Denial of Disabling Conditions and Specific Interventions in the Rehabilitation Counseling Setting

Abstract

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.

The Adjustment Process for Individuals With Spinal Cord Injury

“…Denial has also been viewed positively. For example, negation of the consequences of the impairment allows the individual to maintain a sense of competence and self-esteem based on preinjury functioning (Naugle, 1988;Stewart, 1994). Denial can also allow injured individuals to regulate their emotional distress associated with their current situation and consequently decrease anxiety (Vash & Crewe, 2004;Wheeler & Lord, 1999).…”

Denial of Chronic Illness and Disability

“…Although denial has been considered by pioneering researchers to be a relatively stable, cross-situational, and even predictable temporal stage during the process of psychosocial adaptation to life crises, including CID (Cohn-Kerr, 1961;Fink, 1967;Shontz, 1965), others have since emphasized the dynamic, fluctuating, and context-dependent nature of it (Lazarus, 1983;Russell, 1993;Stewart, 1994;Vandereycken, 2005). Indeed, findings from several longitudinal studies have shown that denial following CID can best be described as fluctuating.…”

“…Denial, then, is a focused, yet mostly unconscious, ongoing process that operates to minimize perception, awareness, and recognition of impending affective distress. Accordingly, it implies (a) self-deception, subterfuge, or reality distortion; (b) selective or restrictive screening of threatening stimuli; (c) meaningful behavior; (d) motivational thrust; and (e) psychic tension (Lazarus, 1983;Levine et al, 1994;Morley, 1997;Stewart, 1994;Weinstein, 1991).…”

Assessment of psychopathology and personality in people with physical disabilities.

“…Personality assessment is extremely important to the overall rehabilitation endeavor. Individuals with personality problems can disrupt their treatment environment (Stewart, 1994). For example, an individual with borderline personality disorder can undermine his or her rehabilitation while creating dissension (e.g., provoking disagreements) among staff (Bockian, 1994).…”