Client-Centered Therapy versus Rational Emotive Behavior Therapy: Applications in Adjustment-to-Blindness Training

By Justin M. H. Salisbury, MA, NOMC, NCRTB, NCUEB

Justin Mark Hideaki Salisbury is Coordinator of Educational Programs at Associated Services for the Blind, Incorporated, located in Philadelphia, Pennsylvania.

Abstract

This article compares and contrasts person-centered therapy, also known as client-centered therapy, with rational emotive behavior therapy. This juxtaposition is used to highlight different parts of each model, which can be used effectively in the provision of adjustment-to-blindness training. Best practices for adjustment-to-blindness training are discussed and the counseling theories are applied to these training practices. Though adjustment-to-blindness training is not a mental health intervention, components of both counseling theories are useful in adjustment-to-blindness training. Since each instructional relationship between teacher and student is unique, each individualized style of instruction invokes its own combination of the two counseling theories.

Keywords

adjustment-to-blindness training, Structured Discovery, rational emotive behavior therapy, person-centered therapy, client-centered therapy

Introduction

Adjustment-to-blindness training provides students with alternative techniques for accomplishing tasks, but most importantly focuses on an emotional adjustment to blindness. The emotional adjustment is the keystone of the blindness rehabilitation process. This training is most effective in residential, comprehensive programs operating under the Structured Discovery model (Bell & Mino, 2015). This training employs sleepshades to help students focus on non-visual stimuli, as well as to overcome emotional barriers (Olson, 1982; Tigges, 2004). Students begin training with learning basic techniques, where the instructor is much more top-down in the instructional process, and involving more guided learning. For example, an instructor who is teaching a new student how to hold a cane will employ more hand-over-hand techniques and really show the student what to do rather than letting them figure it out on their own (Morais et al., 1997; Salisbury, 2020a). As time progresses, students practice these techniques to the point of automaticity (Maurer et al., 2006; Mettler, 2008). Eventually, entire problem-solving routines become automatic, so that blind people can activate those problem-solving routines with minimal cognitive resource allocation (Maurer, 2011). As students advance through training, the emotional adjustment to blindness takes on a heavier focus in the training process. Students begin to realize that they are climbing the ladder of role modelling, where everyone is a role model in the beginning, and everyone else is looking to the senior student as a role model by the end. Such growth allows the student to give back, which is an important part of working toward first-class status (Omvig, 2009; Salisbury, 2018a, 2018b). This training typically requires six to nine months on a full-time basis (Omvig, 2002), and the duration is primarily necessary because of the emotional adjustment to blindness (Salisbury, 2017). Adjustment-to-blindness training is not a mental health intervention or medical treatment (Omvig, 2002; Riccobono, 2020; Salisbury, 2020b) and should not be confused as a mental health intervention or treatment. Students and staff alike at the training center must understand at the gut level, where they feel and live, that blind people are not helpless (Jernigan, 1977). Students are finally ready to graduate from a training program when they, their center director, and their rehabilitation counselor agree that they have made enough progress to manage their own continuing training and adjustment processes.
 
Omvig (2002) described the history and evolution of quality adjustment-to-blindness training. By the mid-1950s, most state rehabilitation programs for the blind were either not useful or downright harmful to the blind. The leadership of the organized blind devised a plan to get one of their leaders hired as the director of a state agency serving the blind. After the rehabilitation programs in Iowa were identified as the worst in the country and the directorship became open, Kenneth Jernigan was hired to overhaul the agency. It became an experiment to determine if the ideas of the organized blind would be effective when put into action, and it was a wild success. Ten years after his arrival, Jernigan received a presidential citation from Lyndon B. Johnson for his pioneering work in vocational rehabilitation. The Iowa experiment worked, and the organized blind were correct in their belief that blind people could live wonderful, normal, successful, meaningful, and rewarding lives if they were given the proper training. Thus, this article will discuss the model of adjustment-to-blindness training promulgated by the organized blind themselves and practiced at training centers similar to the one directed by Kenneth Jernigan. Dodds (1984) coined the term “Structured Discovery” to describe the learning experience, and Structured Discovery Cane Travel has become a registered trademark of the National Blindness Professional Certification Board (2020). Structured Discovery can be applied to all areas of blindness rehabilitation, and this model will prevail in this discussion.

