Empowerment Therapy

"Frequently Asked Questions"

Question number One

QUESTION: What is positive self-esteem, and how does this differ from positive self-image?

ANSWER: Positive self-esteem is a person’s basic ability to have a sense of control over meeting his or her own physical or psychological and social needs. The last two categories are usually referred to in a combination with the word psychosocial. Physical needs are obvious to most people - food, water, oxygen, and shelter. It is obvious if we do not meet these physical needs, we cannot survive.

But as the world-renowned psychologist Abraham Maslow pointed out, human beings have a hierarchy of needs that must be met if we are to survive, and these are not only the physical needs, but psychosocial needs as well. For the purpose of simplicity, we can categorize these psychosocial needs as LOVE & BELONGING, FUN & RECREATION, SELF-WORTH & SELF-IMAGE and FREEDOM AND AUTONOMY. These psychosocial needs are just as important for human beings, because if we do not meet these needs, it is likely that we will become quite unhappy, or even, to one degree or other, mentally ill. If we do not meet these needs, it is likely we could become depressed, anxious, or develop other symptoms that are part of an emotional disorder.

Therefore, positive self-esteem is a person’s ability to meet his physical and psychosocial needs in a balanced, flexible manner

It is equally important that these psychosocial needs be met INTERDEPENDENTLY. No man is an island. We need to depend on others to get the needs for LOVE & BELONGING as well as SELF-WORTH & SELF-IMAGE met. We depend on others to be validated and affirmed. The essence of interdependence is positive communication skills, the ability to express what we want in assertive, but pleasant manners.

So, what’s the difference between self-esteem and self-image? As you can see from above, self-esteem is the overall ability to meet all of our needs, the physical and four psychosocial needs, whereas self-image is only one of the four psychosocial needs. While the sense of feeling as if we are worthy people deserving of respect, this need has to be balanced out with the other three psychosocial needs in order to have positive self-esteem

It is very important to highlight the fact that people from all walks of life need positive self-esteem if they are to lead satisfying and healthy lives. A human being is a human being. It doesn’t matte what color we are, what country we come from, what sex we are, what religion we practice, which sex we prefer or what physical and psychological limits we have. All human beings need, to one degree or another, a positive self-esteem to live better lives. The better our self-esteem, the better the quality and healthiness of our lives.

Question Number Two

QUESTION: What is empowerment, and how does it differ from positive self-esteem?

ANSWER: Simply put, empowerment is a person’s ability to maintain positive self-esteem during the course of our life cycles.

Throughout the course of our lives, we all experience losses that are not only stressful, but can lead to emotional symptoms and problems. These losses fall into two types: necessary losses and traumatic losses. Necessary losses are the unavoidable losses that we experience while growing up, from infancy all the way up to our senior years. While it is obvious that we lose things when we are growing up, we can also gain things. When we pass into the adolescent years from childhood, we may lose the magical beliefs of our childhood, but we become stronger and are able to learn more things to accomplish new skills, such as driving a car. When we pass from adulthood into the senior years, we may not be able to get around as quickly as we could in earlier years, but we could possibly become wiser about what is really important in life.

Traumatic losses are losses that happen as a result of an injury, illness, a congenital disease or because some violation has occurred against us (e.g. theft, destruction of property or loss of loved one and/or job). Whether these losses are natural or traumatic, great stress can occur. This stress can temporarily or permanently interfere with our ability to meet our psychical and psychosocial needs. In essence, losses can interrupt or even terminate our positive sense of self-esteem.

In the case of natural losses, if a man used to meet his need for fun by skiing, but can no longer ski when he reaches his senior years for whatever reason (perhaps he has acquired arthritis), this man must find another way to meet his need for fun. Similarly, if an adult has lost his sense of self-worth by loss of a job, he must find another way to meet his need for self-worth (or self-image) if he is to maintain his self-esteem.

The same is true for people who have experienced traumatic losses. If a person who has suddenly become disabled because of a car accident can no longer meet his need for fun by scuba-diving, that person must find another way to have fun in order to maintain his self-esteem. The other possibility, depending on the nature of the disability, he must find another way to scuba dive.

The essential point is that through out the course of our lives, we must find alternative ways continuously for meeting our physical and psychosocial needs. This is because we are continuously faced with losses, natural and/or unnatural, that challenge our ability to meet our needs. Therefore, empowerment is the ability to be adaptive and flexible with a positive attitude and good problem-solving skills that enables us to meet our needs (thus, our self-esteem) over the course of our lives. A person can have positive self-esteem at any one point in their lives, but an empowered person finds a way to maintain positive self-esteem over the course of their lives, regardless of what kinds of challenges face them.

QUESTION NUMBER THREE

QUESTION: What are the ‘Eight Elements of Empowerment’ that enable people to become empowered?

ANSWER: Although various professionals may use different terms and/or words to describe the practice or habits necessary to become empowered, the ‘Eight Elements of Empowerment, in my view are: self-aware, responsible, goal-setting,solution-focused, genuine, empathic,collaborative and growth-oriented (See Chapter 8 in From Emptiness to Empowerment: Changing Physical and Other Losses for elaboration, clarification and examples).

QUESTION NUMBER FOUR

QUESTION: Why is it important for disabled people to become empowered?

ANSWER: When people become disabled, they have experienced a loss, whether that is a physical or mental loss. Examples of different types of disabilities (discussed in another question ahead) are visual impairment/blindness/visual impairment, deafness/hearing impairment, mobility impairment (e.g. spinal cord injury, multiple sclerosis, amputation) or mental impairment (e.g. traumatic brain injury, mental retardation, stroke).

Whether these losses occur later in life (adventitiously), at birth or progressively over a period of time, these losses mean that there is going to be a loss of an ability to meet physical and psychosocial needs. For example, becoming paralyzed from a spinal cord injury means not only losing one’s ability to walk, but also the ability to get to the store so groceries can be purchased for food (physical need) or the loss of one’s previous ability to golf (psychosocial need)

Most rehabilitation programs for those with physically disabled focused on restorative functions to be able to meet physical needs, but offer very little assistance in regaining the ability to meet psychological and social needs. Because empowerment is the ability to maintain or regain our sense of self-esteem over time, including the challenging times of losses, it is imperative for a person confronted with a disabling condition of a physical and/or a mental loss to become empowered if he or she is not already empowered from previous life circumstances.

QUESTION NUMBER FIVE

QUESION: What is ‘grieving’ and what does it have to do with becoming empowered?

