Skills Development for
Multicultural Rehabilitation Counseling:
A Quality Of Life Perspective
Leo M. Orange
California State University
article focuses on a discussion of specific strategies usable
in promoting the development of leadership capabilities in
individuals with disabilities from minority groups. This paper
states that rehabilitative success in counseling such persons
depends on "the counselors understanding the life factors
unique to consumers whose sociocultural experiences are
different." Frequently, the general population affixes
action-engendering stigmas and stereotypes on entire groups of
minority members with disabilities. The author states that
professionals also entertain pejorative cultural assumptions
about disability. Recommended and discussed in detail in this
paper is the Quality of Life (QOL) approach shortly defined as
an orientation towards a wellness and holistic outlook
addressing both the consumer's individual development and
his/her environment in the broad sense of the term.
ethnic minority persons with disabilities is a topic deserving
debate and discussion in the field of counseling. If quality
counseling services are to be provided to ethnic minority
persons with disabilities, rehabilitation counselors and human
service professionals need to examine the issues involved in
interacting with this consumer group. As suggested by Herbert
and Cheatham (1988), and Kunce and Vales (1984), the success
of rehabilitation counseling services to persons from minority
groups is dependent upon the counselor's understanding of the
life factors unique to consumers whose sociocultural
experiences are different. For example, the rehabilitation
challenges facing African Americans with disabilities are
varied and complex and require counseling approaches that are
sensitive to the idiosyncrasies of the African American
community. Wright (1988) and Atkins (1986) indicate that human
service professionals need to be cognizant of the cultural
issues involved in serving minority persons with disabilities.
Disability and Minority Status
similarities in stigmas and inequities experienced by persons
from minority groups and people with disabilities are
numerous. Historically, both groups have been excluded from
the mainstream of American life and share an underprivileged
status. Walker (1988) gave a brief historical account of
societal perception of people with disabilities. Though some
societies looked upon individuals with disabilities with
"awe" and "reverence," in most societies
disabilities have traditionally been associated with
negativism. In the most recent past, people with disabilities
have been consistently relegated to economic deprivation and
associated with the minority status reflect these experiences.
Wright (1983) noted that racial minority-group members have
always had to deal with non- minority individuals who insist
that they "not only know their place but also keep their
place, that is to feel and act less fortunate than
others." Herbert and Cheatham (1988) stated that either
having a disability or being a minority person can present
stigmas that pose barriers to full participation in education,
employment, and social opportunities. Wright (1983) asserted
that an individual is appraised according to the presumed
characteristics of the group in which he or she is placed. An
example would be that individuals with disabilities are often
stereotyped as having suffered a great misfortune, and their
lives are consequently disturbed and damaged.
also exist for persons from minority groups in the larger
society. For example, African Americans are perceived as low
achievers, promiscuous, and untrustworthy (Atkins, 1988).
Wright (1983) maintained that the impact of these stigmas
associated with disabilities or minority status can be so
intense and pervasive that it can overpower other positive
personal characteristics of the individual which may run
counter to these stigmas. Minority persons with disabilities
are already aware of the stereotypes and negative attitudes
held by the majority of Americans. These observations are
significant because they suggest that minority persons with
disabilities must learn to cope with what Marshall (1987)
called the "double whammy" - racial discrimination
and physical impairment. The double bias of being a member of
both status groups can manifest itself through extreme
prejudice on the part of the non-disabled, non-minority
individuals who lack awareness and sensitivity to the combined
effects of being a minority person and having a disability.
disability experience is described through psychological,
sociological, and economic paradigms. More recently,
ecological and minority models are advocated as appropriate
frameworks for analysis through inclusion of an analysis of
the person-in-environment (Fine & Asch, 1988; Hahn, 1987;
Liachowitz, 1988). Hahn (1988) proposes that a socio-political
(minority model) provides a framework from which to examine
the disabling environment rather than examining personal
limitations (medical model) or functional limitations
(economic model). Fine & Asch (1988) challenge the
research and professional community to stop considering the
environment as unalterable, and to reconsider common
assumptions about the meaning of disability which helps to
perpetuate cultural stereotypic responses.
cultural assumptions about disability also shape professional
thinking and attitudes. These assumptions also reinforce
language, social beliefs, and interactions throughout the
culture. Common cultural assumptions and their implications
1. Disability is solely biological
and outcomes of social interaction are based on disability as
the independent variable.
2. Problems faced by persons with
disabilities are a result of the impairment rather than the
cultural, legal, economic, social, and environmental contexts.
3. Persons with disabilities are
victims of biological injustice rather than social injustice;
hence, interventions are directed toward changing individuals'
abilities rather than social context.
4. Disability is central to the
individual's self-concept, self- definition, social
comparison, and reference groups.
5. Disability is synonymous with
needing help and social support, reinforcing associations
between disability and conditions of helplessness,
incompetence, and the perpetual receipt of various forms of
assistance (Fine & Asch, 1988).
