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An empowerment philosophy for rehabilitation in the 20th century.

The field of rehabilitation, its systems, agencies, facilities, companies, and especially its rehabilitation professionals, individually and collectively share major responsibilities in responding to the needs of the estimated 34 million individuals with disabilities in the United States. For purposes of addressing the primary phenomena of this paper, rehabilitation is defined as "a process of helping handicapped individuals move from positions of dependency in their community toward positions of independency in a community of their choice" (Emener, Patrick & Hollingsworth, 1984, p.6). Furthermore, the following considerations of "empowerment" presume some of rehabilitation's basic, a priori, philosophical assumptions such as those articulated by Dowd and Emener (1978):

First, the profession has consistently held the belief that each individual is of great worth and dignity. Second, rehabilitation professionals have maintained that every person should have equal opportunity to maximize his or her potential and is deserving of societal help in attempting to do so. Third, the rehabilitation profession assumes that people by and large strive to grow and change in positive directions, reflecting both traditional American optimism and the belief in human perfectability characteristic of the Age of Enlightenment. Fourth, the rehabilitation profession assumes that individuals should be free to make their own decisions about the management of their lives (p. 35).

Thus, pertinent empowerment issues such as locus of control (Lefcourt, 1976), especially in terms of the roles and functions of rehabilitation professionals (Emener & Cottone, 1989), are critically contingent upon rehabilitation's a priori philosophical tenets. For example, Condeluci (1989) poignantly offered that "the concept of community integration and the empowerment model have their roots in social vaporization, right to choose and risk, individualization and consumer control" (p. 16). There are, however, other critical aspects of rehabilitation theory and philosophy which also are germane to considerations of empowerment.

There are numerous divergent positions regarding the interface between what people "need" versus what people "want". For example, the author of this paper frequently has felt that what some people need is to learn that they cannot always have what they want. What does "independence" mean for an individual with a severe disability--especially if considerations are given to the vicissitudes of economic independence, functional independence, social independence and psychological independence. Similar considerations also are pertinent to the concept of "freedom". Perhaps independence is sine qua non to freedom. Nonetheless, if rehabilitation professionals are dedicated to issues of individual independence and freedom on behalf of individuals with disabilities, then it indeed would appear fitting to assure that "empowerment" is a critical construct and guiding operational value within rehabilitation's systems, agencies, facilities, companies and professional service delivery personnel.

Empowerment

The process of empowering an individual or a system, means "to give power or authority to; to authorize; as, the president is empowered to veto legislation" (Webster, 1978, p. 595). Thus, the rehabilitation professional committed to an empowerment approach to rehabilitation service delivery, should facilitate and maximize opportunities for individuals with disabilities to have control and authority over their own lives. This approach involves modifications and controls both internal and external to the individual. For example, as an individual with a severe disability it is important for me to be internally empowered--I should be helped to empower myself so that I see myself as being powerful, and in a position of authority, over my own life. To a great extent, empowerment is a mind-set. Likewise, from an external point of view, the laws, rules and regulations governing aspects of my life also should be designed to accommodate my self-empowerment (Hahn, 1982, 1985). If I want to fly to another city, for example, the aviation laws should assure that I can board an airplane. Importantly, this model promotes rehabilitation professionals' activities that attend to me as an individual as well as to the environment in which I live and work. This model also surfaces the importance of modeling.

If it is critical for individuals with disabilities to be empowered, then it would be fittingly consistent for rehabilitation systems, agencies, facilities, companies, and rehabilitation professionals to likewise be empowered. It should behoove rehabilitation professionals to practice in their own lives those life-style considerations which they attempt to promote within, and on behalf of, their clients.

