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Electronic publication ahead of print,
Published on April 8th, 2025.
https://doi.org/10.33700/jhrs.4.1.133
eISSN: 2820-5480
Alma Mater Europaea University – ECM
Journal of Health and Rehabilitation Sciences
Psychology Research
Health Psychology Paradigm Shift in the Hungarian
Rehabilitation Psychology and Clinical Special Education
Dóra SZANATI
ELTE Bárczi Gusztáv Faculty of Special Needs
Education, Instititute for the Methodology of Special
Needs Education and
Rehabilitation,
Budapest, Hungary
Email:
szanatidora@hotmail.com
Original article
Received: 01-Mar-2025
Revised: 04-Apr-2025
Accepted: 07-Apr-2025
Online first: 08-Apr-2025
Abstract
Aim: The aim of this study is to provide readers with insights into the paradigm shift that has occurred and is still
ongoing in the field of clinical psychology in Hungary over the past 20 years, particularly in relation to
rehabilitation.
Methods: This study is a theoretical overview that offers a new perspective on the relationship between
rehabilitation psychology, health psychology and clinical special education. It processes and compares Hungarian-
language studies of the past 20 years with some recent English-language studies.
Results: I do not aim to achieve this by describing methods or empirical research but by using examples and
insights from practice, primarily from key clinical areas where special educators are involved in rehabilitation
teams.
Conclusion: This text demonstrates how current factors can shape professional diversity in the field of clinical
rehabilitation, and how the long-discussed issue of multidisciplinarity and interdisciplinarity, have become more
prominent. These changes, resulting from the paradigm shift, also significantly affect the work of special educators
within clinical teams.
Keywords: Rehabilitation psychology, health psychology, clinical special education, multidisciplinary team,
resilience, social support
Citation: Szanati, D. (2025). Health Psychology Paradigm Shift in the Hungarian Rehabilitation Psychology and
Clinical Special Education. Journal of Health and Rehabilitation Sciences. Advance online publication.
Copyright ©2025 Szanati, D. This is an open-access article distributed under the terms of the Creative Commons
4.0 International License (CC BY 4.0)
Corresponding address:
Dóra SZANATI
ELTE Bárczi Gusztáv Faculty of Special Needs Education,
Instititute for the Methodology of Special Needs
Education and Rehabilitation, Budapest, Hungary
Email:szanatidora@hotmail.com
Szanati, D. Health Psychology Shift in Hungarian Rehabilitation
2 https://jhrs.almamater.si/
1. Introduction
This paper outlines the paradigm shift in
rehabilitation psychology and explores the
relationship between clinical special education and
health psychology, focusing on both shared activities
and the significance of collaborative teams (Csabai,
Molnár, 2009). In doing so, the study serves as a
historical interdisciplinary overview and summary,
presenting multiple perspectives with the ultimate
goal of emphasising multidisciplinary and
interdisciplinary efforts and encouraging reflection
on methodological issues at the onset of a paradigm
shift (Riskó, 2015). Therefore, it is essential to first
explain the concepts of clinical special education and
rehabilitation psychology, before introducing health
psychology and its growing prominence within
rehabilitation psychology-a development that also
influences the perspective of clinical special
education. This task is relevant for all professionals
working in both special education and psychology,
whether in higher education or in diagnostic and
therapeutic settings. This manuscript was not created
to define the speceific roles of professionals from
various disciplines or to offer practical advice. On the
contrary, it approaches the subject from the
perspective of rehabilitation psychology, continuing
with the development of health psychology, as these
fields have experienced the most significant paradigm
shift over the past decade and a half.
2. Material and methods
In the theoretical part of the study, I employed the
method of descriptive categories and pillar questions
as the conceptual framework for the analysis.
