Strengths Based Counselling For Persons With Disability

Abstract:
Disability is often misunderstood and a person with disability is consequently excluded by the society. This has led to non-recognition of the full capacity of the person with disability, thus de-valuing him or her and relegating this person further to the margins. Strengths approach is a relevant paradigm that social workers can use to enhance the capacities of intervention with a person with disability. Using a case illustration, this article highlights the application of strengths based practice in disability counseling.

Introduction:
World Health Organization (1976) defines, disability as a condition or function judged to be significantly impaired relative to the usual standard of an individual or group. The term is used to refer to individual functioning, including physical impairment, sensory impairment, cognitive impairment, intellectual impairment mental illness, and various types of chronic disease.

Disability has a multidimensional experience for the person involved. There may be effects on organs or body parts and there may be effects on a person's participation in areas of life. Correspondingly, three dimensions of disability are recognized in International Classification of Functioning (2001) namely, body structure and function(and impairment thereof), activity (and activity restrictions) and participation(and participation restrictions).
 
Types of Disabilities
The types of disabilities include various physical, sensory and mental impairments that can hamper or reduce a person's ability to carry out his day to day activities. These impairments can be termed as disability of the person to do his or her day to day activities. These impairments can be termed as disability of the person to do his day to day activities as previously. "Disability" can be broken down into a number of broad sub-categories, which include mobility related impairments, sensory impairments such as visual, speech or hearing impairments, intellectual impairments including mental retardation or autism, mental illness, leprosy cured, and learning disability.
 
Causes of Disability:
The common and main causes of disability are infection in early childhood, consanguineous marriages, poor health status of the mother, early or late motherhood, inadequate and poor hygiene and sanitation, trauma / poor mental state of the mother, age related disabilities, and accidents.
 
From a Medical to Social Model:
While the medical model focussed on the impairment and the medical construct of disability, the widely emerging and accepted model of disability is now the social model.  The change began when people with impairments were disabled by the fact that they were excluded from participation within the mainstream of society as a result of physical, organisational and attitudinal barriers. These barriers prevented them from gaining equal access to information, education, employment, public transport, housing and social/recreational opportunities.

Anti-discrimination legislation, equal-opportunity policies and programmes of positive action have arisen because it is now more widely recognised that disabled people are unnecessarily and unjustly restricted in or prevented from taking part in a whole range of social activities which non-disabled people access and take for granted. The social model postulates that a person is disabled because of architectural, attitudinal and social barriers created by the society (www.open.ac.uk). The social model presents disability as a consequence of oppression, prejudice and discrimination by the society against disabled people. With widespread global awareness and in the perspective of human rights, the focus in the early nineties shifted towards an inclusive society and a remarkable change has been seen in the society’s attitude towards persons with disability.

In this scenario affirmative policies and positive discrimination of the government led to legislations that mandated affirmative action, provision of welfare schemes and services that facilitated the growth of the potential of the person with disability, as authorized by the Persons with Disability Act, 1995 in the areas of education, employment and concessions in other areas such as accessibility and so on. This has been re-affirmed and reinforced by the United Nations Convention on the Rights of Persons with Disability, which India has ratified and is thus obligated to implement (2007).
 
Social Stigma and Exclusion: A Two way process:
Although there has been a shift to a social model of disability, there still exists a wide gap between inclusion and exclusion and acceptance at all levels. Despite legislative progress, the experience of families and person with disability reveals that there are certain reservations present in society that hinder people’s acceptance of persons with physical and mental disorders. Additionally,a person with disability and his family also create certain withdrawal and avoidable circumstances to cope with people in society. Decreased social interactions, staying indoors in their “comfort zones” add to further alienation. This two-way interactive process serves to reinforce and perpetuate stigma and excludes persons with disability from partnering and participation in  the family and in the society.
 
