Rehabilitation Psychology 2014, Vol. 59, No. 4, 367-375

© 2014 American Psychological Association 0090-5550/14/$12.00 http://dx.doi.org/10.1037/a0037502

How We Treat Our Own: The Experiences and Characteristics of Psychology Trainees With Disabilities Emily M. Lund

Erin E. Andrews

Utah State University

Texas A&M Health Science Center College of Medicine and Central Texas VA Healthcare System, Temple, Texas

Judith M. Holt Utah State University Objective: To better understand the characteristics and experiences of psychologists and trainees with disabilities. Method: An invitation to participate in a survey of psychologists and psychology trainees with disabilities was sent to professional listservs related to psychology and/or disability. Fifty-six trainees and psychologists with doctoral training in clinical, counseling, school, or rehabilitation psy­ chology completed the survey. Over half (57.1%) were practicing psychologists and 42.9% were current trainees. The most commonly reported disabilities were physical, sensory, and chronic health. Results: The majority of the participants reported experiencing disability-related discrimination during their training, and less than one third had received mentorship from psychologists with disabilities. Less than half of respondents disclosed their disability to a university disability services office, and many relied on informal accommodations alone. Most participants did not disclose their disability during the graduate school, internship, or postdoctoral application processes. Conclusions: Professional psychology pro­ grams and training sites should work to remove barriers and provide support for trainees with disabilities, especially during preintemship doctoral training. Programs should not expect disability services offices to provide all support for students with disabilities, especially support related to clinical training. Keywords: disability, graduate school, psychology trainee, psychologists with disabilities, discrimination

Impact and Implications

Introduction

• This is the first known quantitative survey of the experiences of

Diversity is increasingly considered a vital part of psychology training, and efforts have been taken at the university, state, and national levels to recruit and support diverse psychologists and psychology graduate students (American Psychological Associa­ tion [APA], 201 lb). However, relatively little is known about the experiences of graduate students and psychologists with disabili­ ties, despite the fact that disability is widely considered to be a facet of diversity (Brown, 1995; Olkin, 2002). Despite the focus on diversity in general within APA, there is a paucity of data on the prevalence of disability among psycholo­ gists and graduate students in psychology. A survey of APA members in the early 2000s revealed that only 2% of respondents self-identified as having one or more disabilities (Olkin, 2002; Olkin & Pledger, 2003). In an earlier survey of 73 clinical and counseling psychology program chairs concerning graduate stu­ dents with learning disabilities specifically, Paquette (1997) found that 41% of respondents were aware of any students with learning disabilities in their program and that over half of respondents reported having little or no experience with graduate students with learning disabilities in their role as a program director. Further­ more, less than 10% of respondents were aware of any faculty members with learning disabilities in their psychology graduate program, suggesting that graduate students with learning disabil­ ities may be unlikely to find mentors with similar disabilities. Perhaps the most thorough data on psychology graduate stu­ dents with disabilities comes from the Association of Psychology

professional psychologists and psychology trainees with disabilities. • The results of this study indicate that many professional psychology trainees rely only on informal accommodations to meet the demands of clinical and didactic training and frequently encounter disability-related barriers and perceived discrimination during training. • Faculty, supervisors, and training directors should be aware that for­ mal data from disability services offices and accommodation offices may not adequately account for this population or completely address the barriers they face.

This article was published Online First August 18, 2014. Emily M. Lund, Department of Special Education and Rehabilitation, Utah State University; Erin E. Andrews, Texas A&M Health Science Center College of Medicine, and Central Texas VA Health Care System, Temple, Texas; Judith M. Holt, Department of Special Education and Rehabilitation, Utah State University. We thank the members of the Psychologists with Disabilities Special Interest Group of Division 22 for their assistance in developing the survey. Correspondence concerning this article should be addressed to Emily M. Lund, MEd, Department of Special Education and Rehabilitation, Utah State University, Logan, UT 84322. E-mail: [email protected] .usu.edu or [email protected]