Empowerment: Internal and External Considerations

There are four areas of rehabilitation service delivery within which empowerment is critical: (a) rehabilitation systems (e.g., agencies, facilities and companies); (b) rehabilitation professionals (e.g., rehabilitation counselors, supervisors, managers and administrators); (c) families (of individuals with disabilities); and (d) rehabilitation clients. Important internal and external considerations of empowerment pertinent to these four areas of rehabilitation service delivery are displayed in Figure 1. The following discussion highlights and offers illustrative examples of critical internal and external empowerment considerations within each of these four areas.

Systems

External. It is important to remember that as the world and society continues to change, the field of rehabilitation and the rehabilitation systems within it must continuously and proactively change (Emener, Luck & Smits, 1981; Emener & Stephens, 1982; Hahn, 1986). It is critical for proposed and enacted public laws and policies to empower systems so that they can have the power and control they need to establish and implement negotiations with other systems in ways that facilitate effective and efficient services to individuals with disabilities. Moreover, rehabilitation systems should manage their relationships with other systems, control and market others' perceptions of them, and thus be one of many human service systems within society that collectively and synergistically attend to the needs of all citizens including those with disabilities. When discussing the importance of independence on behalf of rehabilitation facilities, Van Doren, Smith and Beigel (1986) aptly stated, "properly used, marketing helps to sharpen the social service direction so that everybody wins" (p. 14). And when social service systems are empowered by, and on behalf of, society, everybody wins.

Internal. McDaniel and Jacobs (1981) stated that "an organizational philosophy is a system of beliefs or value statements that serve as a basis for decision making" (p. 193). The organizational philosophy of a rehabilitation system, including its policies and procedures, should be written and operationalized so that the system empowers itself for purposes of self-direction, self-improvement and self-governance (consult Sussman, 1982). For example, it is quite understandable that rehabilitation professionals frequently become frustrated when the systems in which they work do not accommodate their need for freedom and autonomous functioning. And it is also interesting to note that in situations like this rehabilitation professionals are often very tempted to blame people for systems problems. Thus, it is not only important for rehabilitation systems to be empowered as systems, but to be designed, managed and therefore postured to facilitate empowerment on behalf of the professionals working within them as well. Moreover, it is critical for rehabilitation systems to recruit, retain and manage competent professional staff. Lorenz, Larson and Schumacher (1981) suggested that "personnel management in rehabilitation in the future will be a complex, decentralized task, and will require technically competent personnel specialists with well-developed leadership skills at the helm" (p. 367). Leadership in these domains is critical (Bordieri, Reagle & Coker, 1988; Emener & Stephens, 1982; Galvin & Roessler, 1986; Latta, 1987). As Frayne (1989) recently and accurately stated, "As employees' demands for flexibility, autonomy and challenge increase, managers are struggling to find an approach that accommodates both the employees' need for freedom and the organization's need for control. Self-management may be one solution" (p. 46), and "Perhaps the time has come to implement an approach to management that includes training people to manage themselves more effectively" (p. 50).

Professionals

External. Rehabilitation professionals, in order to be assured of having external empowerment (viz., to enjoy the luxuries of having social, professional, legislative and regulatory empowerment), must be competent (Emener & Cottone, 1989; Emener, Patrick & Hollingsworth, 1984). Demonstrating high level skills and efficient and effective service delivery are tantamount to receiving professional sanctioning, negotiating desired opportunities with other systems and professionals, and establishing and maintaining a desired public image. The author of this manuscript often has suggested that when the Rehabilitation Act of 1973 legislatively mandated the utilization of an Individualized Written Rehabilitation Plan (IWRP) with all clients served through the state-federal vocational rehabilitation program, the professional autonomy of the rehabilitation counselor was infringed upon. In effect, this unempowering aspect of the law told rehabilitation counselors how to serve their clients (consult Emener & Andrews, 1977). "Who do I serve?", "How do I serve?", and "When do I terminate services?" are three questions which are critical to the professionalism of the rehabilitation counselor. It is also suggested that Congress's perceived need to enact this aspect of the legislation, was a societal indictment of the quality of the clinical case management component of rehabilitation service delivery. It is somewhat ironic that this legislated mandate (viz., the required utilization of the IWRP), which was designed to empower rehabilitation clients, when implemented systemically, had a disempowering effect on rehabilitation counselors. Nevertheless, it is critical for professionals to assure that they are not externally impeded from having self-management and self-regulatory controls, and that they have the external empowerment necessary to advance and enhance their professionalism.