Specifically, I examined studies in which
rehabilitation psychology, health psychology, and
clinical special education intersect, with a focus on
prioritising interdisciplinarity. Following the
introduction of the historical context and paradigm
shift, I based my analysis on key questions and
concepts, the synthesis of which included coping with
stress, resilience, and social support. The practical
sites briefly presented in the study were determined
by the pillar questions listed above, as these locations
have seen the most significant positive changes in the
cooperation of rehabilitation professionals in
Hungary over the past 1-2 decades. The criteria for
literature selection were therefore grounded in the
previously mentioned description. Clinical special
education was established as a legitimising concept at
the 2003 III Educational Science Conference (Oct 9-
11, 2003, "The European Learning Space and
Hungarian Educational Science," MTA Pedagogical
Committee, Budapest). Its key issues include:
addressing disability at the functional and ability
system levels; defining and tracking conditions;
methodological concerns in case investigation;
diagnostic possibilities; applying prevention and
intervention strategies; cognitive, artistic, social, and
behavioral therapeutic models; performance and
ability testing procedures; analysing of effects,
developing special educational protocols; presenting
special forms of outpatient care, habilitation, and
rehabilitation in institutional settings; evaluating the
rehabilitation process; providing special educational
counseling and family care; and examining special
educational teamwork and supervision. The
professional scope of clinical special education spans
general special educational sciences, psychology,
cognitive neuroscience, as well as health and
multidisciplinary medical sciences (Gereben, 2004).
The relationship between clinical special education
and health psychology was not addressed in this study
20 years ago. However, before clarifying this concept,
it is necessary to first define another key term. The
term “rehabilitation psychology” has not yet become
widespread in Hungary. It encompasseses the
collaborative work of professionals in fields such as
geriatrics, pediatric neurosurgery, neuropsychology,
cardiology, neonatal care, as well as musculoskeletal,
oncology, pulmonology, psychosomatic, and
psychiatric rehabilitation. Proponents of "good
enough" theories may be professionals who apply
systemic thinking and holistic care, integrating the
often-fragmented rehabilitation efforts within the
team (Riskó, 2015). Rehabilitation psychology can be
positioned at the intersection of clinical, social,
occupational, and health psychology. As a relatively
young field, it is important to review its brief history
and key principles, which fundamentally shape the
rehabilitation perspective.
2.1 The History, Perspective, and Main
Principles of Health Psychology
In Schoefield's 1969 study, it was noted that
psychologists were unprepared to address issues
beyond the purely psychological. They lacked
experience in areas such as preparing for surgical
interventions, managing psychological stress
following accidents, or contributing to rehabilitation
efforts, where they could provide competent
assistance (Kállai et al., 2021). This crisis was further
exacerbated by the inability to move beyond the
dualistic view of body and mind, which was rooted in
the pathogenetic approach. Psychosomatics
attempted to resolve this issue, being to propose
psycological processes behind physical diseases. One
of its most influential representatives in the 1950s was
the Hungarian-born Franz Alexander. A new era in
psychosomatics and a completely new way of
thinking emerged with George Engel's 1977
biopsychosocial model. According to this model,
intrapsychic conflicts were seen as just one aspect of
diseases (Kállai et al., 2021). By the late 1960s,
cardiovascular diseases, cancer, and accidents had
become leading causes of death, making chronic
diseases the primary concerns in medicine. The
traditional biomedical model could adequately
explain the significant rise in these conditions or the
Psychology Research
Journal of Health and Rehabilitation Sciences 3
healing process. As a result, there was a growing
emphasis on identifying the behavioral patterns
associated with disease processes.
The health psychology approach outlined the
mapping risk and protective factors, as well as the
empirical study of personality traits that influence the
course of the disease (Kállai et al., 2021). In this
context, we can also observe that changes that have
occurred in special education in recent decades. The
three-part model has gained prominence, both in the
renewal of classification systems (e.g., the
International Classification of Functioning, Disability
and Health, 2009) and in systems-oriented
intervention techniques. The approach of health
psychology is closely aligned with the positive
psychology movement, which seeks to uncover
individual resources and strengths that can be relied
upon in the coping process. Methodologically, it
primarily employs cognitive and behavioral therapy
techniques. In its empirical studies, health psychology
focuses on the individual's experiences, attitudes,
cognitions, and behaviours (Paksi, 2010).
The emergence of health psychology can be traced
back to the 1970s. While the ideas of positive
psychology had long been present in the field, they
gained increasing attention after World War II and
became an independent movement in the 1990s.