Two major counseling theories are Rogers’s (1959, 1977, 2001) person-centered therapy, often called “client-centered therapy,” and Ellis’s (1973, 2001, 2002, 2003) rational emotive behavior therapy (REBT). Client-centered therapists allow the clients to lead the way in their own therapy, from choosing the counselors to choosing the types of therapies to choosing which topics to discuss (Corsini & Wedding, 2010). Client-centered therapists believe in clients’ abilities to know what they need and provide them with an empathetic and congruent counselor, who expresses unconditional positive regard to talk with them as they find their way. REBT operates more logically and confrontationally. The therapist leads the client in discovering their own irrational beliefs about the world and teaches them how to correct those beliefs (Corey, 2011). This article will provide overviews of each theory and then proceed to compare and contrast the two theories. Applications in adjustment-to-blindness training will be discussed. Applications in multicultural counseling and other related disciplines will be provided when appropriate to help illustrate the characteristics of these two theories, as well as compare and contrast them. As these two counseling theories are juxtaposed, their characteristics become more obvious, which helps to highlight the different elements which are present in Structured Discovery adjustment-to-blindness training.

Overview of Client-Centered Therapy

In 1940, when psychoanalytic and behavioral paradigms dominated the field, Carl Rogers attended a meeting of the Psi Chi chapter at the University of Minnesota (Corsini & Wedding, 2010). At that meeting, he presented his ideas and inspired an impassioned debate. By the 1950s, he and other humanistic psychologists mounted a real challenge to prevailing paradigms. This challenge to prevailing paradigms is in parallel with the evolution of Structured Discovery Cane Travel, which was first named by Dodds (1984). It was developed as a reaction to the concerns that the organized blind movement had with the previously prevailing approach (Aditya, 2004). The client-centered therapist does not guide the therapy sessions into specific areas but rather trusts that the client will lead them into the areas where they need the most help (Corey, 2011). Developing a good therapeutic relationship will facilitate the optimal therapeutic results. Client-centered therapists believe that the client has the right to choose their own goals, including the type of therapy and therapist. Therapists practicing client-centered therapy provide three core conditions: (a) congruence, (b) an empathic understanding of the client’s perspective, and (c) unconditional positive regard (Rogers, 1959). Each of these conditions will receive deeper individualized discussion.

In blindness rehabilitation, student and consumer direction parallels the way that clients in client-centered therapy lead the way to their true desires. Schroeder (2005) explained that consumers are supposed to be given informed choice in the process of selecting the services that they receive as they move toward the employment goal that they choose. Adjustment-to-blindness training providers allow and encourage the consumer to voice their own personal and career goals, but there are certain themes which come up in the curriculum based on the collective experience of blind people. Riccobono (2011, 2014a, 2014b) explained that consumers should be empowered to be the drivers—rather than the passengers—in their own lives. In Structured Discovery adjustment-to-blindness training, students are encouraged to be the drivers in their own lives.

Omvig (2002) described a meeting at a conference on blindness education and rehabilitation, where one participant said that he would fire any teacher who established a personal relationship with a student; in response, Dr. Kenneth Jernigan said that he would fire any teacher who refused to get to know students on a personal level. The family atmosphere is an important part of the culture of a Structured Discovery training center. Individual relationships are a necessary part of a family atmosphere. Personal and trusting relationships between students and instructors in adjustment-to-blindness training enable students to confront fears and other emotional challenges with the guidance of the instructors.  