Strengths perspective:
The strengths approach attempts to understand clients in terms of their strengths, involving a process of systematically examining survival skills, abilities, knowledge, resources and desires that can be used in some way to help meet client goals (Saleebey, 1996). The helping process from initial contact, goal identification, assessment and intervention to evaluation has the underlying assumptions that human beings have the capacity for growth and change (Weick, 1992), knowledge about one's situation (Early &GlenMaye, 2000), resilience (Garmezy, 1994) and membership (Walzer, 1983). The major focus in practice from the strengths approach is collaboration and partnership between social workers and clients. Other methods include environment modification and advocacy (Early &GlenMaye, 2000).This method has not only emerged as an approach to case management for people with severe mental illness (Saleebey, 1992; Sullivan & Rapp, 1994; Weick,Rapp, Sullivan &Kisthardt, 1989), but also with other client groups. Literature indicates that strengths perspective influences both the well-being and the coping of people with mental illness (Saleebey, 1996; Rapp and Goscha, 2006). When using the strengths approach, the professional builds a perspective that the individual already is doing something to better his/her situation. It is the social worker’s job to help the individual identify the strengths and pursue achievement of the goal(s) of the intervention.      

The strengths approach postulates that everybody (no exceptions here) has external and internal assets, competencies, and resources; we cannot know the upper limits of a person’s capacity to grow and change, challenges offer opportunities for growth, the community is an ‘oasis of naturally occurring resources’, people have a knowledge of what is right for them, every person has some innate resource, collaborating with hopes and possibilities promotes healing, every maladaptive response or pattern of behavior may also contain the seeds for a struggle for health and self-righting, the client is the director of services (Saleebey, 1996 and personal communication).

Thus using the strengths approach in disability counseling is most appropriate as it encourages use of the 3 Ps namely, promise, possibility and positive expectations in the form of hope and optimism (Saleebey, personal communication) in empowering a person with disability to lead an inclusive life. Using a case illustration, we will describe how the strengths approach has provided an affirmative framework of intervention.

Jamila Bi ( name changed for anonymity), aged 25 years, from a conservative Muslim family, has polio in her lower limbs. She got polio when she was 2 years old after a severe bout of fever. Youngest of 4 sisters, her family was shattered when they found that Jamila would not be able to walk like the other daughters.The father, a rickshaw driver, became involved with his work and stayed out of the house most of the time. The mother Zubeida Bi took it upon her as a challenge to bring up this little girl and make her independent. With this determination, the tryst of the mother and daughter continued for the next fifteen years till Jamila completed her studies.

Jamila continued her therapy at the hospital alongside her education in a local mainstream school.  Life was not easy at home and in school especially during monsoons, as she had to maneuver the narrow by lanes, slippery roads, and inaccessible classrooms. She had to face severe difficulties in surmounting these problems. Jamila would several down on several occasions but her determination was strong. A firm mindset and the belief of the mother saw her through these tough times. Using the unfriendly public toilets in the urban slum was one of her biggest ordeal but the mother helped her even with this task till she could manage on her own.

Extremely bright in studies, Jamila completed her X class and enrolled for higher education in a Junior College opting for Commerce stream. Now using the public transportation was the only choice and Jamila using her crutches and calipers managed this journey for five long years travelling at least 5-7 kms. to college to complete her graduation. Alongside her studies, Jamila used her potential to teach and hence started giving home tuitions to pay for her education. She pushed her boundaries to study hard and thus became the only child in the family to have completed her graduation despite her disability while the others could barely complete their X Std.

Since the completion of her graduate degree, Jamila began to search for a job. She appeared for several entrance examinations for banking, insurance, public sector companies while working in a private firm. Her hard work paid off when she was shortlisted for a Government Sector undertaking after passing the entrance examination. The first posting was in Chennai and there was stiff opposition from family.  Jamila decided to write to  the company asking them to consider her posting in Mumbai as it would have been difficult to stay alone in Chennai. Her perseverance paid off when within a  year she got a local posting in Mumbai itself.

Marriage for a girl with disability has its set of challenges. Most often it has been of several compromises and unfair adjustments. But in Jamila’s case a young man with no disability who was her friend in college proposed to her. Jamila took a fair bit of time to agree to this proposal. The families were involved in the negotiations as Jamila used crutches and calipers for her mobility. The boy’s family had reservations but the boy was determined and Jamila exuded tremendous confidence. After along courtship,  the marriage was finally solemnized. She continues to work managing a family of her husband and a new born baby girl.

