Working With Clients With Disabilities: The Case Of Valeriev

Working With Clients With Disabilities The Case Of Valerievalerie Is

Working With Clients With Disabilities: The Case of Valerie Valerie is a 56-year-old, heterosexual, African American female. She receives Social Security Disability Insurance (SSDI) and works part time at a credit card company as a telemarketer. She currently lives in an apartment alone but receives home attendant services for 5 hours a day. She lost her left leg when she was hit by a car and has a prosthesis. She uses a walker or an electric scooter to be ambulatory but generally prefers the scooter.

She is slightly overweight, which makes using the walker more painful. She has been prescribed Zoloft® (100 mg per day) for general anxiety and has been taking it for almost 3 years. Valerie has a history of drug and alcohol abuse, although she has been drug free for 15 years. She has a core group of friends she has maintained a relationship with over the course of her lifetime, and although she does not see them as often as she would like, she keeps in touch over the phone and through email. She has no criminal background.

Valerie came for services to address unresolved feelings related to an abusive marriage. She continued to be in contact with her ex-husband, John, although they had been divorced for almost 13 years. Valerie said that she and John had remained intimate since the separation and divorce and that John texted and called her to meet for sex. She felt torn because she believed no one else would want to date her due to her disability but also felt John was using her. She also stated that although he had stopped hitting her, he continued to be verbally abusive.

She remained anxious and depressed and felt hopeless about the situation. Valerie said John abused alcohol and began using drugs in the first few years of their marriage. Unaware of his illicit drug use, Valerie arrived home from work early one day to surprise him and found him using cocaine. John attacked her and forced her to use cocaine as well. She relented due to her fear of continued assault.

An ongoing pattern of drug use and physical assault persisted throughout their marriage. Valerie lost her left leg when she was walking across the street and was hit by a car, and she spent close to 9 months in the hospital and a rehabilitation program. She was fitted for a prosthetic leg and given an electric scooter through her insurance company, which allowed her to begin working part time at a credit card company when she returned home. John’s abusive behavior and drug use continued, so Valerie hid her paychecks, slowly saving her money until she had enough to leave. Eventually, she was able to rent a room.

In addition, she was able to secure the assistance of a home health aide. Valerie began individual and group sessions to address her feelings of depression and anxiety. I worked with her to set manageable goals to increase her independence in physical functioning and from her ex-husband’s controlling and abusive behaviors. Valerie and I agreed to use cognitive behavioral therapy to address her continued negative thought patterns that affected her behavior. Valerie shared many insights into her disability to help me understand how she felt in a world that was not very accessible.

Through our meetings, I learned about the Americans with Disabilities Act (ADA) and how inaccessible buildings and programs affected her quality of life. We met once a week for 3 months, and I monitored Valerie’s depression through a baseline and then periodic administrations of a depression screen using the Beck Depression Inventory. After 12 weeks, we decided together it was time for termination. She reported fewer episodes of anxiety and expressed feelings of hope for the future. She continued to attend the group sessions and found new friends who had become a support network for her. She had stopped seeing her ex-husband and changed her phone number to prevent him from contacting her.

Paper For Above instruction

Working with clients who have disabilities presents unique challenges and opportunities for mental health professionals to promote healing, independence, and quality of life. The case of Valerie exemplifies the multifaceted nature of providing effective support to individuals with disabilities who are also coping with trauma, mental health issues, and social barriers. This paper discusses effective strategies for working with clients like Valerie, emphasizing the importance of understanding disability, trauma-informed care, cultural competence, and advocacy within the framework of the Americans with Disabilities Act (ADA).

Understanding the Client’s Context and Disability

Valerie’s case highlights the importance of understanding the composite impact of physical disability, mental health, and social circumstances. Her physical disability resulting from a traumatic car accident has significantly affected her mobility and independence. Her use of prosthetic leg and scooter symbolizes adaptive strategies to navigate a world that is not fully accessible, consistent with the ADA’s goal to eliminate barriers for individuals with disabilities. Therapists must acquire a deep understanding of the specific physical, psychological, and social challenges that such clients face (Nosek et al., 2018). This includes being knowledgeable about assistive devices, accessible environments, and the social stigma associated with disability.

In Valerie’s case, her marginalization is compounded by her history of violence and substance abuse. Her history of abuse, including physical and verbal forms, underscores the importance of trauma-informed care, which seeks to create a safe space for clients to process their trauma without re-traumatization (Hopper et al., 2019). Recognizing the interplay between trauma, substance use, and physical disabilities helps clinicians tailor interventions that are compassionate and effective.

