Denial of disabling conditions is prevalent and significant in the rehabilitation counseling setting. For effective diagnosis and intervention with denial, rehabilitation counselors need to understand the causes and consequences of denial as a defense against anxiety. They also need generic intervention skills, as well as skills specific to each client in denial. Because individuals with personality disorders and unstable personalities have unique difficulties in counseling, their extensive use of denial is explained and specific interventions with that population suggested.
A set of issues which rehabilitation and other counselors must evaluate in their attitudes toward treatment modalities has to do with chemical use/abuse as it relates to counselor attitudes toward treatment and measures identified as “harm reduction”. Two measures of harm reduction which had been adopted primarily in Europe, and are now being used in communities in the United States, are needle exchange and methadone treatment. In order to examine rehabilitation counselors' attitudes toward these measures, a brief confidential survey was mailed to each member of the Ohio Rehabilitation Association about their attitudes toward such measures, as well as demographic information about the respondents. This information was then examined to provide the statistical data examined, which in turn resulted in the conclusions and recommendations to the study.
Rehabilitation Counselors frequently work with individuals who have recently experienced severe traumatic physical injuries. Beck originated cognitive therapy, a comprehensive approach to dealing with dysfunctional cognition and behavior. Livneh has proposed a model of adaptation to traumatic physical injuries with five phases. Each phase contains different cognitive, defensive, behavioral, and emotional reactions to the resulting disabilities. In this article, Beck's cognitive therapy and Livneh's model are combined to produce a comprehensive approach to help individuals in the five phases of reaction to physical trauma. Specific interventions are suggested for dealing with the cognitive, defense mechanisms, and emotional aspects in each phase.
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