She has further evolved in her personality as she has begun to drive a two wheeler to work. Jamila is a role model for many as she is no ordinary girl. Her strength lies in her zest for life and the never say die spirit. 

From the above case illustration, we can find that despite the father’s non-availability, the mother had hope and was optimistic for Jamila. Further she pushed her boundaries, so that she could achieve independence not only for mobility, but also education, training and employment, thus challenging her own limits and extending her capacity for growth. She used the support of the family to explore the scope of her possibilities and thus excelled in her work. The positive expectations both from her mother and herself motivated her to persevere both in personal and professional pursuits. The promise she held was internalized in her psyche that she exuded confidence and courage. This indicated the depth of her internal resource which was harnessed and further by choosing appropriate external resources,  (for example, her marriage proposal which was initiated by the current husband, her victory over mastering the use of the public toilets in the urban slum or taking tuitions to support her education). This was possible due to the adoption of the strengths approach that aided both the parents and the NGO that she sought help from.

Saleebey cautions us to be mindful of ‘the Four A’s’ in the practice of strengths approach. They include believing in one’s own capacities and strengths-which means the practitioner has to “make an account for, appreciate, affirm, and act on them in as many ways as you can. Everything that I have said about the strengths of clients applies to you. And, in my experience, this is essential for respecting and realizing client strengths. In other words this is a double feedback loop: from you to client; from client to you” (Saleebey, personal communication). The author recommends that the practitioner or social worker has to develop a strengths way of thinking in order to practice it. This not only empowers the client but also invariably strengthens the practitioner too.
 
Conclusion:
While undertaking strengths based practice in disability social work, one is aware and cognizant of the limitations that are related to the impairment. However, the social worker does not get confined by these limitations and hence is able to find creative options and solutions to various challenges that is encountered by the collaborating team. The strengths approach urges the practitioner to partner with the client, thus preventing the use of an expert model and placing the adult with disability in the driver seat. This paradigm of disability counseling has double benefits, both to the client system as well as the practitioner.
 
References:

1. Early, T., &Glen Maye, L.F. (2000).Valuing Families: Social work practice  with families from a strengths perspective, Social Work, Vol 45, No 2, 118-130.
2. Garmezy, N. (1994).Reflections and commentary on risk, resilience, and development. In R. J. Haggerty, L.R. Sherrod, N. Garmezy, & M. Rutter (Eds.), Stress, risk and resilience in children and adolescents.  Processes, mechanisms and interventions, (pp. 1–19). Cambridge: Cambridge University Press.
3. Rapp, C. A., & Goscha, R. J. (2006). The strengths model: Case management with people with psychiatric disabilities, (2nd Ed.). New York, NY: Oxford University Press.  
4. Saleebey, D. (1992). The Strengths Perspective in Social Work Practice. New York: Longman Publishing
5. Saleebey, D. (1996). The Strengths Perspective in Social Work Practice, 2nd edition, New York:Longman Publishing
6. Sullivan, W. P.,& Rapp, C. A. (1994).Breaking away: The potential and promise of astrengths-based approach to social work practice, In R. G. Meinert, J. T.Pardeck& W. P. Sullivan (Eds.), Issues in social work. Westport, CT:Auburn House
7. Walzer, M. (1983). Spheres of Justice, New York: Basic Books.
8. Weick, A., Rapp, C., Sullivan, W.P., &Kisthardt, W. (1989).A strengths perspective for social work practice, Social Work, 34, 350-354.

 
Web References:

1. www.disabled world.com/disability/types /May 7, 2012
2. en.wikipedia.org/ International Classification of Disability / May 8, 2012
3. www.open.ac.uk/ social model of disability / May 8, 2012

 
Srilatha Juvva
Associate Professor and Chairperson, Centre for Disability Studies and Action, School of Social Work, Tata Institute of Social Sciences, Mumbai
 
Chitra Lakshman
Hon. Director, VidyaVardhini Foundation Trust  (an NGO working on disability issues) & Program Head – Disability at NGO Apnalaya, Mumbai.