Chapter

The Psychologist

Authors:
  • University of Perugia. Italy
  • Università degli Studi di Perugia e Università per Stranieri di Perugia
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Abstract

The present chapter deals with the role and the competencies of the psychologist in a center for technical aid. The lapse of the psychologist’s role in assistive technology (AT) assessment is probably due to the non-coding of personal factors in the ICF. In viewing the psychologist as the “specialist” on personal factors, the authors call for a revision of the ICF, so that in the biopsychosocial model, “psycho” does not continue as merely a prefix. The psychologist in a center for AT evaluation and provision has the goal of supporting the user’s request in the user-driven process, as well as acting as a mediator for users. The psychologist also acts to build a team spirit and enhance the relationship between the client and the home environment. Finally, an original study closes the chapter, focusing on the psychologists’ and professionals’ representations of disabled users and AT.

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Book
La première édition de La psychanalyse, son image et son public était une thèse. Cette seconde édition est, je l’espère, un livre. De l’une à l’outre j’ai modifié le style, le mode d’exposition des faits et des idées, éliminé des indications techniques et théoriques qui n’intéressaient qu’un cercle restreint de spécialistes ou qui sont devenues monnaie courante. Ce travail de réécriture correspond, bien entendu, aussi à une évolution personnelle et intellectuelle vis-à-vis des rites d’initiation universitaire et de la science. Lors de sa parution, la thèse a provoqué un malaise. Des psychanalystes surtout ont vu d’un mauvaise œil la tentative de prendre la psychanalyse comme objet quelconque d’étude et de la situer dans la société. 2 J’ai été frappé alors, et je le suis toujours, par le fait que les détenteurs d’un savoir, scientifique ou non, croient avoir le droit de tout étudier — et en définitive de tout juger — mais estiment inutile, voire pernicieux, de rendre compte des déterminismes dont ils sont le lieu, des effets qu’ils produisent, bref d’être étudiés à leur tour et de regarder le miroir qu’on leur tend en conséquence. Ils y voient une immixtion intolérable dans leurs propres affaires, une profanation de leur savoir — veut-on qu’il reste sacré ? — et réagissent, suivant leur tempérament, avec mépris ou mauvaise humeur. Ceci est vrai de la plupart des scientifiques, ceci est même vrai des marxistes. C’est pourquoi nous n’avons pas de sociologie de la science, ni du marxisme, ni de la psychanalyse. Je me suis cependant aperçu qu’en dix ans, du moins en ce qui concerne la psychanalyse et les psychanalystes, les attitudes ont beaucoup changé dans un sens favorable à un travail tel que celui-ci. 3 Au centre de ce livre est le phénomène des représentations sociales. Depuis la première édition, de nombreuses études tant de terrain que de laboratoire lui ont été consacrées. Je pense notamment à celles de Chombart de Lauwe, Hertzlich, Jodelet, Kaës d’un côté et à celles d’Abric, Codol, Flament, Henry, Pêcheux, Poitou de l’autre. Elles ont permis de mieux saisir sa généralité et de mieux comprendre son rôle dans la communication et la genèse des comportements sociaux. Mon ambition était cependant plus vaste. Je voulais redéfinir les problèmes et les concepts de la psychologie sociale à partir de ce phénomène, en insistant sur sa fonction symbolique et son pouvoir de construction du réel. La tradition behavioriste, le fait que la psychologie sociale se soit bornée à étudier l’individu, le petit groupe, les relations informelles, ont constitué et continuent à constituer un obstacle à cet égard. Une philosophie positiviste qui n’accorde d’importance qu’aux prédictions vérifiables par l’expérience et aux phénomènes directement observables s’ajoute à la liste des obstacles. 4 Cette tradition et cette philosophie empêchent, à mon avis, le développement de la psychologie sociale au-delà des limites qui sont les dermes aujourd’hui. Quand on s’en rendra compte et que l’on osera franchir ces limites, les représentations sociales, j’en suis convaincu, prendront dans cette science la place qui est la leur. En outre, elles seront un facteur de renouvellement des problèmes et clés concepts de la philosophie qui doit sous-tendre le travail scientifique. Là encore, les jeux ne sont pas faits. Au contraire ils sont à refaire et la crise que traverse la psychologie sociale le montre à l’évidence. 5 Il y va de l’intérêt de bien d’autres domaines de recherche concernant la littérature, l’art, les mythes, les idéologies et le langage. Enfermés dans des cadres dépassés, prisonniers de préjugés quant au pecking order des sciences, les chercheurs dans ces domaines se privent des moyens que, dans son état actuel, la psychologie sociale met à leur disposition. En France notamment ils se réclament, sous l’emprise du structuralisme, d’une orthodoxie saussurienne, tout en oubliant ce que Ferdinand de Saussure a entrevu avec précision : « La langue est un système de signes exprimant des idées, et, par là, comparable à récriture, à l’alphabet des sourds-muets, aux rites symboliques, aux formes de politesse, aux signaux militaires, etc. Elle rat seulement le plus important de ces systèmes. On peut donc concevoir une science qui étudie la vie des signes au sein de la vie sociale ; elle formerait une partie de la psychologie sociale et par conséquent de la psychologie générale ; nous la nommerons sémiologie (du grec semeïon, « signe »). Elle nous apprendrait en quoi consistent les signes, quelles lois les régissent. » Mais le lecteur n’a pas à se soucier de ce passé, de cet état de la science, des projets flottant autour du livre. Pas plus que je ne m’en soucie. En faisant l’étude d’abord, en lui donnant forme ensuite, je me suis enrichi et j’ai eu du plaisir. Tout ce que je souhaite c’est que, en lisant ce livre, il lui arrive la même chose.
