Understanding the stages of acceptance
Author of the seminal work on the grieving process, On Death and Dying (McMillan Press, 1969), Elisabeth Kubler-Ross, identified stages of mourning
related to the loss of a loved one. These stages can be applied to other
kinds of losses as well, such as the loss of the "perfect self" and the
acceptance of a learning disability. Understanding learning difficulties
means working towards acceptance of these problems. By understanding one's
limitations, an individual can discover how to compensate, achieve and
celebrate his or her unique learning style. If someone can not accept
that he has these difficulties, then he may be in denial. This can result
in self-loathing and a tendency to compare oneself to others. If the person
is struggling with learning and sees that others approach these same tasks
with ease, he is going to have a negative self-concept. He may begin to
think that he is "stupid," which may lead to low self-esteem, failure
to try and further feelings of failure. A negative spiral of despair may
result. However, if someone is taught to understand that although his
learning-style difference may require more effort, this difference is
what makes him a unique individual, then he can learn to value himself
as a worthwhile individual. This is what we refer to as "self-acceptance."
Dealing with denial
As adults, especially as previously undiagnosed adults with learning disabilities,
a very common response to the problem is to deny that it is happening.
An individual may hide these difficulties from others because he feels
that having a learning disability is something that is shameful and "bad."
It can be too painful to admit that "I have more trouble learning than
others." He learns to blame others, such as teachers or bosses who are
unreasonable, or he may say that people do not explain things clearly.
If this happens over and over again, it becomes more and more difficult
to explain it away as someone else's problem. Consequently, he learns
to deny his difficulties. He may spend great amounts of effort hiding
his disability so that no one will see his problems and he does not have
to face them. This effort can be very draining, since it utilizes a great
deal of energy.
After the shock comes relief
When an individual reaches the point when he has to admit to himself that
there is a problem, this can be a shock to the system, at least initially.
He can no longer pretend that there is nothing wrong. It's similar to
someone not wanting to admit that the person he loved has died. The recognition
of a learning disability is admitting that the perfect person he hoped
to be does not exist. As adults, we relinquish our wish for a perfect
self. As adults with learning disabilities, this can be an arduous task,
but when the shock wears off, in it's place can come a feeling of great
relief. It can be a heavy burden for an individual to sense that something
is wrong throughout his life -- to have that nagging fear that he is stupid.
Addressing the anger
Once the shock wears off, the individual with learning disabilities may
find that he is angry. He may think about times that he did not receive
the help he badly needed. He may think of people who might have helped,
but for whatever reason, did not. He may feel "robbed" of the support
that he might have had if others had recognized his problems earlier.
An individual may feel enraged because others have misinterpreted his
difficulties as laziness or emotional problems. When it is determined
that there is a real neurological reason for the difficulties, he may,
for the first time, feel entitled to his anger. There also can be self-directed
anger because he did not acknowledge his learning problems sooner. There
can be rage directed towards whatever or whomever he thinks may be responsible
for the learning disabilities in the first place - a feeling of "Why me?"
Just as it is critical to address feelings of denial
so that the process or mourning can begin, it also is important to address
the anger so that it does not become a crippling force. If an individual
with a learning disability becomes enmeshed with blaming or self-pity,
he robs himself of the possibility of moving forward. Once the rage is
addressed, he is often left with a feeling of profound sadness.
Feeling the sadness
When an adult with learning problems has worked through the anger, he
can begin to address the sense of loss. It is a difficult loss to realize
the loss of the idealized self -- the self that was supposed to be. We
all have dreams and images of ourselves as we develop emotionally and
cognitively that can help, in a constructive manner, to drive us toward
various goals. Having to give up certain images of the self and dreams
that we have had in order to bring them more in line with reality is something
that everyone faces as they become adults. An adult with a learning disability
often will be faced with limitations that others may not experience.
I see one young man in psychotherapy who has spent
many hours coming to terms with the loss of certain dreams. He had been
depressed for a long time, in part because he felt like a failure. He
had decided that, if he could not reach those dreams, then he and his
life were nothing. Through therapy, he is beginning to see that, as he
gives up some of his hard-held dreams, he has new dreams to pursue. These
new dreams may not be as grand as his previous dreams, but they are worthwhile
nonetheless. Often, there can be great regret at the opportunities that
were missed or the path that cannot be pursued. With the mourning of these
losses, certain paths may indeed be closed. At the same time, it is possible
to become aware of the many roads that are still available.