Prominent representatives of this movement included
Mihály Csíkszentmihályi and Martin Seligman.
According to their views, it is not only important to
uncover what does not function well in the
personality, but also to identify the strengths on which
therapy or development can be based
(Csíkszentmihályi, 2004).
In both prevention and intervention, the primary focus
is on mapping protective factors and developmental
potentials. The spread of health psychology has also
led to a shift in perspective within rehabilitation
psychology, as it now addresses not only health and
healthcare, but also the psychological aspects of
specific disease processes.
As a result, it emphasises prevention, education, and
conscious, active coping in the fight against and
coexistence with illness. The focus shifts to turning
inward, toward one’s own body, seeking social
support, and relying on others, which brings up issues
of control and autonomy. In the etiology of diseases,
the sense of control over one’s condition is of crucial
importance.
However, the rise of chronic diseases alters this
perspective (Riskó, 2015). That is, disease is not
solely caused by external factors, but rather develops
within a framework of internal psychological and
social factors. Health behaviour, therefore,
encompasses all actions an individual believes will
help maintain their health, recognise their illness, and
prevent further disease development. It includes all
behaviours the individual engages in to seek the
treatment they believe is most appropriate and
effective for themselves (Kaptein, 2022). Instead of
the traditional biomedical model, which positioned
the sick, disabled, and impaired person in a passive
and vulnerable role, the biopsychosocial model has
become the dominant perspective in both health and
rehabilitation psychology. This new approach is often
referred to in the literature as the empowerment
concept (Tiringer, 2007).
Seligman’s 1975 theory suggests that learned
helplessness occurs when a person perceives a
situation as unsolvable through active behaviour,
leading to passive, avoidant responses and significant
negative physiological changes. In contrast,
Rosenbaum's (1988) concept of learned
resourcefulness emphasises the skills and processes
that regulate behaviour, focusing on personality
factors that influence coping effectiveness by
selecting the most appropriate coping strategies
(Urbán, 2022). Health psychology has also brought a
significant shift in perspective within rehabilitation
psychology, with an increased focus on concepts such
as coping with stress, resilience, and social support.
These concepts will be explored in more detail in the
following pages.
2.2 Coping with Stress
The first crisis is the illness or injury itself. During
this time, the patient experiences a strong mix of
despair, confusion, shame, guilt, anxiety, and fear,
which can also affect the parents in the case of
children. Initial denial is often followed by anger and
sadness.
Overcoming the crisis is marked by the gradual
acceptance of what cannot be changed, the
reorganisation that follows, and adaptation to the new
task. The crisis ends with confronting the precise
diagnosis, accepting and adapting to the new state,
and finding new meaning in life (Kálmán, 2004). The
classification of coping strategies is diverse. One
approach categorises them based on their success,
distinguishing between adaptive and maladaptive
coping strategies (Oláh, 2005).
2.3 Resilience
Resilience, also known as mental toughness, has been
a subject of research for developmental psychologists
for many years. It has been observed that many
children who grew up in difficult life circumstances
remained psychologically healthy. Researchers began
searching for the personality traits that help maintain
"health" and for protective factors that support
resilience, such as supportive relationships
(Campbell-Sills et al., 2006). More recent theories
suggest that resilience is a combination of
constitutional variables (temperament, personality)
and specific skills (active problem-solving) (Kállai et
al., 2021).
These factors work interactively to enable adaptation
(Paksi, 2010). Resilience is a dynamic process made
up of multidimensional factors that allow individuals
to positively adapt to unfavorable life events. In this
sense, resilience is negatively related to neuroticism
Szanati, D. Health Psychology Shift in Hungarian Rehabilitation
4 https://jhrs.almamater.si/
and positively related to extraversion. According to
Bonanno (2004), it is more than recovery from
trauma; it is a form of positive growth that contributes
to maintaining psychological health. People with
resilience typically exhibit the following
characteristics: they believe they can control or
influence events and perceive changes as challenges
rather than threats (Urbán, 2022).
