December 3 is International Day of Persons with Disabilities, a day to celebrate and recognize the diverse experiences, capabilities, and contributions of people with differing abilities. Standing alongside people with disabilities includes accessibility, safety, community acceptance, independent living and quality of life, full and active participation in society, and equal access to education and employment.
Within the EMDR therapy framework, we often think about events or experiences that create emotional or physical pain or discomfort in a person’s past. Persons with disabilities could face many types of oppression and marginalization throughout life, including a lack of inclusion in policies, lack of access to healthcare, lack of autonomy, physical spaces that do not fit the person’s needs, and most recently being overlooked during the time of COVID-19. EMDR therapists working with persons with disabilities are encouraged to learn how these clients are overlooked in our social system, how best to provide inclusive care, and advocate for inclusive changes and actions in both policies and physical practice spaces. In addition, alongside honoring the specific traumas this population may have experienced, it is equally important to learn about the celebrations and joy experienced in communities of people with differing abilities!
We turned to an EMDRIA member experienced in using EMDR therapy with clients who have differing abilities: Mary Rixford, LPC
Mary Rixford, LPC
This bio will not list what I have done or accomplished in my professional career. Instead, I will offer glimpses into who I am as a human being. When engaging with a disabled person, it is far more important to learn who they are than to focus on what they can or cannot do.
Who am I?
I am a homesick New Mexican who has lived in Texas for 45 years. My husband and I have been married for more than 51 years, and we still like each other. I am a mother of a son and daughter who pays their fair share of taxes which means they are loving, honorable, and responsible citizens. Love for my grandchildren tickles a physical sensation in my heart reserved exclusively for my children’s children. I have been a professional counselor and trauma therapist for more than 40 years. Though I have retired from clinical practice, I remain an active EMDRIA Approved Consultant who passionately passes along the gift of EMDR to working clinicians. I am blind.
Retinitis Pigmentosa (RP), a genetic metabolic disorder that prevents the absorption of Vitamin A, has gradually stolen my sight since I was a child. Night blindness progressed into color blindness into an ever-decreasing peripheral field of vision into shadowy light and dark blurs. All the descriptors of who I am are equal. Often, however, blindness dominates the perception of who I am in the eyes of the normally sighted universe. Who I truly am is not separated from my disability. Instead, my disability separates me from others.
Disability is possible for all humans regardless of race, ethnicity, creed, or gender identity. People with identifiable physical limitations are easily banished to the land of misfit beings. Fear of one’s physical fragility can result in the rejection of those who embody “my greatest fear.”
“Who I am” is committed to giving voice and visibility to those of us who successfully negotiate life with sound, sight, intellectual, and mobility limitations. I represent the disabled who desire inclusion, equity, and curious, accepting respect.
What is my experience of EMDR as a clinician working with disabled clients?
As a clinician, my first experience of EMDR was when I sought basic training with Rick Levinson, LMSW, in Austin, Texas. I told Rick that I was afraid and doubtful that I could do EMDR without sight. He gently assured me EMDR was well within reach because I had already been doing therapy without sight for more than 25 years. He was right. I read my clients with my somatic experience instead of being distracted by what I see with only my eyes. Rick’s words freed me up to realize my capacity to use EMDR with clients was infinite. Rick encouraged me to trust my adaptive network, “Go with that.” His wisdom is the hallmark of my work with disabled clients.
Conversely, I have also experienced spoken preconceptions from other EMDR clinicians who thought my capacity to be effective with EMDR is limited because of what I cannot see. Overall, my experience as an EMDR clinician has been the best of my entire career because I encountered accepting and curious colleagues who were open to learning who I am. And how I use EMDR techniques differently from them.
My work with disabled clients must first be refracted through the question, “Who is a disabled client?” All our clients seek therapy because of some disabling experiences in their lives. The obvious answer is that a disabled client has a physical, intellectual, or mobility limitation (please note: these three categories in no way encompass the entirety of the disabled experience).
A better view of disabled clients is to see them as just as all other clients presenting for therapy. The difference with these cases is that disabled clients are more obviously limited than clients with less visible constrictions.
What myths would I like to bust about working with the disabled?
Not all disabled clinicians work exclusively with disabled clients.
Disabled clients do not always come to therapy to deal with their disabilities. Some do. If the disability is part of the presenting problem, often, it is to deal with how the world responds to them as a disabled person.
