Psychosocial Adaptation to Chronic Illness and Disability.

Hanoch Livneh, Ph.D.
Richard Antonak, Ed.D.
Gaithersburgh, MD
Aspen Publishers, Inc.
1997, 471 pp.
$52.00 hardcover

The theories of adaptation to a disability have advanced significantly in the field of rehabilitation counseling over the decades. In Psychosocial Adaptation to Chronic Illness and Disability, Drs. Livneh and Antonak (1997, p. 25) present a model of psychosocial adaptation that is "nonlinear, multidimensional, and hierarchical."

In contrast, Cohn's (1961) model illustrates how research on adaptation has evolved. Cohn (1961) depicted adjustment to disabilities in terms of linear diagrams: a person's goals were blocked by the "barrier" of a disability. Other models of adaptation to a disability have included a survival model, a positive-striving model, a model from a medical viewpoint, and an engineering model (see Roessler and Bolton, Psychosocial Adjustment to Disability, 1978).

There have been many proposals about the quantity, content, and temporal ordering of the stages of psychosocial reactions to a disability. In their book, Livneh and Antonak present an eight-stage model that is based on empirical research. To account for some of the variation of psychosocial reactions by individuals with the same disability, Livneh and Antonak describe four groups of variables that will influence the rate and outcome of adaptation to a disability.

These four variables consist of three classes of intrapersonal variables: disability and illness-related, sociodemographic, and personality variables. The fourth class of interpersonal variables includes the external variables from the socioeconomic and physical environments; the attitudinal barriers; and the social and family supports.

In Livneh and Antonak's (1997) model, these four classes of variables are combined in a unique way in each individual. This dynamic model of adaptation helps to elucidate why each individual with a disability will proceed through the stages of adaptation at a different rate; why some individuals may never fully adapt; or why individuals with the same type of disability may experience a very different process of adaptation.

Psychosocial Adaptation to Chronic Illness and Disability also contains critiques of scales that are available to measure adaptation to illness and disability. Both general inventories of adaptation and inventories that are constructed for specific disabilities are discussed in terms of their strengths and weaknesses. The multidimensional scale, "Reactions to Impairment and Disability Inventory" by Livneh and Antonak (1990) is one of many instruments surveyed.

Another valuable aspect of Livneh and Antonak's book consists of discussions of 18 groups of disabilities. The disabilities that are examined range from traumatic or sudden-onset disabilities (such as spinal-cord injuries, amputations) to neurological and neuromuscular disabilities (epilepsy, multiple sclerosis) or other disease-related health-disorders (cancer, diabetes mellitus). Each chapter contains a description of the etiology, projected course, complications and other medical data about the disability; an extensive literature review of the research findings on the psychosocial adaptation to this specific disability; and a summary of information available about the relation of the four classes of variables (from Livneh and Antonak's 1997 adaptation model) to the psychosocial adaptation to the disability being discussed.

In Psychosocial Adaptation to Chronic Illness and Disability, Livneh and Antonak also review different types of counseling intervention strategies. They discuss theory-driven approaches, phase-specific psychosocial therapies, and various therapeutic approaches that are based on the type of disability. Research on the effectiveness of clinical interventions is also presented with recommendations of techniques to improve future research conducted on the process of adapting to a disability.

Psychosocial Adaptation to Chronic Illness and Disability provides a wealth of information for researchers and counselors interested in the stages of reactions that may be experienced when a disability occurs. Livneh and Antonak's multi-faceted model is unique because it describes the typical sequence of psychosocial adaptation, while allowing for individual differences in the process. This book also offers practical and useful information for rehabilitation counselors by providing extensive research citations on specific disabilities and the psychosocial processes associated with the adaptation to those disabilities.

Erin C. Martz

California State University, San Bernardino