Values and valuing in rehabilitation.

Rehabilitation service providers must identify what is valued in terms of consumer goals and outcomes. On a practical level, service providers must assess if values guide the provision of services or if, in actuality, standard practices shape the values that professionals hold toward consumers and services provided. In the latter instance, one may wonder if values evidenced by service providers reflect consumers' needs or service providers' needs. It is therefore significant to propose values that influence rehabilitation and understand their potential for impacting practices.

Values are indicators of what is held in esteem (Gordon, 1975; Rokeach, 1973). Values act as standards or beliefs that guide actions and judgments across situations and time. Typically values are organized by priority into what is known as a value system, thereby resulting in a continuum along which judgments are made regarding behaviors and actions (Kluckhohn, 1951; Rokeach, 1973, Schwartz, 1990). Values and resulting value systems operate at the individual or personal level, the institutional or professional level, and a societal or national level (Rescher, 1969; Schwartz, 1990). Personal values, for example, are values that do not necessarily involve interaction with others. Personal values are expressed by an individual's behavior that generally brings about the value satisfaction (for example, someone who works diligently on a job because he or she values a strong work ethic; Gordon, 1975). Institutional or professional values, alternatively, may be described as a specified prioritization or constellation of values that serve to express and encourage the identification and advancement of the group's values (Schwartz, 1990). In this sense, professional values serve as a group's standards and have the propensity to set the direction toward which an organization works (NICHCY News Digest, 1993). This happens whether values are clarified by the group and stated up front or whether they are ambiguous because they have not been formally identified. When values are not articulated, assumptions are made about what is considered to be of value. Unspoken values and assumptions made about what is of value to the group, however, will continue to influence and shape the behaviors and actions of the group. The purpose of this paper is to propose values that influence the field of rehabilitation and to explore how values influence both service providers and consumers of rehabilitation services.

Values Identified in Rehabilitation

In the field of rehabilitation, values serve as motivating forces (Jenkins, 1987). Hotz (1992), discussing philosophical considerations that serve as cornerstones in rehabilitation, outlined the following "Moral Argument" for rehabilitation: "In our society we greatly respect and value the human rights and dignity of all people, and feel a moral obligation to provide assistance to people with special needs" (p. 9). Emener, Patrick, and Hollingsworth (1984) stated that rehabilitation is "a process of helping handicapped [sic] individuals move from positions of dependency in their community toward positions of independency in a community of their choice" (p. 6). In this definition of rehabilitation, the values of helping (or altruism), independence, community, and choice are highlighted. Empowerment, a concept that has been identified as a central concern in rehabilitation psychology (Bolton and Brookings, 1996), incorporates the values or concepts of self-control, choice, independence, and self-determination (Szymanski, 1994). When operationally defined, these concepts potentially serve as motivating forces for policies and procedures within which rehabilitation counselors perform their jobs.

In rehabilitation, as in other professions and institutions, values help to establish the manner in which the organization or profession functions on a daily basis (Wilson, 1988). Service providers in the field of rehabilitation are guided by values that are inherent in mission or goal statements expressing the philosophy and purpose of the organization (McLaughlin & Warren, 1992). Additionally, values serve as the basis for professional codes of conduct. Values serve as standards by which competency requirements for certification, licensure, educational degrees, and the provision of services are established (Wilson, 1988).

Mission statements serve as practical illustrations of how values influence the federal and state rehabilitation system. The purpose statement of the federal vocational rehabilitation mandates two areas of concern:

(1) to empower individuals with disabilities to

maximize employment, economic self-sufficiency,

independence, and inclusion and integration into

society, . . .

(2) to ensure that the Federal Government plays a

leadership role in promoting the employment of

individuals with disabilities, . . . in assisting States

and providers of services in fulfilling the aspirations

of such individuals with disabilities for meaningful

and gainful employment and independent living (29

U.S.C., Chapter 16, Sec. 701).

On the state level as well, values are often evidenced in the Purpose (or mission) and Philosophy Statements of state vocational rehabilitation systems. The following, taken from the Georgia Division of Rehabilitation Services, is one such example - "Purpose: To provide opportunities to improve the quality of life for Georgians with disabilities" and "Philosophy: To celebrate a belief that all people deserve the best we have to offer" (Georgia Department of Human Resources, Division of Rehabilitation Services, Strategic Plan, 1996). At first glance these statements may appear broad and open to interpretation; however, they are further refined by Value Statements that follow and detail actions and behaviors that correspond to the specific value. For example:

We value persons with disabilities. Therefore, we will:

* Involve customers and stakeholders in decision making

* Honor the rights of persons with disabilities to make life choices

* Develop policies and procedures to `assist, not hinder'

* Recognize and respect the individuality of persons with disabilities

* Provide accessible facilities, offices, and staff (Georgia Department of Human Resources, Division of Rehabilitation Services, Strategic Plan, 1996, p. 1-2).

