vocational function goals of rehabilitation counseling for congenitally adults with physical disabilities by building clients innate potential to lobby for equal access, attainment, and opportunities. Approximately 24% of them reported that this was through foregrounding notions of equity in their vocations. The logistic regression model (see Table 5) indicates that the predictors as a set reliably distinguished between practitioners who reported that spirituality built the innate potential of clients with congenital physical disability to lobby for equality vis-à-vis those who indicated that in general, spirituality foregrounded notions of equity, LRχ²(9) = 81.12, Prob. > χ² = .0001. Prediction success was 28.17% (pseudo R² = .2817). The odds ratio of the predictors country, service duration, work profile, and DSES scores is greater than one. This means that practitioners from European countries, the United States, the United Kingdom, Canada, Australia, and New Zealand; those who had more than 10 years of service; those who focused on client-centered work; and those who had higher DSES scores were more likely to say that spirituality built the innate potential of the congenitally adults with physical disabilities to lobby for equal access, attainment, and opportunities.

Table 5.

Logistic Regression—Predictors of Practitioners’ Views on Spirituality in Meeting Vocational Function Goals of Rehabilitation Counseling for Adults With Congenital Physical Disabilities (Building Clients’ Innate Potential to Lobby for Equal Access, Attainment, and Opportunity = 1; Foregrounding Notions of Equity = 0).

Views on spirituality in meeting the vocational function goals of rehabilitation counseling for adults with congenital physical disability (equal access, attainment, and opportunity = 1; foregrounding notions of equity = 0)	Odds ratio	SE	t	P > \|t\|	95% CI
Constant	2.89	.3256	2.75	.03	1.4475	8.1397
Country	1.16	.1376	2.11	.04	0.3349	3.1128
Age	0.94	.2156	1.87	.89	0.4678	4.1235
Gender	0.92	.3452	1.76	.08	0.3287	5.1534
Religion	0.95	.7629	2.33	.07	0.2086	5.9765
Education	0.86	.6513	2.74	.12	0.6785	6.1325
Service duration	1.19	.1385	3.09	.03	1.0137	5.6732
Work profile	1.15	.2127	3.12	.02	1.0714	4.1194
DSES scores	1.13	.1341	2.76	.02	1.0912	6.2861
SEI-R SS subscale scores	0.93	.1145	4.15	.13	0.2817	3.1126
SEI-R SO subscale scores	0.94	.3981	3.89	.26	0.1192	5.1652

Note. CI = confidence interval; DSES = Daily Spiritual Experiences Scale; SEI-R = Spiritual Experiences Index–Revised; SS = Spiritual Support; SO = Spiritual Openness.

Views on Spirituality in Restoring Vocational Function Goals of Rehabilitation Counseling for Adults With Acquired Physical Disabilities

Approximately 56% of the practitioners reported that spirituality could enable the vocational function goals of rehabilitation counseling for adults with acquired physical disabilities by enabling clients to reposition themselves and re-create vocations. Roughly 44% of them indicated that it enabled revisiting and rationalizing vocational goals of the clients, in the wake of acquired disability. The logistic regression model (see Table 6) indicates that the predictors as a set reliably distinguished between those practitioners who indicated spirituality-enabled clients with acquired physical disabilities to reposition themselves and re-create vocations vis-à-vis those who reported that it enabled them to revisit and rationalize vocational goals, LRχ²(9) = 73.12, Prob. > χ² = .0001. Prediction success was 26.15% (pseudo R² = .2615). The odds ratio of the predictors country, service duration, work profile, and DSES scores is greater than one. This means that practitioners from European countries, the United States, the United Kingdom, Canada, Australia, and New Zealand; those who had more than 10 years of service; those who focused on client-centered work; and those who had higher DSES scores were more likely to say that for adult clients with acquired physical disabilities, spirituality enabled meeting the vocational function goals of rehabilitation counseling by enabling them to reposition themselves and re-create vocations.

Table 6.

