Three Faces of Adjustment Counseling: Support, Psychotherapy, and Lifeskils Coaching
Reprinted from the VISIONS Newsletter
Alliance for the Blind and Visually Impaired
Senior Services (now Meritan) * Memphis, Tennessee
Vol. 4, No. 5, May 19, 2000
Editor: Don H. Morris, Ed.D..
Author’s Note: I wrote this article while employed as the adjustment counselor for the Alliance for the Blind and Visually Impaired, a program of Senior Services in Memphis, Tennessee. I left that position in November 2001. I am now working as a personal development coach in private practice in Little Rock, Arkansas.
What Is Adjustment Counseling?
Many of you may wonder what adjustment counseling is, and how it differs from other forms of counseling and psychotherapy. In my experience at the Alliance for the Blind and Visually Impaired, I have found that clients need three types of services from the adjustment counselor: mourning, psychotherapy, and coaching. These are best provided in conjunction with the full range of services ABVI offers, including orientation and mobility training, rehabilitation teaching, and job development and placement services.
People who have experienced a trauma, such as the loss of sight, undergo a period of pain and confusion. Newly blinded people can expect to feel intense sadness, anger, fear, confusion, and dread. They may isolate themselves from others, or be afraid to be alone. They may feel overwhelmed by the experience, and need support and understanding from those around them. A primary need during this time is to mourn the vision loss and the many other losses that accompany it (jobs, driving, reading, independence, etc.). Newly blinded people need someone who will listen to them, acknowledge their pain, and validate the grief they feel. Each person will mourn in their own unique, private way, yet certain commonalities exist with others. An adjustment counselor can provide support and education to people in grief.
Spirituality can provide strength and comfort to people undergoing loss. But loss and trauma can also raise existential questions, such as why a loving God would allow pain and suffering. Some clients may need to seek guidance from religious leaders to deal with these issues.
In addition, visually impaired people in the grieving phase need role models who have successfully faced the challenges of vision loss. Support groups provide an opportunity for newly blinded people to meet others who have gone through the pain of vision loss. At ABVI it is the adjustment counselor who coordinates the monthly peer support group. Family members and friends are also welcome to attend.
Some people experience more severe reactions to vision loss, and require a greater level of professional assistance. This can take the form of intensive psychotherapy and/or drug intervention. In my experience about 10-15% of blind and visually impaired people fall in this category. This level of assistance is called for when the psychological symptoms cause a marked decrease in functioning, are highly distressing, or persist longer than would normally be expected for the grieving process. A careful diagnostic interview is required to determine which of several forms of depression, anxiety, or other medical condition a person presents with (see Warning Signs of Depression and Anxiety). An adjustment counselor conducts psychotherapy with clients who need it, and works with other mental health professionals, such as psychiatrists and clinical psychologists.
The majority of people with severe vision loss, however, are not in the acute phase of grief. Nor are they markedly depressed or anxious. Although many of these people are facing challenges and difficulties they recognize they need help to deal with, they are reluctant to seek counseling in the traditional sense. For such people there is another service available from an adjustment counselor, called personal development coaching. Just as an athlete can accomplish only so much on his/her own, and needs the experienced feedback from a coach, so do people facing the challenge of adjusting to a life without sight. Many new skills must be learned. Many everyday tasks and activities must be done in a different way, using the other senses. The skills needed to build a new life (called lifeskills) must be focused and honed. An adjustment counselor can provide lifeskills coaching for clients who need this level of assistance.
A personal development or lifeskills coach accepts clients where they are, without criticism. A coach lets clients set their own goals. However, a coach provides clients with tools, resources and structure. He/she helps clients clarify their goals and establish action plans. Clients can then turn their dreams into realities. Yet a coach does not do the work for clients. Instead, the coach respects clients enough to let them succeed or fail on their own. The coach then helps clients learn from their failures. With this caring support and structure, clients can make great strides in reaching their goals.
Lifeskills coaching is for motivated, resourceful people who want more out of their lives. It is for people who recognize they need help with specific problem areas, and are willing to take a close look at what they are doing now and what changes may be needed to achieve their goals. Typically, coaching is done in thirty minute phone sessions once a week, with voice messages or e-mail as well. This arrangement is ideal for visually impaired people with limited transportation.
Coachable clients can be relied upon to keep appointments, to do the homework assigned between sessions, and to be open and honest about their needs and experiences.