Rehabilitation psychology is a specialty area of psychology aimed at maximizing the independence, functional status, health, and social participation of individuals with disabilities and chronic health conditions. Assessment and treatment may include the following areas: psychosocial, cognitive, behavioral, and functional status, self-esteem, coping skills, and quality of life. As the conditions experienced by patients vary widely, rehabilitation psychologists offer individualized treatment approaches. The discipline takes a holistic approach, considering individuals within their broader social context and assessing environmental and demographic factors that may facilitate or impede functioning. This approach, integrating both personal (e.g., deficits, impairments, strengths, assets) and environmental factors, is consistent with the World Health Organization's (WHO) International Classification of Functioning, Disability and Health (ICF).

In addition to clinical practice, rehabilitation psychologists engage in consultation, program development, teaching, training, public policy, and advocacy. Rehabilitation psychology shares some technical competencies with the specialties of clinical neuropsychology, counseling psychology, and health psychology; however, Rehabilitation Psychology is distinctive in its focus on working with individuals with all types of disability and chronic health conditions to maintain/gain and advance in vocation; in the context of interdisciplinary health care teams; and as social change agents to improve societal attitudes toward individuals living with disabilities and chronic health conditions.Elliott, T. R., & Rath, J. F. (2011). Rehabilitation psychology. In E. M. Altmaier & J-I. C. Hansen (Eds.), Oxford handbook of counseling psychology (pp. 679-702). New York, NY: Oxford University Press. Rehabilitation psychologists work as advocates with persons with disabilities to eliminate attitudinal, policy, and physical barriers and to emphasize employment, environmental access, social role, and community integration.

Rehabilitation psychologists provide clinical services in varied healthcare settings, including acute care hospitals, inpatient and outpatient rehabilitation centers, assisted living centers, long-term care facilities, specialty clinics, and community agencies. They typically work in interdisciplinary teams, often including a physiatrist, physical therapist, occupational therapist, and speech therapist.Rath, J. F., & Langer, K. G. (2019). Consultation.  In L. A. Brenner, S. A. Reid-Arndt, T. R. Elliott, R. G. Frank, & B. Caplan (Eds.), Handbook of rehabilitation psychology (3rd ed.). Washington, DC: American Psychological Association. A nurse, social worker, prosthetist, chaplain, and case manager also may be included depending on individual needs. Members of the team work together to create a treatment plan, set goals, educate both the patient and their support network, and facilitate discharge planning.

In the United States, the specialty of Rehabilitation Psychology is coordinated by the Rehabilitation Psychology Specialty Council (RPSC), which comprises five professional organizations that represent the major constituencies in Rehabilitation Psychology: Division 22 of the American Psychological Association (APA), the American Board of Rehabilitation Psychology (ABRP), the Foundation for Rehabilitation Psychology (FRP), the Council of Rehabilitation Psychology Postdoctoral Training Programs (CRPPTP), and the Academy of Rehabilitation Psychology (ARP). RPSC represents the specialty to the Council of Specialties in Professional Psychology (CoS). Rehabilitation Psychology is its official journal. Rehabilitation Psychology is certified as one of 14 specialty competencies by the American Board of Professional Psychology (ABPP).

History

The specialty of rehabilitation psychology was established well before psychologists were regularly involved in healthcare settings. In the 1940s and 1950s, psychologists became increasingly involved in caring for persons with disabilities, often the result of combat injuries. Advances in medical care had led to an increased number of people surviving injuries and illnesses that would have been fatal in previous generations. Individuals living with disabilities and chronic health conditions needed help to adjust, and rehabilitation psychology emerged to meet these needs using psychological knowledge to help maximize independence, health, and welfare. In 1954, the Vocational Rehabilitation Act was passed, providing grant funding for research and program development. As a result of this act, many universities opened vocational rehabilitation counseling programs within their graduate schools.

In 1958, Rehabilitation Psychology was established as Division 22 of the American Psychological Association, as an organization of psychologists concerned with the psychological and social consequences of disability, and with the development of ways to prevent and resolve problems associated with disability. By the 1960s, rehabilitation psychology was considered a mature specialty and was prominent throughout the United States. However, it was not until 1997 that the American Board of Professional Psychology approved the establishment of the American Board of Rehabilitation Psychology.

Key principles and models

Theoretical models are important in rehabilitation psychology for understanding and explaining impairments, aiding treatment planning, and facilitating the prediction of outcomes. Models help organize, understand, explain, and predict phenomena.Reel, K., & Feaver, S. (2006). Models: Terminology and usefulness. In S. Davis (Ed.), Rehabilitation: The use of theories and models in practice (pp. 49–62). New York: Elsevier. The models used integrate information from a number of disciplines, such as biology, psychology, and sociology. A wide array of models is needed because of the diverse problems and concerns faced by individuals with disabilities and chronic health conditions. Often, more than one model must be applied to properly understand an individual's condition.

