Counseling Today, Online Exclusives

Reconciling disability studies with mental health counseling

By Emily Cutler January 21, 2020

Growing up Jewish and queer in a conservative part of Birmingham, Alabama, I faced some pretty severe bullying as a child and teenager. It was a common occurrence for me to be called anti-Semitic slurs and mocked for looking and acting different. I was excluded by almost all of my classmates and had very little social support.

As a result, I struggled a great deal with my mental health. I felt depressed and anxious almost every day, and there were times when I felt sheer panic and terror about the prospect of attending school. Because I never seemed to fit in, I was convinced that I was fundamentally unlikeable and that the only positive quality I possessed was my near-perfect academic track record. So, on top of the anxiety and depression I felt as a result of being bullied, I also put enormous pressure on myself to score perfect grades. Any score less than 100 would send me into a spiral of shame and self-hate.

I cried a lot, and this worried many of the adults around me. I was sent to a number of therapists throughout my childhood. Most of them focused on figuring out ways to get me to stop crying so much. I was prescribed medication, exercise and an array of breathing techniques. Some of the therapists worked on encouraging me to act more “normal” — perhaps if I didn’t talk about my academic interests so much, or if I stopped trying to be the teacher’s pet, or if I were just less sensitive, then more of my classmates would like me.

Although some of the advice was useful, there were many times I walked out of therapy continuing to feel like something was wrong with me — that it was my fault that I was being bullied because I was just too weird and different to understand how to act like everyone else. More than anything else, I was frustrated with myself for not being able to stop crying or feeling depressed.

 

An empowering approach

My experiences with and perspective on therapy changed drastically when I went away to college. After struggling considerably with the transition to a new city and new environment, I reluctantly sought counseling from my university’s mental health center. I can still remember my first session. After answering some questions about my childhood during the intake, I said, “I know I must seem really messed up. Everyone hated me in high school, and now I just started college and I still don’t fit in. There’s something wrong with me. I know it. I just can’t fit in anywhere.” I could feel myself starting to tear up, so I immediately apologized for crying. “And on top of that, I am so overly emotional! I must be your worst client.”

My new counselor raised his eyebrows and looked up from his notes. “I was actually about to say that the way you’re reacting seems normal to me. It sounds like you had a pretty difficult time in school, and that was hard for you — it would be for anyone. And the transition from high school to college is hard too, which is also normal. I don’t know if I’ve met anyone who didn’t struggle to make friends in the first few months of college. I think it shows that you have a lot of resilience to get through all of that and to reach out for help.”

I was shocked. Here was a counselor who was not saying that anything was wrong with me or that I needed to change myself to fit in better. In his opinion, I was having a natural reaction to the circumstances I had been through. I’d never heard anything like it before.

Over the next several months, I went from viewing myself as an unlikeable weirdo to a person who is different (and perhaps weird in a good way!) but still deserving of acceptance and belonging. I started to see my uniqueness as a strength. Instead of encouraging me to change myself to fit in, my counselor empowered me to seek out on-campus groups and spaces where I would be accepted. As a result, I joined my campus Hillel as well as Active Minds, a student mental health organization. My counselor also encouraged me to stand up for myself in instances of bullying. Above all, he never pathologized my emotions or told me it was wrong to feel sad or depressed. I finally felt that I was being given the space to process and react to some of my experiences as a child.

 

Finding my path

Later on, I began to get involved with initiatives and organizations that focus on combatting prejudice and social injustice. I interned at the Anti-Defamation League of Philadelphia during my senior year of college, and I completed an honors thesis on weight-based bullying (bullying due to a child’s weight or size). Eventually, through my coursework and through my involvement in different advocacy communities, I found my way to disability studies, a discipline that centers the voices of people with disabilities and explores philosophical, cultural and sociological perspectives on the experience of disability.

Generally, the field of disability studies challenges the idea that disability is solely or primarily an individual defect in need of medical treatment. Instead, it posits that disability is the result of a multitude of factors, including societal exclusion and inaccessibility. The perspectives encompassed by disability studies greatly resonated with me as someone who cares deeply about challenging social injustices and exclusion rather than primarily changing individuals. Over the past several years, I have become intricately involved with disability studies research and advocacy.