Core Condition 1: Congruence

Congruence, for the therapist, means being aware of and willing to observably demonstrate the feelings that the therapist is experiencing in the moment during the interactions with the clients. An integrated and whole therapist will be relaxed, genuine, and open about their own emotions, which will help the client understand that the therapist is not up to anything covert (Brodley, 2011; Moon, 2005). Even if the therapist grows weak in the areas of unconditional positive regard or empathic understanding, congruence will act as a buffer and enable the client and therapist to understand these emotions and deal with them accordingly. It is noteworthy that such a loss of one of the three conditions compromises the therapeutic environment, but the three conditions can have checks and balances over each other.

Instructors in adjustment-to-blindness training must be aware of and willing to demonstrate feelings that they experience as well. Agency staff must have a deep personal belief in the capacity and normality of blind people and they must have embraced the agency’s properly defined philosophy about blindness (Omvig, 2002). Instructors need to be able to give students real feedback. If, for example, a student comes to class with hygiene problems, the staff need to address that with the student. The student needs to get those problems in order and learn how to manage them as a matter of preparing for success in employment. Being willing to have the authentic communication also allows the student to understand when something is truly going well or truly not going well. This helps the student to feel more complete satisfaction with successes and clearly understand when something is a problem that requires adjustment. It also communicates to the student that the instructor views them as a mature adult who can handle the candid information, part of helping them understand their first-class status.

Core Condition 2: Unconditional Positive Regard

Upon entering the relationship with the client, the therapist expects and attempts to have unconditional positive regard for the client. Nonjudgmental and warm, the therapist will strive to accept all feelings, thoughts, reactions, and interpretations as natural, human, and legitimate, given the client’s experience and background (Corsini & Wedding, 2010). Something a client says or does may bother a therapist, but, with proper investigation into its origin, it can come to be explained, and the unconditional positive regard can be restored. The therapist needs to be honest with themself about the inherent human tendency to have judgmental reactions and introspect about these responses that naturally want to manifest themselves (Corsini & Wedding, 2010). Over time, the process of being nonjudgmental with the client will develop. In order to be more effective at having unconditional positive regard for clients, a therapist must be open to becoming more accepting, take initiative in challenging their own prejudices and biases, and give the clients the benefit of the doubt that they are truly doing their best to traverse the conditions and situations that they face, known and unknown (Bozarth & Brodley, 1993).

Every human being has their own unique worldview. This is true of students in adjustment to blindness training. It is important for instructors to understand that the thoughts and feelings that students express have some kind of origin; the instructor can consider all feelings, thoughts, reactions, and interpretations as natural, human, and legitimate given the student’s experience and background. If a student has developed a maladaptive way of thinking about blindness, it came from somewhere. Often, it is from the negative messages about blindness which are pervasive in society. If a student is afraid of the flame on a gas stove, maybe that student had a traumatizing experience with fire in the past, or maybe they have only experienced fire second-hand through newscasts and horror films without any first-hand positive experience with fire. Just because an instructor acknowledges the valid origins of the fear does not mean that the student should be allowed to avoid that experience, but a solid and trusting relationship with the instructor can prepare the student to be willing to face that fear with the instructor eventually. Instructors need to be honest with themselves about the inherent human tendency to have judgmental reactions and introspect about these responses that naturally want to manifest themselves, especially as it relates to beliefs about blindness and other minority identities. Instructors need to be able to wrangle with their own beliefs about blindness because the ceiling is always rising for the expectations of blind people, so that no present state can be captured in a moment in time (Riccobono, 2010).

Core Condition 3: Empathic Understanding

The empathic understanding of the client’s perspective involves an attitude of desire to understand the client’s narratives, interpretations, and emotions. Thus, all of these components are at the center of the process, making the therapy client-centered. As a result, the client is the expert on their own life and feels some sense of control in the therapeutic process. The therapist will ask whatever questions or make whatever comments they see fit to achieve a solid understanding of what the client is experiencing. This often includes the therapist attempting to reiterate what the client is saying. If clients perceive something to be real, then the consequences of that thing are real, whether or not it is real itself (Thomas, 1928). The therapeutic process under this approach is not about figuring out what really happened from a neutral outsider’s perspective; instead, it is about figuring out what happened from the client’s perspective.

