Chapter 54: Rehabilitation Psychology

INTRODUCTION AND OVERVIEW

The purpose of this chapter is to (1) introduce the reader to rehabilitation psychology, (2) provide a brief history of the discipline, and (3) describe (a) medical and mental/behavioral health populations for whom rehabilitation psychology is consulted or referred, (b) the scope of work of rehabilitation psychologists, and (c) assessment and treatment modalities used by rehabilitation psychologists.

Rehabilitation psychologists serve vital functions in the management, research, and advocacy of rehabilitation patients.¹ In partnership with team members from multiple rehabilitation disciplines, rehabilitation psychologists can reduce health care costs by addressing mental health needs, adjustment to disability, cognitive and pain concerns, and noncompliance. Scherer defined rehabilitation psychology as “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 life span”² Along with other health care colleagues, rehabilitation psychologists navigate the changes in US health care to ensure high-quality care.^3,4 Rehabilitation psychologists serve diverse roles as clinicians, researchers, educators, advocates for people with disabilities, health care administrators, policymakers, and program developers. Additionally, they are members of professional organizations within psychology, rehabilitation psychology, and other multidisciplinary organizations. Many rehabilitation psychologists have or are pursuing board certification in recognition of their specialty training and abilities in the field.

To illustrate the treatment aspects of rehabilitation psychology, the following patient example is provided, which will be referred to throughout this chapter: TM is a 60-year-old man who sustained approximately 45% total body surface area (TBSA) chemical burns and inhalation injuries in an industrial explosion at work. He was hospitalized for 6 weeks in an intensive and acute burn care unit and for 4 weeks in the inpatient medical rehabilitation unit. A few years prior to this event and subsequent injuries, he was diagnosed with posttraumatic stress disorder (PTSD) related to his service in the Vietnam War, for which he was treated with psychotropic medication but had not participated in psychotherapy. To assist in TM's care, a rehabilitation psychologist assessed (1) adjustment to his physical limitations and need for assistance, (2) body changes related to disfigurement, (3) emotional functioning, (4) potential cognitive disability and preserved cognitive abilities, (5) vocational capacity, (6) perceived challenges and changes in sexual functioning and intimacy, (7) substance use/abuse, and (8) social and behavioral functioning. The rehabilitation psychologist in this case provided cognitive-behavioral psychotherapeutic management, education to TM's wife, and consultation with his physicians and other health care professionals regarding his emotional, cognitive, and vocational functioning in both inpatient and outpatient settings.

This patient represents a typical patient for rehabilitation psychologists. Rehabilitation psychologists provide a breadth and depth of care to patients and their families and significant others, from childhood through older age.

BRIEF HISTORY OF REHABILITATION PSYCHOLOGY