A total of five guiding values are stated in this document; each value statement followed by a number of corresponding statements identifying how that value will be expressed by individuals working in the Georgia Division of Rehabilitation Services.

Another example of a mission statement that results in the identification of an organization's values is seen in the mission statement of the National Rehabilitation Association (NRA): ". . . providing opportunities through knowledge and diversity for professionals in the fields of rehabilitation" (Tourigny, Sales, & Organist, 1995, p. 19). Based upon this mission statement, seven core values are identified:

1. all people, 2. professionals in rehabilitation, 3. visionary

leadership, 4. responsible resource management, 5. advocacy,

6. personal and professional enrichment, and 7. relationships

built on trust and integrity (Tourigny, Sales, & Organist,

1995, p. 19).

When values are clearly identified and stated, as in the above examples, they serve as a focal point in the organization's blueprint. Values set the standards which form the framework for an organization's daily practices, procedures, codes of conduct, and mindset.

Values, Federal Legislation, and Rehabilitation

Federal legislation has helped shape much of the rehabilitation system in this country. Jenkins (1987), in describing this process, remarked that ". . . changes in federal legislation have reflected marked changes in values and beliefs in our society" (p. 3). Societal values have influenced the passing of federal legislation which, in turn, has further impacted values and beliefs evidenced in this country. Examples of changing societal values that have influenced federal legislation include the Civil Rights and anti-war movements, women's liberation movement, and gay rights activism. The disability rights movement, including parent and consumer advocacy groups, the independent living movement, and peer-provided rehabilitation services, has helped to alter federal legislation in this country as well (Bolton & Brookings, 1996). The reciprocal relationship between societal values and federal legislation can be seen in the passing and administration of laws that have affected the fields of rehabilitation and education in the last 25 years (e.g., the Rehabilitation Act of 1973; Education for All Handicapped Children Act; Individuals with Disabilities Education Act; and the Americans with Disabilities Act of 1990).

Values that influence federal legislation may not always be explicitly stated, yet they often are based upon a priori, philosophical assumptions that helped to shape the founding of this country; for example, individualism and equality (Emener, 1991; Fowler & Wadsworth, 1991; Pole, 1978; Sampson, 1988;). Sampson (1988) stated that, because individualism and equality are highly meaningful to most Americans, they are values that are associated with additional values, including self-reliance, self-determination, independence, autonomy, freedom, and responsibility.

Empowerment

The values of choice, independence, and self-determination take on added significance in that they are concepts also found under the rubric of empowerment (Szymanski, 1994). Emener (1991) identified empowerment as a critical guiding value since rehabilitation professionals are dedicated to issues of independence and freedom for individuals with disabilities. Emener indicated that it is consistent for rehabilitation systems to be empowered in the same manner that individuals with disabilities seek empowerment. Service providers in rehabilitation must be willing not only to advocate for the empowerment of clients but exemplify and model empowerment in their own lives as well (Emener, 1991).

Empowerment is an overriding concern in rehabilitation because within the concept of empowerment exist indicators which point to the quality of one's life. For example, Parent (1993) stated that empowerment assumes consumers are able to express their choices and exert control over their lives. Thus, quality of life may be measured by the degree of satisfaction individuals with disabilities experience and is based, in part, upon one's ability to make choices and act upon them. Again, federal legislation has supported the values of choice and personal control through the passage of the Americans with Disabilities Act (ADA) of 1990 (Public Law 101-336) wherein equal opportunity is guaranteed for individuals with disabilities in employment, public accommodations, transportation, services of state and local government, and telecommunications.

Hahn (1991) suggested that a focus on the civil rights of individuals with disabilities should become fundamental for service providers in rehabilitation. By focusing on the civil rights of individuals with disabilities, disability becomes a product of a disabling environment rather than a personal defect or deficiency. With this focus, much of the discrimination that individuals with disabilities experience could be refocused on environmental concerns. Rather than having to fight for basic rights, such as employment and housing, persons with disabilities could truly focus on the expression of values such as independence, autonomy, and self-actualization. For this to happen, schools, communities, neighborhoods, and society must work together in recognizing that all people, including persons' with disabilities, belong and are valued (Racing, 1992). Racino (1992) indicated that "We are on the brink of an era that will demand new concepts to guide us into the future. Normalization, mainstreaming, empowerment, community participation, lifestyle choices, independence, least restrictive environment, and integration . . ." are some of the values that will help pilot rehabilitation into the future (p. 131).