In adjustment-to-blindness training, it is helpful when the instructor can lead the student to articulate exactly what it is that they are experiencing. This can help the student to take ownership of their experience. It also allows the instructor to help the student make sense of the experience that they are having. Since the student will carry their own worldview with them throughout life outside of training, they will need to know how to work within their worldview and their way of processing the information that they receive. For example, if a student is often more receptive to auditory feedback versus tactile feedback when traveling through a city, the student will need to know how to do more with auditory feedback. The instructor should not try to aim the student into specializing in one sensory learning modality, but the information that they receive will be a function of their own ability to perceive the environment. In addition to inanimate stimuli, human interactions mean different things to different people. Cultural and personality components of conversational interaction will be relevant to the way a student can use that information. The instructor can and should work with students on more techniques for interacting with their environment, both physical and human, in order to have more tools in their toolbox for gathering information. But, it is important to work with the information that the student receives, not what the instructor receives. This keeps the student as the locus of experience.

Overview of Rational Emotive Behavior Therapy

In the 1950s, Albert Ellis developed rational emotive behavior therapy (REBT), which integrates cognitive therapy and behavioral therapy. While many people tend to claim that an emotional consequence is a direct result of an activating event, REBT is based on the belief that a vital intermediary exists: the individual’s belief system. It is only because of the filtering through that individual’s belief system that the emotional consequence is produced (Gehardt, 2015). When an individual has an irrational belief, and, if that irrational belief applies to the activating event, the individual can experience a negative emotional consequence or distress. If the therapist helps the client to challenge the weaknesses in these irrational beliefs rationally, the distress can be minimized. REBT also involves finding the differences between what the client thought happened and what really happened. Irrational beliefs are considered irrational because they magically and persistently conclude that some component of the universe either exists when it really does not or exists in a different form than its true form (Corsini & Wedding, 2010). Also, if a client appears to be demonstrating transference, the REBT practitioner will confront it right away.

REBT practitioners dispute irrational beliefs using a confrontational style (Gehardt, 2015). Sometimes, in adjustment-to-blindness training, this needs to be done in a philosophy class or any other class when students are stuck in irrational beliefs about blindness. These are often based in societal low expectations and misperceptions. Instructors can role model how students need to challenge societal beliefs and sometimes must confront misperceptions that provide a faulty foundation for unproductive beliefs about blindness. Society teaches its members many incorrect ideas about blindness; if rehabilitation practitioners fail to challenge those ideas, they allow them to continue in a cycle that is self-reinforcing (Jernigan, 1984).

Because the REBT practitioner believes in confrontational methods, they will give clients homework assignments in order to have the clients confront their own irrational beliefs and take ownership of their therapy. Homework assignments can be given to clients to lead them to intentionally face rejections and failures (Corsini & Wedding, 2010). Clients are more likely to change their thinking if they work with engaged and directive therapists who assign homework than if they work with less-act and less-directive therapists who do not (Corsini & Wedding, 2010). REBT practitioners often use positive reinforcements as well as punishments to incentivize clients to do their homework (Ellis, 2001, 2002, 2003). The homework assignments in REBT are applicable to group work in that the group leaders can discuss and negotiate the assignments to take more control over the therapy, and some of the assignments are actually carried out in the group itself (Ellis, 2001; Ellis & Dryden, 1997). Even though clients with more severe symptoms have been clinically observed to do more shirking and less homework, REBT practitioners are, in fact, able to report that they get better results with a broad array of clients than other types of practitioners (Ellis, 1994; Lyons & Woods, 1991; McGovern & Silverman, 1984; Silverman et al., 1992). Clients who work hard at REBT will take away from it a much more effective new belief system (Corsini & Wedding, 2010).