The Role of Cognitive Behavioral Therapy (CBT)

Given Valerie’s ongoing negative thought patterns, CBT was an appropriate intervention to address her depression and anxiety. CBT’s focus on modifying dysfunctional thoughts can help clients like Valerie challenge beliefs related to self-worth, independence, and vulnerability (Beck, 2011). The therapeutic process also enables the client to develop coping strategies for dealing with residual feelings of hopelessness stemming from her abusive past and societal barriers.

Research supports the efficacy of CBT for individuals with disabilities, particularly when adapted to accommodate physical limitations (Ferguson et al., 2019). For Valerie, cognitive restructuring helped her challenge thoughts such as “no one else will want me because of my disability,” fostering healthier self-perceptions and resilience. Additionally, behavioral activation encouraged her to re-engage in social activities, which contributed to her developing a new support network.

Addressing Social and Environmental Barriers

Social isolation and inaccessible environments pose significant barriers to the mental health and well-being of clients with disabilities. Valerie’s awareness of ADA limitations and her efforts to find accessible spaces demonstrate the importance of advocacy and environmental modifications (Rusch et al., 2017). Mental health professionals can support clients by assisting with advocacy efforts, promoting self-advocacy, and connecting clients to community resources that improve accessibility and social participation.

Therapists should also recognize internalized ableism—negative beliefs about oneself due to societal attitudes—and work to reinforce self-acceptance and empowerment (Cain et al., 2020). Valerie’s decision to change her phone number and sever contact with her abuser exemplifies empowerment and self-protection. Supporting such actions can foster a sense of control and agency, which are crucial for mental health recovery.

Integrating Support Systems and Behavioral Goals

Building a robust support network is vital for clients with disabilities. Valerie’s participation in group therapy and her development of new friendships significantly improved her social functioning. As clinicians, promoting engagement with support groups, peer networks, and community services can mitigate feelings of isolation and build resilience (Rogers et al., 2018).

Setting manageable goals that enhance independence—such as improving physical functioning and creating safety plans—is a core aspect of empowering clients. Valerie’s progress in reducing anxiety episodes and increasing hope demonstrates the importance of collaborative goal-setting, which aligns with motivational interviewing principles and strengths-based approaches (Miller & Rollnick, 2013).

Legal and Ethical Considerations

Knowledge of legal frameworks like the ADA informs ethical practice when working with clients with disabilities. Clinicians must respect clients’ rights to accessibility, confidentiality, and autonomy while advocating for reasonable accommodations (Vernooij-Dassen & Jehoel-Greau, 2016). In Valerie’s case, her decision to change contact information and seek independence reflects her agency and informed choice—the core principles of ethical practice.

Moreover, practitioners must remain aware of cultural competence, ensuring interventions respect Valerie’s racial, cultural, and individual identity factors (Sue et al., 2019). Tailoring treatment approaches to align with her culturally rooted perspectives enhances engagement and efficacy.

Conclusion

The case of Valerie underscores the importance of an integrative, trauma-informed, and culturally competent approach to working with clients with disabilities. By fostering understanding, addressing environmental barriers, utilizing evidence-based therapies like CBT, and supporting self-advocacy, mental health professionals can enhance clients’ well-being, independence, and quality of life. Future practice should continue to incorporate advocacy and policy literacy to ensure equitable access and inclusion for all clients with disabilities, in line with the principles set forth by the ADA.

References

• Beck, J. S. (2011). Cognitive Behavior Therapy: Basics and Beyond (2nd ed.). Guilford Press.
• Cain, D. J., et al. (2020). Internalized ableism and mental health: Toward an inclusive approach. Disability and Society, 35(4), 570-589.
• Ferguson, E., et al. (2019). Enhancing the effectiveness of cognitive behavioral therapy for individuals with disabilities: A systematic review. Journal of Rehabilitation Counseling, 52(2), 86-96.
• Hopper, E. K., et al. (2019). Trauma-informed care in behavioral health services. Psychiatric Clinics of North America, 42(2), 347-359.
• Miller, W. R., & Rollnick, S. (2013). Motivational Interviewing: Helping People Change (3rd ed.). Guilford Press.
• Nosek, M. A., et al. (2018). Understanding the impact of disability on participation and quality of life. Rehabilitation Psychology, 63(4), 473-481.
• Rogers, J., et al. (2018). Peer support and social connectedness in health outcomes for individuals with disabilities: A systematic review. Disability and Health Journal, 11(2), 177-185.
• Rusch, F. R., et al. (2017). Accessibility and environmental modifications for persons with disabilities. Journal of Disability Policy Studies, 29(4), 233-240.
• Sue, D. W., et al. (2019). Multicultural counseling competencies: Guidelines in working with clients with disabilities. Journal of Counseling & Development, 97(4), 445-453.
• Vernooij-Dassen, M., & Jehoel-Greau, J. (2016). Ethical considerations in advocacy for people with disabilities. Ethics & Behavior, 26(2), 115-125.