By Ella Anderson, Psy.D., Maria J. Palmeri, Ph.D., and Robert M. Gordon, Psy.D.
As our healthcare system continues to evolve with growing inequities, the roles of advocacy and social justice have become critical healing forces. During this time of uncertainty, psychologists are confronted with the moral distress of witnessing or participating in changes in healthcare that are inconsistent with their core values of compassion, respect for the inherent dignity of others, and cultural humility (Rushton, 2018a).
The field of rehabilitation psychology often turns to what are known as the “six foundational principles” (Dunn et al.,2016), based on Beatrice Wright’s (1983) value-laden beliefs, to seek guidance in understanding how current psychological, social, environmental, and political forces influence individuals with disabilities or chronic health conditions.
Briefly, the six foundational principles are:
- The Person-Environment Relation: Behavior is not solely determined by individual characteristics, but by the interaction between the person and environment (e.g., not viewing someone as being socially-avoidant when their absence is due to lack of access to the building).
- The Insider-Outsider Distinction: Individuals with disabilities or chronic health conditions have unique lived experiences with challenging though manageable tasks. Outsiders typically attribute the behavior of people with disabilities to individual/personal characteristics rather than to the effects of the environment (Dunn et al., 2016) and view the person’s disability or illness as the core aspect of their identity affecting all aspects of their life and being (Dunn et al., 2016).
- Adjustment to Disability: Coping/adjustment to disability or chronic illness is an ongoing, dynamic process that leads to acceptance.
- Psychological Assets: Each individual living with a disability or chronic health condition possesses—or is capable of developing—strengths that focus on accomplishments and future possibilities.
- Self-Perception of Bodily States: Self-perceptions (e.g., pain, fatigue) have a significant impact on shaping thoughts, emotions, and behaviors.
- Human Dignity: Regardless of the severity of a disability or chronic health condition, all individuals deserve respect for their common humanity and uniqueness and to be treated with dignity as whole persons (Andrews et al., 2023).
Social Justice and Advocacy
The field of psychology often discusses social justice and advocacy, but rarely are these concepts and their clinical and practical applicability defined. Erin Andrews and colleagues (2023) proposed the concept of advocacy as “the seventh principle,” the goal of which is enhancing the health and well-being of individuals with disabilities.
Andrews et al. (2023) encourage a collaborative effort with the disability community, emphasizing the importance of listening to/understanding lived experience to prevent well-intended advocacy by allies from having a negative impact (e.g., insider-outsider distinction). Historically, the psychology field has faced valid criticism for emphasizing the individual’s adjustment to social, economic, and political issues rather than broader systemic and structural barriers and challenges (Andrews et al., 2023).
Social justice (as outlined by Goodman et al., 2004) is “the scholarship and professional action designed to change societal values, structures, policies, and practices, such that disadvantaged or marginalized groups gain access to… tools of self-determination” (p. 795).
Types of Advocacy
There are different types of advocacy, including individual, researcher-policymaker, institutional, and discipline and specialty level (Andrews et al., 2023). Below, we provide a brief overview of these concepts, strategies for psychologists to advocate on behalf of their clients, and tips for clients themselves.
- Individual advocacy: Involves understanding how fatigue, pain, stigma, and discrimination can impact one’s self-concept, overall mood, and trust of medical institutions. Here, clinicians embrace the core value of treating individuals with disabilities and chronic health conditions with dignity and respect, as unique individuals with specific strengths, coping strategies, and resilience (i.e., psychological assets), including the capacity to accept their disability as one part of their identity (i.e., adjustment to disability).
- Researcher-policymaker advocacy: Psychologists are encouraged to cultivate researcher-policy partnerships to address ethical issues experienced by individuals with disabilities or chronic health conditions through legislative outreach.
- Institutional advocacy: Holding organizations accountable to include disability diversity in their policies and practices. Specifically, it involves actively recruiting individuals with disabilities and chronic health conditions, reviewing and updating policies to reflect social justice values, and integrating diversity topics into educational and professional settings.
- Discipline and specialty level advocacy: Establishing comprehensive standards for education and training that prioritize social justice, respect, dignity, and equality by promoting cross-disability leadership (e.g., voices from various disability communities) and shifting from a focus on individual independence to collective communities.
What Do Advocacy and Social Justice Look Like in Practice?
For psychologists:
- Strive for integrity on a daily basis where one’s words, thoughts, and actions align with one’s core purpose and moral compass (Rushton, 2018b).
- Ask “are my actions in tune with the person I want to be?” (Rushton, 2018b).
- Integrate social justice and advocacy principles, including the six Foundational principles, into education for both peers and trainees (e.g., didactics, continuing education courses, Grand Rounds) to encourage critical thinking about how social justice and advocacy are being implemented within your institution.
- Collaborate with clients, healthcare providers, policy makers, and advocacy groups to understand the most pressing issues related to policy development.
For clients:
- Let others know what kind of response you need from them (e.g., just listening, support, reassurance, mutual problem-solving).
- Equip yourself with knowledge about your rights within the healthcare system, including accommodations you are entitled to under the law and how these can improve your healthcare experience.
- Create a network of healthcare advocates, which can include family members, friends, or providers, to help you navigate the complex healthcare system.
- Contact local legislative bodies in your area and ask how they advocate for members of the disability community and their plan to strive toward social justice and equitable access to resources.
Resilience Essential Reads
Navigating Uncertainty
“At this time in history, issues related to diversity, equity, and inclusion are simultaneously emphasized by professional organizations and attacked in the broader society” (Kratz and Perrin, co-editors of Rehabilitation Psychology). Psychologists advocating alongside clients and promoting social justice, self-determination, self-respect, and human dignity through small daily acts can help counter feelings of powerlessness and moral distress and can provide hope and renewed passion for future clinical work.
About the authors: Ella Anderson is currently a Postdoctoral Psychology Fellow in Clinical Rehabilitation Research and Traumatic Brain Injury (TBI) through the Advanced Rehabilitation Research Training Program. Maria J. Palmeri is currently a Postdoctoral Psychology Fellow in Clinical Rehabilitation Research and TBI through the Advanced Rehabilitation Research Training Program. Robert M. Gordon is a Clinical Associate Professor at NYU Grossman School of Medicine and a member of the Medicine and Addictions workgroup (established by 14 divisions of the American Psychological Association).