Article
Purpose: The study brings together three aspects rarely observed at once in assistive technology (AT) surveys: (i) the assessment of user interaction/satisfaction with AT and service delivery, (ii) the motivational analysis of AT abandonment, and (iii) the management/design evaluation of AT delivery services. Methods: 15 health professionals and 4 AT experts were involved in modelling and assessing four AT Local Health Delivery Service (Centres) in Italy through a SWOT analysis and a Cognitive Walkthrough. In addition 558 users of the same Centres were interviewed in a telephone survey to rate their satisfaction and AT use. Results: The overall AT abandonment was equal to 19.09%. Different Centres' management strategies resulted in different percentages of AT disuse, with a range from 12.61% to 24.26%. A significant difference between the declared abandonment and the Centres' management strategies (p = 0.012) was identified. A strong effect on abandonment was also found due to professionals' procedures (p = 0.005) and follow-up systems (p = 0.002). Conclusions: The user experience of an AT is affected not only by the quality of the interaction with the AT, but also by the perceived quality of the Centres in support and follow-up. Implications for Rehabilitation AT abandonment surveys provide useful information for modelling AT assessment and delivery process. SWOT and Cognitive Walkthrough analyses have shown suitable methods for exploring limits and advantages in AT service delivery systems. The study confirms the relevance of person centredness for a successful AT assessment and delivery process.
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The International Classification of Impairments, Disabilities, and Handicaps (ICIDH) published and used by the World Health Organization is currently undergoing a revision. Its conceptual basis is the medical model which leads to the medicalization of disability. From this point it is a short step to eugenics and a class-based evaluation of people with disabilities using the concept of 'normal'. People with disabilities are found to be lacking and a burden. The language and the logic of the ICIDH are faulty. It is replete with biased, handicapist language. In its present form and even in its proposed revised form (ICIDH-2) it is a threat to the disability community world wide.
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When clients have disabilities, questions arise about boundaries, advocacy, and the interface between personal and political agendas. In disability-affirmative therapy the clinician incurs responsibilities in multiple areas: understanding the minority model and its treatment implications; valuing disability culture; awareness of the distinction between disability and impairment; facility with discussions of values and disability dialectics; ability to integrate sociopolitical forces into treatment; facility with countertransference; ability to incorporate disability into the case formulation; staying within one's area of competence; working with disability within larger systems; understanding of disability in context; and valuing disability as part of diversity training, teaching, and research.