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Postdoctoral and Internship Centers (APPIC) annual survey of applicants for predoctoral internship. These data have shown that about 6 -8 % of internship applicants endorse having at least one disability (APPIC, 2008a, 2009, 2010, 2011a). Because respon­ dents are allowed to select multiple disability categories, the exact number of respondents who reported a disability is unclear. The most commonly reported disabilities for the 2010-2011 internship cycle were chronic health conditions, learning disabilities, and mental illness (APPIC, 2011a; see also Table 1). The overall rate of endorsement of disability and the most commonly endorsed disability categories have generally remained consistent over the years (Andrews et al., 2013). The issue of accommodations for psychology graduate students with disabilities has received similarly little empirical attention. As with all professions, psychologists and trainees with disabilities are qualified to receive “reasonable accommodations” under the Americans with Disabilities Act (ADA, 1990), and its application to clinical situations has been discussed in detail in previous works (Crewe, 1994; Klimoski, & Palmer, 1994; Vande Kemp, Chen, Erickson, & Friesen, 2003). Additionally, the APA Disability Issues Office and its Committee on Disability Issues in Psychology (CDIP) provide information and strategies for graduate psychol­ ogy students with disabilities as well as the faculty and supervisors who are working with them (APA, 2011a). In marital and family therapy, an allied field, there has been discussion of applying universal design principles to make coursework more accessible to students with “diverse and different learning styles” while reduc­ ing—although not eliminating—the need for individual accommo­ dations (Bernal & Zera, 2012). Although helpful and necessary, formal or academic accommo­ dation may not adequately address some of the attitudinal and systemic barriers faced by psychology trainees with disabilities. A 2008 survey of psychology students with disabilities from all levels of postsecondary education and all subfields of psychology Table 1 Comparison o f APPIC (2011a) Disability Data and the Present Study

Disability category2 Physical or orthopedic Deaf, HOH, or hearing impaired Blind or visually impaired Cognitive or TBIb Chronic health condition Psychiatric0 Learning disability Otherd

Percent endorsed (n = 56)

Percent endorsed in APPIC 2010-2011 survey data, of those endorsing at least one disability (n = 214 category endorsements)

33.9% 21.4% 23.2% 7.1% 25.0% 8.9% 10.7% 3.6%

7% 4% 5% 1% 38% 15% 21% 8%

Note. HOH = hard of hearing; TBI = traumatic brain injury. a A category of ADHD was included in the present survey but not included in the APPIC survey. b The APPIC category did not specifically include traumatic brain injury (TBI). c The APPIC category was labeled as “men­ tal illness.” d Five other participants who originally selected “Other” were re-coded into other categories based on their responses; before recoding, the other category represented 12.5% of our responses.

found that over 80% of the 92 respondents perceived experiencing disability-related barriers during their education (APA, 2009). Furthermore, approximately one third reported experiencing mixed or negative reactions upon disclosing their disability to faculty. Specific to experiences of professional psychology trainees, An­ drews and colleagues (2013) and Taube and Olkin (2011) dis­ cussed some of the issues that trainees with disabilities may face. These include biased or uncomfortable remarks and assumptions from supervisors and colleagues, inaccessible training environ­ ments, and inappropriate pressure to disclose one’s disability to clients or prospective clients. Specific to rehabilitation settings, Andrews and colleagues discussed the fact that trainees with visible disabilities may be expected to automatically understand the experiences of clients with similar disabilities, which could be a dangerous and inaccurate assumption. Disability identity devel­ opment is a complex and individual process (Gill, 1997), and two individuals, even those with similar disabilities, may differ widely in their experiences, beliefs, and attitudes regarding disability. Thus, similarity or perceived similarity of experiences cannot be viewed as a substitute for skilled clinical interviewing and careful case conceptualization. Conversely, some supervisors may assume that a psychologist with a disability would lack clinical objectivity when working with clients with similar disabilities, which may cause a supervisor to prejudicially evaluate an applicant’s clinical abilities or professionalism (Andrews et al., 2013). The issue of discrimination against professional psychology students with disabilities has primarily been explored anecdotally. For example, Andrews and colleagues (2013) discussed inappro­ priate disability-related questions during practicum, internship, and postdoctoral interviews, and Hauser, Maxwell-McCaw, Leigh, and Gutman (2000) discussed similar issues faced by deaf and hard of hearing internship applicants. In a qualitative study of 19 blind clinical psychology and counseling students, Joshi (2006) found that participants frequently reported experiencing barriers sur­ rounding faculty attitudes and unawareness of how to work with blind students during their training. The 2008 APA survey of psychology students with disabilities found that approximately one-quarter of respondents reported experiencing disability-related barriers during “internship” (APA, 2009). However, because par­ ticipants came from a wide variety of educational levels and subfields, it is not clear what type of internships respondents were referencing in their responses (e.g., undergraduate internships, predoctoral internships, and research internships). Nevertheless, this suggests that trainees with disabilities may face considerable barriers during fieldwork, such as practicum and internship. With regard to predoctoral internship specifically, APPIC peri­ odically releases data on internship match rates by applicant char­ acteristics, including disability type (see APPIC 2008b, 2011b). However, because most of the disability categories have small samples— all under 100, with only chronic health condition, men­ tal illness, and learning disability having cell sizes greater than 20 (APPIC, 2008a, 201 la)-comparison to the general population of psychology interns (n > 2,300 respondents to each annual APPIC survey) should be done with considerable caution (APPIC, 2011b). In 2006, the APPIC survey included a question regarding per­ ceived disability-related discrimination during the internship ap­ plication process. That year, there were 196 endorsements of disability across all disability categories, and 45 of individuals reported that they had experienced disability related discrimination