Internal. It is very important for rehabilitation professionals to be internally empowered (Pinkard & Gross, 1984). For example, Majumder, MacDonald and Greever (1977) reported that rehabilitation counselors who have a more internal orientation tend to have more positive attitudes toward the economically poor, higher levels of job satisfaction, better morale, higher performance ratings, and more positive attitudes toward super visio. In addition to having high level skills and abilities, rehabilitation professionals should also embrace a philosophy of helping commensurate with the philosophy of client-empowerment. Ruffin (1984), for example, offered that "the goals of therapy should not be to help the individual find meaning. Rather, it should be to help individuals accept the responsibility to face meaninglessness, and through their creativity to bring order out of chaos" (p. 42). The professional's professional self-concept and professional identity are also critical (Kyril, 1988). For example, as a rehabilitation counselor in the state of Florida who happens to be a rehabilitation counselor, or am I a professional rehabilitation counselor who happens to be working for the state of Florida?" Responses to questions such as these can provide rehabilitation professionals with helpful insights into their concepts of themselves as professionals, their sense of collegiality, corresponding networking critical to their career and professional endeavors, and the extent to which they, as professionals, are self-empowered.

Families

External. The critical role(s) of the family in a disabled individual's rehabilitation, have been clearly documented (e.g., Cook & Ferritor, 1985; Cottone, Handelsman & Walters, 1986; Dew, Phillips & Reiss, 1989; Marlatt, 1988; Power & Dell Orto, 1986). For example, in order for families of individuals with disabilities to maximize their potentials for externally oriented empowerment, it is suggested that rehabilitation counselors work with families and assist them in establishing and maintaining economic security. Roessler (1987) suggested that "vocational rehabilitation counselors must be informed about national economic projections, shifts in their local economies, vocational preparation opportunities, and entry requirements of new employment areas" (p. 190). Comparisons of rehabilitation counselors' roles and functions indicate an increase in attending to, and working with, the families of individuals with disabilities (Emener & Rubin, 1980; Pubin, Matkin, Ashley, Beardsley, May, Onstott & Puckett, 1984). It would appear very appropriate and helpful for rehabilitation counselors to occasionally ask themselves, "Is it possible that one of my client's family members could be more helpful to my client than I could be? And if this is the case, how can I facilitate the family member's providing such helpful assistance?" The importance of assisting families in managing themselves and maximizing their functional effectiveness cannot be underscored enough (Herbert, 1989). From an external empowerment perspective, it is imperative for the family to be empowered to attend to itself and its family members.

Internal. Families should be encouraged and assisted to empower themselves to prevent and ameliorate difficulties and issues pertinent to individual family members as well as to the family as a whole. For example, the author of this manuscript once was working with a teenager who had recently had a severe and permanent loss of vision as a result of an automobile accident. When talking with his family during a home visit, the young man's nine-year-old sister began crying and asked, "Will Jerry still be able to go swimming with all of us next summer?" It would be understandably tempting for a rehabilitation counselor to say something in a situation like this one; however, it was more important that Jerry turned to his sister and said, "Yes, I will, and you can help me." A family's potentials for internal empowerment are critically related to the individual family members' abilities in communication with each other (Clifford, 1987). Herbert (1989), for example, recently stated that "while rehabilitation counselors are not trained as family therapists, counselors should be able to assess family dysfunction as it relates to qualified personnel" (P.49). The individual competence and assistance of family members should be reinforced and input on behalf of family members should be encouraged. Minimally, "practioners must become involved intimately enough with the family to know about transition and to determine the impact on the disabled member's needs" (Rehab Brief.,1984,p.4). With family participation, "the vocational rehabilitation counselor can develop a plan that will help the family achieve a healthy balance between meeting the requirements of the disability and the needs of the family, which in turn increases the likelihood of a successful vocational rehabilitation outcome for the client" (Dew, et al., 1989, p. 43). When a rehabilitation counselor thinks, for example, "What can I do with my client if her family is going to continue to sabotage what I am accomplishing with her?", it is suggested that the question be reframed to, "What can I do to help her family to be more helpful to my client?"