How Values Influence Service Providers

To a large extent, counseling theory and techniques influence rehabilitation counseling practices. For instance, most students in graduate rehabilitation counseling programs are taught counseling techniques such as basic attending skills (Carkhuff, 1987; Ivey, Gluckstern, & Ivey, 1982). Additionally, rehabilitation counselors may find it necessary to use interventions such as modeling, role-play, rehearsal, and cognitive restructuring with consumers (Hackney & Cormier, 1988). Inherent in the rehabilitation counseling process is an attempt to assist consumers to seek empowerment and, ultimately, self-actualization (Mallow, 1959; Rogers, 1964).

Patterson (1989) discussed the self-actualizing process as a goal or value common to all persons and as such should not be considered solely within the jurisdiction of psychotherapy. Self-actualization and empowerment are goals that influence professionals who work in the field of rehabilitation and produce parallels seen when exploring values in counseling and rehabilitation services.

Bergin (1985) stated that values used in the context of counseling are ". . . orienting beliefs about what is good for clients and how that good should be achieved" (p. 99). He argued that because values are "necessarily embedded in the treatment process, they should be made explicit and . . . openly used to guide and evaluate change" (p. 99). Patterson (1989) contended "the problem is not simply whether or not therapists should openly impose their values on clients. Can therapists avoid influencing the values of their clients?" (p. 33).

When values are stated in counseling, they should be clearly identified as the counselor's values (Patterson, 1989). Both Patterson and Bergin (1985) indicate that counselors' values cannot be kept out of the therapeutic relationship. Therefore, counselors need to be aware of their values and the role values play in counseling. Patterson (1989) stated "the awareness that the therapist is a person who is participating in a personal relationship with the client brings the importance of the therapist's values into focus" (p. 169).

Since service providers in rehabilitation are equally incapable of removing values from their work, it would seem necessary to understand one's own values as opposed to values of individual consumers. When this happens both consumers and counselors are served. A counselor's self-awareness of her or his private values and value system helps consumers clarify the consumer's unique position when making value-based decisions. This occurs because value-based decisions are made by consumers as a result of their value system and are not the result of a counselor super-imposing the counselor's value system on the consumer. When service providers do not understand or cannot articulate their personal and professional values, their ability to provide guidance and help consumers make choices regarding services is diminished. In such a situation, not only is a counselor incapable of modeling self-awareness and empowerment, their undifferentiated value system will most likely influence the decision making that is part of setting goals and establishing rehabilitation plans. It is necessary for consumers to voice desires and set goals based upon the consumer's values rather than merely accepting goals based upon service providers' values. In turn, increased self-awareness in consumers helps to indicate to counselors that they are effective agents of change and results in empowering consumers Defining the nature of the client-counselor relationship, Bergin (1985) stated:

Although we have to be patient while people struggle with

their choices and may have to watch them make bad

decisions without interference, it is irresponsible to fail to

inform them of our educated opinions about the alternatives.

Like good teachers or parents, we should at times instruct

carefully. We need to be honest and open about our views,

collaborate with the client in setting goals that fit his or her

needs, then step aside and allow the person to exercise

autonomy and face consequences (p. 107).

Value Conflict and Consumer Choice

Career counseling provides an example where values play an important role within the broader scope of rehabilitation counseling. When participating in career planning and counseling, persons are typically expected "to value work, to plan, to be purposeful, to be productive, to be serious about life's meaning, to be useful, and to be committed to growth and learning rather than to passively accept being unemployed or on welfare" (Herr & Niles, 1988, p. 9). What happens to consumers seeking vocational or career guidance who do not share values and goals held in esteem by their counselors?

Bergin (1985) indicated that when our values are implied or elusive we are more likely to unwittingly influence another's choice. If counselors are not aware of their own values and do not recognize the fact that consumers may hold different values when seeking career guidance, then consumers may be unknowingly swayed to incorporate the counselor's beliefs and values into the consumer's value system. A more pertinent issue in such a case may be that of a counselor attempting to change consumers to meet the counselor's value-based perception of the world. This situation may be seen when counselors functioning from a white Anglo-Saxon Protestant world view (Sue, 1981), who prefer clients that are young, attractive, verbal, intelligent, and successful (YAVIS; Schofield, 1964), work with clients that do not fit this profile. The counselor may not understand the client's value system or why such values are important to the client (Herr & Niles, 1988). In such a case, conflict may occur if the counselor

limits him or herself to viewing client behavior through

a psychological lens that assumes individual action to be

the prime determinant of success or happiness. In such

a view, individual initiative, planfulness, deferred

gratification, and achievement orientation may be values

consciously or unconsciously imposed on the client by

the counselor. In these situations, clients for whom such

values are neither prized nor socially inculcated may be

viewed as lazy, marginal, unmotivated, abnormal, or

described using other such labels that are, in fact, value-laden

rather than a result of valid, client-centered

differential diagnosis. (Herr & Niles, 1988, p. 6).

