Counseling clients with invisible disabilities

Articles | Counseling Resources

If a person misses multiple days of work because of influenza, an employer likely will understand. After all, no one wants to spread the flu throughout the workplace, and the symptoms are fairly clear. But, what if someone repeatedly calls in sick because of sheer exhaustion, an undiagnosed condition frequently referred to as chronic fatigue disorder? With few visible symptoms, that person may risk losing his or her job if an employer is doubtful of the condition or simply cannot afford to be short staffed so regularly.

This challenge is one of many that counselors may encounter when working with a client who lives with an invisible disability.

What are invisible disabilities?

An invisible disability is a physical or mental, or physic-mental impairment that substantially limits one or more major life activities. These conditions and their symptoms are not outwardly apparent to others. These disabilities may be hard for health care professionals to identify, which can lead to extreme frustration and hopelessness for individuals suffering from them. It is a broad term that encompasses a number of health concerns, including the following:

  • Chronic fatigue syndrome.
  • Diabetes.
  • Fibromyalgia.
  • Arthritis.
  • Autoimmune disorders.

Diseases such as cancer also can be considered invisible disabling conditions. Unless a person loses hair or drops a significant amount of weight, outsiders may not realize that he or she is sick without being told directly. If a person is walking with a cane, vomiting, wearing a cast, gaining weight or any other number of signs that suggest a health concern, the illness is clear even to strangers. However, the flip side is that when a condition is not outwardly identifiable, outsiders and loved ones alike may have difficulty accepting that there is actually a problem.

The effects of an invisible disabling condition

Even though the effects of an invisible disabling condition can range from mild to severe, the common thread is that people who suffer from them do not look sick. Whereas this perception of health could be considered positive, it actually can cause problems in and of itself. When outsiders perceive an individual as healthy, they may downplay the sickness or even refuse to believe that there is an illness. This response can cause anxiety and even depression on top of the actual physical challenges with which the ailing person is dealing day to day.

The symptoms themselves also can be emotionally and mentally exhausting as a result of the physical toll that they take. While the Invisible Disabilities Association reported that the physical expressions of these conditions can vary greatly, frequent “invisible” symptoms of these conditions include migraines, joint and muscle pain, and fatigue. Living with constant pain or exhaustion with no end in sight takes both a physical and emotional toll.

“Everything with fibromyalgia is invisible,” Shelley Smith, 31, of Houston, told U.S. News & World Report. “Even people who know me very well cannot tell when I’m in pain or when I’m exhausted. Even when I’m at my worst, and I feel like I’m completely falling apart, I look totally normal.”

Although suicide risk has been associated with individuals who live with invisible disabilities, it is not purely a result of depression. Even when people are not clinically depressed, they may become suicidal if they feel that their diagnosis is hopeless. Hopelessness is an essential feature of depression. Many invisible disabilities are chronic, with no known cure. Some even have limited or no options in terms of treatment plans. Not knowing if they ever will be healed or capable of resuming their normal activities can tempt ill people to give up.

Whereas counseling is not a cure for these conditions, you still may have individuals who come to you while dealing with invisible disabilities. Because many of these conditions can lead to limited mobility or energy, clients may lose their job or have to skip social outings. This result can lead to feelings such as failure or isolation that also can manifest in depression.

Invisible Illness

Counseling those without outward symptoms

One of the most important things you, as a counselor, can do is believe your clients. It is likely that they already have colleagues, friends and family members who question whether they really are ill or who try to suggest how to solve their problems with simple diet or lifestyle changes.

Using neutral language and remaining value-neutral also is important. According to Cathy L. Pederson, Ph.D., and Greta Hochstetler Mayer, Ph.D., authors of an article in the American Counseling Association’s Counseling Today publication, even saying “You look good” could be interpreted by your client as the equivalent of saying “I do not think you are really sick.” Be careful to avoid adjectives that suggest value judgments. The publication reported that as a counselor, you are well positioned to provide a safe space for your clients, something they may not have elsewhere.

You cannot ignore that there is a physical problem occurring. Read existing literature on the particular condition to familiarize yourself with the effects that it has in your client’s life. Because people often can be sensitive to noises, smells and lights, Pederson and Mayer recommend avoiding the use of candles or anything with a strong scent and possibly using a dimmer light bulb or pulling the window blinds. When working with clients who are living with an invisible disability, focus on creating a relaxing space and welcoming, accepting and empowering them.

Another important role that counselors can play is in comprehensive assessment of clients’ conditions. Counselors are trained to engage in biopsychosocial aspects of wellness and to work in multidisciplinary teams with experts from other areas from the health care paradigm. This competence positions counselors as positive agents of change when working with people who suffer with invisible disabilities.

Do you aspire to be a counselor? Learn more about Bradley’s online M.A. in Counseling program.