Clients

External. External empowerment considerations must include economic security (Roessler, 1987) and social networking phenomena critical to being able to govern one's own life. In the journey of life, happiness is not a station we arrive at; rather, it is a manner of traveling-it is a by-product of effective living. In the teaching of independent living skills to individuals with disabilities, it is important to include attending to their life-style management and self-management skills (Iceman & Dunlap, 1984). In his evaluation study of the teaching of self-management skills to individuals with disabilities, Farley (1987) reported that "Rehabilitation clients who completed the social skills class independent of the self-management training made significantly less gain from class assessment to the 3-month follow-up as compared to rehabilitation clients who completed the social skills class plus self-management training" (p. 50). In effect, it is important to teach individuals with disabilities how to manage their external environments so that their potentials for self-empowerment are not impeded or negatively affected.

Internal. It is critical that individuals with disabilities empower themselves (Bruyere,1985; Condeluci, 1989). It is important for them to conceptualize and operationalize self-empowerment from an internal perspective. Lefcourt (1976), in summarizing research on locus of control phenomena, stated that "it is fairly safe to conclude that the perception of control has some profound effects upon the manner in which organisms come to grips with adversity" (p. 144). Having a healthy self-concept, meaningful interpersonal relationships, and supportive social networks, combined with a high level of self-esteem and self-management (Kazdin, 1974), indeed places an individual in a good position to empower himself or herself to be in charge of his or her life. Rehabilitation professionals must remember that they frequently are in excellent positions to initiate and reinforce internalized empowerment on behalf of their clients. For example, when an individual with a disability says to a rehabilitation counselor, "I would appreciate your telling my boss that I need that ramp complete as soon as possible," one alternative empowering response may be, "Yes, I could do that, but I would prefer that since you have been taking more and more responsibility for your life and you have the ability to express your needs and wants to other people, that we discuss how you would tell him yourself."

Empowerment Is a Mind Set

As stated earlier,empowerment is a mind set. Congress and executive boards can legislate and mandate rehabilitation agencies companies and facilities so that they are technically empowered, but unless they consider themselves as being empowered, they are not empowered. Agencies and facilities can tell the professionals working within them that they are empowered, but unless they think of themselves as being empowered, they are not empowered. Families and clients can be told that they are empowered, but unless they feel empowered, they are not empowered. When rehabilitation agencies, companies and facilities and the rehabilitation professionals working within them consider themselves, think of themselves and feel empowered, then they truly are in positions of facilitating and modeling self-empowerment within and on behalf of individuals with disabilities and their families.

Recommendations and Concluding Comments

An interesting "Catch 22" can emerge when considering issues pertinent to internal empowerment and external empowerment. For example, it could be argued that internal empowerment is a prerequisite for facilitating external empowerment; likewise, it could be argued that external empowerment is a prerequisite for internal empowerment. Rather than to debate an understandable "the chicken or the egg" question, it would appear more realistic and functional to suggest that systems, professionals, families and individual clients must attend to both their external empowerment and their internal empowerment issues simultaneously and continually. The benefits of such, indeed, are worth the effort. For example, William Holahan (1988) shared his transitional learning and movement toward self-empowerment as he progressed from being an intern to being a senior staff member in a counseling center:

In the end, I have also become more self-nurturant, and this is the finest result of my quest to understand the transition experience. Because I function with considerable autonomy, I can no longer rely soley on nurturance from others. I have begun to be self-encouraging and self-reinforcing, skills that I am sure I shall need as I continue to develop and assume professional positions with less supervision and more autonomy (p.120).

