Stephen Rothenberg, Psy.D.

Excerpted from Successful Lifetime Management: Adults with Learning Disabilities.
 

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:

1. to learn about his strengths and weaknesses and

2. 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.