Students in adjustment-to-blindness training receive homework assignments from their instructors. Homework assignments build skills but also lead students to continue challenging societal beliefs about blindness. Students who work hard in training will also take away a more effective belief system about blindness. What also draws a parallel to REBT is the independent work that students perform in adjustment-to-blindness training. In both cases, students are working independently, solo or in groups, to challenge their own fears or perceived limitations. Some homework assignments are more regularly assigned for skill building, such as the number of braille pages for reading or slating assigned by the braille instructor on a given night or over a given weekend. It is common for a braille instructor to target about one hour of reading per weeknight and five hours of reading per weekend, set by page goals in accordance with the current reading speed of the student. Other types of homework are more generalized. For example, students are generally expected to keep their apartments clean and tidy, to do their own laundry, and to shop for their own groceries. These tasks come up on a routine basis, and the needs of daily life impose those tasks upon the students. These are training activities too and should be treated with the same level of importance and respect as the other more directly prescribed homework activities from the instructors. These goals are often assessed with apartment instruction activities on a recurring basis, perhaps twice per month. As students work together in class under sleepshades and out of class, more informally, without sleepshades, they can push each other to be the best they can be. Students should not be using each other’s residual vision (Altman, 2012) but instead reinforcing the nonvisual techniques that they learned in class.

Sometimes, instructors need to help students find the difference between what they thought happened and what actually happened. The trouble is, though, that the instructor has their own subjective concept of reality. Ideally, all instructors are either blind people who are well-adjusted to their blindness or sighted people who have a deep personal belief in the capacity of blind people and with a strong understanding of the challenges that blind people face (Omvig, 2002; Salisbury, 2018a). It is this part, being further along in the adjustment to blindness, that often makes the difference in helping a student to deconstruct and reconstruct narratives about what happened. For example, if a student is traveling through the city during cane travel class and has an interaction with someone who demonstrates low expectations for blind people, the instructor can help the student to deconstruct the narrative and identify where a detail might have gone differently, perhaps with one of the participants’ attitudes about blindness. Then, the problems are often attributed to the deficits in blindness philosophy, and solutions are driven toward addressing those deficits.

Similarities Between Models

There are some similarities between client-centered therapy and REBT. Both theories demonstrate significant optimism about the human ability to change, viewing human beings as dynamic creatures. This theme is central to the empowerment of blind people as well. Both theories hold a perception that people are often too critical of themselves. This can be true with blind people as well because society teaches blind people to doubt and discredit themselves far too often. Practitioners of both theories must be willing to invest a substantial amount of effort to help their clients. Neither theory is super-technical, and practitioners of both theories are open and willing to demonstrate their techniques broadly and without charging a fee. This is also true of Structured Discovery practitioners because it is a common-sense approach to blindness rehabilitation (Hill, 1997a, 1997b) and part of the social justice movement to empower blind people (Altman & Cutter, 2004). By contrast, many technically-oriented theories are more restricted in who gets to learn about them, often requiring organized training programs. Lastly, both theories demonstrate a respect for research and scientific methodology. The Structured Discovery model of blindness rehabilitation also shows respect for research and scientific methodology, as long as the research is driven by the organized blind and acknowledges the social model of disability (Schroeder, 2010).

Differences Between Models

Therapist-Inspired Therapist Actions

The differences between rational emotive behavior therapy and client-centered therapy are many and strong. Corsini & Wedding (2010) explains that while the client-centered therapist focuses more on getting clients to feel better, the rational emotive behavior therapist focuses on getting clients to actually get better. In adjustment-to-blindness training, the primary objective is the emotional adjustment to blindness (Omvig, 2002; Salisbury, 2017; Tigges, 2004). Thus, a major part of getting better in adjustment to blindness training is feeling better about oneself and blindness. At the same time, a student needs to be developing healthy attitudes about blindness and an awareness of social justice challenges affecting blind people. Being made to feel happy and comfortable without having the alternative techniques, social justice contextual knowledge, and problem-solving skills to succeed will not set up a blind person for success (Tigges, 2004). In short, adjustment-to-blindness training requires a combination of feeling better and getting better, thus invoking a combination of client-centered therapy and rational emotive behavior therapy.

