1. History

2. Key principles and models

3. Specialty areas

4. Education and training

5. References

Rehabilitation psychologists work in a variety of settings including acute care hospitals, inpatient and outpatient rehabilitation centers, assisted living, long-term care facilities, specialty clinics, and community agencies.^[2] They typically work in interdisciplinary teams within these settings. Members of these teams vary based upon the individual patient's needs but may include a doctor, nurse, social worker, physical therapist, occupational therapist, speech therapist, prosthetist, chaplain, and case manager.^[1] Members of the team must be in constant communication in order to create a treatment plan, set goals, educate the patient and their support network, and help with discharge planning.^[1]

History

Historically, chronic mental and physical illnesses have been highly stigmatized and considered to be untreatable.^[2] Dorothea Dix, a 19th century activist, is often credited with challenging the notions of reform and illness that fueled these beliefs and laid the early groundwork for the field of rehabilitation psychology.^[3] Beginning in the early 1840s, Dix spent years traveling to prisons, workhouses, and asylums across the US. During these visits, she would document the inhumane treatment of individuals with chronic health conditions that she witnessed and report her findings to state legislatures.^[2] Her work led to the establishment of thirty-two mental hospitals around the United States and combated the stigma regarding chronic health conditions.^[2] This led many to believe in the necessity and effectiveness for active interventions in treating chronic health conditions.

The field of rehabilitation psychology was further necessitated by the onset of the Civil War. Veterans returned from the war with visible physical disabilities, leading to the first federal funding of rehabilitation.^[3] Despite federal funding, rehabilitation efforts were primarily spearheaded by private charitable organizations, that promoted the philosophy of caring for those who were ill or disabled. These organizations typically had a religious association, .^[4] A second force in establishing the field of rehabilitation psychology occurred when state-federal partnerships began to emerge at the start of the 20th century. These partnership are illustrated by laws such as the Smith-Hughes Act of 1917, the Soldiers Rehabilitation Act of 1918, and the Civilian Vocational Rehabilitation Act of 1920.^[3] These laws were major steps in recognizing the importance of rehabilitation, however, efforts were primarily focused on vocational rehabilitation for veterans.^[4] Ultimately, it was the Second World War that acted as a catalyst for the establishment of the field of rehabilitation psychology.^[5] Advances in technology during the time led to an increased number of people surviving catastrophic injuries and illnesses that would have led to casualties in previous generations.^[4] The needs of returning veterans exceeded resources and overwhelmed society. As a result, rehabilitation psychology emerged to meet these needs by focusing on applying psychological knowledge to cases of individuals with chronic health conditions to maximize their functional status, independence, health, and welfare.^[6]

Society had experienced a dramatic change in the perception of chronic health conditions since the time of Dorothea Dix. In 1954, the Vocational Rehabilitation Act was passed and provided funding for research and grants.^[3][7] As a result of this act, many universities opened rehabilitation counseling programs within their graduate schools, however, their focus continued to primarily be vocational. In 1958, rehabilitation psychology became Division 22 of the American Psychology Association.^[8] By the 1960s, rehabilitation psychology was considered a mature specialty.^[4] The specialty was prominent throughout the United States, however, it was not until 1997 that the American Board of Professional Psychology approved the establishment of the American Board of Rehabilitation Psychology.^[8]

Key principles and models

Within the specialty of rehabilitation psychology, models are important for understanding and explaining impairments, aiding treatment planning, and facilitating the prediction of outcomes.^[9] Models accomplish this by helping to organize, understand, explain, and predict phenomena.^[10] Similar to the field's roots, the models are reflective of interdisciplinary work.^[6] The wide array of models is advantageous because of the diverse problems that individuals with chronic health conditions face. Often, more than one model must be applied in order to properly understand the condition.^[10]

Biopsychosocial Model - In order to understand an individual's adaptation, biopsychosocial model points to the interaction of disease, psychological stressors, the environment, and individual factors.^[9] The model is an acknowledgement that chronic health conditions can only be understood within their larger context. This reflects the longstanding belief within the discipline that cultural attitudes and environmental barriers can influence an individual's adaptation and accentuate disability.^[11] Notably, the tenets of this model are reflected within the World Health Organization's International Classification of Functioning, Disability, and Health (ICF).^[12] This process highlights how a health condition influences, and is influenced by body functioning, activities, participation, environmental factors, and personal factors.^[12] Overall, the framework is holistic and necessitates that providers learn about the patients home life or broader context, allowing the providers to begin to fully understand the impact of the diagnosis.

Psychoanalytic Model - Freud, the father of psychoanalysis, held that individuals developed through predictable and linear stages.^[9] In the context of rehabilitation psychology, Freud's stage model can be applied to severe losses. This concept is reflected in Jerome Siller's stage theory of adjustment, designed to increase understanding of acceptance and adjustment following the sudden diagnosis of a chronic health condition.^[9] These models have been retouched and adapted more recently, however, there is not strong empirical evidence to support their effectiveness.

Social Psychology - The pioneers in rehabilitation psychology were a diverse group but many came from the field of social psychology. Kurt Lewin is one example of this. Lewin was a Jewish man in Germany during the early years of the Nazi regime.^[3] This experience shaped his psychological work and is reflected in the insider-outsider distinction as well as society's understanding of stigma.^[3] In addition to framing the conversation around disability and stigma, Lewin is known for his conceptualization (B=f(PE)).^[9] This model implies that behavior is a function a person and their environment and is still pertinent to rehabilitation psychologists today. One of Lewin's social psychology students, Beatrice Wright, is also known as a pioneer in the field of rehabilitation psychology during its early years. Wright wrote many of the field's early books including, Physical Disability: A Psychological Approach.^[3] Wright proposed the somatopsychological model that advocated for interpreting disability within its context.^[9] Much like Lewin's model, the somatopsychological model holds that the environment can either aid or hinder an individuals adjustment.^[9] Today, these models are extremely influential in the field of positive psychology.