Gaining self-confidence through acceptance
As an individual with learning disabilities has progresses through this
mourning process, he is more likely to have a balanced and integrated
view of himself. Emotional energy is no longer as connected to denial,
anger and sadness. The individual has more resources available to pursue
realistic and valuable goals. Acceptance also has an important impact
upon self-esteem. An individual's self-concept will improve when he is
able to look at all parts of himself and feel that he is "O.K." He is
not as prone to feelings of low self-esteem or depression, if he is able
to assess himself accurately.
If an individual has not accepted an accurate image
of his strengths and weaknesses, then it is likely that he continually
will have the feeling that he has failed or live in fear that others might
discover the truth about his "incompetence." When he accepts his particular
combination of personal strengths and weaknesses, then he is able to accept
failure as just an instance where "I was unable to do something the way
I wished," rather than "Look, this proves that I am a failure." He can
gain self-confidence since he doesn't have to hide what he can't do and
be proud of what he can do.
Getting what you need by knowing what you
have
In order to have an accurate and balanced view of an individual's cognitive
strengths and weaknesses, it is often helpful to seek a psychoeducational
or neuropsychological evaluation. By doing so, an individual can get a
better understanding of his learning style, such as why learning about
math comes so easily and reading is such a chore. Clinicians can assemble
a cognitive picture of his strengths and weaknesses. They also can teach
strategies -- "tricks" -- to help the adult learn to compensate for his
weaknesses in learning. Having a "picture" that makes sense helps that
person feel better about himself. Consequently, he is in a better position
to acquire the skills he needs to be successful in a particular field
of endeavor. He also is less likely to label himself as dumb or stupid.
When I work with an individual with learning disabilities
in psychotherapy, we establish two important goals:
to learn about his strengths and weaknesses and
to become an advocate for himself.
When
an individual does not have a sense of what he might need in school and/or
in the workplace, he can flounder, and it is less likely that he will
get what he needs to succeed. When he can go to school or work and have
a good sense of what it takes to be successful, he is more likely to do
so. Prior to understanding what the learning problems are, an individual
with learning disabilities can head in many different directions, wasting
valuable time and effort. When he learns what the problems are and what
can be done, then he has a "compass" to guide him and give him a clearer
sense of direction.
Seeking appropriate emotional help
Individual counseling or psychotherapy can be very helpful in addressing
issues of self-esteem, depression, anxiety and goals clarification, among
others. Since many individuals with learning disabilities also struggle
with depression and/or anxiety at some time, it can be quite helpful to
seek a consultation with a mental health professional.
Tim, a 30-year-old man, came into therapy following
an incident with the law. He had average intelligence, could not read
or write, was anxious a lot of the time (and drank to cope with his anxiety)
and had extremely low self-esteem. After he came in for therapy, we realized
that, among other problems, he had previously undetected learning disabilities.
Through the combination of an educational evaluation, tutoring and psychotherapy,
he was able to understand his learning difficulties, realize how they
had affected his life and to feel better about himself. He was able to
increase his reading level, become more confident and he eventually reached
a position of some responsibility in his union.
In the above example, Tim's undetected learning problems
resulted in secondary emotional difficulties that were addressed through
psychotherapy. Learning disabilities themselves, unless they are learning
problems that are secondary to emotional difficulties, are not usually
the direct focus of counseling or psychotherapy. Sometimes feeling depressed
or anxious can be the result of struggling with learning disabilities.
In a number of publications, depression and anxiety are referred to as
"comorbid disorders." This means that anxiety and depression can coexist
along with learning disabilities. It is not necessary to sort out which
led to which. It is more important to get help for each area involved.
Finding support groups and group therapy
There are various support groups available for adults with learning disabilities.
Some of these support groups focus upon the following:
learning disabilities and work;
learning disabilities and school; and
learning disabilities and self-esteem.
Support groups allow people with similar problems to
come together periodically to give each other mutual support and share resources.
Groups can be very helpful because they provide an opportunity for people
to be with others who have similar types of experiences. In this way, group
"members" do not feel as alone or ashamed of their challenges. They can
receive affirmation of their feelings and realize that what they are feeling
is "normal." Support groups also offer a sense of hope for those involved.
