What types of therapy are available to disabled people?

My name is Michael (previously referred to as Jarred on Diary of a Disabled Person) and I am a BACP registered therapeutic counsellor with a Post-Graduate Diploma in Counselling & Psychotherapy. I identify as having a disability and a chronic illness. I am also so mentally ill that I got married in a My Chemical Romance Black Parade jacket. Dax has very kindly let me write this blog post detailing how different approaches to therapy might deal with disabled clients. The psychologist Rosenzweig observed that different types of therapy appear equally effective so long as the therapist is skilled and the client is willing. “Everybody has won and all must have prizes” as the dodo puts it in Alice in Wonderland, and I quite agree. The good news is that means you are free to choose the type of therapy you want. The bad news is that means you have got to choose the type of therapy you want. 

This post is of course limited in its scope but I hope to give an overview at least. The focus of this post is on the main therapies offered by the NHS but should be equally relevant to those seeking therapy outside of the UK. At this point I also have to acknowledge that therapy has historically often been harmful for disabled people. None of the therapies presented here are inherently ableist, but I cannot deny that each has its ableist practitioners. You may need to shop around to find the therapist that is right for you. 

Psychodynamic

Let’s start with the granddaddy of them all: Psychodynamic psychotherapy. Psychodynamic psychotherapy is largely concerned with the cause and effect of mental health problems. The problem is that we are often unaware of what causes us to feel what we feel. Freud likened therapists to archaeologists brushing away the soil to reveal the artefacts hidden beneath. Struggling with internalised ableism? Talking about it with your therapist might uncover a childhood memory of your dad complaining about granny becoming a “burden” as her mobility diminished with age. That event lodged itself in your subconscious and now you associate disability with being a burden. Can it really be as simple as that? No, probably not. Still, as far as Psychodynamic psychotherapy is concerned, knowing is half the battle. 

CBT

Elephants. What are you thinking about now? Probably elephants. According to Cognitive Behavioural Therapy mental illness works in much the same way. Your thoughts drive your emotions which drive your actions which drive your thoughts and so on and so forth. Certainly if you could retrain your mind you could break the chain of thought, feeling and action. Does the prospect of an inaccessible restaurant and ableist waiters making you feel sad so you decline an invitation the work Christmas party? Your therapist might take you through a series of exercises designed to get you to think about the prospect of having fun socialising your colleagues instead of the possibility of encountering ableism. By changing the thought from ableism to fun, you change the feeling from sadness to joy and so change the action from staying in to going out. Now, I am trying to remain neutral but, if I were not, I might say that sounds like victim blaming. None the less, if you want a structured approach backed up by a robust model then CBT might be for you.

You can read about Dax’s (unfortunately not so good) experiences of CBT here.

Counselling

The word counselling means many different things to many different people. To the NHS it appears to refer specifically to talking therapies that might alternatively be called Person Centred or Humanistic. These work on the principle that people have an innate tendency towards growth and the role of the therapist is to nurture that growth. To do this they will seek to create, within the therapy room, the ideal conditions for the client to flourish. While these conditions cannot be maintained once the client goes back out into the real world, hopefully the growth they have achieved can. Wracked with doubts about whether you are strong enough to cope with the barriers you would face as a disabled person going to university? Your therapist will gently guide you towards finding your own inner strength in the hopes that you are emboldened to take on those challenges. At this point it might sound like the the counsellor just sits there being supportive while the client does all the work. Certainly we would not be much impressed with a doctor who expected us to fix our own broken leg. A counsellor could counter that view with a proverb beloved of teachers delivering school assemblies: “Give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime.”

Private Practice

And now for something completely different. As a private practice therapist I have more freedom to tailor my sessions to the wants and needs of my clients. A session with me might be a vigorous debate, a gentle conversation or a change for you to tell your story while I sit back listening. Since I am under no obligation to produce quantifiable results that look good on a spreadsheet, my clients can set their own therapeutic goals. I may have one disabled client who wants to build resilience to better tolerate ableism and another who wants to find the strength to fight for inclusion. It is not my place as a therapist to say one of those clients is right and the other is wrong. 

In my professional experience theoretical frameworks are useful to therapists but of little consequence to clients. What matters is the strength of the relationship, the therapeutic alliance, forged between two persons who are in psychological contact. With the NHS it is the luck of the draw who you get assigned but with private practice you can shop around. So what’s the catch? As you may have noticed we live in a capitalist hellscape. Every good therapist I know would gladly do what we do free of charge but we have bills to pay, just the same as the rest of you. What I will say is do not be put off by a therapist’s advertised rate. It is increasingly common for therapists to offer a concessionaire rate where appropriate, so don’t be afraid to make an enquiry.

Conclusion

At the end of the day, someone seeking therapy is blessed and burdened with a multitude of options. By necessity this article has barely scratched the surface. Aside from the three mentioned above there is existential, transactional analysis, emotion focused, systemic, and gestalt therapy to name but a few. Even if you have tried therapy before or you think it is just not for you, remember the dodo and keep an open mind.  

Michael is a BACP registered theraputic counsellor working in private practice. He has previously written for this blog under the pen name of Jarred. He can be found here.