ANSWER: Grieving is the unavoidable and inevitable painful response whenever we lose something that is important to us. Whether it be loss of a job, a prized possession, a loved one (death, divorce relocation) and/or a physical /mental ability, it is going to hurt, and, sometimes, hurt tremendously. This is one of the prices we pay for being human. The painful feelings are numerous and can range in intensity, but typical painful feelings are sadness, anger, guilt and fear. The painful feelings associated are not only emotional feelings, but mental feelings as well. It is very common after suffering from any important loss that we may experience confusion, forgetfulness, difficulty in concentrating etc. Notice how all these feelings can range in intensity. For example, the feeling of anger can range from mild annoyance to a full-blown rage, or sadness can range from mild feelings of sadness to a full-blown despair. Unlike some mental health experts, I believe that the painful feelings do not necessarily occur in a predictable order, but, depending on the individual and uniqueness in circumstances associated with the loss, the painful feelings in grieving can be quite unpredictable an can re-occur at any given time.

With respect to a physical loss, such as loss of sight, hearing, the ability to walk and/or the ability to think, the intensity of the grief response depends on several factors. But, overall, it is noteworthy to point out that the reference book used for diagnosing psychological and psychiatric disorders, The Diagnostic and Stastical Manual of Psychiatric Disorders (DSM-IVR), cites the loss of a physical function as an example of an ‘extreme psychosocial stressor’. The three main factors contributing to the intensity of the grief response are severity of the loss,, the functional aspect of that loss and the nature of the loss (e.g. at birth, traumatically later in life). This is covered extensively in my book From Emptiness to Empowerment: Changing Physical and Other Losses into Strengths.

Keeping in mind that empowerment is the ability to meet our physical and psychosocial needs over the course of our lifecycles which always involves losses (whether the natural loss associated with growth or traumatic losses that can occur suddenly and unpredictably), it is only the empowered person that will be able to recover and ‘bounce back’ from the grieving process. Similarly, if a person is not empowered (or has a low level of empowerment), it will be essential to become empowered to be able to get through the grieving process. How does the person begin to become empowered to recover from inevitable grieving during their lives (since everyone suffers from losses; at the very least, when they reach senior years)? By learning, slowly but surely, to develop alternative ways in meeting their needs. The more needs the person finds alternative ways in meeting, the more empowered the person becomes.

Conversely, the more losses a person has successfully weathered and found bridges to meeting their basic physical and psychosocial needs, the more empowered is, no doubt about it. So the next time any of you patronizing folks sees a rather severely disabled person in the community, you may want to consider how empowered that person possibly could be rather taking pity on this person, especially if this disabled person projects an attitude of optimism and love. This being the theory, the greater the losses successfully resolved, the greater the empowerment, thus, the greater the man or woman. In fact, they may be very rare folks indeed, folks that a great deal could be learned from. Abraham Maslow has studied positive mental health, or what he calls self-actualization, by studying self-actualized people (rather than mentally ill people) such as Abraham Lincoln, Ghandi and others. I have often wondered how much we could learn about empowerment if we studied people like Helen Keller, Albert Einstein, Mohammed Ali and many other obviously empowered people who aren’t necessarily famous or have big name recognition. I have often wondered what it would be like to get a grant and conduct research of courageous empowered people and learn some pretty incredible things, not only about rehabilitation, but also about life. Perhaps I will attempt to do this some day.

QUESTION NUMBER SIX

QUESTON: Who are exactly those defined as the ‘disabled’?

ANSWER: While this question may appear rather obvious, it is, in reality, far more complex when one attempts to get to the ‘nitty-gritty’ of defining the disabled. Far more significant, this complexity has thrown a real monkey wrench in sincere efforts to develop policies and programs to serve the disabled. The complexity centers around diversions of opinions that emanate from diverse groups that serve the disabled with their conflicting philosophical backgrounds.

To simplify, most policies and programs, private or governmental in older times used to be developed by professionals and organizations whose philosophy of illness and chronic illnesses/disabilities were anchored in the ‘medical model’ of illness. By the medical model, this refers to a view that an established hierarchy within the medical profession, from physicians (usually MDs) to nurses to occupational therapists all the way down to physical therapists (including audiologists, speech pathologists, pharmacists, lab technicians, etc.) were the most qualified to determine what exactly constitute illnesses, acute ilnesses or chronic illnesses (which is fundamentally what a disability is). Thus, not only did the medical profession spearhead the classification of a disability, but, more significantly, these authority figures also spearheaded the best treatment program for the disabled individual.

Therefore, from the medical model base of defining and treating disabilities, it was the medical team that was at the helm. There was very little collaboration from outsiders, especially the disabled person, their families, friends and advocates. In fact, if these non-medical professionals did not immediately and wholeheartedly agree with the views of the medical team, these troublemakers were often viewed with scorn and labeled with such terms as ‘resisting’ or ‘un-cooperative’ and were branded with ‘poor prognosis’ for their recovery or rehabilitation. With this perspective, the entire spectrum of the treatment/rehabilitation process were defined by the medical hierarchy. This hierarchy used its own diagnostic labels that included terminology that described chronic illness, its origin (etiology) and outlook for the future (prognosis). Thus, the disabled were typically defined by diagnostic labels such as spinal bifida, muscular dystrophy, multiple sclerosis, retinitis pigmentosa, diabetic retinopathy, glaucoma, otosclerosis, sensori-neural deafness/hearing impairment, spinal cord injury and other three, four and even six syllable exotic words that rang with the flair of the unquestionable, often detached medical authority.

However, in the wake of civil rights movements in the 60s, which had its strong philosophical basis in responsibility and individualism, values in relationships began shifting from dominance and authority to collaboration and intimacy. One of the major forces behind this shift was the growing acceptance of the connection between the mind and the body. Thus, the emerging medical field of psychiatry, armed with their MD degrees and closely allied with the very well respected medical specialty of neurology, was reporting with increasing credibility that many physical illnesses were either caused or catalyzed by psychological and social (psychosocial) factors such as stress and depression. In turn, this meant that the patient’s feelings and attitudes often could play a major role in the cause and treatment of illness. Therefore, it was likewise that the patient’s feelings about his or her illness as well as his or her desire to recover also played a major role. This breakthrough in understanding the power of the mind in wellness, as influenced by Sigmund Freud and becoming widely accepted in medical and mental health domains as well as religious arenas, meant that the patient was to be treated as a live flesh and blood, breathing human being with a power source of its own, not a objective, inanimate object that is to be ‘worked on’ in a similar fashion that a carpenter works on wood to create the end results.

