Start
here.
What changes in my approach when disability is in the room?
One practice point from each approach, with a two-minute starting box on every hub.
What this is: a quick way into the site for busy therapists.
How to use it: find your approach, then open its hub’s starting box.
Time needed: two minutes per approach.
One thing to take away: check for a practical or bodily explanation before a psychological one.
The short version
This page gives you one practice point from each approach on the site, so you can find your own approach quickly and see what changes when disability is in the room. Each approach’s hub also has a two-minute “For therapists: start here” box with five practice points, something to try in your next session, and a link to the evidence.
One point from each approach
Pluralistic psychotherapy
Treat access as part of the therapy, and agree goals in the client’s own words.
Start here ↗CBT
Aim for an accurate thought, not a positive one.
Start here ↗ACT
Ask what needs accepting, what can change, and what deserves resisting.
Start here ↗Compassion-focused therapy
An inner critic often repeats an outer one. Ask whose voice it is.
Start here ↗Trauma-informed therapy
Ask whether the threat is past, ongoing or still necessary.
Start here ↗Systemic and family therapy
Ask the disabled person first, and ask who carries the work of care.
Start here ↗Narrative therapy
Externalise the burden story, not the disability.
Start here ↗Attachment
The amount of help someone needs can’t tell you how securely they relate.
Start here ↗Humanistic therapy
Check how warmth is received. Positive regard can land as pity.
Start here ↗Psychodynamic therapy
A real, current limit isn’t automatically a symbol.
Start here ↗Object relations
Physical dependence can coexist with psychological autonomy.
Start here ↗Body psychotherapy
A bodily pattern is never automatically psychological.
Start here ↗Jungian psychotherapy
Understand what actually happened before deciding what it means.
Start here ↗Three readings to begin
- Mine, Yours, Ours, System: the site’s core formulation tool, for working out where a difficulty sits before deciding what it means.
- Assessment Bias and Diagnostic Overshadowing: how disability can lead to new difficulties being misread, or missed.
- Access Is Part of the Therapy: why communication, energy, format and pace belong inside the work.
One tool to use this week
The between-sessions worksheet
Six questions to bring to supervision or use after a session: what happened in the client’s words, your first interpretation, what supports and challenges it, what might belong to each of the four places, what the client thinks you’re missing, and what you’ll do differently. Open the worksheet
From noticing to review: one example
Tiarnán is 44 and has lupus, a condition whose fatigue and pain come and go. He has cancelled three of his first six sessions, usually on the day.
Tiarnán is a fictional teaching example, not a real person.
Noticing
The therapist notices the pattern of late cancellations and a flatness in the sessions Tiarnán does attend.
First interpretation
The therapist’s first thought is ambivalence about therapy. They hold this as one possibility, not a conclusion.
Asking together
They ask, without assuming: what tends to be happening on the days he cancels? Tiarnán says that by four o’clock, after work, he is often exhausted, and on flare days he can’t face travelling. He hadn’t mentioned it because he didn’t want to seem unreliable.
Agreeing an adaptation
They move to morning video sessions of 40 minutes, with the option of switching to a phone call on a bad day, and no charge for cancelling during a flare.
Reviewing
Six weeks later, Tiarnán has attended five of six sessions, missing one during a flare. The sessions feel less flat. Over time, he also says that one topic, his relationship with his father, is something he had been glad to avoid. Both explanations turned out to be partly true. Reviewing together let them see which was which.
The point isn’t that cancellations always mean fatigue. It’s that checking for a practical or bodily explanation, and reviewing what changes, lets the therapy find out.
Across every approach
Our framework- Ask about access first, and keep asking. Access Is Part of the Therapy
- Before reading something as psychological, check for a practical or bodily explanation. Assessment Bias and Diagnostic Overshadowing
- Make it easy for clients to tell you something isn’t working. Feedback Without Having to Please
- Compare approaches for a particular client. Comparing Approaches
- Check the sources behind any claim. Sources and Bibliography
How to cite this page: Donaghey, C. (2026). For Therapists: Start Here. Disability in Psychotherapy. Available at: https://disabilityinpsychotherapy.online/for-therapists/start-here/ (Accessed: [date]).
Shared under CC BY-NC 4.0, with an extra permission to teach from it on fee-paying courses. Credit the site. See Reusing This Material.