Article
In 1999, the World Health Organization issued a document (Beta-2 ICIDH-2) that outlines proposed revisions to the original International Classification of Impairments, Disabilities, and Handicaps. The document, issued for trial purposes, is significant in that it redefines the theoretical context in which audiological research into hearing disability has operated since 1980 and will develop in the future. The purpose of this article is threefold. First, it provides an introductory descriptive overview of the primary disablement dimensions outlined in the Beta-2 version of the ICIDH-2 framework. Second, in discussing the implications of the revised framework for audiology, the article highlights particular classification issues that require clarification if the framework is to be applied effectively in audiological research and practice. Third, the article evaluates the revised framework in the context of recent conceptual developments in audiological research and raises a number of issues for further discussion and investigation. The article concludes that the Beta-2 ICIDH-2 represents a significant advance on the original ICIDH classification framework on three counts. First, much of the rationale underpinning the revised framework, particularly its redefinition of the primary disablement dimensions, is consistent with recent conceptual developments in audiological research into hearing disablements. Second, the framework offers specific pointers for the development of current audiological research and practice. One potential line of enquiry focuses attention on specific ICIDH-2 dimensions that are currently under-represented in audiological literature, namely, the participation and contextual factors dimensions. Another potential line of enquiry focuses attention on issues pertaining to the measurement of function, specifically the inclusion of “positive” outcome indicators in assessment. Finally, the publication of the revised ICIDH-2 framework offers a standard frame of reference from which to conduct larger debates in the audiological literature about the nature and purpose of audiological rehabilitation and the influence of the ecological perspective on the rehabilitative process. Sumario En 1999 se emitió la Clasificación Internacional de Funcionamiento y Discapacidad (Beta. 2 ICIDH-2) para propósitos de evaluaciones de campo. Este doc-umento refina la versión anterior de la Clasificación Internacional de las Incapacidades, Actividades y Participación (ICIDH-2) publicada por la Organizatión Mundial de la Salud (OMS) en 1997. Estos dos documentos son importantes puesto que re-definen el marco ICIDH original de la OMS (1980) que influyó la investigación audiológica hasta que se initió el proceso actual de revisión. Este artículo tiene tres objetivos. El primero es aportar una revisión descriptiva introductoria de las dimensiones primarias de incapacidad delineadas en la versión Beta-2 del marco ICIDH-2. Segundo, al discutir las implicaciones para la Audiología del marco revisado, se destacan asuntos particulares de clasificación que requieren aclaración si dicho marco ha de ser apli-cado efectivamente en la práctica y la investigación audiológica. Tercero, se evalúa el marco revisado en el contexto de los más recientes desarrollos conceptuales en investigación audiológica, y destaca una serie de asuntos que deberán ser discutidos e investigados. El artículo concluye que el Beta-2 ICIDH-2 representa un avance significativo con respecto al marco original de clasificación ICIDH en tres aspec-tos. Primero, muchas de las razones que sustentan el marco revisado, particularmente su redefinitión de las dimensiones primarias de discapacidad, es consistente con desarrollos conceptuales recientes en investigación audiológica sobre discapacidad auditiva. Segundo, el marco ofrece puntos específicos para el desarrollo actual de la investigación y la práctica audiológica. Una línea potencial de interrogatión concentra su atención en dimensiones especi-ficas ICIDH-2 que actualmente están sub-representadas en la literatura audiológica, a saber, las dimensiones de participación y de factores de contexto. Otra línea potencial de interrogatión concentra su atención de indicadores de resultado “positivo” en la evaluatión. Finalmente, la publicatión del marco ICIDH-2 revisado ofrece un marco normado de referenda a partir del cual se podrán conducir debates mayores en la literatura audiológica sobre la naturaleza y el propósito de la rehabilitación audiológica y sobre la influencia de la perspectiva ecológica en el proceso de rehabilitatión.
Article
This paper begins with four reinterpretations about the prevalence, trends, temporality, and spread of disability. Together they lead to a different view of disability as quite pervasive in terms of sheer numbers, length of disability experience, and domains of life, as well as organ systems affected. The denial of this reality is related to our attempt to make disability "fixed" and "dichotomous," whereas it is better conceived of as "fluid" and "continuous." The costs of maintaining the former position are traced in notions of disability's "real" numbers and measurement, as well as in research, policy, and advocacy arenas. A redirection is suggested in terms of a more multidimensional approach and a purging of the inherent negative elements in current conceptions and measurement of disability.
Article
People who have sustained brain injury are administered standardized neuropsychological tests designed to evaluate brain dysfunction. Phenomenology is a descriptive method that seeks to explicate people's lived experience and hence goes beyond the realm of mere brain function. Our method of neurophenomenological assessment mitigates the dangers of reducing people to brain dysfunction, and facilitates collaborative assessment of people who have brain injury. We offer examples of how clinicians can supplement their understanding of brain‐injured people, and we report concrete suggestions that relate to these clients’ everyday lives.