In the wake of this humanistic movement, alternative language was increasingly being used that would describe the functional aspect of a disabling condition. For example, in the landmark American with Disabilities Act(ADA) signed by President Bush into law on July 20, 1990, a disability is defined in terms of functional limits. Thus, a disabled person is a person who has limits in any of life’s major functions such as the ability to breathe, walk, see, hear, talk, think, etc.. In this progressive view,now the relationship between patient (, many times being referred to as clients , consumers or,simply, customers) and service providers were being viewed as critical and a vital part in the rehabilitation and/or recovery process by the helping profession.

QUESTION NUMBER SEVEN

On the other hand, the advantages and advantages for those with invisible disabilities are sort of reversed for those with visible disabilities. Because the disability the disability is not visible, there tend to be a lack of supports and services for these people and, at times, much anger can be generated at these people for not participating more often in the mainstream and working harder in the labor force. Very often, people with invisible are branded as ‘lazy’ and ‘egocentric’ people just looking for attention. On the upside, these people are less likely as a whole to be victimized with prejudice as a whole and are not cast into the nomenclature of ‘second class’ citizenry based on appearances alone. It is this set of advantages and disadvantages that sets up a vicious circle, because if they are not branded with negative social status because of their appearances, there is a very understandable motivation to hide their disabilities, participating less and less in the mainstream, and taking very few risks. This lack of ‘risk-taking’ preventsempowerment building, because empowermentcannot occur without taking risks.

QUESTION NUMBER EIGHT

QUESTON: What are the advantages and disadvantages for acquiring a disability later in life (adventitious, from either an illness or an accident) as opposed to acquiring one at birth? And what about genetic disorders acquired at birth, but they symptoms don’t appear until later in life?

ANSWER: A disability acquired later in life can be very shocking and devastating. A person who loses his or her ability to walk because of a spinal cord injury can be so traumatized by the injury that he or she can likely lapse into severe depression and/or social isolation. The suddenness and trauma can make life a very burdensome task and there will be, of course, drastic changes in that person’s behavior and personality.

On the other hand, a person who becomes suddenly disabled later in life will have the advantages of developing, to one level or another, physical and psychosocial skills that will counteract the great challenges that interfere with recovery. For example, it is likely that the person acquiring a disability later in life will have developed significant relationships that may prove invaluable in encouraging skills necessary for rehabilitation and, ultimately, empowerment. Likewise, the person disabled that becomes disadvantageously disabled may have attended mainstream type schools or have even been employed for a period of time, thus have acquiring some job skills that not only increase likelihood for returning to work, but increase motivation as well.

A person who is born with a disability such as cerebral palsy may not experience the shock and disbelief that a person with an adventitious disability typically does. (In fact, those who suffer from a debilitating injury later in life may not only acquire the disability such as blindness, but a psychiatric illness as well called ‘post-traumatic stress disorder.) This is especially true if the child with the disability is born into a mature, supportive family who openly expresses nurturing love. But, on the downside of being born with a congenital disability is the obvious fact that such a child will more likely have had less, or even, very little opportunity to develop skills that are necessary for independent living. It is also important to be very careful not to assume that people being born with congenital disabilities do not experience emotional trauma that has to be dealt with for recovery. This is especially the case if mental and cognitive functioning is at least relatively intact. Despite being born with no or little awareness that anything is different, there always comes a time in that person’s life when he or she becomes aware that they are different to such an extent that one of their four basic psychosocial needs (especially self-image) may become compromised

For those, like myself, who are born with genetic conditions in which one is born with the disability, but the symptoms do not show up until later in life (and most likely deteriorate during the life cycle), the advantages and disadvantages are somewhat a compromise of the two situations mentioned above. For example, while I was born with retinitis pigmentosa and severe hearing impairment, I had enough vision to be able to participate in the mainstream such as attending public schools (this was in the early ‘) 50s and develop some extremely invaluable friends. I was fortunate to have been able to participate in athletics. I was also able to learn some invaluable skills. But when the first symptoms of failing eyesight started appearing during my teens, the emotional impact of the loss was quite devastating, but I am not sure it would have been as devastating if I were in my later years and raising a family with a good job that I would have to give up (but who really knows?)

The essential point here is that no matter how a person acquires his or her disability, there are disadvantages and advantages for each pattern or type of loss. In terms of empowerment, this awareness may give us some clues which of the four psychosocial needs may need to be a bit more focused on. It is quite possible that a child born with a congenital disability may have been quite overprotected and the need for freedom will be quite a struggle in the recovery process, whereas, a person who acquires the disability suddenly may feel so traumatized that the resulting ‘different ness’ will challenge the need for love and belonging. Of course, there are many other factors that play a role in the empowerment process as well such as types of families reared in, the socio-economic advantages and overall cognitive/mental abilities. But it is helpful to take into consideration the type of disability acquisition when considering one’s capacity for empowerment. This will all come together in the question dealing with the factors that contribute to one’s overall likelihood of becoming empowered

QUESTION NUMBER NINE

QUESTION: Why is it obvious that many people with disabilities have poor self-esteem, or in essence, are not empowered?

ANSWER: Although very little research has been conducted on the mental health issues of the specific sub-population of the disabled, there are indicators that make this fact obvious. The reason little research has been conducted are numerous, but the most likely one is that little research conducted by global entities such as the National Institute of Mental Health is that research centers around specific emotional disorders and mental health issues around the entire population (e.g. the incidence of depression and its etiology and contributing causes)

But there pretty clear-cut indicators that make it quite obvious that many disabled have poor-self esteem and, therefore, are not empowered. The first indicator is based on my own observation. When I first began encountering larger numbers of disabled people when my own disabilities were becoming more severe, which was after I received my own mental health training in clinical social work, I noticed that many disabled people seemed to be both quite shy and timid or, on the other hand, quite controlling and dominating.

But there are other more concrete indicators that many disabled people are not empowered. A study conducted at Boston University School of Rehabilitation (Sargent College) conducted by Pelletier and Rogers found that in over 2000 disabled people surveyed, over 85% felt significant levels of emotional problems and a far greater need for counseling. The handbook for classifying mental disorders and psychiatric diagnosis cited the loss of physical functioning as an example of a severe psychosocial stressor. A review I conducted for a substance abuse program revealed that substance abuse was anywhere from three to six times greater than the non-disabled population. This one is very interesting. When I was Chair of the Rhode Island Independent Living Rehabilitation Council, ‘lack of self-confidence’ was found to be the greatest barrier to independent living. Furthermore, a study conducted by the University of Tennessee revealed that the vast majority of severely disabled people were socially isolated and their social contacts were limited to either family members of paid staff members of organizations that served them. There are many other indicators that reveal the lack of empowerment, but much more documentation is necessary in order to deal with this pervasive social problem if we want the severely disabled to live more independently.