How Values Influence Consumers

It is seen then that service providers in rehabilitation do more than merely provide services. They work within a value-laden context wherein goals and objectives are established which impact the provision of ensuing services. Ju and Thomas (1987) noted that it is important for rehabilitation counselors to perceive clients' needs, problems, and values accurately in order to identify and deliver appropriate services. They indicated that this is not always the case. Based on their study of general services delivered in rehabilitation workshops, Ju and Thomas (1987) found that counselors were accurate in perceiving the importance of economic security to their clients. It was noted, however, that counselors underestimated the importance of clients' other work values. The authors indicated that, when counselors interact with clients through affective content, counselors:

increase their understanding of clients and learn about

clients needs, values, and beliefs. Counselors in

rehabilitation settings also regard affective counseling as

important. Some counselors in these settings, however,

do not really function as counselors although they are

called `counselors.' For example, it was observed that

some of the counselors who participated in this study

functioned more as floor supervisors than as counselors

despite job titles of `rehabilitation counselor' or `case

manager.' For these counselors, interactions with the

clients were primarily work related and task oriented. It

is possible that they dealt less with affective and more

with the cognitive and behavioral content and thus did not

gain adequate understanding of client needs or values (pp.

162-163).

Conclusion

Values play an important role in rehabilitation. Values are embedded in the definition, philosophy, and purpose of the rehabilitation system in this country. The values that drive this system are proposed in Table 1. Core values are highlighted with accompanying values listed below each core value.

Table 1
Values and Value Structure in Rehabilitation

   Altruism:
      Individual dignity
      Individual worth
      Self-actualization process

   Choice:
      Community participation
      Integration
      Least restrictive environment
      Mainstreaming normalization

   Empowerment:
      Independence
      Self-control
      Self-determination

   Equality and Individualism:
      Autonomy
      Freedom
      Responsibility
      Self-reliance

Altruism. The value of altruism represents the "Moral Argument" for rehabilitation (Hotz, 1992). As a society, we believe in the value of the individual (Emener, 1991). Accordingly, each and every person is regarded as holding inherent worth and dignity. Our society also holds the belief that people should and will better themselves (or move toward self-actualization). Therefore, each and every person should have the opportunity to develop their potential and there is an obligation to offer assistance to people with varying needs (Dowd & Emener, 1978). In this way, altruism is a value that influences the rehabilitation system as well as most social service organizations and institutions in this country.

Choice. Choice is a value that influences how we live; indeed, even where we live. The value of choice is the belief that one should be able to determine, as much as possible, the manner in which one lives. Within the value of choice are concepts such as community participation, integration, least restrictive environment, mainstreaming, and normalization (Racing, 1992). These concepts represent areas in which individuals with disabilities may not have been able to exercise choice. Choice is important because one's ability to choose often helps to determine the quality of life experienced.

Empowerment. While choice is the ability to determine how one lives, empowerment is the ability to act upon choice (Parent, 1993). Empowerment is a value that indicates one has an awareness of choice and the opportunity and independence to act upon one's choices. Found within the value of empowerment are the concepts of self-control and self-determination (Szymanski, 1994). The nature of one's self-control and self-determination may indicate the degree of empowerment experienced.

Equality and Individualism. Equality is a value that is also based upon the belief of individual worth and dignity. Precisely because each individual holds worth and dignity he/she should be afforded an equal chance to develop his/her potential (Dowd & Emener, 1978). Activists such as civil and human rights workers, feminists, gay rights activists, and disability advocates are examples of individuals banding together in our society seeking equal opportunities. Individuals in our society often seek equal opportunities in order to maintain autonomy as much as possible within the general structure of our society. Autonomy is based upon individual and societal freedoms. Autonomy and freedom, however, do require the individual to maintain self-reliance and personal responsibility in order to function individually and as a member of society. Equality forms a circular link to individual and societal autonomy and freedom, which in turn requires personal and societal responsibility and self-reliance.

In conclusion, the values of altruism, choice, empowerment, and equality and individualism have the potential to serve as standards guiding professional codes of conduct and the provision of services in rehabilitation. As such, the importance of exploring the role of these values is found in understanding their capacity to positively influence service providers and consumers alike. In that values are inherent in the counseling process, counselors must be able to differentiate their personal and professional values from those of consumers. By exploring the role that values play in the counseling process, service providers can function more effectively in that they are not hidden persuaders. When consumers have the opportunity to explore their values and make choices based upon pertinent knowledge, they will be one step closer in moving toward the ultimate goal of self-actualization.

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Rebecca S. Curtis, Ph.D., CRC, Roosevelt Warm Springs Institute for Rehabilitation, Vocational Unit, PO Box 1000, Warm Springs, GA 31830-0268.