Myrya Kyril (1988) reported a similar experience and concluded that "I had come into my own" and had a renewed appreciation for the "phenomenological experience of its meaning in the larger context of my professional development" (p.121).

Living and modeling an internally empowered lifestyle is critical to rehabilitation service delivery. Bruyere (1985), for example, suggested that "as counselors, we should explore with clients meaning in life for them, so we are better able to set with clients both vocational and larger life goals consistent with this meaning. To do so better assures the ultimate value of rehabilitation service in the life of a given client" (p.40). The true value of rehabilitation services, even in an era of accountability,is not vested in the number of "closures" but in its impact on the quality of life and on the happiness in life of each individual client served.

Rehabilitation systems, professionals, clients' families and clients themselves need to be encouraged and assisted in the process of enhancing and managing their externally oriented empowerment considerations. Likewise, they need to attend to the internal, self-empowerment aspects of their lives. While addressing the disability of cerebral palsy, Condeluci (1989) recently offered a poignant observation and recommendation relevant to the broader field of rehabilitation: "... We must bridge the gap from the medical model to an empowerment model. We are learning that when people with cerebral palsy are given the opportunity to be in control of their situation, good things happen. People want to belong and be a part of their community. An empowerment approach can make this happen" (p.16). If autonomy, freedom and independence are the by-products of effective living and the heart of happiness in life, then empowerment is the backbone of rehabilitation service delivery. It is imperative for rehabilitation professionals to maximize every opportunity they have to facilitate each client's self-empowerment. Individuals with disabilities can grow toward independence when they can experientially discover their own key to freedom, which was so beautifully expressed by Dr. Shirley Kashoff:

The Key to Freedom

I used to think that Freedom

Was what someone gave to me

Until I found that I was bound

By nameless heavy chains

I could not see.

I used to think that Freedom

Was what someone gave to me

Until I learned that what I'd earned

Was simply my permission

To use that very freedom

That no one but myself

Could give to me.

Those locks and bonds and prisons

Are the things we've learned to hate

Yet those most despised constructions

Are identically the ones

We have masterfully come to create.

I spent my lifetime waiting

For someone to set me free

I could not grow

I didn't know

That in my very hands I held

The key.

And in the broader scheme of rehabilitation in America, this is what it is all about!

Acknowledgements

For their suggestions, recommendations and critical review of an earlier draft of this manuscript, sincerest appreciation is extended to five members of an advanced graduate Field Research Seminar in the Department of Rehabilitation Counseling at the University of South Florida: Margaret A. Darrow, David E. Layman, Marilyn N. McClain, A. Miranda Ray and Wendy L. Struchen.

This manuscript is based on a symposium proceedings paper, "Empowerment: The Backbone of Rehabilitation Service Delivery", presented by the author at the National Rehabilitation Counseling Association's Seventh Annual Professional Development Symposium, in Boston, Massachusetts, on February 10, 1990. Appreciation is extended to Dr. Tennyson J. Wright, Coordinator of the Symposium and Editor of the Symposium's Proceedings, for his review of this manuscript and for granting permission to submit it to the Journal for consideration for publication.

For their valuable assistance in modifying and expanding this manuscript from the Symposium Proceedings paper, a hearty "Thank-you" is respectfully forwarded to Dr. Bobbie J. Atkins, Professor of Rehabilitation Counseling at San Diego State University and to Margaret A. Darrow, a doctoral student in the Department of Special Education at the University of South Florida.

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Author:Emener, William G.
Publication:The Journal of Rehabilitation
Article Type:Editorial
Date:Oct 1, 1991
Words:4583
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