Logistic Regression—Predictors of Practitioners’ Views on Spirituality in Restoring Vocational Function Goals of Rehabilitation Counseling for Adults With Acquired Physical Disabilities (Enabling Clients to Reposition Self and Re-Create Vocations = 1, Facilitating Clients to Revisit and Rationalize Vocational Goals in View of Current Realities = 0).

Views on spirituality in restoring vocational function goals of rehabilitation counseling for adults with acquired physical disabilities (reposition self and re-create vocations = 1; revisit and rationalize vocational goals = 0)	Odds ratio	SE	t	P > \|t\|	95% CI
Constant	2.19	.3182	1.32	.03	1.4986	4.1287
Country	1.12	.1276	2.13	.02	0.9907	14.0986
Age	0.92	.8723	1.37	.09	0.1346	5.6095
Gender	0.88	.9872	1.13	.08	0.1128	4.0976
Religion	0.93	.8327	1.28	.13	0.7812	7.1134
Education	0.86	.6215	2.18	.28	0.2186	4.1197
Service duration	1.09	.3286	2.38	.04	0.1673	3.9074
Work profile	1.06	.3765	2.39	.02	1.0135	3.6742
DSES scores	1.13	.1253	3.14	.03	0.9812	6.2416
SEI-R SS subscale scores	0.98	.1138	2.87	.19	0.7162	8.1125
SEI-R SO subscale scores	0.96	.2015	3.19	.23	0.1862	3.1156

Note. CI = confidence interval; DSES = Daily Spiritual Experiences Scale; SEI-R = Spiritual Experiences Index–Revised; SS = Spiritual Support; SO = Spiritual Openness.

Discussion and Conclusion

The study results have shown that practitioners had a favorable view of spirituality for rehabilitation counseling of adults with disabilities. The findings highlight several cross-country nuances in views of practitioners on spirituality for rehabilitation counseling, and more so, differentials in terms of adults with congenital and acquired physical disabilities. Practitioners who focused on a client-centered approach vis-à-vis those who diversified also into macro-level work of networking and advocacy, and specifically those who had high self-reported spirituality in terms of spiritual experiences and openness proposed that for adults with congenital physical disabilities, spirituality enabled living with disabilities (vis-à-vis rationalization and justification of the disability). They favored mindfulness techniques as the modes of working with the clients and reported that by cultivating relational consciousness, spirituality enabled meeting the social goal of rehabilitation counseling.

Specifically practitioners from European countries, the United States, the United Kingdom, Canada, Australia, and New Zealand; Christians; and those with high self-reported spirituality reported that spirituality facilitated meeting the psychological goals of rehabilitation counseling for adults with congenital physical disabilities, by focusing on their distinctive self-acceptance and proactive negotiation of this selfhood. They favored spirituality’s role in deconstructing the idea of client’s disability for significant others and society, and thereby meeting the social goals of rehabilitation counseling. Furthermore, they indicated that spirituality aided meeting the vocational function goals of rehabilitation counseling by building the innate potential of the congenitally adults with physical disabilities to lobby for equal access, attainment, and opportunities.

Different nuances emerged in terms of practitioners’ views on spirituality in rehabilitation counseling for adults with acquired physical disabilities. Practitioners’ self-reported spiritual experiences and client-centered approach to work had a significant influence on practitioners’ views, with practitioners saying that spirituality enabled an affirmative acceptance of disabling conditions and the core spiritual technique as building inner strength and resilience. They reported the role of spirituality in meeting the psychological goals of rehabilitation counseling for adults with acquired disabilities as affirmative acceptance and letting go of grief and pain associated with the disabling condition. Spirituality, according to them, also met the social goals of rehabilitation counseling of adults with acquired disability by restructuring clients’ relational consciousness and redefining their social relationships. Moreover, vocational function goals for these clients could be redefined through spirituality, by enabling them to reposition themselves and re-create vocations. Practitioners from European countries, the United States, the United Kingdom, Canada, Australia, and New Zealand indicated that spirituality could build clients’ potential to enable self and significant others to transcend the ability/disability binary. They also proposed that for adult clients with acquired physical disabilities, spirituality enabled meeting the vocational function goals of rehabilitation counseling by enabling them to reposition themselves and re-create vocations.

