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Grist for the Mill
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Grist For The Mill
The Experience of a Clinician with a Disability

Josephine DeFini, Ph.D., LCSW, Mental Health Practitioner

June 2009

 

One of the very first issues that surfaces with my new clients is whether or not to tell the individual in advance of the first session that I am blind. Some might argue that it is important, as it would prepare the client for the first meeting. I, however, believe that it is more beneficial to note the client’s reaction to the fact that I am blind and how he or she deals with this first encounter. Granted, the client is seeking therapy because of his or her own issues/problems, and someone might argue that the client confronted with the therapist’s blindness is placed at a disadvantage, inhibiting him or her from dealing with his or her own problems. Is it the therapist’s responsibility to prepare the client or to use the client’s reaction as a therapeutic intervention? A skilled therapist should be able to make use of whatever reaction the client presents to enhance the engagement process.

Many individuals find it difficult if not impossible to deal with a person who is blind. There is no question that we live in a visually dominant society and that making eye contact equals making a connection. When speaking to someone, it is required that you look at them. To not look at someone when they are speaking is often seen as disrespectful toward, disinterested in or devaluing of the individual. A client was referred to me for individual therapy. Sensing her hesitation upon our meeting, I asked if she knew prior to coming to see me that I was blind. She said no and remained mostly quiet for the remainder of the session. When she returned for the second session, I commented that she seemed to be having difficulty talking. She admitted that she could not continue to see me because I was blind and I could not see her eyes. She explained that seeing her eyes was of major importance as it would tell me about her and then I would understand her problems. I offered a therapeutic intervention as a means of engaging her and suggested that she allow me to ask questions and perhaps, that would help her express some of her struggles. When she agreed, I then narrowed the therapeutic intervention, asking which areas would be helpful for me to ask questions about, e.g. her family, her substance abuse, her emotional problems. After many sessions, she confessed that it was helpful that I asked questions and that it was really okay that I couldn’t see as I then could not read her emotions and expressions, hence judge her.

On the other hand, there are those clients who are immediately more relaxed in the presence of a therapist who is blind and who display what I term unorthodox behaviors. They act in ways they would not normally act had their therapist been sighted. One of my clients came to sessions and would immediately sit down and take off her shoes. During one of our sessions, I inquired if her feet hurt. She was startled, wondering why I asked. I commented that she always took her shoes off. She couldn’t believe that I was aware that she was barefoot and couldn’t understand how I knew as I could not see her. Another of my clients would routinely begin to apply fresh make-up several minutes before the session ended. I also had a client who would enter my office and turn off the lights. While some might argue that these are acts of aggression, defiance or hostility, or acts taking advantage of the therapist’s vulnerability, they could be interpreted as acts which make the client feel that he or she has an advantage, that he or she may in some way be “better” than the therapist, or that there is someone more helpless than him or herself. Whatever the motivation, these behaviors become “grist for the mill,” and can be used to enhance the therapeutic process.

There is no question that the therapist with a disability must be very aware of his or her own vulnerabilities and the kind of situations (transference and countertransference issues) that the client can trigger. The client who wants to know about the therapist’s disability - What happened? How? How can the therapist help? - may be asking these questions out of curiosity or may be using the query to seek a solution to his or her own struggle. Whether one has a disability or not, every therapist must be skilled in knowing how to respond to personal questions and how to help the client to understand the reason he or she is asking the question. Again, is the client seeking a solution for his or her own problems or trying to avoid the work of the therapy?

Sigmund Freud often had his clients face away from him, breaking eye contact, as he felt that clients needed to verbalize – that is put into words all of their thoughts and feelings – if therapy was to be effective. Like Freud, I feel that whether the therapist be blind or sighted, it is his or her responsibility to engage the client, enabling the client to put into words the problems, thoughts and emotions that brought him or her into treatment.

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