Introduction

Rehabilitation is an integrated program of interventions that empower individuals with disabilities and chronic health conditions to achieve “personally fulfilling, socially meaningful, and functionally effective interaction” in their daily contexts (Maki & Riggar, 2004, p. 1). Rehabilitation psychology is a specialty area within psychology that focuses on the study and application of psychological knowledge and skills on behalf of individuals with disabilities and chronic health conditions in order to maximize health and welfare, independence and choice, functional abilities, and social role participation across the lifespan. Rehabilitation psychologists are uniquely trained and specialized to engage in a broad range of activities including clinical practice, consultation, program development, service provision, research, teaching and education, training, administration, development of public policy and advocacy related to persons with disability and chronic health conditions.

Scope of the Field

Consistent with the World Health Organization's International Classification of Functioning, Disability, and Health (ICF), rehabilitation psychologists address multiple personal factors impacting the ICF domains of activities and participation in which persons with disabilities engage. Rehabilitation psychologists’ work includes assessment and intervention regarding the range of physical, personal, psychosocial, cognitive, and behavioral factors that may be affected, such as neurocognitive status, sensory difficulties, mood/emotions, desired level of independence and interdependence, mobility/freedom of movement, self-esteem and self-determination, behavioral control and coping skills, subjective view of capabilities and quality of life. In addition, rehabilitation psychologists consider the influences of culture, ethnicity, language, gender, age, developmental level, sexual orientation, social network, residence and geographic location, socioeconomic status, and relative visibility and/or assumption of disability on attitudes and available services.

When planning interventions and recommending services, rehabilitation psychologists involve the rehabilitation team and consider the network of an individual’s environments (e.g. familial, social, cultural, physical, service availability, and political) and the means of addressing barriers in these areas, such as personal adaptation, the use of assistive technology and personal assistance services and modifications of physical and social environments. It is frequently a blend of such products and services that is most beneficial to individuals in achieving desired goals and well-being. The preferences, needs, and resources of persons served are taken into account in treatment planning, and any obstacles preventing the highest level of personal and social functioning are identified and reduced or removed when feasible. The broad field of rehabilitation psychology includes not only clinical practice, but also rehabilitation program development and administration, research, teaching of psychology students and other health trainees, public education and development of policies for injury prevention and health promotion, and advocacy for persons with disabilities and chronic health conditions.

Work Settings

Rehabilitation psychologists work in a variety of settings, including acute care hospitals and healthcare centers, inpatient and outpatient physical rehabilitation units/centers, assisted living and long term care facilities, specialty clinics (e.g., pain and sports injury centers, cardiac rehabilitation facilities), and community agencies serving individuals with specific disabilities or chronic illnesses (e.g. cerebral palsy, multiple sclerosis, spinal cord injury/disease, brain injury, deafness). Rehabilitation psychologists may be full or part-time university or college faculty focusing on teaching, research, and/or administration. Others may work in or consult to industry, provide expert legal testimony, or conduct assessments and evaluations for insurance agencies. They may work for private facilities or nonprofit organizations, or for government facilities such as Veterans Administration hospitals and centers or offices of Social Security Disability Determination. Some rehabilitation psychologists work across diverse settings and with a broad range of persons with varying disabilities and illnesses while others specialize in a particular area of practice. Regardless, rehabilitation psychologists are concerned with individuals from a systemic, holistic perspective, considering all factors of the person, the context, the relationships in which the person is involved or needs to be involved, the team of treatment providers, as well as the full range of the person’s characteristics, such as gender, temperament or personality, intellectual and cognitive skills, and developmental factors throughout the lifespan, from earliest childhood through late adulthood.

Services

Rehabilitation psychologists provide services with the goals of increasing function and quality of life for persons living with disability, activity limitations, and societal participation restrictions. Because disability impacts multiple areas of a person’s life, rehabilitation psychologists provide services within the network of biological, psychological, social, environmental, and political environments to assist the persons served in achieving optimal rehabilitation goals via intervention, therapeutic support, education, consultation and interdisciplinary collaboration, and advocacy. This necessarily includes the provision of training, educational and support services to families and primary caregivers as well as other significant people in the individual's social/community circle (e.g. teachers, employers, co-workers, clergy, friends).