PSYCHOLOGY TRAINEES WITH DISABILITIES

(APPIC, 2006). Even assuming that no respondents endorsed more than one disability category—which is very unlikely—that still represents a perceived discrimination rate of almost 25%. Al­ though the disability discrimination question was unfortunately eliminated from subsequent surveys, the high rate of reported discrimination, coupled with anecdotal reports of disability-related discrimination, should still be cause for concern.

Purpose Given the lack of empirical evidence on the experiences of psychology graduate students and psychologists with disabilities, we designed and disseminated an online survey to gather informa­ tion about this population and their experiences with disability impact, disclosure, and discrimination during training. We ana­ lyzed responses only from those participants in professional psy­ chology fields (i.e., clinical, counseling, school, combined, or rehabilitation psychology). The primary goals of this study were (a) to describe the characteristics of psychologists and trainees with disabilities and (b) to better under how their disabilities impacted their professional education and training, decisions, and experiences in graduate school, internship, and postdoctoral training.

Method Procedure After the study procedures and survey instrument were ap­ proved by the institutional review board, we recruited participants via electronic mail listservs, with an emphasis on listservs related either to disability studies or rehabilitation, psychology graduate students or psychologists, or disability services offices. Recruit­ ment emails contained a brief description of the study and a link to the survey. Sample organization listservs targeted include, but are not limited to, the APA Division 22 (Rehabilitation Psychology), the Council of Directors of School Psychology Programs, Disabled Student Services in Higher Education, APA Council of Disability Issues in Psychology, APA early career psychologists, and Dis­ ability Studies in the Humanities listservs. A reminder email was sent out to listservs after 2 weeks by the principal investigators. Recipients were encouraged to forward the email to students, colleagues, and other potentially interested contacts. The recruitment notice stated the names and affiliations of the researchers, eligibility requirements, and the approximate content and length of the survey. The notice also stated that all responses would be stored in password protected locations and that no identifying information would be collected. Although the notice did not explicitly identify the principal investigators as individuals with disabilities, they were active participants on many of the listservs used for survey distribution and so their disability statuses were likely known some, but not all, listserv members and partic­ ipants. Individuals were invited to participate if they self-identified as having a disability or as deaf or hard of hearing and were enrolled in doctoral program in psychology or a related field, held a doctorate in psychology or a related field, or were planning to apply to a doctoral program in psychology or a related field within the next academic year. The survey was open for 4 weeks; a few

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respondents who completed the survey after the 4 week window but before data analysis began were also included. After opening the survey, participants had 1 week to complete it and could return to the last unanswered question by clicking on the survey link again. At the conclusion of the 1 week window, incomplete sur­ veys were automatically closed and entered into the response set by the survey software.

Measure We developed a survey with the input of several colleagues with personal and professional experience with disability. The initial survey was drafted by the principal investigators, all of whom have disabilities, and then was modified based on feedback and sugges­ tion from other psychologists and psychology trainees with dis­ abilities. The survey consisted of 30 primarily multiple choice questions, 24 of which were analyzed for this study and 6 of which are long-form open-ended questions that will be analyzed sepa­ rately. The goal of the survey development was to create a short survey that placed minimal time burden on participants while collecting data on different aspects of training (e.g., program selection, disclosure, and barriers) and allowing applicants to share their experiences. The survey was formatted in a screen-reader accessible manner (e.g., providing question tags and text-based progression buttons) and was delivered via Qualtrics, a Section 508 compliant survey system. Spontaneous comments from par­ ticipants with visual disabilities in the “other comments and ques­ tions” field generally indicated that they indeed found the survey to be screen reader accessible. The survey questions belonged to six general categories: 1.

Demographics (i.e., gender, race/ethnicity, and age)

2.

Training (i.e., degree type, field/subfield, specialization and research interests, stage of training, and year or anticipated year of doctorate completion)

3.

Disability characteristics (type of disability, primary dis­ ability, and when primary disability was acquired or diagnosed)

4.

Impact of disability (influence of disability on institution or specialization choice, use of accommodations during graduate school, and mentorship by professionals with disabilities)

5.

