When models of health care collide: a qualitative study of rehabilitation counsellors' reflections on working in physical health care settings

Abstract

Although well established in North America, rehabilitation counsellors have limited acceptance and funding in the UK. Yet counselling during and after the rehabilitation phase may enable clients to explore the psychosocial impact of acquired disability, optimising subsequent adjustment. In this study, qualitative accounts were received from 12 health professionals qualified (or soon to qualify) in Rehabilitation Counselling. The course is primarily client-centred in orientation, although students are encouraged to study other perspectives to achieve an integrative approach to practice. The participants in this study offered examples of client work to illustrate some strengths and limitations of counselling in various rehabilitation settings, including stroke and head injury units. Positive outcomes included helping clients resourcefully to tackle altered family roles, anxiety problems such as nightmares, and chronic pain. Negative experiences included blurred boundaries between counselling and other therapeutic roles, negative evaluation of counselling time by other health professionals who constantly face time pressure, problems differentiating between problems of psychological and neurological origin, and the difficulty of empowering dependent individuals without addressing family dynamics. These tensions seem to illustrate the differing priorities of biomedical and holistic models of rehabilitation.

Key Words:

• Disability
• rehabilitation
• counselling
• models
• adaptation