Individuals can learn from others who have been able to face and cope with
various challenges. The group can offer a safe haven to draw strength from
and to address whatever issues present themselves. Most importantly, individuals
can learn to become assertive and effective advocates for themselves.
There may be more than one support group related to
an individual's needs. Be selective in choosing a group. Each support
group will develop its own "character" that reflects a unique mixture
of individuals. One group may not be a good match, while another may "feel"
just right. Look for a group where there are other individuals with similar
issues. Listen to discussions over two to three meetings to see if you
identify with what is being discussed. If not, it might mean that you
should find a group that is more compatible with your needs.
There are different types of support groups. Some
support groups are self-help groups. This means that the group is run
by and for people with learning disabilities. There is no designated professional
leader in these groups. An individual who joins the group shares his or
her experiences with others and talks about what has and has not been
effective.
Some self-help groups have been very successful without
a professional leader (AA support groups, for example). There are also
times within any group when very strong emotional reactions arise and/or
complicated dynamics within the group may occur and may make it difficult
for group members to manage on their own. A professionally led support
group can offer more containment and safety under these circumstances.
These groups differ from the self-help groups in that a professional leads
the discussion. They function in a manner similar to the self-help group.
Various topics are covered, resources are shared and support is available
among group members. Your local learning disabilities association should
be aware of the various support groups in your area.
Considering psychotherapy groups
Psychotherapy groups are helpful when an individual wants to work on problems
that often accompany learning disabilities, especially those that stem
from difficulty in interpersonal relationships. A psychotherapy group
is one led by a professional. The purpose of the group is to alleviate
certain problems (such as anxiety or depression) or to help compensate
for a deficit (such as a social skills deficit).
An individual with learning disabilities also may
experience significant difficulties in navigating the social world. He
or she may have difficulty with their co-workers, bosses or people in
close personal relationships. There is no known cause for these social
difficulties. Some have problems reading social cues. Others may be able
to read the cues, but may have more difficulty executing the appropriate
response. Whatever the problem in social functioning, group psychotherapy
can offer help. In the context of a safe, accepting atmosphere, people
with similar problems can practice new, more effective ways of relating.
They are then in a better position to try out these new ways in their
larger, social world.
Having a learning disability can be a tough challenge,
but it is made easier when an individual is able to share his difficulties
and successes with others. These groups provide strength and allow the
individual to develop the inner resources to fall back upon when times
are hard.
Having a learning disability can be a tough challenge,
but it is made easier when an individual is able to share his difficulties
and successes with others. These groups provide strength and allow the
individual to develop the inner resources to fall back upon when times
are hard.
Finding a therapist
When seeking a therapist, it is important to find someone with whom you
feel comfortable, and who is equipped to understand your important thoughts
and feelings. At first, you may feel uncomfortable and quite anxious.
This is to be expected. You should feel that the therapist shows empathy
for your difficulties and is competent. Seek a therapist who has particular
expertise in helping people who have learning disabilities. This expertise
makes it more likely that the therapist will have an understanding with
what an adult with learning disabilities has to cope. Your local learning
disabilities association will most likely have a list of licensed professionals
in your area who help adults with learning disabilities.
Remember that you are not only a potential client,
but a consumer as well. Feel free to ask the therapist questions about
his or her credentials and experience. A good therapist should be open
to answering these questions. Be cautious of therapists who come across
as overly defensive or impatient with these kinds of inquiries.
The therapist will most likely want to know your background.
This will include your learning and medical history, as well as family
background and relationship history. Following the initial evaluation
(which can take from one to three sessions), you and your therapist will
formulate a "treatment plan." Ideally, you would formulate goals for therapy
upon which both you and your therapist agree. These goals should be clear
and make sense. It is difficult to say exactly how long a given therapy
will take, but your therapist should be able to give you an idea about
whether therapy will be short or longer term. It will be helpful to "check
in" with your therapist periodically to talk about how you are progressing
toward your specified goals.
Stephen Rothenberg, Psy.D. is a licensed psychologist
practicing in Framingham, Massachusetts. He is also the founder and president
of Good Connections,
a friendship and dating service for individuals with special needs.