Disability-related support and discrimination (general fac­ ulty and supervisor support and knowledge, perceived ex­ perience of discrimination at various levels of training)

6.

Open-ended (questions about resources used and desired during training).

The questions about discrimination, impact of disability on graduate school choice, and mentorship by individuals were dis­ abilities also allowed for open-ended text entry.

Participants Race, ethnicity, and age. In total, 56 participants who com­ pleted the survey endorsed that they hold or are currently working

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toward a graduate degree in professional psychology (i.e., clinical, counseling, school, or rehabilitation psychology). Slightly less than three-quarters identified as female (71.4%; n = 40). Mean age was 41.49 (SD = 13.22; range = 22-72; n = 55). Fifty-four participants (96.4%) identified as White, 2 (3.6%) as Hispanic or Latino/a, 2 (3.6%) as Black, 1 (1.8%) as Asian or Pacific Islander, 1 as American Indian or Alaskan Native, and 1 as “Other” (Jewish American). Participants could endorse multiple racial or ethnic categories, and four participants (7.1%) endorsed more than one category. Accounting for multiracial or multiethnic participants, a total of six participants (10.7%) did not identify exclusively as White. Disability. Participants were allowed to endorse multiple dis­ ability categories. The possible disability categories were physical or orthopedic, deaf or hard of hearing, blind or visually impaired, autism, cognitive or traumatic brain injury (TBI), chronic health condition, psychiatric, ADHD (i.e., attention deficit hyperactivity disorder), LD (i.e., learning disability), and other. In all but one case (a speech impairment), the responses to the other category were recoded based on the information provided by the participant. An additional participant selected the other category but did not provide any additional information about his or her disability. Approximately one third of the participants endorsed multiple disability categories; 11 participants (19.6%) endorsed two cate­ gories, and 8 (14.3%) endorsed three categories. The most com­ monly endorsed disabilities were physical or orthopedic (n = 19; 33.9%), chronic health condition (w = 14; 25.0%), blindness or visual impairment (n = 14; 23.2%), deafness or hearing impair­ ment {n = 12; 21.4%), and ADHD (14.3%; n = 8). The prevalence of each disability category is available in Table 1 and Table 2. Participants were also asked what they considered to be their primary disability. The most commonly selected categories for primary disability were physical or orthopedic (n = 14; 25.0%), blindness or visual impairment (n = 10; 17.9%), deaf or hearing impairment (n = 9; 16.1%), and chronic health conditions (n = 8; 14.3%). More information on primary disability endorsement is available in Table 2. Twenty-six participants (46.4%) indicated that their disability is visible or readily apparent. In terms of disability onset, more than half (60.8%) of respon­ dents acquired or were diagnosed with their primary disability Table 2 Disability Type and Primary Disability (n = 56)

Disability category Physical or orthopedic Deaf, hard of hearing, or hearing impaired Blind or visually impaired Cognitive or TBI Chronic health condition Psychiatric Learning disability ADHD Other (speech impairment) Other (not specified)3

Percent endorsed (n)

Percent endorsed as “primary disability” (n)

33.9% (19)

25.0% (48)

21.4% (12) 23.2% (13) 7.1% (4) 25.0% (14) 8.9% (5) 10.7% (6) 14.3% (8) 1.8% (1) 1.8% (1)

16.1% (9) 17.9% (10) 1.8% (1) 14.3% (8) 5.4% (3) 7.1% (4) 8.9% (5) 1.8% (1) 1.8% (1)

a Based on the selection for the primary disability category; five other participants who specified a disability under “Other” were recoded into other categories and are reflected as such here.

