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Rehabilitation psychology is a specialty area of
psychology Psychology is the science, scientific study of mind and behavior. Psychology includes the study of consciousness, conscious and Unconscious mind, unconscious phenomena, including feelings and thoughts. It is an academic discipline of immens ...
aimed at maximizing the independence, functional status, health, and social participation of individuals with
disabilities Disability is the experience of any condition that makes it more difficult for a person to do certain activities or have equitable access within a given society. Disabilities may be cognitive, developmental, intellectual, mental, physical, ...
and chronic health conditions. Assessment and treatment may include the following areas:
psychosocial The psychosocial approach looks at individuals in the context of the combined influence that psychological factors and the surrounding social environment have on their physical and mental wellness and their ability to function. This approach is ...
, cognitive, behavioral, and functional status,
self-esteem Self-esteem is confidence in one's own worth or abilities. Self-esteem encompasses beliefs about oneself (for example, "I am loved", "I am worthy") as well as emotional states, such as triumph, despair, pride, and shame. Smith and Mackie (2007) d ...
, coping skills, and
quality of life Quality of life (QOL) is defined by the World Health Organization as "an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards ...
. As the conditions experienced by patients vary widely, rehabilitation psychologists offer individualized treatment approaches. The discipline takes a
holistic Holism () is the idea that various systems (e.g. physical, biological, social) should be viewed as wholes, not merely as a collection of parts. The term "holism" was coined by Jan Smuts in his 1926 book '' Holism and Evolution''."holism, n." OED On ...
approach, considering individuals within their broader social context and assessing environmental and demographic factors that may facilitate or impede functioning. This approach, integrating both personal (e.g., deficits, impairments, strengths, assets) and environmental factors, is consistent with the
World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level o ...
's (WHO) International Classification of Functioning, Disability and Health (ICF). In addition to clinical practice, rehabilitation psychologists engage in consultation, program development, teaching, training, public policy, and advocacy. Rehabilitation Psychology shares some technical competencies with the specialties of
clinical neuropsychology Clinical neuropsychology is a sub-field of psychology concerned with the applied science of brain-behaviour relationships. Clinical neuropsychologists use this knowledge in the assessment, diagnosis, treatment, and or rehabilitation of patients ...
,
counseling psychology Counseling psychology is a psychological specialty that encompasses research and applied work in several broad domains: counseling process and outcome; supervision and training; career development and counseling; and prevention and health ...
, and
health psychology Health psychology is the study of psychological and behavioral processes in health, illness, and healthcare. The discipline is concerned with understanding how psychological, behavioral, and cultural factors contribute to physical health and illn ...
; however, Rehabilitation Psychology is distinctive in its focus on working with individuals with all types of disability and chronic health conditions to maintain/gain and advance in vocation; in the context of interdisciplinary health care teams; and as social change agents to improve societal attitudes toward individuals living with disabilities and chronic health conditions.Elliott, T. R., & Rath, J. F. (2011). Rehabilitation psychology. In E. M. Altmaier & J-I. C. Hansen (Eds.), ''Oxford handbook of counseling psychology'' (pp. 679-702). New York, NY: Oxford University Press. Rehabilitation psychologists work as advocates with persons with disabilities to eliminate attitudinal, policy, and physical barriers, and to emphasize employment, environmental access, and social role and community integration.   Rehabilitation psychologists provide clinical services in varied healthcare settings, including acute care hospitals, inpatient and outpatient rehabilitation centers, assisted living centers, long-term care facilities, specialty clinics, and community agencies. They typically work in interdisciplinary teams, often including a physiatrist, physical therapist,
occupational therapist Occupational therapists (OTs) are health care professionals specializing in occupational therapy and occupational science. OTs and occupational therapy assistants (OTAs) use scientific bases and a holistic perspective to promote a person's abi ...
, and speech therapist.Rath, J. F., & Langer, K. G. (2019). Consultation.  In L. A. Brenner, S. A. Reid-Arndt, T. R. Elliott, R. G. Frank, & B. Caplan (Eds.), ''Handbook of rehabilitation psychology'' (3rd ed.). Washington, DC: American Psychological Association. A nurse, social worker, prosthetist, chaplain, and case manager also may be included depending on individual needs. Members of the team work together to create a treatment plan, set goals, educate both the patient and their support network, and facilitate discharge planning. In the United States, the specialty of Rehabilitation Psychology is coordinated by the Rehabilitation Psychology Specialty Council (RPSC), which comprises five professional organizations that represent the major constituencies in Rehabilitation Psychology: Division 22 of the
American Psychological Association The American Psychological Association (APA) is the largest scientific and professional organization of psychologists in the United States, with over 133,000 members, including scientists, educators, clinicians, consultants, and students. It ha ...
(APA), the American Board of Rehabilitation Psychology (ABRP), the Foundation for Rehabilitation Psychology (FRP), the Council of Rehabilitation Psychology Postdoctoral Training Programs (CRPPTP), and the Academy of Rehabilitation Psychology (ARP). RPSC represents the specialty to the Council of Specialties in Professional Psychology(CoS). Rehabilitation Psychology is its official journal. Rehabilitation Psychology is certified as one of 14 specialty competencies by the American Board of Professional Psychology (ABPP).