Biopsychosocial model: The biopsychosocial model examines the interaction of medical conditions, psychological stressors, the environment, and personal factors to understand an individual's adaptation to disability. This interdisciplinary model is an acknowledgement that disability only can be understood within a larger context, and reflects the longstanding belief of rehabilitation psychologists that cultural attitudes and environmental barriers influence an individual's adaptation and accentuate disability.Wendell, S. (1996).  The social construction of disability. The Rejected Body (pp. 54-89). New York, NY: Routledge. Notably, the tenets of this model are reflected in the World Health Organization's International Classification of Functioning, Disability and Health (ICF). The framework is holistic and to apply it providers must learn about the disabled person's home life and broader social context.

Psychoanalytic model: In the context of rehabilitation psychology, Freud's concept of castration anxiety can be applied to severe losses, such as the loss of a limb. This concept is reflected in Jerome Siller's stage theory of adjustment, designed to increase understanding of acceptance and adjustment following sudden disability.

Social psychology: The pioneers in rehabilitation psychology were a diverse group, but many came from the field of social psychology. Kurt Lewin is one example. As a Jew living in Germany during the early years of the Nazi regime, Lewin's experiences shaped his psychological work. This is reflected in his conceptualization of the insider-outsider distinction, as well as his understanding of stigma. Lewin is known for his conceptualization B = f(p,e), where behavior (B) is a function of both the person (p) and their environment (e).

Tamara Dembo and Beatrice Wright, two of Lewin's students, are recognized as pioneering figures in the history of rehabilitation psychology. Wright authored two of the field's seminal texts, Physical Disability: A Psychological Approach and the extensively revised second edition, Physical Disability: A Psychosocial Approach. She also proposed the somatopsychological model, which advocates for interpreting disability within its social context. The somatopsychological model is derived from Lewin's field theory and holds that the environment can either aid or hinder an individual's adjustment. Wright's insights and her articulation of the beliefs and principles underlying rehabilitation psychology practice have come to be known as the "foundational principles of rehabilitation psychology" and her work continues to inform contemporary rehabilitation psychology research, theory, and practice.

Cognitive-Behavior Theory: Cognitive behavioral therapy (CBT) approaches such as problem-solving treatment have shown promise in promoting adjustment, well-being, and overall health among individuals with disabilities and chronic health conditions. This model holds that thoughts and coping strategies directly impact feelings and behaviors. By emphasizing, identifying, and changing maladaptive thoughts, CBT works to change an individual's subjective experience and their resulting behavior. A variety of empirical studies have demonstrated CBT's effectiveness in cases of traumatic brain injury, spinal cord injury, and a variety of other conditions common to individuals living with disability and chronic health conditions.

Clinical specialty areas

In clinical settings, rehabilitation psychologists apply psychological expertise and skills to improve outcomes for individuals living with disabilities or chronic health conditions. Common populations treated include individuals with: AIDS Acquired brain injury Cancer Chronic pain Concussion Limb loss Multiple sclerosis Neuromuscular disorders Spinal cord injury Stroke Traumatic brain injury

When addressing these chronic health conditions and disabilities, rehabilitation psychologists offer a variety of services with the goal of increasing an individual's functioning and quality of life. Specific services may include:

Assessment

To enhance the rehabilitation process, one must not only identify barriers to recovery, but also personal strengths and resiliency factors that foster continued recovery and social reintegration. Rehabilitation psychology's focus on personal strengths and resiliency has been influential in the field of positive psychology.

Rehabilitation psychologists take into consideration the medical diagnosis, referral question, background history, pre-morbid functioning (independence with basic and instrumental activities of daily living), current functioning (physical, cognitive, psychological), personality characteristics, and goals (career, academic, personal). Depending upon the referral question and individual patient goals, a structured and focused assessment may include any combination of the following components: cognitive function (decisional capacity, mental status, neurocognitive function); physical function (fatigue, health behavior, pain, sleep); psychological function (emotional adjustment, interpersonal/social functioning, personality, mental health conditions). Aspects of the individual's environment also are assessed, including cultural, community, home, rehabilitation, school, vocational, and social environments. In addition to clinical assessment and interview, standardized measures can be helpful for understanding each of these component areas in greater detail. Specifically, rehabilitation psychologist use data from standardized cognitive assessments to assess both cognitive limitations and positive cognitive abilities such as problem-solving skills.

Cognitive rehabilitation