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 rehabilita
tive 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
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.
Stereotypes 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 are that:
is solely biological and outcomes of social interaction are based on
disability as the independent variable.
faced by persons with disabilities are a result of the impairment rather
than the cultural, legal, economic, social, and environmental contexts.
with disabilities are victims of biological injustice rather than social
injustice; hence, interventions are directed toward changing
individuals' abilities rather than social context.
is central to the individual's self-concept, self- definition, social
comparison, and reference groups.
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
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 rehabilitated.
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, 1990).
(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.
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
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
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 (Campbell, 1981).
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 life.
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 disabilities.
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formatting performed by Megan Dodson
Page last updated on March 20, 1997 by
Mary Kaye Rubin