History

The specialty of rehabilitation psychology was established well before psychologists were regularly involved in healthcare settings. In the 1940s and 1950s, psychologists became increasingly involved in caring for persons with disabilities, often the result of combat injuries. Advances in medical care had led to an increased number of people surviving injuries and illnesses that would have been fatal in previous generations. Individuals living with disabilities and chronic health conditions needed help to adjust, and rehabilitation psychology emerged to meet these needs using psychological knowledge to help maximize independence, health, and welfare. In 1954, the Vocational Rehabilitation Act was passed, providing grant funding for research and program development. As a result of this act, many universities opened vocational rehabilitation counseling programs within their graduate schools. In 1958, Rehabilitation Psychology was established as Division 22 of the
American Psychological Association The American Psychological Association (APA) is the largest scientific and professional organization of psychologists in the United States, with over 133,000 members, including scientists, educators, clinicians, consultants, and students. It ha ...
, as an organization of psychologists concerned with the psychological and social consequences of disability, and with the development of ways to prevent and resolve problems associated with disability. By the 1960s, rehabilitation psychology was considered a mature specialty and was prominent throughout the United States. However, it was not until 1997 that the
American Board of Professional Psychology The American Board of Professional Psychology (ABPP) is the primary organization for specialty board certification in psychology. Mission statement "The mission of the American Board of Professional Psychology is to increase consumer protecti ...
approved the establishment of the American Board of Rehabilitation Psychology.


