Training institutions
and disability.
A therapist can only be as disability-informed as their training allowed them to become. When training programmes never mention disability, the gap doesn’t stay theoretical, it walks into the therapy room with every graduate.
What this is: the specific ways psychotherapy training programmes fail disabled trainees and leave every trainee under-prepared for disabled clients, through curriculum, placement structure, and assessment design.
Why it matters: a training programme can teach excellent psychotherapy while structurally teaching disabled trainees they were not expected. That lesson gets taught by the structure itself, attendance policies, placement requirements, exercise formats, whether or not it’s ever stated out loud.
The sharpest reframe: the durable fix isn’t accommodating the occasional disabled trainee. It’s asking how the curriculum, placements and assessment would look if disability were expected from the start.
One thing to take away: a disabled trainee in an institution built this way faces a double task non-disabled peers don’t: learning the profession, and simultaneously advocating for the accommodations that make learning possible.
You might
recognise this.
Where training
programmes fall short.
- Disability treated as a specialist elective rather than core curriculum
- Case studies and training videos that rarely feature disabled clients or clinicians
- Placement requirements and attendance rules that assume a body that can attend in person, on schedule, without accommodation
- Experiential exercises built around movement, physical proximity, or sensory intensity, with no alternative offered
- Supervision that has no vocabulary for disability-related countertransference or projection
Where these ideas
come from.
Philip Jackson’s 1968 concept of the “hidden curriculum” described the unstated lessons an institution teaches through its structure, rules and routines, not its stated content. A rigid attendance policy teaches disabled trainees something about who was expected, whether or not disability is ever mentioned in a lecture.
Developed by CAST (David Rose and Anne Meyer) from the 1990s onward, Universal Design for Learning proposes building multiple means of engagement, representation and expression into curriculum design from the outset, rather than retrofitting accommodations case by case.
UDL was developed primarily in general education contexts; its application to clinical psychotherapy training specifically is a reasonable extension rather than a body of research conducted in that exact setting.
What this costs
disabled trainees specifically.
A disabled trainee in an institution built this way faces a double task that non-disabled peers don’t: learning the profession, and simultaneously advocating for the accommodations that make learning possible, often while being read as difficult, high-maintenance, or not cut out for clinical work for asking. Institutions rarely intend this, but intent doesn’t change the outcome for the person navigating it.
A fictional
teaching example.
A trainee with a fluctuating chronic illness is completing a required placement with a fixed attendance policy: two absences trigger a review meeting. The policy was written with no fluctuating condition in mind, and treats absence as a single category regardless of cause.
The trainee now has to choose between attending while unwell, disclosing a diagnosis to justify each absence, or risking a review meeting that frames a medical reality as a professional concern. None of these options exists for a trainee without a fluctuating condition, which is exactly the hidden curriculum this page describes: the policy teaches, structurally, whose body it was written for.
In the
training room.
I don’t think I can do the standing exercise today. Is there another way to do this one?
Of course. Let’s find a version that gets at the same thing without needing you to stand. What actually needs to happen for the exercise to do its job?
The trainer doesn’t treat the request as disruptive to a fixed lesson plan, and doesn’t ask the trainee to justify the need with a diagnosis first. Asking what the exercise is actually for, before deciding whether an adaptation is possible, is the training-room version of adapting the mechanism while keeping the aim.
Universal design
as the actual fix.
The more durable question isn’t “how do we accommodate the occasional disabled trainee,” but “how would this curriculum, these placements, and this assessment process look if disability were expected from the start, rather than treated as an exception to plan around.” That reframing tends to produce programmes that work better for everyone, not just disabled trainees.
A process
to try, for training programmes.
- Audit the attendance policyDoes it distinguish fluctuating or predictable absence from disengagement?
- Audit the case materialDo disabled clients or clinicians appear anywhere outside a disability-specific module?
- Audit the experiential exercisesDoes every exercise have a built-in alternative, offered by default, not only on request?
- Audit the supervision curriculumDo supervisors have any language for disability-related countertransference before it shows up unplanned?
- Ask disabled trainees and alumni directlyWhat did the programme’s structure teach you, regardless of what it stated?
Words
you can use.
A few things
not to do.
Mine. Yours.
Ours. System.
A trainee’s own hesitation about disclosing, shaped by real, learned caution.
A trainer’s discomfort with departing from the standard exercise, misread as the trainee being difficult.
A pattern between trainee and trainer. The trainee asks for less to avoid seeming difficult, and the trainer takes the silence to mean all is well.
An attendance policy, written years ago, that never accounted for a fluctuating body.
Evidence
& sources.
Philip Jackson’s Life in Classrooms (1968) introduced the hidden curriculum concept, since widely applied across education research.
CAST’s Universal Design for Learning framework is an established, widely adopted approach in general and higher education, applied here by extension to clinical training.
Rivas, M. & Hill, N. R. (2018), “Counselor trainees’ experiences counseling disability: A phenomenological study”, Counselor Education and Supervision, 57(2), 116–131. doi:10.1002/ceas.12097. Ten counselling interns; the authors recommend adding personal narratives and service learning to training.
Coop, N. (2018), Exploring the experiences of trainee clinical psychologists who identify as living with a disability. Doctoral thesis, University of East London. UEL repository.
Donaghey, C. & O’Connor, N. (2025), Exploring the collective unconscious in visibly disabled psychotherapists’ lives. Unpublished MSc research paper, IICP College. An interpretative phenomenological analysis of interviews with four psychotherapists with visible disabilities (blindness, limb impairment, physical impairment and health impairment) living and working in Ireland.
The 2025 study above recommends compulsory disability modules in therapy training, grounded in the social model and shaped by lived experience; supervision that addresses visibility, disclosure and embodiment; ethical guidance on contingency planning and boundaries for disabled therapists; and inclusion policies that change structures rather than offering token representation.
The 2025 study above recommends comparative research on how therapy training institutions include disability across different countries and cultures.
This page applies hidden curriculum theory and UDL specifically to psychotherapy training structures, rather than proposing an original educational model.