Client-centered therapy emphasizes a great relationship between the therapist and client, operating with the belief that the therapeutic relationship is the source of the growth and progress in the client. However, the rational emotive behavior therapist is much less interested in the therapeutic relationship and much more interested in repairing the client’s irrational beliefs. Client-centered therapists accept the client’s perceptions of reality whether or not they are valid; the REBT practitioner only allows the client to accept their beliefs if they are rational. REBT practitioners are thus more judgmental of their clients than client-centered therapists. This is also represented in how the REBT practitioner will openly demonstrate for their clients how normal people would react to the things that they say, instead of how a client-centered therapist would be more likely to keep that hidden from their client. Client-centered therapists relate to their clients at the feeling level; rational emotive behavior therapists hone in on which thoughts are rational versus irrational as the source of those feelings. This requires REBT practitioners to be much more confrontational than client-centered therapists, often pushing clients out of their comfort zones. The REBT practitioner gives clients homework assignments to push them to confront their irrational beliefs; however, the person-centered therapist does not give homework.

Every Structured Discovery instructor must strike a balance between these opposite counseling approaches to construct a unique style for each unique relationship with a student. Instructors in adjustment-to-blindness training must have a strong personal relationship with students, marked by trust and understanding. Instructors need to meet students where they are and validate their experiences. Sometimes, if their narratives are perhaps constructed through a maladaptive thought filter, instructors can use Socratic questioning to deconstruct and reconstruct their narratives. This may involve taking a student narrative about an experience with the public out on a cane travel lesson with some troubling interpretations, breaking it down, and coming out with an understanding that involved the lens of social attitudes about blindness, so that students may better understand how an interaction may have unfolded. For example, consider a student who is waiting for a traffic signal to change at a four-way lighted intersection so that they can cross the street, who finds that a sighted pedestrian approaches them to offer unsolicited instructions on when to cross. The student may conclude that the other person was only being nice or helpful. The instructor could ask the student why that person felt the need to tell the student when to cross or if the student thought that the other person would have offered the same instructions to a sighted person in the same situation. This could lead the student to become aware that the well-intended offer of help communicated a subtle message that the other person held low expectations for them or for blind people in general. The concept of a “normal person” is highly subjective, but being able to blend into sighted society is a vital goal of adjustment to blindness training (Omvig, 2002, 2009; Salisbury, 2018a, 2018b). Instructors can be judgmental and accepting at the same time, but it can be helpful to lead students via Socratic questioning to think about how society may view or interpret a given situation, rather than making it personal to the instructor. Thus, the instructor can appear to be on the same side as the student while they take on social attitudes together. The early phases of training should inherently involve some rapport building so that the student can trust the instructors as they move forward with learning and risk-taking. This strong relationship enables instructors to be able to work on the student’s irrational beliefs about blindness and help the student to confront them on their own. When instructors challenge the irrational beliefs of students, they push students out of their comfort zones. It is quite normal and quite important in adjustment-to-blindness training to push students out of their comfort zones as part of building self-efficacy (Bandura, 1977, 1997; Patnaude, 2020; Salisbury, 2018b). The process of confronting negative attitudes about blindness and stepping out of one’s comfort zone frequently work in symbiosis, where one feeds the other.