Quality of Life and the Role of Rehabilitation
professionals continue to disagree on what is the primary goal
of rehabilitation. Some rehabilitation counselors believe that
vocational placement is the final outcome of a successful plan
while others promote consumer independence. Atkins (1986)
indicated consumers enter a rehabilitation process with a set
of beliefs, attitudes, values, and goals; they encounter
rehabilitation counselors with their own set of beliefs,
attitudes, values, and goals. Undeniably, the interaction
between consumer and counselor attributes could be critical in
determining whether they leave the program successfully
Quality of Life (QOL) perspective on rehabilitation counseling
integrates competing program goals such as consumer
independence or employment into a higher order,
multidimensional rehabilitation outcome. Counselors committed
to a QOL orientation work from a wellness and holistic
position that addresses both the development of the individual
and the environment in which the person lives (Roessler,
(1988) presented a hierarchical and multifaceted definition of
QOL. He conceptualized QOL as comprising two domains, namely
community and labor force memberships; each of these was
subdivided into two parts - physical and psychosocial
adjustment. Within physical and psychosocial adjustment,
sequential subgoals were further identified down to the level
of specific behavioral objectives for a given individual.
Hence, to enhance an individual's quality of life,
rehabilitation services must target a wide range of body,
self, and social objectives.
of Life began as a political slogan during the 1950s and was
rapidly adopted by the field of medicine (Vash, 1987).
Definitions of QOL in the literature view "quality"
as synonymous with grade or level, which may vary from high to
low. "Life" generally refers to mental life, even
though environmental conditions are included in some
definitions. Admittedly a complex concept, QOL is typically
addressed in three ways, i.e. by user of: (1) subjective
estimates of satisfaction with life in general (well being or
happiness); (2) subjective estimates of satisfaction with
specific life domains (work, finances, health, and
relationships with others); and (3) socio-demographic data of
life quality (social indicators) reflective of environmental
opportunities, barriers, and resources (Baird, Adams, Ausman,
& Diaz, 1985; Schuessler & Fisher, 1985). Satisfaction
of life domains must also address recreation, a factor that
until recently has not been discussed in regard to
rehabilitation services when people with disabilities are
of Life (QOL) is determined by both inner and outer forces (Roessler,
1990). According to Campbell (1981), one's sense of global
well-being "is always dependent on the subjective
characteristics of the person and the objective
characteristics of the situation." Inner (subjective)
factors influencing QOL include aspiration level, past
experience, personal expectations, and perception of current
condition (Lehman, 1983). QOL is also affected by the level of
environmental resources and stressors, as indicated by a
variety of social indicators (Schalock, Keith, Hoffman, &
Karan, 1989). Therefore, to enhance QOL of people with
disabilities, rehabilitation practices must focus on both
personal and environmental conditions.
individual personal estimate of QOL may be registered in terms
of global life satisfaction or dissatisfaction or
domain-specific satisfaction or dissatisfaction. In either
case, the judgment requires people to compare what they have
with what they believe they deserve. Consistency between the
two results in satisfaction and feelings of positive effect
and pleasure. Perceiving oneself as having less than one
deserves creates dissatisfaction and feelings of negative
effect, which create experiences of strain and pressure
QOL may be measured by asking the person to indicate on a
single dimension (terrible to delighted) his/her current
satisfaction with life. For example, "How do you feel
about life in general?" A semantic differential format
with several different adjective pairs (boring-interesting,
useless-worthwhile) for "I think my life is..." may
also be used (Lehman, 1983).
addressing global and domain issues in adopting a QOL outlook
in rehabilitation, the counselor emphasizes consumer input
and, more importantly, the individual affected level is
directly related to personal and environment factors that may
need to be addressed in counseling. Scherer (1988) identified
two personal factors that, if addressed in counseling, have
the potential to improve life outcomes -perceived control over
QOL and the desire to assimilate into society. Other
correlations for people with disabilities underscore the need
for intervention that results in safer living conditions,
improved health care, prevention of health problems,
development of social and leisure skills, increased financial
security for satisfaction of social and family relationships,
and improved employment status.
(1990) stated that QOL orientation benefits rehabilitation in
many ways. It: a) orients the field to a wellness model, b)
stresses the multidimensional nature of rehabilitation,
outcomes, c) requires intervention that addresses both the
development of the individual and the environment in which
that person lives, d) enables practitioners to consider the
consumer's perspective without imposing their own expectations
on the individual, and e) yields program evaluation data
indicating the extent to which interventions and facilities
have enhanced the "quality" of the individual's
QOL perspective on rehabilitation counseling results in a
greater commitment to a holistic approach. QOL is a wellness
construct with multiple dimensions. In contrast to a more
traditional disease or medical model, QOL stresses competency,
wholeness, robustness in individuals and society (Kirchman,
1986). QOL encompasses not only satisfaction with regard to
life's basic necessities but also with regard to less tangible
values such as security and fulfillment. Rehabilitation
counselors must incorporate in their work as well this
commitment to tangible and less tangible values. People with
disabilities tend to downplay the relationship of lost
function (motoric and physiological) to QOL and stress the
importance of social and interpersonal skills.
consistent with the initial premise on global and domain
issues, QOL must play an important role in the evaluation of
rehabilitation programs. Rehabilitation counselors need to
rehabilitate the "whole person" and dedicate their
efforts to the end goal of increasing QOL for people with
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