In addition to working directly with the persons served and their support systems, rehabilitation psychologists play a key role in providing consultations regarding disability and health issues to attorneys, courts, governmental agencies, educational institutions, employers, and insurance companies. Because rehabilitation psychologists advocate for improvement in quality of life for people with disabilities and chronic illnesses, they are involved in the development and promotion of public policies and legislation that supports nondiscriminatory practices and funding of services designed to maximize independence. They also conduct critical research on the occurrence of, and immediate and lifelong implications of, circumstances leading to disability. Common research areas include, but are not limited to, risk factors for disability and chronic illness and associated prevention strategies; identification and reduction of co-morbidities; development, use, and effectiveness of assessment and intervention tools and strategies; changes in social support, familial and cultural networks; coping needs and resources; educational and community re-entry and participation processes, developmental processes and aging after diagnosis; and healthcare access, resource needs, and cost. Rehabilitation psychologists also plan and conduct teaching programs to develop clinical and research skills for psychology and other health trainees. The ultimate goal is to help reduce or ameliorate the negative impact of disability and chronic illness and optimize the well-being of persons served throughout their lives.

Clinical practice focuses on the provision of services to assist individuals and their support systems in coping with, and adapting to, the effects of the injury or illness. In addition, rehabilitation psychologists address the implications of the injury or illness in one’s life context, both currently and developmentally as the person’s needs change over time. Rehabilitation psychologists view persons served holistically and as active partners in the rehabilitation process. They work together with an interdisciplinary and/or multidisciplinary team of professionals and the persons served to broaden opportunities to facilitate maximal individual functioning as well as participation in social relationships and activities, recreation, education, employment and the community in general.

Populations Served

Rehabilitation psychologists who provide clinical and counseling services assist individuals and their significant others in coping with acute or chronic, and traumatic, progressive or congenital injuries or illnesses, that may result in a wide variety of physical, sensory, neurocognitive, behavioral, emotional, and/or developmental disabilities. Common populations with whom Rehabilitation Psychologists work include persons with spinal cord injury; brain injury; stroke and other health conditions typically associated with aging; amputations; neuromuscular disorders; chronic pain; other medical conditions, such as cancer, AIDS, multiple sclerosis, or limb weakness, that have the potential to limit functioning and participation in life activities; developmental disorders such as mental retardation and autism; psychiatric disability; substance abuse; impairments in sensory functioning, such as deafness and hearing loss and/or blindness and vision loss; burns and/or disfigurement; and impairments that may be compounded by cultural, educational and/or other disadvantages. In addition, rehabilitation psychologists address the implications of the injury or health condition as the person’s needs change over time.

Training, Licensure, and Career Development

Rehabilitation psychologists have completed doctoral degrees in psychology and have had extensive pre-doctoral and post-doctoral training in healthcare settings. Further, rehabilitation psychologists providing clinical services are required to be licensed in order to provide services in their state or province of practice and to receive reimbursement for services from health insurance payers. The American Board of Professional Psychology (ABPP) recognizes rehabilitation psychology as a specialty area of practice within psychology and maintains a complete listing of board-certified rehabilitation psychologists.

While rehabilitation psychologists may belong to many professional organizations relevant to their area of practice and specialization, the major organization representing rehabilitation psychology is the American Psychological Association (APA), Division of Rehabilitation Psychology (Div. 22). This division publishes a scholarly journal, newsletter and sponsors sessions relevant to rehabilitation psychology research and practice at the annual summer APA conference and the annual spring Rehabilitation Psychology conference. In addition, rehabilitation psychologists participate in other education venues for psychologists and other healthcare professionals. The American Psychological Association can be contacted for a list of rehabilitation psychologists who live in and outside of the U.S.

Finally, there are excellent textbooks available on the general topic of rehabilitation psychology as well as books on areas of specialization within this field.