A COMPARISON OF A TRADITIONAL AND A MARITAL APPROACH TO REHABILITATION COUNSELING

Mark W. Teismann Beverly Rodgers Northern Illinois University International Reha bilitution Associates, Inc.

Charlotte, NC

For many years rehabilitation of the disabled has focused on helping the individual client and providing links to community services. Little consideration has been given to the disabled person’s family as both a hindrance and resource to the rehabilitation effort. Few medical facilities, rehabilitation hospitals, and rehabilitation agencies have formu- lated programs that systematically include the disabled person’s spouse or family. Moreover, while it has been argued that family counseling can play an important role in rehabilitation programs (Bray, 1978; Nau, 1973; Schwab, 1975), there has been little research in this area (cf. Litman, 1966; Marra, 1959 McPhee & Magleby, 1960). Family members have tended to be included only when absolutely necessary, as in a crisis situation. Consequently family members often are uninformed about agency policy, treatment procedures, available community services, and especially how they might be helpful to the disabled member. Further, family stress and dysfunction, when untreated, often detract from the rehabilitation effort (Lindenburg, 1976).

This was a posttest only study that compared a traditional, individually-oriented approach and a marital approach to rehabilitation counseling. It was intended as an exploratory pilot study to ascertain the feasibility of marital therapy as rehabilitation counseling and, indirectly, to provide a small link between these two disconnected counseling fields.

METHOD

Thirty clients and their spouses from a medium size city office of the Illinois Department of Rehabilitation Services participated in the study I k o clients and their spouses who refused to participate were dropped from the study. Clients were randomly assigned to a traditional (control) group (14 males, 1 female) or to a marital (experimen- tal) group (11 males, 4 females). The mean age and mean number of years of disability were 38 and 8 for the control group and 36 and 5 for the experimental group, respectively The disabilities, judged to be similar with regard to overall severity between groups, included diabetes, arthritis, paraplegia, quadraplegia, stroke, and cancer.

Case management procedures for both groups followed the agency’s manual and differed in that the spouses of the experimental group were convened (cf. Teismann, 1980) and actively involved in the counseling. Specifically, the marital treatment differed from the traditional treatment in that the therapist actively encouraged the cooperation of both the client and spouse in defining a problem in behavioral-transactional terms and

Mark W. Teismann, PhD, is Program Director, Specialization in Marital and Family Therapy,

Beveriy Rodgers, MS, is a Rehabilitation Counselor, International Rehabilitation Associates, Northern Illinois University, DeKalb, IL 60115.

Inc. Charlotte, NC 28212.

April 1982 JOURNAL OF MARITfi AND FAMILY THERAPY 91

developing a treatment plan with behavioral goals. 'If-eatment procedures in the marital therapy group included clarifying and restructuring the decision-making hierarchy and process and interrupting dysfunctional behavioral sequences. No paradoxical interven- tions were used. The number of sessions ranged from three to seven with a mean of five sessions for both groups. The counselors were both married women in their late 20s with similar rehabilitation counseling training and experience except that the experimental condition counselor had training in the problem-focused family therapy of Haley (1976).

A 23-item, forced choice questionnaire was independently completed by both spouses in each group five months after the final counseling session. The questionnaire was based on eight problem areas commonly confronting disabled clients and their families. They included psychological stability, financial stability, mobility, role functioning, knowledge of disability, family relationships, sexual functioning, and safety needs. A question example was: Since counseling had begun, my concern for the safety needs of the disabled person has a) increased, b) remained the same, c) decreased. Employment data and two open-ended questions regarding satisfaction with the counseling process were also included.

RESULTS

A significant difference (t = 2.84, p<.Ol) between the total scores of the groups supported the hypothesis that the inclusion of clients' spouses in rehabilitation counsel- ing would be regarded as a significantly more favorable rehabilitation experience than counseling without the presence of the spouse. Chi-square analyses indicated signific- antly more favorable @<.01) responses on seven of the eight criteria. The sexual functioning area revealed no difference. Significant chi-square values ranged from 31.66 to 9.38. Reports of improvement in the experimental group were significant @<.001) on several specific questions: decreased concern over safety needs, decreased marital con- flict, decreased perception of the disabled person as a burden, increased mutual under- standing, and increased hopefulness for the future. There were five case closures due to gainful employment of spouse and/or client in the experimental group and only one in the control group. Responses to the open-ended questions strongly supported the inclusion of both spouses and children in the rehabilitation counseling process.

DISCUSSION

Limitations of this study included the lack of pretest data and a no-treatment group. The 23-item instrument, while supported by content validity, lacks construct validity and reliability. Further, since there was only one therapist for each treatment condition, it is uncertain whether the results were due to a treatment effect or a therapist effect. Finally, results could be confounded by the fact that the experimental group therapist provided evening hours to accommodate working spouses and clients, whereas no such accommo- dation was made for the control group clients.

Future research should include attention to the methodological limitations of this study. Additional outcome measures should be included, such as rates of employment, recidivism, new illnesses and accidents for both the disabled and other family members, and divorce. Studies could compare programs relative to cost-effectiveness, appointment keeping, stress in other family members, and attitudinal and morale changes for both family members and counseling staff.

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Marra, J. Family problems in rehabilitation counseling. Personnel and Guidance Journal, 1959,38,

Nau, L. Why not family rehabilitation? Journal of Rehabilitation, 1973,42, 14-17. Schwab, L. Rehabilitation of physically disabled women in a family oriented program. Rehabilita-

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April 1982 JOURNAL OF MARITAL AND FAMILY THERAPY 93