Article
In this book, leading experts explore ways psychologists and other helping professionals can collaborate with users of assistive technology to help them get the most out of these devices. Thanks in large part to the past century's advances in technology, people with disabilities can live independent lives, contribute to their communities, attend regular schools, and work in professional careers. This technological evolution has fomented a shift from a medical to a social model of technology delivery, an approach that puts as much emphasis on users' community reintegration as it does on their physical capabilities. This change means that those in the field can no longer focus on the delivery of technology as an end in itself, but must go one step further and partner with consumers and communities to ensure that assistive devices are put to their best possible use. This interdisciplinary book provides research-based guidance for finding the perfect match between device and consumer, including key information on personality assessment, the influence of pain, coping skills, and the power of new technology and social programs. This volume will be of interest to rehabilitation psychologists, researchers, and anyone working with or using assistive technology. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Past discussions of the International Classification of Functioning, Disability and Health (ICF) have focused minimally, if at all, on quality of life. This paper critically discusses the contribution of the ICF to quality of life concept development, and the impact that the ICF has had thus far on health-related quality of life measurement. “Contribution” focuses on modelling the relationship between disablement and quality of life, evaluating the content of existing instruments, and thinking holistically about the individual. “Impact” relates to the association of quality of life with functioning, pathology and outcomes, the trend towards life compartmentalization, and the disproportionate emphasis on individuals' functioning at the expense of their life context. Examples are drawn from adult acquired conditions (mainly aphasia), and terminology used in the paper reflects a rehabilitation stage of service provision. The World Health Organization's approach to quality of life definition and measurement is also discussed. An operational definition of quality of life for adults with acquired communication and swallowing disorders is presented, alongside an alternative conceptualization of quality of life. This paper ends with recommendations for future research concerning the importance of context, the subjective or personal perspective, and having a goals orientation for life as well as rehabilitation. It is also argued here that the ICF and quality of life are different constructs and that quality of life should be the starting point for understanding the client's perspective of his/her goals and/or his/her disability.
Article
To ascertain whether a physician's positive or negative attitude significantly impacts the quality of life of ophthalmic patients. A standardised, validated, time trade-off, utility instrument was administered to consecutive vitreoretinal patients by interview to assess the quality of life associated with their current ocular health state (baseline scenario). Each was then given a scenario for the exact same health state with the same long-term prognosis in which their doctor emphasised the possible negative consequences (bad-news scenario) and one for the same health state in which their doctor emphasised the positive consequences (good-news scenario). Among the 247 patients enrolled were 140 women (57%) and 107 men (43%) with a mean age of 66 years and a mean educational level of 13.8 years after kindergarten. The mean baseline utility for 247 patients was 0.87 (SD = 0.19; 95% CI 0.84 to 0.89). The mean bad-news scenario utility was 0.80 (SD = 0.22, 95% CI 0.78 to 0.83), a 70% diminution in quality of life compared with the mean baseline utility (p = 0.0009). The mean good-news scenario utility was 0.89 (SD = 0.18, 95% CI 0.86 to 0.91), an insignificant difference compared with the mean baseline utility (p = 0.26). Ocular patients had a considerably poorer quality of life when their physician emphasised the possible negative consequences associated with their eye disease(s), as opposed to a more positive approach. While at times necessary, a negative emphasis approach can theoretically result in a considerable loss of life's value.
Article
This review provides an overview of the literature on the conceptualisation of the Personal Factors (PF) component of the International Classification of Functioning, Disability and Health (ICF). A systematic literature review was carried out. Electronic searches were performed in Pubmed, Embase, PsycINFO, CINAHL and SSCI. Qualitative content analysis of statements about PF was conducted using inductive coding. The searches yielded 353 citations, 79 papers were eligible for analyses. Five hundred thirty-eight statements about PF were extracted, condensed and coded. Beside conceptual statements, 238 examples of potential PF as well as five attempts at classifying PF were found in the literature. PF were considered in relation to clinical service provision, assessment and intervention, in research and social security contexts. PF were seen to be related to various aspects of health, functioning, disability and the environment. The analysis of the literature shows that PF is seen as relevant to the application of the ICF in various settings. The review revealed a need for standardisation of PF. The literature points to the potential of PF in enhancing the understanding of functioning, disability and health, in facilitating interventions and services for people with disabilities, and strengthening the perspective of individuals in the ICF.
Article
The World Health Organization's International Classification of Functioning, Disability and Health (ICF) conceptualizes functioning and disability as a dynamic interaction between a person's health condition and their contextual factors. Contextual factors "represent the complete background of an individual's life and living" and comprise two components: Environmental Factors and Personal Factors. This review aims to: (1) discuss why contextual factors are important for speech-language pathologists to address in their clinical practice, (2) describe how environmental factors are coded in the ICF, (3) identify environmental factors that are relevant for people with communication disorders, and (4) identify personal factors that are relevant for people with communication disorders. Research on environmental factors that can influence the functioning of individuals with various communication disorders is presented, in addition to studies on personal factors that are important for speech-language pathologists to consider. The paper concludes that speech-language pathologists need to address contextual factors routinely, in order to provide a holistic approach to intervention for their clients. Furthermore, although a number of contextual factors that are relevant for people with communication disorders have been reported in the literature, more research is needed in this area.