before adulthood, and about three-quarters of the sample entered graduate school with a disability. An additional 14.3% of respon­ dents (n = 8) acquired or were diagnosed with their disability during a masters or doctoral program. More information on pri­ mary disability diagnosis can be seen in Table 3. Education and training. Over two thirds of participants (67.8%) had already completed a doctoral degree; 27 (48.2% of the total sample) identified themselves as licensed psychologists. An­ other 31.2% of participants were current doctoral students; 14 of the 18 (25.0% of the total sample) were preinternship doctoral internship students. Most participants reported they had earned or were in the process of earning a PhD (67.9%; n = 38) or PsyD (28.6%; n = 16). More than half of participants (60.7%; n = 34) indicated that their doctorate is or would be in clinical psychology, and about a quarter received training in counseling psychology (23.2%; n = 13). Additional information on training characteris­ tics is available in Table 3. Those who held doctorates reported that they were awarded between 1975 and 2012, and most who did not yet hold a doctorate anticipated that they would earn one within the next 1 to 3 years. Of the 38 participants who held a doctorate, the mean time since graduation was 11.66 years {SD = 10.43); 81.6% (n = 31) earned their degree after 1990 and 63.2% (n = 24) did so after 2000. More than a quarter (28.9%; n = 11) had earned their degree within the past 3 years. Research and clinical specialties. Respondents identified a broad range of clinical and research specialties and interests, including child psychology, trauma, college counseling, adult psy­ chology, addiction, multicultural psychology, rehabilitation psy­ chology, and health psychology. Twenty-eight (50%) participants’ responses specifically mentioned rehabilitation, disability, or neu­ ropsychology. An additional (nonoverlapping) nine (16.1%) re­ sponses specified health psychology. R esults Influence o f D isability on Training Of the 41 participants who indicated that they had acquired their disability before graduate school, 39 answered a question regard­ ing whether or not then disability in any way influenced their choice of graduate school. Of these, about half (43.9%; n = 18) indicated that their choice of graduate school was influenced by their disability. Seventeen of the 39 participants provided addi­ tional qualitative information on how their disability impacted choice of program. Several participants indicated that issues such as winter weather, size of the campus, or availability of accessible parking or transportation were factors in their graduate school decision; others mentioned campuses and programs that had a reputation for supporting students with disabilities, programs that they had personal experience with, or programs that seemed more welcoming toward students with disabilities during the interview process. Others reported that their personal experiences with dis­ abilities impacted their research and clinical interests, which in turn influenced their program choice. One participant reported that access to disability-specific medical specialists affected his or her program choice. Another question was whether participants’ disabilities had in­ fluenced their choice of specialization or area of research focus.

PSYCHOLOGY TRAINEES WITH DISABILITIES

Table 3 Sample Disability Acquisition, Training, and Education Characteristics Percent (n) of total sample (n = 56) Primary disability acquisition (n = 55) Congenital or at birth As a child (under 12) As an adolescent As an adult (before graduate school) During graduate school During postdoctoral training After postdoctoral training Current stage of professional training Preintemship doctoral student Predoctoral intern Doctoral student—all but dissertation Postdoctoral trainee In a position that does not require licensure Licensed psychologist Doctoral degree held or earning PhD PsyD EdD Type of doctoral program Clinical psychology Counseling psychology School psychology Rehabilitation psychology Combined (e.g., clinical, counseling, or school)

30.4% 25.0% 5.4% 10.7% 14.3% 1.8% 10.7%

(17) (14) (3) (6) (8) (1) (6)

25.0% 5.4% 1.8% 10.7% 8.9% 48.2%

(14) (3) (1) (6) (5) (27)

67.9% (38) 28.6% (16) 3.6% (2) 60.7% 23.2% 3.6% 1.8% 10.7%

(34) (13) (2) (1) (6)

Half (n = 28) indicated that their disability did indeed influence their choices whereas 33.9% (n = 19) indicated that it did not. An additional nine participants (16.1%) indicated that they were not sure if their disability influenced their choice of specialization or that the question did not apply to them.

Disclosure, Mentorship, and Resources Disclosure. Participants were asked to indicate to whom and at what stages of their training they disclosed disability. Six participants (10.7%) did not endorse any items, perhaps as an indication that they did not disclose their disability to anyone. In general, participants were more likely to disclose their disability outside of the application process; of those who acquired their disability during or before graduate school, 77.6% reported that they disclosed their disability to program faculty, and 53.6% disclosed their disability to practicum supervisors. In contrast, 34.7% reported that they disclosed their disability during the graduate school application process and 26.5% disclosed during graduate school interviews. Similar, although less pronounced, differences were noted for application and postapplication disclo­ sure in the internship and postdoctoral application processes. Only about 45% of participants reported that they disclosed their dis­ ability to a university disability services office. The percent of respondents who endorsed each item can be seen in Table 4. Mentorship. More than a quarter of participants (28.6%; n = 16) reported that they received mentorship from faculty or profes­ sionals with disabilities during their training. When asked about their mentors, participants most often mentioned faculty or super­ visors with disabilities, although one respondent mentioned being

