About Disability in Psychotherapy

Therapy can help. Therapy can also misunderstand.

Psychotherapy gives us powerful ways of understanding ourselves. It can help us recognise patterns, grieve, make sense of relationships, find language for difficult experiences, experiment with change and develop greater freedom in how we live.

But psychological ideas are not neutral. Every theory carries assumptions about what a healthy person looks like. What independence means. How a body should move. What emotional regulation looks like. What counts as resistance. What counts as avoidance. What development is supposed to lead toward.

For many people, those assumptions work reasonably well. For disabled people, they can become complicated very quickly.

A therapist might see dependence where the person experiences interdependence. They might see avoidance where there is fatigue. They might interpret restricted movement as psychological inhibition. They may encourage somebody to “push through” when the body is communicating an actual limit. They might hear anger about exclusion and search immediately for its childhood origin. Or treat acceptance as the psychological goal when something in the outside world actually needs to change.

None of this necessarily comes from bad intentions. Often it comes from applying a theory too confidently.

Sometimes the therapist is right.

Sometimes something is avoidance. Sometimes fear is limiting a person’s life. Sometimes old relationships shape present ones. Sometimes the body carries a history of protection. Sometimes anger belongs partly to something that happened long ago. Sometimes we genuinely do need to challenge ourselves.

Disability-informed psychotherapy should not mean that every difficulty is blamed on society or that psychological exploration becomes impossible. But neither should psychotherapy begin by assuming that everything difficult belongs inside the client.

The work is learning to tell the difference.

And sometimes the staircase is just a staircase.

This has become one of the simplest principles behind this project.

Sometimes somebody cannot enter the building because there are stairs. That is not resistance. Sometimes somebody is exhausted because their body is exhausted. That is not necessarily withdrawal. Sometimes a person needs help. That does not automatically tell us something pathological about dependency.

Sometimes somebody is angry because they were treated badly. Sometimes a medical professional really did dismiss them. Sometimes a relationship really is controlling. Sometimes an environment genuinely is inaccessible.

Psychological insight cannot replace structural change. And equally, changing the structure does not automatically resolve everything a person has felt, learned or carried because of it.

Often we need both.

What happens when we look differently?

This is where the work becomes interesting.

Instead of asking: Why won’t this person become more independent?
we might ask: What kind of autonomy matters to them, and what support allows it?

Instead of: Why are they resisting this exercise?
we might ask: What is their body telling us, and what assumptions are built into the exercise?

Instead of: Why are they so sensitive about being helped?
we might ask: What has help meant in this person’s life? Has it brought dignity, control, intrusion, gratitude, dependence — or all of them?

Instead of: What is wrong with this reaction?
we might first ask: What happened?

That small shift can change an enormous amount.

The body matters here

I have a particular interest in body psychotherapy and embodiment. But “listening to the body” is not as straightforward as it sometimes sounds.

A tight jaw might carry anger. Or pain. Or medication effects. Or muscular difference. Or concentration. Or absolutely nothing psychologically significant.

Fatigue might contain grief. It might also simply mean the person needs to rest.

A wheelchair might carry social meaning because of how other people respond to it. But the wheelchair itself is not a psychological defence.

The body can carry history without every feature of the body needing psychological interpretation. One of the questions running through this Hub is therefore:

Who gets to decide what this body means?

The therapist is part of the picture too

Psychotherapy often concentrates on understanding the client. I am equally interested in what the therapist brings.

Their assumptions. Their discomfort. Their ideas about independence. Their reaction to visible difference. Their desire to help. Their fear of saying the wrong thing. Their need to rescue. Their theoretical loyalties. Their own body.

A disabled client does not enter an empty room. Neither does a disabled therapist. Therapy happens between people, and both people bring histories, bodies, expectations and cultural ideas with them.

That does not make therapy hopelessly complicated. It makes reflexivity necessary.

Mine. Yours. Ours. System.

One way I try to hold that complexity is through a simple framework:

Mine — what belongs to my feelings, choices, history and patterns?
Yours — what belongs to the other person?
Ours — what are we creating between us?
System — what is being produced by culture, institutions, access, policy or power?

The answer is often more than one. That is why psychological explanations should be held as possibilities rather than verdicts.

Explore Mine, Yours, Ours, System →