Cognitive-Behavior Theory - In recent years, cognitive-behavioral therapy (CBT) has shown the most promise in promoting adjustment, well-being, and overall health among individuals with chronic health conditions.^[9] This model holds that cognitions and coping strategies directly impact feelings and behaviors.^[13] Therefore, by emphasizing, identifying, and changing maladaptive thoughts, CBT works to change an individual's subjective experience and subsequent behavior. A variety of empirical studies have demonstrated the therapy's effectiveness in cases of chronic pain,^[13] depression,^[14] anxiety,^[15] PTSD,^[15] and a variety of other conditions common to individuals with chronic health conditions.

Specialty areas

Rehabilitation psychology professionals apply their psychological knowledge and skills to maximize individual's functional status, independence, health, welfare, participation, and to minimize secondary complications of individuals with disabilities or chronic health conditions.^[16] Common populations include but are not limited to individuals with:^[6]

• Spinal cord injury
• Brain injury
• Stroke
• Amputation
• Neuromuscular disorders
• Chronic pain
• Cancer
• AIDS
• Multiple Sclerosis^[6]

When addressing these chronic health conditions and disabilities, rehabilitation psychologists offer a variety of services. The primary goal of the field is to increase an individual’s functioning and quality of life.^[6] Working to achieve these goals span across a variety of areas including biological, psychological, social, environmental, and political. As a result, the scope of the clinical practice is broad. Specific services may include:^[16][4]

• Providing a diagnosis and treatment
• Helping an individual understand what is to be expected
• Provide coping strategies
• Addressing an individual’s limitations and aiding the adaption process
  • Limitations in activity and subsequent changes in self-control, choice, independence, autonomy, and privacy
  • Restrictions in social participation
• Addressing impairments in functional status and subsequent changes in self-concept, body image, self-perceived attractiveness, and self-efficacy
• Perceived stigma
• Addressing physical, social, and policy environments that can restrict participation and accentuate a disability
• Short-term and long-term treatment planning
• The interaction of psychology and law
• Vocational issues^[4][16]

Education and training

Universities began offering rehabilitation counseling programs within their graduate schools during the mid-twentieth century. By the 1960s, the need for standardized guidelines for postdoctoral training in rehabilitation psychology was recognized during the field’s national conferences.^[17] The APA Rehabilitation Psychology Division 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.^[17] Patterson and Hanson outlined the entrance requirements, training length, curriculum requirements, supervision, and evaluations:^[17][16]

• Trainees are accepted only from programs approved by the national psychological association
• The minimum length of training is one year
• There are a minimum of two supervisors during training
• The curriculum includes supervised practice, seminars, and coursework
• The 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^[17]

In 1997, the American Board of Professional Psychology allowed the establishment of the American Board of Rehabilitation Psychology.^[8] Subsequently, the board elaborated on the guidelines from 1995 by requiring board certification that assesses an individual on the expected competencies.^[16] 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.^[16] In addition to displaying these competencies, rehabilitation psychologists are expected to collaborate and consult with other professionals within their field and their interdisciplinary team throughout the treatment process.^[16]

Today, individuals interested in rehabilitation psychology must meet the guidelines outlined above and complete the necessary education and training.^[8] Rehabilitation psychologists are required to complete a doctoral degree in psychology and have extensive training working in health care settings.^[6] The American Board of Professional Psychology specifies that in order to meet the standards of the field, an individual must complete: a recognized internship program, have three years of experience within the field, and have supervised experience within the specialty.^[8] In addition to meeting these basic requirements, rehabilitation psychologists offering clinical services must be licensed with a board certification within the state they practice.^[6]

Rehabilitation psychology training sites around the United States and Canada were surveyed to gain insight into the educational component of rehabilitation psychology.^[18] Researchers found that only 36% of psychology training sites that treated rehabilitation populations provided their staff with training in rehabilitation psychology. On average, the programs were founded fifteen to twenty years ago and nearly all of the existing sites were based in a hospital and associated with a medical school. In addition to gathering background information, the survey assessed if the existing rehabilitation programs meet the standards outlined by the Peterson and Hanson 1995 and ABPP.^[17] Most of the sites followed the regulations. The average length of training was one year for an intern and one to two years for the program's residents. During this training period, trainees received 2–4 hours of supervision and 2–5 hours of instruction per week. Additionally, trainees were provided with evaluations two to four times a year in order to track their progress.^[18]

References

• Fredrika Limnell
• Fredrik Andersson (ice hockey)
• Fredrika Stenhammar
• Fredrik August Lidstroemer
• Fredrik Austbo
• Fredrik Austbø
• Fredrik Axwik
• Fredrik Balkasen
• Fredrik Balkåsen
• Fredrik (band)
• Fredrik Bekken
• Fredrik Belfrage
• Fredrik Bergstroem
• Fredrik Bjoerck
• Fredrik Boeoek
• Fredrik Bojerud
• Fredrik Book
• Fredrik Bringnas
• Fredrik Bringnäs
• Fredrikbruhn
• Fredrik Bull-Hansen
• Fredrik Carl Muelertz Stormer
• Fredrik Carl Mülertz Störmer
• Fredrik Carlsen
• Fredrik Carlsson