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matched to a mentor with a disability through the APA Disability Issues Office disability mentor match program. One participant who acquired his or her disability after completing graduate train­ ing reported that he or she had a mentor with a disability during training who provided a “great model” that proved helpful to the participant after his or her later acquisition of a disability. Al­ though most participants appeared to regard having a mentor with disability in a positive light, two participants reported less satis­ fying experiences. In one of these cases, the participant reported that because their disabilities differed substantially in severity, he or she did not find the professor’s experience to be analogous to his or her own, and therefore did not consider the experience to be helpful. Accommodations and resources. Participants were asked about the type of accommodations, if any, they received or re­ quested during preintemship graduate training. Formal accommo­ dations were defined in the survey as “accommodations made through a disability services office or other official channels, such as extended times for tests, alternate format books, readers, or sign language interpreters.” Informal accommodations were defined as “accommodations made through an informal agreement with a faculty member or supervisor.” Of the 49 participants who indi­ cated that they acquired their primary disability during or before graduate school (i.e., not during or after postdoctoral training), 11 (22.4%) reported that they received only formal accommodations, 14 (28.6%) reported that they received only informal accommo­ dations, and 10 (20.4%) reported that they received both formal and informal accommodations. Thus, less than half of respondents (42.8%; n = 21) received any formal accommodations during their preintemship training. Fourteen (28.6%) reported that they re­ ceived no accommodations, indicating that they did not request them or that their requests for accommodations were denied.

Table 4 Disability Disclosure by Training Stage Stage of training (n) Graduate school application process (n = 49)a,b Preinterview During interviews Graduate school (n = 49)a Disability services office Program faculty Practicum supervisor Internship (n = 35) Application (preinterview) Application (during interview) Internship supervisors (after matching) Postdoctoral application (n = 31) Preinterview During interviews Postdoctoral training (n = 32) Postdoctoral supervisors All stages of training (n = 56) Fellow students or colleagues

Percent disclosing (n) 34.7% (17) 26.5% (13) 44.9% (22) 77.6% (38) 63.3% (31) 45.7% (14) 60% (21) 74.3% (26) 22.6% (7) 32.3% (10) 53.1% (17) 60.7% (37)

a One participant who did not indicate when his or her disability was acquired was included in the calculations. b Includes eight individuals who reported acquiring their disability during graduate school, as they may have acquired or been diagnosed with a disability during a masters program and may have had a disability during the doctoral admissions process.

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Participants were also asked what disability-related resources they found helpful during their training, and what disability-related resources that they believed would have been helpful (if they had already completed training) or would like to have access to (if still in training). Participants commonly reported that assistive technol­ ogy and mentorship or camaraderie with students or professionals with similar disabilities were helpful resources. Accommodations, improved assistive technology, and mentorship from professionals with disabilities were commonly cited as desired resources. A few participants who had already completed their training noted a perception that the availability and awareness of disability-related resources had improved since their graduate training and that these resources likely would have been helpful to them when they were undergoing their training.

Discrimination and Support Participants were asked to rate how supportive they found their faculty and supervisors in general with regard to disability-related issues. A 5-point Likert-type scale with the anchors of 1 = not all supportive and 5 = extremely supportive was used. For the 55 participants who answered the question, the mean score was 3.04 with an SD of 1.25. Responses were fairly evenly divided among the bottom two ratings (34.5%), the middle rating (29.1%), and the top two ratings (35.7%). Participants were also asked to indicate whether or not they had experienced any type of perceived disability-related barriers or discrimination (structural, attitudinal, systemic, etc.) during grad­ uate school and postdoctoral training or the related application processes. The four phases and the total sample size for each phase are as follows: (a) preintemship graduate training or the graduate school application process (n = 49); (b) internship or the intern­ ship application process (n = 46), (c) postdoctoral training or the postdoc application process (n = 38), or (d) the licensure process (n = 33). The highest level (67.3%; n = 33) of reported discrim­ ination and disability-related barriers occurred during graduate school and the graduate school application process, and the lowest level (36.3%; n = 12) occurred during the licensure process. A little less than half of respondents reported that they experi­ enced disability-related barriers or discrimination during the internship (43.4%; n = 20) and postdoctoral phases of training (47.4%; n = 18).

Discussion The present article reports the results of a survey of 56 psychol­ ogy graduate students and professionals with disabilities. The sample was majority White females who held or were pursuing PhDs in clinical or counseling psychology. Approximately twothirds of the sample already held a doctorate, and the remaining participants were current doctoral students. The sample was di­ verse in terms of disability; approximately one third of respondents endorsed multiple disability categories. Most of the participants reported that they acquired or were diagnosed with their primary disability before beginning graduate school. Overall, participants reported that their disability had consider­ able impact on their training, in both positive and negative ways. About half indicated that their disability played a role in their choice of specialty; likewise, about half reported that their disabil­

ity influenced their choice of graduate program. Only approxi­ mately one third of participants reported that they connected with a mentor with a disability, but those who did usually considered it to be a positive and helpful experience; some who did not have a mentor with a disability reported that they would have found it helpful. Less than half of survey respondents disclosed their dis­ abilities to a university disability services office or received formal accommodations for their disability during graduate school. With regard to perceived disability-related barriers, approximately twothirds reported that they faced disability-related barriers or dis­ crimination during graduate school or the graduate school appli­ cation process, slightly less than half reported that they experienced such discrimination during internship, postdoctoral training, or the associated application processes, and slightly less than one third reported that they experienced barriers or discrim­ ination during the licensure phase.