QUESTION NUMBER TEN

QUESTION: Why do a lot of people with disabilities have poor self-esteem or, in essence, are they not empowered?

ANSWER: In one sense, this may seem like a naïve question with an obvious answer. This is because many of the non-disabled, especially before the days of mainstreaming the disabled through landmark legislation such as The Americans with Disabilities Act (ADA), Independent Living/Title VII of the Rehab Act and the Education of the Handicapped Act, not to mention the impact of the media having a positive impact on the disabled, were heavily socialized into believing that the disabled were ‘less than human’.

But the answer to this question is in actuality more complex than it may seem at first glance. Why are some disabled people able, if even the minority, acquire positive self-esteem while others are not?

In answering this, it is important to remember what good self-esteem is. Positive self-esteem is the ability to feel a sense of satisfaction and fulfillment by meeting the four basic psychosocial needs; fun, freedom, self-worth and love and belonging. Equally important, at least for older adolescents and adults, it is important to meet these needs inter-dependently and a balanced, flexible manner. For children, it is a legitimate and healthy situation for them to be dependent on their parents and/or other guardians to meet these needs for the simple reason that children need the guidance to learn how to meet these needs. But, as John Donne, said ‘no man is an island’, therefore, no one is totally independent. Inter-dependence is the ability, through mature, non-threatening and assertive communication, that we find assistance in meeting our basic needs. Thus we depend on others to provide support and guidance (and even role modeling) in meeting our needs, which enable us to have positive self-esteem.

Many, many disabled people do not get this support; guidance and role modeling t learn alternative ways of meeting our basic psychosocial needs.

While many people may assist in helping the disabled to find alternative ways of meeting physical needs e.g. wheelchairs for ambulation, the white cane for blind mobility, the psycho-social needs that give true quality to our lives are very often neglected by support systems or agencies that serve the disabled. In fact, during the initial days of the Rehabilitation Act of 1973, it is assumed that physically restorative services are made available for the physically disabled, while the psychiatrically restorative services are reserved only for the psychiatric disabled. Somewhere along the line, someone forgot about the mind-body connection and forgot that not only are many physically disabled people quite depressed, but that many psychiatrically disabled people are unable to take care of their physical needs.

This lack of adequate psychosocial supports reflected in society and the agencies within them that supposedly serve these disabled people is laid on a foundation of negative attitudes about the disabled. Many believe, myself included, that this negative attitude that treats disabled people, for the most part, is based on fear. Many people are threatened by the appearance of a disabled person. Consciously or unconsciously, they ask themselves ‘could this be me someday?’ or ‘what do I say to this person’ or ‘how do I behave/interact with this person’. Thus, intimacy, or the need for love and belonging is very hard to acquire, as are the needs for self-worth, fun and freedom.

These neglected needs set up a very lonely existence and, therefore, set the stage for the vicious circle of dependency. More than likely, many of the disabled person’s activities will be quite restricted and few in option, setting up the likelihood for social isolation. [As stated in one of the previous question and answer, the University of Tennessee conducted research revealing that most severely disabled’s social contacts are limited to family members and paid staff. This, in turn, set the stage for depression and increasing senses of helplessness. When these stressful emotional conditions become integrated in the disabled person’s life, cognitive functioning such as good problem solving skills, concentration and memory become impaired, thus even making it harder to find ways to meet the basic needs for positive self-esteem.

So, in my view, the primary factor that trigger the vicious cycle of dependency that inhibits positive self-esteem is the lack of quality support systems, informal (e.g. friends) and formal (e.g. agencies, social clubs), that provide the necessary support, guidance and role modeling that is necessary to learn new personal competencies that will pave the way for meeting our basic physical and psycho-social needs.

QUESTION NUMBER ELEVEN

QUESTION: What’s the difference between healthy and unhealthy systems of support for the encouragement of empowerment, not just for the disabled and/or elderly, but also for all people?

ANSWER: To answer this question, it is critical to understand just exactly is a support system. A ‘support system’ is one or more individuals that play significant roles in another person’s life. So one person can be a support system, such as a friend, parent or teacher. Also, however, a collective group of people can be considered support systems as well. These collective groups can be formal groups such as social groups, self-help groups or an informal collective group such as a group of friends or gangs. The support system’s role is to, in one way or another, provide relief from some of life’s stresses rather than a specific task such as education in the school system. Also, a support system provides three basic functions: support or relief from stress, guidance in stressful situations, and role modeling in the face of stressful events.

Put simply, a healthy support system of support encourages growth and empowerment (again, the ability to meet physical and psycho-social needs in a balanced, flexible and inter-dependent manner) whereas an unhealthy support system does not do that. It is extremely important to note that if a support system is not healthy, then it is unhealthy; there is nothing in between (although there can be, of course, varying degrees or levels of unhealthiness or healthiness).

Thus, in more operational terms, healthy support systems follow the eight elements of empowerment. They do not control, dominate or manipulate other people to do what they, the support system, think is best, but, rather, help the person being supported to make their own decisions about their own goals and the most satisfying methods to reach these goals in a solution-focused manner. Healthy support systems are not judgmental, but they are genuine in a non-threatening manner (empowerment elements of empathy, collaborative and genuineness). They accomplish this task of healthy support by clear and effective communication skills

It is important that healthy support systems also take into consideration the age and other characteristics of the person being supported such as level of intellectual level, or cognitive skills (that is appraised on an honest, objective basis). If, for example, the person being provided support is a relatively young person between the ages of three to five, the healthy support system will undoubtedly place more emphasis on the guidance role, but not at the total expense of the supportive role. In other words, if the healthy person is assisting a child to learn to ride a bike, instructions will be provided, and the bicycle will most often be held firmly by the person providing the support. However, he will also listen to the child’s fears, excitement and even his own suggestions what may make the task easier. In other words, he will be a good listener and will demonstrate patience and friendliness in the supportive role. It is all of these qualities that set him up as a good role model.

On the other hand, if the healthy system of support is providing support to an older adult, it is likely that much more emphasis will be placed on the supportive role through active listening and empathy and working out problems much more in a collaborative manner rather than a controlling one. However, there are times that the healthy system of support will provide guidance, especially if it is asked for, or it is obvious that the person requiring support is unable to make decisions, such as in a crisis. So healthy systems of support provide the correct combinations of support, guidance and role modeling in a balanced age and ability-appropriate manner.