Article
Purpose: While the limitations of self-report measures are clearly acknowledged, less apparent is attention to the potential limitations of their 'objective' counterparts leading to the assumption that objectivity results in more robust and scientifically valid measurement tools. This article aims to: (1) test this assumption; (2) consider the implications of advocating for a measure on the basis of its objectivity; (3) propose an alternative approach to measure selection. Key findings and implications: A critical evaluation of one 'objective' measure highlights a number of potential limitations suggesting that the apparent willingness to adopt 'objective' measures with little questioning may be misguided. The possible implications of this are discussed and include a risk to the advancement of, and capacity for, knowledge in rehabilitation; or worse, of making clinical decisions based on erroneous conclusions. Conclusions: Characterising a measure on the basis of objectivity (or not) assumes an overly simplistic dichotomy that is unhelpful and perhaps misleading. We argue that assessing whether a measure is fit for purpose and makes mathematical sense is the key consideration. Indeed, in some cases, using both an 'objective' measure and a subjective rating scale may be appropriate and the only way of truly capturing the phenomenon of interest.
Article
Many people working in human services in Western countries suffer from burnout, characterized by emotional exhaustion, depersonalization, and decreased personal performance. Prevention of emotional exhaustion (the first phase of burnout) constitutes a great challenge because emotional exhaustion may cause increasing turnover rates in staff and lead to a lesser quality of care. Prevention of emotional exhaustion requires knowledge of its predictors. The aim of this study was to investigate the associations between emotional exhaustion, social capital, workload, and latitude in decision-making among German professionals working in the care of persons with intellectual and physical disabilities. The study was based on a survey in a sheltered workshop and 5 homes for disabled persons with 175 professionals. Burnout was measured with the German version of the Maslach Burnout Inventory-General Survey (MBI-GS). A multivariate logistic regression analysis was computed. Logistic regression identified the following three significant predictors of emotional exhaustion in the sample: workload (OR, 4.192; CI, 2.136-8.227), latitude in decision-making (OR, 0.306; CI, 0.115-0.811), and male gender (OR, 4.123; CI, 1.796-9.462). Nagelkerke's Pseudo-R(2) was 0.344. The results of this study demonstrate that specific factors in work organization are associated with emotional exhaustion. Taking into account sociodemographic changes and the upcoming challenges for human services professionals, the results underline the importance of considering aspects of organization at the workplace to prevent burnout. Specific circumstances of male employees must be considered.
Article
Building on prior conceptual schemes, this article presents a sociomedical model of disability, called The Disablement Process, that is especially useful for epidemiological and clinical research. The Disablement Process: (1) describes how chronic and acute conditions affect functioning in specific body systems, generic physical and mental actions, and activities of daily life, and (2) describes the personal and environmental factors that speed or slow disablement, namely, risk factors, interventions, and exacerbators. A main pathway that links Pathology, Impairments, Functional Limitations, and Disability is explicated. Disability is defined as difficulty doing activities in any domain of life (from hygiene to hobbies, errands to sleep) due to a health or physical problem. Feedback effects are included in the model to cover dysfunction spirals (pernicious loops of dysfunction) and secondary conditions (new pathology launched by a given disablement process). We distinguish intrinsic disability (without personal or equipment assistance) and actual disability (with such assistance), noting the scientific and political importance of measuring both. Disability is not a personal characteristic, but is instead a gap between personal capability and environmental demand. Survey researchers and clinicians tend to focus on personal capability, overlooking the efforts people commonly make to reduce demand by activity accommodations, environmental modifications, psychological coping, and external supports. We compare the disablement experiences of people who acquire chronic conditions early in life (lifelong disability) and those who acquire them in mid or late life (late-life disability). The Disablement Process can help inform research (the epidemiology of disability) and public health (prevention of disability) activities.
Article
A review and critique of models of disability is presented, tracing the development of frameworks and classificatory instruments (International Classification of Impairments, Disabilities and Handicaps) over the past 20 years. While the 'social' model is now universally accepted, it is argued that universalism as a model for theory development, research and advocacy serves disabled persons more effectively than a civil rights or 'minority group' approach. The development of the revised International Classification (ICIDH-2) is discussed in this light.