One of my most pivotal moments has been coming to view myself and accept my identity as a person with a psychiatric disability. Embracing that identity has allowed me not only to accept myself and reduce my shame around having experienced mental health struggles, but also to become connected to a community of people with similar experiences and perspectives. I started working with the National Empowerment Center, an organization led by and for mental health consumers. With the center, I develop advocacy initiatives, educational programming and workshops that center the voices of people with lived experiences of mental health challenges and advocate for increased self-determination and acceptance of people with psychiatric disabilities.

The most meaningful and fulfilling part of my work has been spending time with people who have psychiatric disabilities, sitting with them through difficult times and empowering them to advocate for their rights and self-determination. My work has often included responding to people in crisis and providing space for them to experience strong emotions and extreme states.

 

A ‘fit’ for counseling?

My passion for that kind of intensely interpersonal, relational work sparked my interest in becoming a mental health counselor. As I began to explore the possibility of pursuing a graduate degree in counseling, I became increasingly certain that it was the right choice for me. There is little I care about more than supporting people with psychiatric disabilities to gain agency over their lives and experience community, connection and meaning. However, I also wondered how my disability studies background and perspective would fit with my role as a counselor. Whereas the disability studies field seeks increased acceptance and accommodation of disability in society, the counseling field often seeks to treat or prevent psychiatric disability. Would it be possible for me to reconcile both of these goals and perspectives?

I am only in my third semester of graduate school, so I do not yet fully know how I will integrate my disability studies background with my role as a mental health counselor. However, I believe it will be quite possible to do so.

In my own experience with counseling at my university’s mental health center, I felt that my counselor focused much more on encouraging me to accept myself and to find spaces where I would be accepted than on changing me or “fixing” me. I hope to take this same general approach with my clients. I believe that person-centered therapy and other humanistic approaches to counseling provide an excellent framework to accomplish this. These approaches require therapists to work with clients from a position of unconditional positive regard and to support clients in discovering their strengths rather than operating from a deficit-based model.

I also believe it is important to learn from counseling approaches developed by and for other marginalized communities. For example, while homosexuality used to be pathologized as a mental illness in the Diagnostic and Statistical Manual of Mental Disorders, many counselors now practice LGBTQ-affirming therapy. This approach supports LGBTQ clients in accepting themselves and decreasing any feelings of shame they may have related to their identities. Similarly, feminist therapy focuses on empowering women and people from other marginalized groups to advocate for themselves and to challenge injustice in their daily lives. Similar approaches could be applied to counseling clients with disabilities, including those with psychiatric disabilities.

I do not mean to suggest that psychiatric disabilities should never be treated or prevented. Many people with psychiatric disabilities want treatment such as cognitive behavior therapy, dialectal behavior therapy, and medication. Neither should exercise and breathing techniques be discounted because they are very useful for many people. However, there is no reason why the social and systemic factors affecting a person should not also be explored. In fact, professional counselors have an ethical and moral obligation to encourage people with disabilities to advocate for themselves. If clients are facing prejudice or discrimination on account of their psychiatric or other disability (or other difference), it may be helpful to explore ways of addressing that with them. Counselors can also encourage clients to request disability accommodations and link them to organizations such as peer-run wellness centers and peer support groups through which they might find acceptance and social support.

The 20/20: A Vision for the Future of Counseling initiative, sponsored by the American Counseling Association and the American Association of State Counseling Boards, reached a consensus definition of counseling as “a professional relationship that empowers diverse individuals, families and groups to accomplish mental health, wellness, education and career goals.” I believe that the disability studies field complements and enhances this goal rather than taking away from it. As a future counselor with a disability, I look forward to empowering my clients to accomplish their goals and to stand up to any injustice that stands in their way.

 

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Emily Cutler is a graduate student in clinical mental health counseling at Troy University in Tampa, Florida. In addition to pursuing her studies, she provides training and consultancy on the topics of disability rights, trauma-informed care, suicide prevention, peer-run mental health services, and the Health at Every Size paradigm. Contact her through her website at emilyscutler.com.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

1 Comment

  1. Michele B

    Thanks for this commentary Emily – it has brightened my day to see this so elegantly put. I honestly believe (because it is true in my personal experience) that people can heal once they are heard. Genuine connection is required for this, and acceptance. I work in Australia supporting people with psychiatric (we call it psycho-social) disability access our National Disability Insurance Scheme. I am both saddened and heartened by the amazement my clients often express in regards to my unconditional positive regard – happy that they finally feel seen and validated, but sad that this is the first time in years (for some, decades) of interacting with a mental health system that has repeatedly reinforced just how “wrong” they are instead of seeing them as complex human beings with a trauma history.

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