It is important that many support systems of support appear to be quite healthy, but in reality are quite unhealthy. This is especially the case with issues of co-dependency that we hear so much about these days, a concept that became popularized with the advent of alcohol awareness and Alcoholics Anonymous. It is quite easy to spot a unhealthy system of support when their behaviors are so obviously inhibiting the other person’s growth and empowerment as in the case of abusive parents and spouses, but there are many, many support systems who may appear healthy, but, in fact, quite unhealthy. In many instances, these illusory types of support systems are referred to as co-dependents.

QUESTION NUMBER TWELVE

QUESTION: What is the basic pre-requisite to help others, including the disabled, to become more empowered?

ANSWER: Perhaps the simplest answer to this question is the best one. To help others truly become empowered, then work on your own empowerment. Think about that for a moment. What is the best way to work on your own empowerment? In my view, it is following and improving on the ‘Eight Elements of Emmpowerment’ (Triple E for Excellency!)

With respect to the eight elements of empowerment, the first four refer to more personalized, character traits, while the last four relate to more inter-dependent personality traits. Another point to consider is that whenever you are working on any one of the elements, it will undoubtedly have a positive impact on the other seven elements. Take self-awareness. By becoming more ‘self-aware’ by appraising yourself honestly and appreciating your strengths and accepting your limits, you are also increasing your power towards becoming more responsible. Because when one is more responsible, one has to take into account what’s own limits and strengths (which is self-awareness) in order to ‘expand options’ towards solving a particular problem or challenge in life. This ‘solution-focused approach to problem solving is a more ‘pro-active’ approach and will likely lead to a more goal oriented person than does a ‘re-active’ person becomes. Also, by increasing one’s self-awareness, one is increasing respect for genuineness in understanding oneself, but others as well. This undoubtedly will have a positive impact on empathy and collaborativeness, as expanding awareness of oneself also increases appreciation for one’s uniqueness, as a person separate from others who also have strengths and limits to be appreciated and accepted. See how all of this fits together?

So, the best way to help someone else become empowered is to work on those eight elements of empowerment. This will set the stage for a support system that will be collaborative and empathic. In one’s own personal growth and increasing integrity, one learns to balance out in the best manner possible the three functions of supporting stress, providing guidance through stress and all the while, being the best possible role model. Communication will be truly inter-active, not controlling, thus inter-dependency will be encouraged, not dependency. If a person is truly genuine and empathic, he will make all honest efforts to understand the disabled person’s situation, including his problems and challenges. Sometimes being genuine and empathic in providing supports means directly asking in a sincere, non-threatening manner, "what is it like to be in a wheelchair all the time?" Similarly, when non-disabled people are angrily confronted by disabled people by being accused of not understanding what it is like not ever to be able to see, the empathic, genuine and collaborative (sensitive) person may respond something to the effect of’ You’re right, I couldn’t possibly understand, but I would like to learn through honest communication with you."

Generally, it is best to allow the disabled person ask for assistance, but if it should become evident that some assistance could be helpful, it is quite important, in my opinion, to quietly and discreetly ask IN GENERAL TERMS, if anything can be done to help, e.g. "Can I do anything to help?" Not ‘would you like me to hold the door for you." As the former provides more feedback that the disabled person is in control of his own wishes and needs, thus, to be able to identify his or her challenges more specifically.

Simply speaking, pretentiousness and one-upmanship, taking control or any other forms of grandstanding are unwelcome. A person is a person is a person, each with his or her own set of unique needs that must be fulfilled to become empowered. If a group comes together, even a group of two, why should the focus be on the wheelchair or the white can or the limp any more than the wart on the other guy'’ nose or whatever other idiosyncrasy that person exhibits? When people first come together, there are always a struggle to find common ground, usually starting with more superficial small talk e.g. the weather, the '‘big game’ the other night. However, as time progresses and more common ground is established and the couple and/or group become more engaging and intimate, it can be a sensitive gesture to inquire about the obvious such as the cane or wheelchair, as long as it is done with an obvious purpose e.g. if the group are going somewhere together and that perhaps ways of assisting can be planned. In other words, if it isn’t on some level dealt with openly, it could be interpreted as being a threatening issue for the other people. So judgment has to be exercised, and as long as integrity is being practiced with the Eight Elements of Empowerment, there is really no right or wrong way.

QUESTION NUMBER THIRTEEN

QUESTION: Who are the disabled people most likely to become more empowered and is it more likely that people with the more severe disabilities have little or no hope of becoming empowered?

ANSWER: In regards to the people with the more severe disabilities, do they have little or no chance of becoming empowered? The answer is an emphatic NO! With respect to people with disabilities, I do a sort of ‘profiling’ in terms of their capacity for change, their capacity for growth and empowerment (Actually, I profile all types of people regardless of whatever ‘disadvantage category’ they may be in-or what kinds of losses they have experienced). This profiling takes into account about five variables, most of which we have already discussed in the other questions.

The factors taken into consideration are: the intensity of the grieving associated with the loss; the level of personality maturation (or simply speaking, empowerment) at the time of the loss, the healthiness of the significant support systems and, their overall coping abilities in responses to losses. This last factor is basically a summation of a combination of factor two (level of empowerment at time of loss) and three (strength of support systems), but it takes into consideration what other kinds of losses have the person been through and how successfully were they dealt with. In other words, has the person has some good ‘practice’ in learning to cope with losses?

The important thing to note is that all of these factors are changeable. Someone who is not that empowered (that is, has little ability to take care of basic needs inter-dependently) may learn to become more empowered. Similarly, someone with weak support systems may learn to acquire stronger ones. But what about the first factor that pertains to the intensity of the grief, can that become changed? The answer lies in a paradoxical yes and no. We may not be able to change the severity of a loss, such as a spinal cord injury, but we can change our perceptions and the way we think about the severity of the loss. The same goes for the other sub-components associated with the intensity of the grieving discussed in one of the other questions. We can’t change the functional impact of the physical loss, but we can change the way we think about it. Changing our perceptions and thoughts will ‘lighten the load’ or the burdensome with respect to the intensity of the grieving that has to be dealt with in order to get through the loss. It is also the increasing of our levels of empowerment and the healthiness of our support systems that also set up a ‘circular’ effect that increase our ability to ‘lighten the load’ in the way we think about our losses, which, in turn, increase our capacity and motivation to become more empowered and acquire healthier support systems. Get the picture?