2.4 The Role of Social Support in Coping and
Rehabilitation
It is now unquestionable that one of the key elements
in coping with stressful situations is the presence and
quality of relationships with others. The positive
impact of social support on health and its beneficial
effect in coping with diseases were initially supported
by direct observations and later by empirical research.
For example, studies have shown that social
relationships trigger biochemical changes in the body,
and their absence leads to a decrease in immune
activity (Kállai et al., 2021). Providing help has
multiple dimensions, which vary in their usefulness.
The most obvious manifestation of social support lies
in family relationships.
Close, positive family relationships have health-
preserving effects and, in the case of illness, promote
coping and survival. (Negative family relationships,
of course, also affect health, but in the opposite
direction: they can become a source of chronic stress,
potentially leading to physical symptoms.) There are
gender differences in the presence and effects of
social support.
Women generally establish social relationships more
easily and receive more support from them; they are
more open to both accepting and offering help. Men,
while often having a broader social network, tend to
have more formal relationships that are less open to
mutual support (Paksi, 2010).
In practice, the most constructive and developmental
forms of support for an individual include emotional
support—the "trio" of love, acceptance, and care,
along with listening and actual presence—while
instrumental support, such as financial and
informational support, as well as encouragement and
recognition, can also be helpful.
The least helpful interactions are typically advice or
information not provided by professionals, which
often generate feelings of shame or incompetence in
the patient.
Therefore, the task of professionals working in
rehabilitation is to assist patients in utilising their
social resources. Special attention should be given to
identifying the extent of the social support
surrounding the patient, as well as expanding and
developing these factors. This protective effect is
crucial in the rehabilitation of chronic diseases. We
must encourage greater involvement from patients in
managing their illness and coping with the challenges
presented by the disease. A supportive, empathetic,
and nurturing environment enables the patient to
freely express and release their pain, hostile feelings,
and receive guidance and support through positive
reinforcement. The supportive process fosters the use
of healthy coping strategies and serves as a sustaining
force against the urge to withdraw (Winston et al.,
2020).
3. Results-Health Psychology Approaches
in Clinical Rehabilitation Settings
In the following pages, I will introduce some clinical
rehabilitation settings as examples, focusing on
activities where the health psychology perspective
can be applied.
3.1 Post-Stroke Patient Rehabilitation
A common issue affecting the majority of stroke
patients is severe depression and low mood. Post-
stroke depression (PSD) is a frequent complication
that is therapeutically manageable. This phenomenon
is caused by the sudden onset of neurological
symptoms, along with psychological reactions
triggered by the disruption of normal life.
However, it is important to note that there is no direct
correlation between the severity of mood disturbances
and the neurological symptoms (Antus, 2010).
Another factor contributing to PSD is biological:
damage to brain structures disrupts the balance of
neurotransmitter systems associated with these areas.
The third component is the patient’s premorbid
personality. In addition, as previously mentioned, the
social support system plays a significant role.
According to some studies (Pataky, 2002), 60-80% of
caregivers experience varying degrees of mood
disturbances, which is a significant risk factor for
rehabilitation.
When a patient can relate their stroke to something,
such as finding an explanation for why the injury
occurred and why it happened at that specific time,
their chances of recovery improve. This is referred to
as a naïve illness theory, which, if not irrational, can
cause much less internal tension for the patient.
While we can assist in this process, it is ultimately up
to the patient to develop their interpretation
framework. We must support them in finding it, but
the final understanding and acceptance must come
from them, and we must respect their process.
Improvements in speech comprehension and
production also have a significant impact on
interpersonal relationships, as aphasia is a
communication deficit. As the patient’s independence
increases, they experience a sense of success, can
express their will, share their opinions, and
communicate their feelings. This progress also
facilitates the work of the rehabilitation team.
A key element of the health psychology approach is
for team members to reduce negative experiences
stemming from a sense of failure by selecting
exercises that align with the patient’s capabilities,
while also considering their tolerance for failure.
Psychology Research
Journal of Health and Rehabilitation Sciences 5
The optimal difficulty of tasks is one that challenges
the patient, but remains solvable most of the time
(Pataky, 2002).
It is also essential that, throughout the rehabilitation
process, the patient continuously evaluates their own
performance, adjusts their expectations according to
their altered capabilities, and sets achievable goals.