Key principles and models

Theoretical models are important in rehabilitation psychology for understanding and explaining impairments, aiding treatment planning, and facilitating the prediction of outcomes. Models help organize, understand, explain, and predict phenomena.Reel, K., & Feaver, S. (2006). Models: Terminology and usefulness. In S. Davis (Ed.), ''Rehabilitation: The use of theories and models in practice'' (pp. 49–62). New York: Elsevier. The models used integrate information from a number of disciplines, such as biology, psychology, and sociology. A wide array of models is needed because of the diverse problems and concerns faced by individuals with disabilities and chronic health conditions. Often, more than one model must be applied to properly understand an individual's condition. ''Biopsychosocial model'': The
biopsychosocial model Biopsychosocial models are a class of trans-disciplinary models which look at the interconnection between biology, psychology, and socio-environmental factors. These models specifically examine how these aspects play a role in topics ranging from ...
examines the interaction of medical conditions, psychological stressors, the environment, and personal factors to understand an individual's adaptation to disability. This interdisciplinary model is an acknowledgement that disability only can be understood within a larger context, and reflects the longstanding belief of rehabilitation psychologists that cultural attitudes and environmental barriers influence an individual's adaptation and accentuate disability. Notably, the tenets of this model are reflected in the
World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level o ...
's International Classification of Functioning, Disability and Health (ICF). The framework is holistic and to apply it providers must learn about the disabled person's home life and broader social context. ''Psychoanalytic model'': In the context of rehabilitation psychology, Freud's concept of
castration anxiety Castration anxiety is the fear of emasculation in both the literal and metaphorical sense. Castration anxiety is an overwhelming fear of damage to, or loss of, the penis—one of Sigmund Freud's earliest psychoanalytic theories. Although Freu ...
can be applied to severe losses, such as the loss of a limb. This concept is reflected in Jerome Siller's stage theory of adjustment, designed to increase understanding of acceptance and adjustment following sudden disability. ''Social psychology'': The pioneers in rehabilitation psychology were a diverse group, but many came from the field of
social psychology Social psychology is the scientific study of how thoughts, feelings, and behaviors are influenced by the real or imagined presence of other people or by social norms. Social psychologists typically explain human behavior as a result of the ...
.
Kurt Lewin Kurt Lewin ( ; 9 September 1890 – 12 February 1947) was a German-American psychologist, known as one of the modern pioneers of social, organizational, and applied psychology in the United States. During his professional career Lewin applied hi ...
is one example. As a Jew living in Germany during the early years of the Nazi regime, Lewin's experiences shaped his psychological work. This is reflected in his conceptualization of the insider-outsider distinction, as well as his understanding of stigma. Lewin is known for his conceptualization ''B = f(p,e)'', where behavior (''B'') is a function of both the person (''p'') and their environment (''e''). Tamara Dembo and
Beatrice Wright Beatrice Frederika Wright, Lady Wright, MBE, formerly Rathbone, née Clough, (17 June 1910 – 17 March 2003), was an American-born British politician. Early life Wright was born in New Haven, Connecticut, in the United States on 17 June ...
, two of Lewin's students, are recognized as pioneering figures in the history of rehabilitation psychology. Wright authored two of the field's seminal texts, ''Physical Disability: A Psychological Approach'' and the extensively revised second edition'', Physical Disability: A Psychosocial Approach.'' She also proposed the somatopsychological model, which advocates for interpreting disability within its social context. The somatopsychological model is derived from Lewin's field theory and holds that the environment can either aid or hinder an individual's adjustment. Wright's insights and her articulation of the beliefs and principles underlying rehabilitation psychology practice have come to be known as the "foundational principles of rehabilitation psychology" and her work continues to inform contemporary rehabilitation psychology research, theory, and practice. ''Cognitive-Behavior Theory'': Cognitive-behavioral therapy (CBT) approaches such as
problem-solving Problem solving is the process of achieving a goal by overcoming obstacles, a frequent part of most activities. Problems in need of solutions range from simple personal tasks (e.g. how to turn on an appliance) to complex issues in business an ...
treatment have shown promise in promoting adjustment, well-being, and overall health among individuals with disabilities and chronic health conditions. This model holds that thoughts and coping strategies directly impact feelings and behaviors. By emphasizing, identifying, and changing maladaptive thoughts, CBT works to change an individual's subjective experience and their resulting behavior. A variety of empirical studies have demonstrated CBT's effectiveness in cases of traumatic brain injury, spinal cord injury, and a variety of other conditions common to individuals living with disability and chronic health conditions.