Thus, while at first glance it may appear that those with the most severe disabilities have little or no likelihood of becoming empowered because the severity of the disability (and the other sub-factors with respect to the intensity of the grieving), not only can we change the way we think about these losses, but we can change our support systems and become more empowered, it is these factors that really determine our capability of becoming more empowered

By changing the quality of our support systems, does this mean that we have to give up our old friends and family (as well as other formal and/or informal supports) if these people don’t seem to be relatively empowered? Absolutely not! A physical loss affects everyone, and close friends and family have to get through the grieving process to become more empowered. It is amazing how a crisis, whether it is the loss of physical functioning or a job, separates winners from losers. But some of the old friends and family members who cling to old negativistic thinking patterns and project little faith in one’s recovery may have to be distanced from for a while or maybe even abandoned if they demonstrate little capacity for change.

But let’s get back to the profiling that I was mentioning, using a scale from 1 to 10. For factors 2-4 (level of empowerment, strength of supports and overall coping capabilities based on past losses) a 1 ranks as very low whereas a 10 ranks very high. For the first factor, an inverse rating scale has to be developed to keep the profiling accurate, thus allow grieving intensity (based on severity of loss, its functional aspect, type of onset and day-to day management stress-e.g. multiple sclerosis has many ‘bad’ or ‘good’ days with frequent medications management, mood swings, impairment level in ambulation and speech), so a 1 would represent a very intense grieving process to weather through whereas a 10 would represent a very low-level of intensity of the grieving response.

So, let us say we have a man who has suffered from partial loss of sight and overall, his level of grieving is about an eight. His support systems were quite strong with a ranking of 9 while his level of empowerment at the time of the loss was high as well, ranking about an eight. Finally, his fourth factor ranked high as well with previous successful ‘practice’ in weathering other losses (e.g. divorce of parents), ranking him about a seven. Using this profiling system would rank this man with an overall average of about an 8, which is quite high. Using this profiling system is flexible and not taken too seriously in terms of perceiving it as statistical analysis, but it just gives about this man’s capacity for changing in becoming more empowered. If we take other hypothetical scenarios, it is easy to see how the averages for those with the most severe disabilities could come out substantially higher than those with much less severity in their disabling conditions.

QUESTION NUMBER FOURTEEN

QUESTION: What are some specific, concrete strategies to help others, including the disabled and elderly , to become more empowered?

ANSWER: This question is a tough one to answer in an overall sense of strategic assistance for all people, and the implication of the question is not to suggest that the average person can be a ‘fix-it-quick’ therapist. Whenever one witnesses another, disabled or otherwise, having trouble coping with their lives, the best thing one can do is to gently and non-judgmentally suggest professional help (either a licensed therapist or a physician)

In general, the best way to assist someone’s empowerment building is to work on your own growth. The greater the maturity of another, the less likely of being judgmental, condescending and an overall need to ‘rescue’ another. The need for heroic rescuing is the crux of the ‘co-dependency’ role.

In general, the best manner of assisting others is to make a mature assessment of how to best combine the ‘supportive, guidance and role modeling’ activities of a support system. This means taking a bit into consideration of helping another such as age, level of maturity and judgment (this will be mostly intuitive) and other support systems the person has.

The best way to help anyone else, however, is to build trust with that person. One can hardly help another when that person is not trusted. This ‘trust building’ involves a lot of common sense, but the principle ‘do unto others as you would like others to do for you’ is a safe trust-building principle. Another good principle of relationship and trust building is if you want something from others, the best way to get it is to give it’.

Specifically, it is best to let another approach you with a problem. On the other hand, if you sense that someone is being bothered by something, but is not ‘opening up’ and approaching you with a problem, then perhaps a gentle statement to the effect like ‘something seems to be bothering you, is anything on your mind?’ (Warning: make this statement only one or twice at the most, pushing never helps and nobody likes to be told how they are feeling or thinking; those are private boundaries) If someone should present a problem to you, this is when the art of ‘active listening’ comes in, displaying that you are listen with sensitivity and empathy. Make this the number one principle, save the ‘suggesting or advising’ for later (if ever)

If the person confiding to you is an adult and has demonstrated relatively ‘level-headedness’ in the past, more of the ‘supportive’ role will be helpful. This involves mostly active listening, and then asking if there is any way you can help. There is little ‘guidance’ in this activity, the most guidance that will be helpfully offered is what shrinks call ‘expansion of options’. That is, while showing sensitivity for the problem, helping the other to be more ‘solution-focused’. This will involve providing an array of possible options for dealing with the problem, and making sure that the person understands that by presenting options, you are NOT implying that you are recommending any of these options. This is simply a ‘two heads are better than one’ strategy. If the person can come up with a solution, whether by your presentation of possible options or by his or her arriving at his or her own solution, then simply more listening with a sincere statement of your sensitivity to the problem and reassuring when you may be available again to listen.

However, when one is acting as a support system for someone who is relatively younger or demonstrates less ‘level-headedness’ in problem solving skills, it is likely that more of the ‘guidance’ role of the support system’s activities will be emphasized. However, and this is very important, to emphasize the guidance role in no way implies employing this role in its entirety or ‘taking over’ with the person’s problems, again whether the person is disabled or otherwise

Emphasizing the guidance the guidance role means that the listening skills are equally, if not more, important. However, rather than providing an array of options simply because two heads are better than one, options are presented with more description and also elaborating on the disadvantages and advantages of each option. The key is to enable the person the person into believing that he or she is making his or her own decision, even if more guidance is provided. If the person appears to be demonstrating poor judgment in arriving at a decision, then emphasizing the disadvantages of such an option and the advantages of a better option. If the person is still leaning towards the option that reflects poor judgment, especially where harm can be applied to himself or another, then limit setting is a very appropriate and valid component of the guidance role. Sometimes this guidance capacity of a support system may appear manipulative, and, in a sense, it is, this is valid manipulation simply because the support system is in a wiser position to know what is really helpful or harmful. Furthermore, the limit-setting is in the best interests of the one being helped. For example, if a ten year old complains of feeling frustrated about doing poorly in school, the parents may elaborate on all options simply by asking the child what are some possible things he can do to solve the problem. If one option that is brought up that implies ‘giving up’, the parents can elaborate on the disadvantages of doing this. The parents can simply ask what other options are available simply by asking ‘what else?’ and if ultimately the child responds with putting in more effort or getting help from the teacher, the advantages of this option can be elaborated and supported. But if the child’s behavior reflects that he is really not practicing out this option, but rather is putting less effort, then appropriate ‘limit-setting’ can be applied such as withdrawing certain privileges such as allowance, playtime or TV time, anything that the child takes pleasure in. [Note: this is an abridged form of suggestions. Many more are offered in the unabridged booklet of these ‘Frequently Asked Questions’ which can be purchased. Strategies are also provided extensively in From Emptiness to Empowerment: Changing Physical and Other Losses Into Strengths.]

