In this qualitative study, the authors examined the nature of resilience in people with chronic disabilities. Fifteen people with disabilities identified the factors that helped or hindered them at major turning points, and the triggers and resolutions to these turning points. Turning points were emotionally compelling experiences and realizations that involved meaning acquired through the routes of belonging, doing, or understanding the self or the world. The major protective factors were social support, traits such as perseverance and determination, and spiritual beliefs. Three new protective processes were identified: replacing a loss with a gain (transcending), recognizing new things about oneself (self-understanding), and making decisions about relinquishing something in life (accommodating). These protective factors, processes, and ways in which people with disabilities draw sense and meaning in life have important implications for service delivery.

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Two urban programs of family-centered case management services were established for families of children with both a developmental disability and a chronic health condition. These are children who present significant caregiving demands due to the long-term and severe nature of their disabilities. Thirty-two mothers were interviewed within the family's first month in the project and reinterviewed approximately one year later. The results indicate that more families received respite care, nursing services, training in the care of the child, educational services and transportation to school at follow-up than had been receiving those services at baseline. However, families still indicated high service needs for recreational activities, life planning, regular day care, legal services, and speech therapy at follow-up. Mothers indicated that program services were helpful in obtaining services, financing, information, support, and advocacy. Although maternal life satisfaction improved with program participation, non-handicapped siblings continued to have difficulties coping. The model employed is described and the practice and policy implications of the findings discussed.

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The purpose of this study was to gain insight into the perspective of individuals with congenital disabilities about spirituality as a coping mechanism during crucial times in their lives. Qualitative analysis of interviews assessing turning points in the lives of 15 adults (6 women and 9 men; M = 37 years) with spina bifida, cerebral palsy, or attention deficit disorder was performed to determine how spirituality assisted them at these crucial times. Four recurring themes were identified: God as a guiding force, inner strength, meaning in life, and appropriateness of the use of spirituality in counseling. The authors discuss their findings and the use of spirituality in counseling adults with congenital disabilities. S pirituality refers to the basic human need to experience meaning, purpose, and connectedness. It is a critical component of life that is central to all beliefs and faiths both within organized religion and outside it (McColl et al., 2000;Townsend, DeLaat, Egan, Thibeault, & Wright, 1999).Mental health practitioners see the need to treat the whole person in the therapy session; however, few of them actually address spiritual beliefs in their daily practice (Shafranske, 1996). A recent meta-analysis (Walker, Gorsuch, & Siang-Yang, 2004) indicated that although most therapists viewed spirituality as important, few participated in spiritual or religious practices. Furthermore, the meta-analysis indicated that there was a positive relationship between participation in spiritual or religious practices and the use of spirituality in counseling. One may interpret these findings as recent support for earlier conclusions that few counselors address spiritual beliefs in their daily practice (Shafranske, 1996). This lack of Jacqueline A. Specht, Faculty of Education, University of Western Ontario; Gillian A. King, Elizabeth G. Brown, and Linda Smith, Thames Valley Children's Centre, London, Ontario, Canada; Colleen Willoughby, Rehability, London, Ontario, Canada discussion may be because of the minimal coverage that spirituality received in the training of mental health practitioners (Miller & Thoresen, 2003) or in the selfperceived inadequacy of faculty members to include such training (Young, Cashwell, Wiggins-Frame, & Belaire, 2003). It is an issue, however, that needs to be addressed given that 90% of people in North America have never doubted the existence of God and that 80% believe that prayer or meditation can lead to a cure (McCarthy, 1995). Gallup and Lindsay (1999) reported that 90% of people in the United States prayed and most of them (67%-75%) did so on a daily basis. Given the high number of people who hold spiritual beliefs, counselors may be remiss if they ignore this aspect during therapy, because it has the ability to shape and influence the lives of their clients.The discussion of the role of spirituality and religion in counseling seems to have moved from questioning whether or not they can be beneficial in the therapy process to trying to determine how best to address their role. A rec...