Clinical specialty areas

In clinical settings, rehabilitation psychologists apply psychological expertise and skills to improve outcomes for individuals living with disabilities or chronic health conditions. Common populations treated include individuals with: *
AIDS Human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV/AIDS) is a spectrum of conditions caused by infection with the human immunodeficiency virus (HIV), a retrovirus. Following initial infection an individual ma ...
* Acquired brain injury *
Cancer Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...
*
Chronic pain Chronic pain is classified as pain that lasts longer than three to six months. In medicine, the distinction between acute and chronic pain is sometimes determined by the amount of time since onset. Two commonly used markers are pain that continue ...
*
Concussion A concussion, also known as a mild traumatic brain injury (mTBI), is a head injury that temporarily affects brain functioning. Symptoms may include loss of consciousness (LOC); memory loss; headaches; difficulty with thinking, concentration ...
* Limb loss *
Multiple sclerosis Multiple (cerebral) sclerosis (MS), also known as encephalomyelitis disseminata or disseminated sclerosis, is the most common demyelinating disease, in which the insulating covers of nerve cells in the brain and spinal cord are damaged. This ...
* Neuromuscular disorders *
Spinal cord injury A spinal cord injury (SCI) is damage to the spinal cord that causes temporary or permanent changes in its function. Symptoms may include loss of muscle function, sensation, or autonomic function in the parts of the body served by the spinal cor ...
*
Stroke A stroke is a disease, medical condition in which poor cerebral circulation, blood flow to the brain causes cell death. There are two main types of stroke: brain ischemia, ischemic, due to lack of blood flow, and intracranial hemorrhage, hemorr ...
*
Traumatic brain injury A traumatic brain injury (TBI), also known as an intracranial injury, is an injury to the brain caused by an external force. TBI can be classified based on severity (ranging from mild traumatic brain injury TBI/concussionto severe traumatic br ...
When addressing these chronic health conditions and disabilities, rehabilitation psychologists offer a variety of services with the goal of increasing an individual's functioning and quality of life. Specific services may include:


Assessment

To enhance the rehabilitation process, one must not only identify barriers to recovery, but also personal strengths and resiliency factors that foster continued recovery and social reintegration. Rehabilitation psychology's focus on personal strengths and resiliency has been influential in the field of
positive psychology Positive psychology is the scientific study of what makes life most worth living, focusing on both individual and societal well-being. It studies "positive subjective experience, positive individual traits, and positive institutions...it aims t ...
. Rehabilitation psychologists take into consideration the medical diagnosis, referral question, background history, pre-morbid functioning (independence with basic and instrumental activities of daily living), current functioning (physical, cognitive, psychological), personality characteristics, and goals (career, academic, personal). Depending upon the referral question and individual patient goals, a structured and focused assessment may include any combination of the following components: cognitive function (decisional capacity, mental status, neurocognitive function); physical function (fatigue, health behavior, pain, sleep); psychological function (emotional adjustment, interpersonal/social functioning, personality, mental health conditions). Aspects of the individual's environment also are assessed, including cultural, community, home, rehabilitation, school, vocational, and social environments. In addition to clinical assessment and interview, standardized measures can be helpful for understanding each of these component areas in greater detail.


Cognitive rehabilitation

Cognitive rehabilitation Cognitive rehabilitation refers to a wide range of evidence-based interventions designed to improve cognitive functioning in brain-injured or otherwise cognitively impaired individuals to restore normal functioning, or to compensate for cognitive ...
, also known as neuropsychological rehabilitation, refers to the broad range of evidence-based interventions designed to improve cognitive functioning impaired as a result of changes in the brain due to injury or illness.  Because of their specialized training in the nuances of impaired cognitive abilities, within the context of personality and emotional factors, rehabilitation psychologists are uniquely qualified to provide interventions for cognitive, behavioral, and psychosocial difficulties following brain injury. Cognitive rehabilitation interventions have been used with people who have sustained brain injury, stroke, brain tumor, Parkinson's disease, multiple sclerosis, mild cognitive impairment, ADHD, and a variety of other medical conditions that affect cognitive functioning. Cognitive functions targeted may include processing speed,
attention Attention is the behavioral and cognitive process of selectively concentrating on a discrete aspect of information, whether considered subjective or objective, while ignoring other perceivable information. William James (1890) wrote that "Att ...
, memory, language, visual-perceptual skills, and executive functioning skills such as
problem solving Problem solving is the process of achieving a goal by overcoming obstacles, a frequent part of most activities. Problems in need of solutions range from simple personal tasks (e.g. how to turn on an appliance) to complex issues in business an ...
and emotional self-regulation. Cognitive rehabilitation can include computer-based tasks, with the caveat that such tasks are most effective when administered under the guidance of a trained clinician in an individualized setting. Contemporary rehabilitation psychology approaches to cognitive rehabilitation incorporate the subjective experience of the patient while targeting meta-cognition or self regulation. The ultimate goal of all cognitive rehabilitation interventions is to improve the everyday functioning of people in the setting in which they live or work.