QUESTION NUMBER FIFTEEN

QUESTION: How does change with people come about anyhow, whether it be positive change (empowerment) or negative change (regression)?

ANSWER: Many people believe that change among people is a complex issue, in part due to the workings of the unconscious or sub-conscious mind. Although the unconscious does play a role in resistance to change, what makes people change is a relatively simple issue, unconsciousness or no unconsciousness. This is because change does not occur happen because of one single factor alone, but, rather, a collection of factors that result in movement in a positive or a negative direction. It is ‘cause-and-effect’ thinking that influences people to believe that one factor, and one factor alone, will make someone change, e.g. a single punishment or a single reward. But when we look at this issue as a more complex issue, understanding how change, paradoxically, becomes easier to understand.

However, a brief, oversimplified comment about the unconscious may be helpful in understanding why people don’t change. When anything gets too painful for a person to deal within his or her life, mechanisms of defense come into play. A psychological mechanism of defense is an unconscious strategy that comes into play when a situation in life becomes too unbearable. Denial is perhaps the most common mechanism of defense. Actually, the other forms of defense mechanisms are just different forms of denial. When a situation becomes too painful, denial simply means not to think about it, at least in the conscious mind. Rationalization is another form of a mechanism of defense. When we rationalize, we may think about a particular situation that may actually be unhealthy, but we think about it in a way that ‘twists’ the negative meaning into a positive one. Over-compensation is another defense mechanism. Over-compensation (sometimes called ‘reaction formations’) simply means that rather than accepting a condition as reality, there is a tendency to ‘glorify’ or inflate the meaning of such a circumstance in an effort to make something that is painful into something that is not, or even pleasurable. You can see, however, regardless of the names of displays of these defense mechanisms, they are strategies at ‘denying’ the reality of a painful situation or event. These mechanisms of defense can be extremely powerful inhibitors in encouraging people to change. This is part of what makes change for people so difficult. But if we attempt to encourage change by confronting these mechanisms of defense, we will most likely not only be unsuccessful, but we will alienate the people as well and building positive relationships will be very difficult. Whenever you hear some saying something to the effect of ‘I tried to tell him how unhealthy it is to stay in the house all the time, but he won’t listen to me . . .’ we can have a pretty good idea that mechanisms of defense are playing a strong role. There are other and much more effective ways of dealing with unconscious mechanisms of defense that we will soon be talking about (especially in the next question).

Resistance, conscious or unconscious, to change is usually referred to as ambivalence. Ambivalence simply means a conflict, part of you wants to do something, and another part doesn’t. This includes the desire to change in becoming more inter-dependent. Put simply, we can change in a positive direction towards empowerment (increased capacity to meeting our needs; taking more charge or control over our own lives) or we can change in a negative direction towards regression (decreasing our capacity in meeting our needs; taking less charge/control in our lives). When we look at what makes people change from this angle, the role of ‘unconscious inhibitors’ takes on less significance, thus reducing the ‘mysteriousness’ of change. Thus, this will increase the likelihood of people offering support and guidance and decrease the temptation of throwing one’s arms up in the air and declaring ‘I don’t know what to do!’ There will be some suggestions in assisting people to change in the next question (Question 15).

It is critical to understand that change is a process and occurs in stages. These stages are pre-preparation, preparation, initiation, action and maintenance. Let’s take a look at these stages of change:

Pre-preparation . . . this is a stage in which there is no desire, or motivation, for change. In other words, the benefits or pleasure of a current behavior substantially outweigh the disadvantages

Preparation . . . this is the stage in which the advantages and disadvantages become equal or nearly equal

Initiation . . . This is the stage in which a person takes the very first step in the direction of change as the advantages are being outweighed by the old behavior

Action . . . This is the ‘follow-through’ on a behavioral in the direction of change

Maintenance . . . this is when the new behavior becomes a habit, or at least a repetitive pattern of behavior for a substantial period of time. [Note: Much more detail is provided in the unabridged form of ‘Frequently Asked Questions’ which can be purchased in e-format or in From Emptiness to Empowerment:Changing Physical and Other Losses Into Strengths]

QUESTION NUMBER SIXTEEN

QUESTION: What is the difference between inter-dependence and independence, and how does this relate to empowerment?

ANSWER: While this important differentiation is discussed in some of the other question and answers, the significance of this topic is so important that I wanted to address it separately. While at a glance, it may seem even more important for people with disabilities, in reality it is extremely important for all people. I truly believe that if most people had a better understanding of thisdifferentiation, the world would be a far better and safer place to live in.

In actuality, there is really no such thing as ‘independence’. Even if a man were shipwrecked and stranded on a deserted island, he would still depend on rain, tropical vegetation and other forms of food for survival.

It is important to understand that dependency, independence and inter-dependence are all relative terms,with inter-dependence being on top of the totem pole in terms of empowerment. It is natural and legitimate for a toddler or young child to depend on parents not only for physical needs, but psychosocial ones as well. However, when the child becomes older and moving into his teen years (and even more so in later adolescence), and all goes well, the child becomes more ‘independent’ in his thinking and behavior. As always, this applies to meeting psychosocial needs as well as physical. The teen will want to do more things separately from parents. However, and if things continue to go well, the late teen emerging into adulthood learns inter-dependence is the key to living well. Inter-dependence comes from the realization that we are indeed dependent on one another for physical and psychosocial survival. The key to inter-dependence is clear and effective communication that is assertive, but non-threatening.

QUESTION NUMBER SEVENTEEN

QUESTION: What are some of the major barriers that prevent disabled people, including many disabled elderly, from getting professional services to improve their levels of empowerment?

ANSWER: In some of the previous questions and answers, I have provided some information that not only is there a significant neglect of services to bolster empowerment for the disabled, but also a far greater demand and desire for such services by the disabled. The handbook for psychiatric diagnosis states that loss of physical functioning is an example of an EXTREME psychosocial stressor. A survey I once conducted as Chair of the RI Chapter of National Association of Social Workers (NASW) revealed that less than 2% of people being served in counseling facilities (public or private) were physically disabled.

Although much more research could be conducted, it is common sense to assume that the loss of a physical functioning can cause extreme psychological stress and problems. If this is the case, why aren’t the doors of mental health centers, psychiatrist offices and other mental health providers being torn down, clamoring for more services. What’s holding disabled people, including the elderly disabled, from getting professional services they really could use?