Hence, essentially practitioners made subtle distinctions in the way they saw the role of spirituality for rehabilitation counseling of adults with acquired and congenital disabilities. Two core findings are practitioners own spiritual experiences and self-reported spirituality influence views on the form of spiritually sensitive interventions for adults with congenital and acquired physical disabilities and practitioners from affluent nations (the United States, the United Kingdom, Canada, Australia, and European countries) are able to root for the deconstructing potential of spirituality (i.e., its facilitative role in enabling the clients themselves, and significant others, to transcend the ability/disability binary). Overall, the study results add to the limited studies on rehabilitation counselors’ views on spirituality and spiritual interventions, which could be used to gauge their readiness and inclination in doing so, as well as bolster their corresponding skill-set (e.g., Baldacchino, 2008; Barry & Gibbens, 2011; Cooper, Chang, Sheehan, & Johnson, 2013; Peterson, Johnson, & Tenzek, 2010).

The main limitation of the study is the lack of qualitative narratives of practitioners’ experiences of spiritual interventions. Although self-reported spirituality is a predictor, practitioners’ training in spiritually sensitive interventions or otherwise has not been measured. The study also does not focus on the compounding effects of client variables, and disability onset and severity in the plausibility of use of spiritually sensitive interventions. Furthermore, the study has limitations of sampling and response bias. However, in the absence of any available literature on cross-country views of practitioners on spirituality in rehabilitation counseling of persons with physical disability, few insights on further research are obtained through the study findings. More research is required on how practitioners view spiritual interventions for persons with disability, through the intervening effects of background variables of persons with disability themselves, such as class, age, onset and severity of disability, religion, and clients’ own spiritual starting point.

Implications of the Findings

The study has implications for work with adults with physical disabilities, having congenital and acquired disabilities. The results have highlighted, through practitioners’ views, nuances of spiritual techniques that can be used, and the distinctive contributions of spirituality to meet the psychological, social, and vocational function goals of rehabilitation counseling for adults with congenital and acquired physical disabilities.

Results foreground the following important applications for spiritually sensitive interventions in working with adults with physical disabilities, and the efficacy is further confounded by practitioners’ own spiritual leanings as characteristic of this genre of practice. For adults with congenital physical disabilities, spiritual techniques can aid coping with disabilities, rationalization, and justification of disabling conditions. When the disability is an acquired condition, spiritual techniques could be used to enable acceptance and, at times, sublimate the undesirable. Practitioners from affluent nations focused more on the acceptance part vis-à-vis their Asian and African country counterparts who saw the role of spirituality for disability as sublimating undesirable realities.

The techniques that practitioners saw as effective included mindfulness, proactive building of relational consciousness, building inner strength and resilience and letting go, forgiveness, and sublimation. Specifically practitioners from Asian and African countries focused on letting go and sublimation, foregrounding thereby the transcendental function of spirituality as more important for adults with disabilities (specifically acquired disabilities) vis-à-vis centering and inward looking (as attested by affluent country practitioners).

Goal setting in rehabilitation counseling entails three broad norms: psychological goals, social goals, and vocational function goals. Results suggest that preferred psychological goals are acceptance, adjustment, and well-being. Cultivating a relational consciousness for the client and deconstructing popular notions that disability is a pathological condition or as an inferior position in the ability/disability binary, comprise the social goals. Specifically, practitioners from Asian and African countries seconded the latter goal of spiritually motivated deconstruction of disability. This becomes a culturally significant variant in determining the said social goals. Furthermore, the preferred vocational function goals are lobbying for equal access in occupations, attainment and opportunities and concomitant equity for adults with congenital disabilities in the sphere of employment, and repositioning or rationalizing expectations related to occupations for adults with acquired disabilities.

Footnotes

Ethical Approval

This article does not contain any experiments with human participants or animals performed by any of the authors. Informed consent was obtained from all individual participant respondents (i.e., the rehabilitation counselors) included in the study.

Declaration of Conflicting Interests

The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author received no financial support for the research, authorship, and/or publication of this article.

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