Comparison to APPIC Data Table 1 compares the disability data from our sample to the 2010-2011 APPIC data on self-reported disability (APPIC, 201 la). Overall, our sample appears to have a higher proportion of respondents with physical or orthopedic disabilities, blindness or visual impairment, and deaf or hearing impairment, and a lower proportion of respondents with chronic illness and learning dis­ abilities than the APPIC sample. There are several possible expla­ nations for this. One is that the survey used in this study may have reached more people with these particular disabilities because one of the distribution channels was a rehabilitation psychology listserv; similarly, some individuals with chronic health conditions may not identify themselves using the term disability and believed the survey did not apply to them. Another possibility is that graduate students with physical or sensory disabilities are more likely to experience insurmountable barriers or discrimination and leave graduate school before the internship application process. These students, therefore, would not be reflected in the APPIC survey data but could have been captured in our survey, because of our inclusion of preinternship graduate students.

Implications for Training Programs The results of the present study suggest that students with disabilities frequently experience barriers and perceive discrim­ ination in psychology training programs. Data suggest that students may be reluctant to disclose disability, especially dur­ ing the application phase, possibly because of fear of discrim­ ination. This is problematic for programs that wish to include disability in their broader definition of diversity and suggests that disability may have been communicated to applicants as something to hide, rather than something to highlight. Fear of negative repercussions after disclosure may make it difficult for applicants to inquire about and ascertain the degree to which programs are “disability friendly” or have historically worked successfully with students with disabilities. Although psychol­ ogists are often trained to work with individuals with disabili­ ties as clients or patients, they may be less inclined to think of people with disabilities as potential students and colleagues (Andrews et al., 2013). This mindset is problematic for both trainees and professionals and may lead to devaluation or

PSYCHOLOGY TRAINEES WITH DISABILITIES

discrimination against the trainee (Andrews et al., 2013). In­ creased presence of academic faculty and clinical supervisors with disabilities may help to dispel these attitudes and foster an atmosphere that allows trainees and psychologists to be more open about their own disabilities. In addition, disability should receive more attention as an aspect of diversity within the professional psychology commu­ nity. Currently, discussion of disability in psychology largely occurs in the context of disability as a client characteristic and often omits the experiences of professionals with disabilities. The discrepancy between the number of participants who re­ ported that they had mentors with disabilities and those who said that they wanted to have a mentor with a disability suggests that trainees with disabilities are often interested in connecting with other professionals with disabilities, but are either unable or unaware of how to do so. Informal networking groups, such as the Psychologists with Disabilities Special Interest Group of Division 22, provide one mean through which professionals with disabilities can connect. This model of a disability-focused SIG could potentially be replicated by other divisions to allow trainees to connect with other professionals with disabilities in their areas of interest. Similarly, it is important that the needs and experiences of professional psychology trainees with disabilities be recognized across all areas of professional psychology, including those that may not have a traditional focus on disability. Given their professional expertise in disability, Division 22 and CDIP members could help pilot strategies and policies to support trainees with disabilities, such as mentoring programs or out­ reach strategies. Effective approaches could then be introduced to other divisions to help promote a more consistent and wel­ coming network for professionals with disabilities. Likewise, cross-division efforts could lead to more comprehensive re­ search that provide a larger and more representative picture of disability within the broad scope of professional psychology. Finally, the involvement of trainees and faculty with disabilities on accreditation and training-related councils and committees could help bring additional light to the barriers faced by this group of trainees and potential strategies by which they could by ameliorated. In the present study, over half of respondents who acquired their disability during or before graduate school elected not to disclose their disability to a university disability services office, and less than half reported that they received formal accommo­ dations through either clinical training sites or their university. One potential explanation for this finding is that many students may be unaware that they qualify for or are able to receive services through a university disability services office or at a clinical placement site under the ADA. Alternatively, as dis­ cussed above, trainees may fear that formal disclosure to a university or employer could give an unfavorable impression or lead to discrimination or stigmatization (Maggio, 2007). Addi­ tionally, disability services offices, although well-trained in handling academic accommodations, may be less knowledge­ able about how to address accommodations for clinical training (e.g., psychological test administration), and students may be able to obtain more relevant, specific guidance by working directly with faculty or supervisors, without necessitating in­ volvement with the disability services office. Regardless, these