Therapist-Inspired Client Actions

The differences between the two therapies can be considered from the client’s perspective. Client-centered therapy is client-directed, while REBT is directed and structured by the therapist. The REBT client is pushed to do things outside their comfort zone, while the client-centered therapy client is allowed to work entirely within their comfort zone. The rational emotive behavior therapy client is led to investigate and challenge irrational beliefs, but the client-centered therapy client is not. During therapy, the REBT client can find themself receiving confrontation from the therapist if they demonstrate transference or an irrational belief, but client-centered therapy clients do not find themselves in that situation. The REBT client also receives homework assignments in which they must confront irrational beliefs on their own or within a group, but the client-centered therapy clients do not. From this homework, REBT clients learn to take responsibility for and control of their own therapy, a benefit not experienced by client-centered therapy clients. The REBT clients have more control to independently maintain their own progress because they worked to achieve it. As REBT clients do that homework, they are shifting their locus of evaluation from external to more internal, but client-centered therapy clients never gain that benefit; they continue to defer to the therapist. The construct of internalizing locus of evaluation has different effects on different multicultural clients. Clients from more collectivistic cultures will tend to care more about social perceptions and thus tend to favor a more external locus of evaluation, so they might be better served by client-centered therapy. Clients from more individualistic cultures will tend to care less about social perceptions and thus tend to favor a more internal locus of evaluation, so they might be better served by rational emotive behavior therapy. Extending this analysis to adjustment-to-blindness training, students from more collectivistic cultures will tend to care more about social perceptions, including blending in, and may need more attention to help them balance the need for social acceptance with the need to be able to evaluate oneself to function without constantly having another person present. The client experience is indeed different between the two therapies.

Structured Discovery adjustment-to-blindness training has some consumer direction, especially in its organized form and with the selection and pursuit of a career goal, but it is also guided by the instructors in the day-to-day setting. Students may not be aware on their own of what techniques to use to hold a cane or what thoughts about blindness might be maladaptive, but the instructors can lead them to these realizations. Some ideas are corrected by students on their own, and others are confronted by the instructor. Structured Discovery training pushes students out of their comfort zone regularly as part of building self-efficacy (Patnaude, 2020; Salisbury, 2018b; Tigges, 2004).

Implications for Practitioners and Families

This article has described client-centered therapy and rational emotive behavior therapy (REBT). A comparison of their similarities and contrasting of their differences has followed their descriptions. REBT involves a more confrontational approach, while client-centered therapy involves a much more passive approach. REBT is based on the concept that irrational beliefs are what cause distress, not activating events, and therapists guide clients through the process of confronting and correcting those irrational beliefs. Client-centered therapy is based on the concept that clients inherently know what they need and can find their way to their optimal emotional destination. In client-centered therapy, the relationship with the therapist is viewed as the vehicle for positive change and is thus the focal point of the approach. Quite simply, these two theories are polar opposites.

Effective adjustment-to-blindness training involves some characteristics of each therapy model. There is no prevailing counseling theory used in adjustment-to-blindness training because it is not a mental health intervention. However, Structured Discovery is the leading model of adjustment-to-blindness training and invokes themes and techniques present in counseling theories. Blind people and anyone who works with the blind must come to understand at the gut level that blind people are not helpless. Each student must understand in their gut and in their heart that they are going to be okay as a blind person. Instructors use a combination of techniques for any given student. It is difficult to do all of the things mentioned in this article all of the time. Instructors should use their best judgment and common sense to try to devise a strategy for working with each student all of the time, never sacrificing the emotional adjustment to blindness and development of positive attitudes about blindness. Instructors need to develop strong rapport with students. Once the students trust the instructors, it enables them to confront the irrational beliefs, such as low expectations and misperceptions about blindness, which society has inculcated into the students. Students need to learn how to confront these beliefs on their own so that they can carry on maintaining their own emotional adjustment in their free time during training and in all time after training. Instructors must push students out of their comfort zones to produce the opportunities to learn to manage stress as part of building self-efficacy. Students in adjustment to blindness training will take away from it a much more effective new belief system.

Implications for Future Research

More literature should discuss the efficacy of and teaching methods for group lessons, with and without an instructor present. This article mentioned independent group lessons, but group lessons with an instructor are also meaningful ground to cover in the professional knowledge base. Structured Discovery practitioners have been using group lessons since the beginning of the evolution of the teaching paradigm, but there is little documentation to support the validity of group lessons. Future literature should also discuss the applications of more counseling techniques in adjustment to blindness training.

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