As a mental health professional, having an unbiased perspective is paramount. However, sometimes we perpetuate biases and are ableist without even realizing it. It comes across in our marketing, office space, intake paperwork, tone, and the lines of questioning we have with our clients. These micro-aggressions perpetuate stigmas and make our clients feel marginalized. In this blog, we uncover how ableism shows up in the therapy process and what we can do to address and correct it. Additionally, we will discuss the seven ethical principles in counseling and how they apply to working with people with disabilities.

Autonomy

One of the fundamental ethical principles in counseling is autonomy. This means that clients have the right to make their own decisions and control the direction of their therapy. When someone discloses their condition or limitation, it does not give you a license to ask anything you want. Unless their condition is directly related to their therapy, it’s important to avoid prying or invasive questions about their medical history or personal life.  Your focus should be on treatment, and not on the disability itself. They might share only what they feel comfortable with or what is relevant to the conversation. If you want to know more, you can ask if they are open to talking about it. Remember that people with disabilities have the right to control who knows about their condition and how and when it is discussed. There is a fine line between being curious and being invasive. Empower client by reminding them of  their rights to privacy and honoring their decision. That looks like asking permission before asking a certain question or informing a client they have a right to not answer a question. It can look as simple as "Is it ok if I ask you about..." or "You don't have to answer this question if you don't want to." 

Furthermore, you should avoid statements that misrepresent people with disabilities as a monolithic group of people; in reality, everyone has individualized challenges and experiences. We must listen to our clients so we can learn about how they view themselves and the impact of the intersectionality of their class, ethnicity, sexual orientation, age, religion, disability and gender. In listening we will uncover their personalities and learn about skills and strengths that should be recognized and supported in therapy sessions. Identifying these strengths will help empower clients to recognize their own potential and use it as a tool for growth. For example, someone with impaired vision may have well-developed auditory perception or heightened tactile sensitivity.

Nonmaleficence and Beneficence:

These two principles go hand in hand. Nonmaleficence is the duty to do no harm, while beneficence is the obligation to promote the well-being of our clients. As therapists, our job is to help people to cope with their situations in a healthy way. However, sometimes we inadvertently teach our clients to mask the symptoms of their disability. 

First, let's define what coping and masking mean. Coping means learning to manage and survive daily life, including any challenges or difficulties posed by one's disability. It is about finding ways to adapt and thrive in the face of adversity, staying true to oneself, and finding meaning and joy in life. Masking, on the other hand, means concealing or downplaying one's disability, adapting to fit society's norms and expectations, and trying to pass off as "normal." Masking can be a form of denial, shame, protection, fear of rejection, or stemming from past negative experiences. It can lead to problems such as burnout, anxiety, depression, and social isolation. It's important to recognize that coping and masking are not mutually exclusive, and one can alternate between them depending on the situation or context. 

Justice:

The principle of justice requires that we treat our clients fairly and equitably, regardless of their background or circumstances. This is particularly important when working with people with disabilities, who may already face discrimination or marginalization in other areas of their life. Counselors must be mindful of systemic barriers to access and advocate for our clients to receive the support and resources they need.

Administrative burdens can pose significant challenges for people with disabilities. Complex paperwork, inaccessible websites, and inflexible appointments can make it difficult for people with disabilities to access the resources and services they need. The Americans with Disabilities Act (ADA) mandates businesses make their websites accessible for individuals with disabilities. However, many mental health professionals are still not adhering to these guidelines. For example, someone with a physical disability may have difficulty navigating a poorly designed website, while someone with a mental health condition may struggle with lengthy paperwork. To mitigate these challenges, it is important to provide accessible alternative formats and flexible scheduling options. In addition, resources should be developed and disseminated in plain language to ensure that no individual is excluded from accessing important services and resources due to administrative barriers.

Fidelity and Veracity:

These principles relate to our relationships with our clients. Fidelity refers to our loyalty and commitment, while veracity means that therapists must communicate truthfully and accurately to their clients. When working with people with disabilities, providing accessible, transparent, and useful information can be a way to build trust. You should discuss therapeutic outcomes honestly and set realistic expectations.

In our efforts to market ourselves we sometimes violate both fidelity and veracity. For example, marketing materials that describe a client population as "needing to be cured" are harmful. This phrasing sends a message that the therapist sees their disability as a problem and reinforces negative stereotypes about people with disabilities. Additionally, "cure language" in marketing materials creates an expectation for the client that may not be met while in therapy. Instead, it would be more accurate to acknowledge that people cannot be cured of certain disabilities, but instead, their specific challenges can be addressed and managed. 

Cure language is rampant in therapist bios across marketing platforms, in agency mission statements, and in literature recommended to clients. It would be wise to review and omit such language from your biographies, forewarn clients about ableist language in recommended books, and ensure to create empowering statements for clients rather than glory to therapist.

Final Thoughts

Individuals with disabilities have enough to contend with without having to chase down therapist. Using the spoon theory, let's say they plan to use 5 spoons for the day. They wake up with intentions of finding a therapist. So they expend 3 spoons perusing through profile after profile on Psychology Today before landing on your profile. They email and call you expending 1 more spoon. Now there is one spoon left for  them to end their day. Imagine having to do this day after day because a therapist will not return your calls. People, not just those with disabilities, sometimes contact us at their most vulnerable point in their lives. They should not be required to expend unnecessary energy on navigating a broken system.