Ethical and legal considerations

Rehabilitation psychologists adhere to the same general principles and ethical codes of conduct as all psychologists, under guidelines set forth by the
American Psychological Association The American Psychological Association (APA) is the largest scientific and professional organization of psychologists in the United States, with over 133,000 members, including scientists, educators, clinicians, consultants, and students. It ha ...
(http://www.apa.org/ethics/code/). Rehabilitation psychologists also must follow federal laws relevant to individuals with disability. Rehabilitation psychologists often are faced with ethical and legal considerations when assisting patients with concerns such as end-of-life decision making, ability to return to driving (e.g., following acquired brain injury, stroke, or other medical conditions that may impair driving ability), and the role of faith/religion in the individual's health-care decision making. Relevant federal legislation includes: * Rehabilitation Act of 1973: This Act prohibits discrimination of persons based on disability status in programs conducted by Federal agencies, those receiving Federal financial assistance, in Federal employment, and in the employment practices of Federal contractors. *
Americans with Disabilities Act The Americans with Disabilities Act of 1990 or ADA () is a civil rights law that prohibits discrimination based on disability. It affords similar protections against discrimination to Americans with disabilities as the Civil Rights Act of 1964 ...
(ADA): This Act was an extension of the Rehabilitation Act of 1973. The ADA's five titles prohibit discrimination on the basis of disability in employment, government, public and commercial facilities, transportation, and telecommunications. *
Health Insurance Portability and Accountability Act The Health Insurance Portability and Accountability Act of 1996 (HIPAA or the Kennedy– Kassebaum Act) is a United States Act of Congress enacted by the 104th United States Congress and signed into law by President Bill Clinton on August 21, 1 ...
(HIPAA): This Act was initiated in 1996 in an effort to protect the privacy of patient information. It affects rehabilitation psychologists in a variety of important ways and occasionally contradicts aspects of the APA Ethical Code. For example, under the Act, tests designed to measure psychological and neurocognitive function may not be released to the general public. Instead of releasing the tests themselves, rehabilitation psychologists typically provide summaries of the data, interpretation, and treatment recommendations.