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results suggest that programs cannot and should not simply expect disability services offices to handle all disability-related issues or assume that all students with disabilities will be aware of or involved with university disability services offices. Given the current internship imbalance, it is vital that direc­ tors of clinical training and other program faculty understand how disability may impact the internship application process. For example, applicants who have mobility impairments may have to weigh the pros and cons of limiting themselves to more accessible climates versus reducing their chances of matching, and applicants who have limited stamina as a result of their disabilities may need to specifically select sites with greater flexibility or more concrete work hour maximums. Faculty should also be able to advise students with disabilities on their legal rights regarding disclosure during internship interviews and work with students on if or how to address disability issues during internship interviews. Finally, if students believe that they are unable to complete a full-time, APA-accredited intern­ ship because of their disability, faculty must be willing to have a frank discussion about the professional consequences of not having completed an APA-accredited internship, such as lim­ ited opportunities for professional board certification and inel­ igibility for employment at the Department of Veterans Affairs medical centers and other sites. Faculty could also work with students to select accredited sites that may provide greater flexibility and work with the student on how to request reason­ able accommodations after matching. Another point of interest is the fact that discrimination and barriers were more frequently reported during graduate school and the graduate school application process than in subsequent phases of training (i.e., internship, postdoctoral training, and licensure). It could be that the combination of intense academic, research, teaching, and/or clinical work during graduate school is more likely to create barriers than other, more focused training settings. For example, a student with a learning dis­ ability may require extended time for test-taking for academic courses but may not need any accommodations during intern­ ship and postdoctoral work. Similarly, a student with a chronic health condition may have more schedule flexibility during postdoctoral training than he or she did during graduate school, thus decreasing the likelihood of experiencing work-related barriers due flare-ups of his or her condition. A student may learn to how to address disability-related changes with clinical work during graduate school and thus not perceive them to present a barrier during later training. Another less optimistic interpretation is that students with disabilities may be more likely to drop out of graduate school because of disabilityrelated barriers. As a result, they may no longer be in the field to experience barriers associated with later stages of training. Therefore, data from the APPIC survey may represent only a subset of graduate students with disabilities.

Limitations and Future Research This study has some limitations that should be considered when discussing its findings. First of all, the sample size is relatively small, which makes it difficult to conduct additional analyses that could yield valuable information, such as com­ parisons of people with different types of disabilities. Because

LUND, ANDREWS, AND HOLT

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of the lack of national data on the prevalence of disability among psychology graduate students and psychologists, it is difficult to ascertain how well our sample compares with the appropriate population to which to generalize. Comparisons to the APPIC (2011a) data suggest that our sample may overrep­ resent people with physical and sensory disabilities and under­ represent those with learning disabilities and chronic health conditions, but differences in the context in which the data was collected likely account for some of these differences. Simi­ larly, self-reports of specialization and areas of research interest revealed a strong interest in rehabilitation psychology, neuro­ psychology, and health psychology among those with disabili­ ties. How much of this can be considered a bias in our sample and how much of it may be attributed to the draw of disabilityrelated work for psychologists and psychology graduate stu­ dents with disabilities is not clear. Thus, more research is needed to confirm or contrast our findings. Another limitation of the study is the relative homogeneity of participants; a very large majority of participants were White. Thus, the results likely do not capture the experiences of psychology trainees with disabilities who are also of diverse racial and ethnic identities. Research has suggested that those who belong to multiple marginalized groups may potentially experience new sources and forms of oppression (e.g., Lightfoot & Williams, 2009). A larger or more targeted study may be able to better recruit diverse participants and reflect their ex­ periences. It will be important for future researchers to examine the intersection of disability and other marginalized identities (e.g., diverse sexual orientations and gender identities) in psy­ chology trainees.

Conclusions The present study, despite its limitations, provides valuable information on the characteristics and experiences of graduate students with disabilities. More important, it highlights the issue of discrimination and barriers faced by trainees with disabilities and provides a call to action to address these issues. Research needs to be conducted to better understand this pop­ ulation and their experiences as psychology trainees and psy­ chologists with disabilities.

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Received December 4, 2013 Revision received June 5, 2014 Accepted June 16, 2014 ■

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How we treat our own: the experiences and characteristics of psychology trainees with disabilities.

To better understand the characteristics and experiences of psychologists and trainees with disabilities...
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