Disabled clients can adhere to profound prejudices about their own and others’ disabilities. Unconscious internalization of stereotypes and negative societal perceptions of inferiority can easily be absorbed into the disabled client’s self-concept, and most importantly, into the clinician’s unchallenged view of disability.
Two fundamental prejudices must be explored and assessed as part of the treatment plan: First, the clinician must take an honest and fearless inventory of their prejudices and fears about being disabled. Second, the client must encounter their negative preconceptions about being disabled in a world that worships physical perfection.
Disabled clients do not necessarily “feel more comfortable” with a disabled clinician. I worked with a client referred to me after being diagnosed with a progressive, disabling disease. After four sessions, the client announced, “I feel much better because I realize I am not as bad off as you are … could you refer me to a normal therapist?” Fear and unchallenged societal prejudices can lead to the rejection of a disabled clinician as inferior to clinicians who appear more fully able.
Disabled people who function well in life are not amazing. The precursor to amazement is an expectation of incapability. Disabled people live a good life because they are able, just like everyone else.
You do not have to “know” how to work with any one disabled client. You need to ask them how you can best accommodate their needs.
You do not have to study books to work with disabled clients. The best “book” study is to curiously explore, listen and learn from each client’s unique bio. There are as many shades of sight, sound, and mobility disabilities as there are hues in an artist’s color board. If you know one person who is deaf, you will not be able to transfer what you know to the next deaf or hard of hearing client you meet. The three categories of disability frequently referred to in this document are too reductionist. “Disability” is ill-defined when considering the wide range of how illness, accidents, natural and human-made catastrophes visibly and invisibly disable human beings.
What is my favorite part of working with disabled clients using EMDR?
My most favorite part is that EMDR works. Adaptive Information Processing (AIP) asserts that we all can positively adapt to whatever challenge life presents. Disability presents distinct challenges. Clinicians with a firm understanding of AIP and fidelity to the eight-phase EMDR protocol have everything they need to work with the disabled community effectively. After all, we all have an adaptive network.
The AIP model relies on each client’s unique capacity to adapt positively. This means EMDR clinicians do not prescribe solutions (which risks applying unchallenged misconceptions). EMDR clinicians get out of the way of the disabled clients’ robust adaptive network. Disabled persons accustomed to others defining their ability welcome the respect EMDR affords.
What successes have I had with EMDR and disabled clients?
Phase two’s focus on strengthening the adaptive network through Resource Development and Installation (RDI) is especially powerful when working with disabled clients. Finding already available internal resources moves the focus from unable to able. “What strengths, abilities, or resources do you possess that have helped you adapt to life/your disability?” Finding “I can and do” busts the myth of “I can’t because you told me I couldn’t.”
EMDR is magic with the internalized self-judgments society dumps on the disabled. Negative cognitions (NC) parrot unchallenged societal attributions of the disabled: I am not as good as others; I am invalid (notice in-valid) now that I can’t walk; no one will want me because I am broken; I am a burden. ‘NC’s are infinite in the dictionary of the disabled.
Jim Knipe’s “EMDR Tool Box” is filled with treasures for disabled clients. Disabled people can idealize the dominant, nonimpaired population, forever banishing them to the land of misfit people. Dr. Knipe’s Idealized protocol has busted many a negative, disabling blocking self-perception.
EMDR works well to create or re-establish a solid sense of self (self-definition). “Before my anti-rejection meds left me sick a lot, I could help other people… I can’t do that now. Helping people is who I am.” Development of a “solid sense of self is possible when heretofore, the self-perception is “I am no longer whole because I am broken.”
EMDR has helped many of my clients desensitize and reprocess the traumatic event that disabled them, freeing the adaptive fact that “I am still me.”
I reiterate EMDR works independently of the disability of the client or clinician.
- Centers for Disease Control and Prevention. Disability impacts all of us. https://www.cdc.gov/ncbddd/disabilityandhealth/infographic-disability-impacts-all.html
- Centers for Disease Control and Prevention. Disability inclusion. https://www.cdc.gov/ncbddd/disabilityandhealth/disability-inclusion.html
- United Nations. International Day of Persons with Disabilities, 3 December. https://www.un.org/en/observances/day-of-persons-with-disabilities
- United Nations. Five things you need to know about living with a disability during COVID-19. https://www.un.org/en/desa/five-things-you-need-know-about-living-disability-during-covid-19
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