The rehabilitation outcome will be more satisfactory
for the patient if they let go of plans that exceed their
current abilities and stop comparing their
performance to their past self. Instead, they should
adjust their expectations in line with their changed
abilities (Antus, 2010).
3.2 Oncology Patient Rehabilitation
The goal of psycho-oncology is to provide patients
with the capabilities and resources necessary to cope
with their disease and improve their quality of life,
with a focus on the pursuit of "health" (Horti & Riskó,
2006).
The task is not to directly influence the cancer itself,
but to enhance the patient’s self-awareness so they
can mobiliseg their own strengths in service of
healing. Additionally, assessing the psychosocial
situation of family members, providing psychological
support, and improving the psychological atmosphere
within the healthcare team are also key. Social,
relational, and societal disruptions are often more
difficult to face than the cancer itself. Oncology
patients typically fear pain, loss of bodily integrity,
dependency, and death.
Critical psychological moments include the delivery
of the diagnosis, the start and end of therapy, and
moments of follow-up care.
Later, issues such as recurrence, metastasis, the end
of active therapy, and, when necessary, the transition
to palliative care, become significant psychological
milestones.
Patients who are active, possess good problem-
solving skills, are more flexible, and maintain a
positive outlook tend to have higher survival rates. In
contrast, individuals who use avoidance strategies,
are more passive, and exhibit poorer mood indicators,
often face greater challenges. The primary goal of
health psychology in this context is to foster active
coping mechanisms, which can significantly improve
a patient’s quality of life.
Ambulatory treatments and home care are becoming
increasingly common in oncotherapy, making family
members active participants in the healing and
rehabilitation process. Psychological reactions will
affect them, and their responses will, in turn,
influence the patient.
In family relationships, communication and
emotional expression should be encouraged and made
more open, as this can help foster a more effective
supportive environment. The rehabilitation team can
provide models of coping and reinforcement for the
entire family.
3.3 Rehabilitation in the Neonatal Intensive
Care Unit (NICU)
Today, as the number of preterm births rises, more
research focuses not only on the developmental
capabilities of preterm infants but also on the mother-
father-child triad and the psychological state of the
mother. The mutual attunement of family members
directly influences the infant's development (Hámori,
2005). Preterm mothers are more likely to experience
anxiety, stress, and mood disorders.
Prolonged separation, hospitalisation, and the preterm
infant's unique physical and interactional
characteristics can further affect the mother's
sensitivity toward her infant. The mother-child
relationship is more vulnerable to postpartum
conditions, which can increase the risk of later
attachment or anxiety disorders compared to full-term
infants (Hámori, 2005; Helle et al., 2016).
These risks are compounded by additional factors
during the perinatal period, such as the mother’s
personality traits, her relationship with her parents,
lower socio-economic status, relationship difficulties,
and previous miscarriages.
The Close Collaboration with Parents Intervention
Program was established at the NICU department of
Turku University Hospital in Finland and was later
introduced in 10 preterm birth centers across the
country.
The international training for this program began in
Norway in 2016, and certain training elements were
later introduced in Hungary in the following years
(Björkroth et al., 2019; Toivonen et al., 2020). From
a health psychology perspective, it would be
beneficial to expand this training in Hungary as well.
The time a child spends in the perinatal intensive care
unit should be viewed as a rehabilitation period for
the parents. During this time, parents can (re)learn
how to adapt to their preterm child's specific needs,
acquire new competencies, and receive support in
processing losses and developing new coping
strategies (Törzsök-Connolly, 2022).
The approach to diagnosis and therapy with children
significantly differs from working with adults.
Treatment must be implemented within the family
environment, and the client is not solely the child but
also the family as a whole. One key specificity of
pediatric rehabilitation is that cognitive development
and learning abilities are most intensively shaped
during childhood. In complex rehabilitation, the
primary focus should be on developing motor
functions and addressing communication and
psychological disorders (Szászi-Szrenka & Dóczyné
Nagy, 2021).