The following factors seem to be major barriers, based on my observations and the workshops I have provided. By the way, if anyone out there has encountered a different barrier, please let me know, preferably by e-mail (but you can telephone, regular mail or fax as well).

• Architectural and Transportational barriers
• Double Stigma Barrier- Many disabled people have difficulty dealing with the stigma of being physically disabled and fear the added stigma of being mentally disabled as well.
• Financial Barriers
• Lack of Consumer Awareness- Many disabled people believe they are receiving professional counseling when they visit a vocational rehabilitation counselor or a ‘peer’ counselor who is not professionally trained.
• Lack of Consumer Trust- Most mental health professionals are not disabled. Disabled consumers often wonder if a therapist who has never experienced or dealt with a disability can truly understand what it is like to live with one.
• Negative Attitudes of the Mental Health Professionals- I will never forget one of my students at a training session. She told the group that she ws advised by her supervisor not to consider in specializing with the disabled, because, to use his words, ‘it is way too depressing’.
• Lack of Consumer Motivation- It usually takes a psychological stressor or even a crisis to motivate a person into seeking professional counseling. This could be a loss of job, or threat of job loss. It could be a major fight with a spouse who threatens to leave. Because many disabled people are socially isolated and not participating to a significant degree in the community (e.g. work, school), there are less chances of a ‘precipitating event’ that motivates a person into seeking counseling.

QUESTION NUMBER EIGHTEEN

QUESTION: Why is empowerment among the disabled and the elderly such a ‘hot issue’ for the 21^st Century?

ANSWER: As much as I would like to cite humanitarian reasons, the bottom line answer is, I believe, money.

With increasing awareness of the disabled population, thanks in part to landmark legislation such as the American With Disabilities Act (ADA), Title VII of the Rehabilitation Act that developed Independent Living and other Federal programs, it has become nearly common knowledge that there are 64 million disabled Americans. With advancing medical science and pharmacology, the average life span for both men and women is increasing, thus greatly increasing the elderly population. This doesn’t even take into account the number of post-World War II ‘baby boomers’ who will be reaching their senior years shortly. President Clinton’s impeachment was one of the most publicized events of the 20^th Century. One of the most controversial activities he conducted was to provide a State of the Union Address in January, 1999 while impeachment proceedings were being carried out, thus attracting millions of viewers nationwide and abroad. What does he talk first and the most about? Saving Social Security!

The fact that the disabled and elderly population is dramatically rising and Social Security may be in trouble is indeed alarming. This doesn’t take into consideration rising health costs as many, if not most, disabled and elderly require extensive medical care. With the advent of ‘managed care’ and its ferocious efforts to keep health costs down while laying the groundwork for many horror stories that result from the neglect of appropriate medical care doesn’t help matters much either. Physicians, health care professionals and other consumers/advocates are finally and fortunately, in my opinion, beginning to reverse the tide, but the money for health care will have to come from somewhere to support public (Medicare, Medicaid) and private programs.

The shortage of nursing homes, institutional and other assistive living care will be increasing markedly, UNLESS the disabled and elderly can be encouraged and provided with enough community supports to live independently within the community. What is the biggest factor in living independently (or more accurately-inter-dependently)? The first and foremost variable is attitude, an empowering attitude. I have witnessed some people with some pretty severe disabilities live independently in the community while with others with far less severe disabling conditions live in nursing homes and other institutional care. The average cost per year for nursing home care is roughly$150,000 to $300,000 while the cost for community supports for living in the community ranges from $10,000 to $50,000. That’s quite a difference. And empowerment is the difference.

QUESTION NUMBER NINETEEN

QUESTION: Why did I write From Emptiness to Empowerment: Changing Physical and Other Losses Into Strengths?

ANSWER: For one very simple reason- there has never been a book written like it. This may sound pretty incredible, but it’s true. In fact, this fact disappointed me.

After conducting my program at Counseling for Independent Living, Inc., the nation’s first program to provide professional counseling to the disabled on a community based level, I realized that the great things we were doing were reaching a very small percentage of disabled people. I wanted to have a far more reaching impact on how helpful professional counseling aimed at the physically disabled could be. Writing a book for a regional or national audience seemed like a logical possibility, so I explored that option. The first thing I wanted to do was to see what else had been written. I wasn’t looking for biographies about disabled people or factual accounts about the disabled, but, rather, I was looking for more of a ‘self-help’ guide targeted specifically for the disabled. In essence, I was looking for a book along the lines of Don’t Sweat the Small Stuff by Richard Carlson, Your Erroneous Zones by Wayne Dyer, Men are From Mars by John Gray, Releasing the Giant Within by Anthony Robbins and Living, Loving and Learning by Leo Buscaglia. But all of the self-help books ever written and put on the open market were written for everyday people. While there have been other self-help books written for special populations such as alcohol troubled and financially challenged people, again, there was never a book written exclusively for people dealing with physical and some other types of devastating losses.

I stated earlier this was frustrating as I hoped there had been something I could find that would allow me a beginning point for improvement. Actually, this was the same kind of frustrating experience when I started Counseling for Independent Living, as I hoped there had been something similar to assist me, but there was nothing (see the Providence Journal, January 15, 1990 story in this website for verification, if you wish)

I believed that a book on empowerment development not only could be extremely beneficial for the unique needs and counseling issues of the physically challenged, but a book would also encourage much networking with other disabled consumers, professionals and advocates.

I started the book around 1994 and began realizing the challenges of writing a book without sight and very little hearing. I also had no computer or word processing experience, so the first edition of the book was dictated and transcribed in its entirety. Also, I had to rely on volunteerism the community for the most superficial of editing. However, it was good enough to sell all of the first 500 copies printed and sold, securing not only many national speaking engagements, but also the recipient of a testimonial ‘A Salute to Author Brian J. Hubbard’ on September 11, 1997

But I really wanted to improve the book, not only its content, but also its format and reading style. But I knew I had to learn how to use the computer. Undaunted by prostate cancer and other life challenges (divorce, loss of remaining sight), I went full steam ahead in learning the computer despite a dual sensory impairment of total blindness and profound deafness. My learning experience was good enough to receive the First RI Award for Personal and Professional Achievement by Tech Access, my computer training organization. This paved the way to write the second version exactly the way I wanted, allowing me far greater control over the writing and editing process. While this book is no available in e-book format, I am also in the process of negotiating with literary agents and publishers across the country for its more traditional publication.

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