Education and training

In the United States, rehabilitation psychologists complete doctoral degrees (e.g.,
PhD PHD or PhD may refer to: * Doctor of Philosophy (PhD), an academic qualification Entertainment * '' PhD: Phantasy Degree'', a Korean comic series * '' Piled Higher and Deeper'', a web comic * Ph.D. (band), a 1980s British group ** Ph.D. (Ph.D. al ...
or
PsyD The Doctor of Psychology (Psy.D. or D.Psych.) is a professional doctoral degree intended to prepare graduates for careers that apply scientific knowledge of psychology and deliver empirically based service to individuals, groups and organizat ...
)Rath, J. F., Bertisch, H., & Elliott, T. R. (2017). Psychologists specializing in rehabilitation psychology.  In R. Sternberg (Ed.), ''Career paths in psychology: Where your degree can take you'' (3rd ed, pp. 227-243). Washington, DC: American Psychological Association. in fields such as clinical psychology,
counseling psychology Counseling psychology is a psychological specialty that encompasses research and applied work in several broad domains: counseling process and outcome; supervision and training; career development and counseling; and prevention and health ...
,
neuropsychology Neuropsychology is a branch of psychology concerned with how a person's cognition and behavior are related to the brain and the rest of the nervous system. Professionals in this branch of psychology often focus on how injuries or illnesses of t ...
, or
school psychology School psychology is a field that applies principles from educational psychology, developmental psychology, clinical psychology, community psychology, and behavior analysis to meet the learning and behavioral health needs of children and adol ...
, plus pre-doctoral and post-doctoral clinical training in healthcare settings. Rehabilitation psychologists must be licensed in order to provide services in their state of practice and to receive reimbursement from health insurance payers. In most states, obtaining a license requires a doctoral degree from an approved program, a minimum number of hours of supervised clinical experience, and a passing score on the Examination for Professional Practice in Psychology (EPPP), a standardized knowledge-based examination. Most states also require a prescribed number of
continuing education Continuing education (similar to further education in the United Kingdom and Ireland) is an all-encompassing term within a broad list of post-secondary learning activities and programs. The term is used mainly in the United States and Canada. ...
credits per year to renew a license. By the 1960s, the need for standardized guidelines for postdoctoral training in rehabilitation psychology was recognized during the speciality's national conferences. The APA Division of Rehabilitation Psychology (Division 22) and the American Congress of Rehabilitation Medicine spent four years developing guidelines leading up to the 1992 Ann Arbor Conference in Postdoctoral Training in Professional Psychology. Patterson and Hanson outlined the entrance requirements, training length, curriculum requirements, supervision, and evaluations: * Trainees are accepted only from doctoral programs approved by the
American Psychological Association The American Psychological Association (APA) is the largest scientific and professional organization of psychologists in the United States, with over 133,000 members, including scientists, educators, clinicians, consultants, and students. It ha ...
. * Minimum length of training is one year * There are a minimum of two supervisors during training * Curriculum includes supervised practice, seminars, and coursework * Patient populations and didactics are related to disabilities and chronic health conditions * There is a minimum of two hours of supervision per week * All trainees are funded * There are written objectives for the training program * Formal trainee evaluations occur at least twice a year * Program evaluations occur annually In 1997, the
American Board of Professional Psychology The American Board of Professional Psychology (ABPP) is the primary organization for specialty board certification in psychology. Mission statement "The mission of the American Board of Professional Psychology is to increase consumer protecti ...
approved the establishment of the American Board of Rehabilitation Psychology. Subsequently, the board elaborated on the guidelines from 1995 by requiring a board certification that assesses an individual on the expected competencies. Expected competencies were the capability to assess and treat disability adjustment, cognitive functioning, personality functioning, family functioning, social environment, social functioning, educational functioning, vocational functioning, recreational functioning, sexual functioning, substance abuse, and pain. In addition to displaying these competencies, rehabilitation psychologists are expected to collaborate and consult with other rehabilitation professionals within the interdisciplinary team throughout the treatment process. The ABRP Board Certification process recognizes, certifies, and promotes competence in the specialty. The
American Board of Professional Psychology The American Board of Professional Psychology (ABPP) is the primary organization for specialty board certification in psychology. Mission statement "The mission of the American Board of Professional Psychology is to increase consumer protecti ...
specifies that in order to meet the standards of the speciality, an individual must complete a recognized internship program, have three years of experience within the field, and have supervised experience within the specialty.


Notable rehabilitation psychologists

* Roger Barker * Tamara Dembo *
Beatrice Wright Beatrice Frederika Wright, Lady Wright, MBE, formerly Rathbone, née Clough, (17 June 1910 – 17 March 2003), was an American-born British politician. Early life Wright was born in New Haven, Connecticut, in the United States on 17 June ...


See also

* Neurorehabilitation * Rehabilitation Psychology (journal)


External links

*
American Board of Rehabilitation Psychology

Foundation for Rehabilitation Psychology

Council of Rehabilitation Psychology Postdoctoral Training Programs

Council of Specialities in Professional Psychology


References

{{Reflist Applied psychology Behavioural sciences Branches of psychology Health care occupations