In pediatric therapies, finding the balance between
motivation and indication is a particularly sensitive
issue. Whose motivation drives the treatment, and
what should the indication be when the client is the
entire family? Who sets the therapeutic goals?
Szanati, D. Health Psychology Shift in Hungarian Rehabilitation
6 https://jhrs.almamater.si/
In whose interest is the behaviour change? Both the
child and the parents are undergoing a crisis.
The fear of the future and the grief over the "desired
future" often become prolonged and difficult
processes. Therefore, it is crucial to support the
family itself during rehabilitation (Kálmán, 2004;
Vekerdy-Nagy, 2019).
4. Discussion
In rehabilitation programs, both psychologists and
special education professionals play crucial roles in
the assessment and therapeutic processes. During the
assessment, mapping the psychological and cognitive
state not only records the current condition but also
provides valuable information for developing the
rehabilitation plan. This is achieved through symptom
assessment scales and psychodiagnostic tools. The
rehabilitation protocol (23/2006 /V.18. Ministry of
Health Regulation in Hungary) primarily highlights
the psychologist's role in facilitating the acceptance
of the condition, in addition to the assessment.
However, rehabilitation psychology can contribute
much more at every level and aspect of the
rehabilitation process (Szegleti, 2022).
In Hungary, as demonstrated by several international
examples, there is urgent need to apply these
experiences and establish a service system with a
broad scope that is already operational and proven
internationally.
This system should ensure that the additional services
provided by the multidisciplinary team are not funded
for a single period, but rather in the long term, through
normative financing. In a multidisciplinary approach,
the health psychologist must always be a member of
the professional team.
Additionally, it is clear that the care of chronic
diseases through a complex, interdisciplinary
approach has been established for decades in some
countries, ensuring the timely recognition and
treatment of psychological issues.
This integrated approach requires the presence of
well-trained, cooperative professionals, where
psychological sensitivity and openness to a
comprehensive approach are expected from all team
members, not just the psychologist. It is most
effective when information about the clients'
condition is shared continuously among the team, and
when all team members approach the client with a
unified attitude (Bechtold & Mikesell, 2025).
5. Conclusion
The guidelines of the Health Psychology Section of
the British Psychological Society (2025) emphasise
the critical role of health psychologists in
rehabilitation and prevention.
Health psychologists are skilled in applying
psychological knowledge, which enables them,
among other things, to develop and implement
interventions aimed at improving self-care for
patients with chronic conditions and supporting the
development of healthy behaviors. In their work, they
collaborate with hospital professionals, patients, their
families, and professional organisations. They
provide long-term care for patients with physical
symptoms and assist with self-management.
They can also make recommendations for the
development of healthcare systems, provide
information and advice to both professionals and the
general public, conduct research, and base their
everyday practice on scientific evidence.
Additionally, they are involved in education and
communication, preparing patients for surgery to help
them cope with the psychological challenges of the
procedure, and fostering trust between the doctor and
patient during rehabilitation (Lund et al., 2025).
Introduction to Low Intensity Psychological
Interventions (LIPI): These interventions involve
brief steps that can be applied in practical care,
incorporating techniques such as motivational
interviewing and behavioural activation in
rehabilitation (Chambers et al., 2014).
Rehabilitation should focus not only on visible
physical difficulties but also on the less obvious
psychological processes that hinder an individual’s
reintegration (Szegleti, 2022). Residual symptoms
affecting communication can significantly impact
social relationships and, in children, their school
performance. In these cases, avoiding failure and
isolation becomes a primary therapeutic goal.
It is essential to emphasise how symptoms and
residual symptoms affect the individual’s self-esteem
and emotional well-being.
The aim should be to help individuals set realistic
goals that shape their future, rather than focusing
solely on what has been lost. One limitation of this
study is that the clinical settings mentioned are
involved in different rehabilitation tasks, making it
difficult to speak of a unified health psychological
approach. Additionally, there are several other
important areas of rehabilitation practice that were
not addressed.
Future work should focus on defining the role of
health psychologists within rehabilitation psychology
more precisely and in greater detail, particularly in
Hungary.
Conflict of interests
The author declares that there is no conflict of
interest. No financial interests are reported.
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