Quality of life is considered to be a vague, subjective, multidimensional concept that incorporates all life dimensions and experiences. The Centers for Disease Control and Prevention (CDC) defines quality of life as "a person or group’s perceived physical and mental health over time" (CDC, 2010; para 1). This chapter explores the concept of quality of life, the impact of disability at various life stages, and the impact of various types of disabilities on quality of life. The quality of life is a difficult construct to measure because it is impacted by numerous objective and subjective variables and individual preferences. For people with disabilities, additional factors related to their health conditions may challenge attaining optimum quality of life. In addition, developmental progression may both have an effect on, and be affected by, disability because roles, responsibilities, goals, and outlooks are affected by life stage.

This chapter discusses the impact of disability on a family by examining the reactions of family members to disability, factors that influence adjustment to disability in the family, adjustment models, parenting reaction perspectives, effective family coping, the impact of disability based on the family role of the person with a disability, and the cultural influence on family adaptation to disability. Understanding the role of the family and how it functions to enhance or to detract from the lives of people with disability is imperative because this basic social unit can provide a lifetime of love, support, encouragement, and care. It is important to assess family needs and support services so that the family does not become overwhelmed or feel isolated in their endeavors to assist their loved one and to integrate into the larger community.

Sexuality and disability is a topic that has been neglected for a long time by professionals. This chapter focuses on (a) sexuality and related components; (b) disability and intimate relationships; (c) disability type and related sexual issues; (d) sexual orientation, sexual functioning, procreation, and parenting; (e) sex education, sex therapy, and sexual surrogates; and (f) sexual abuse. Issues related to sex and sexuality for people with disabilities (PWDs) incorporate some important topics that can affect how PWDs view themselves and live their lives. This chapter discussed the social construction of gender identity and body image and the role that social construction plays in the sexual stigmatization and abuse of PWDs. Societal attitudes additionally play a role in self-esteem and body image for PWDs and affect their intimate partnering choices.

The topic of ethics is vast and impossible to cover comprehensively in any single work. This chapter presents some of the relevant and controversial topics in this arena. It focuses on common ethical dilemmas, factors that influence counselor ethics, counselor competence, and current and debated ethical issues. Some ethical dilemmas seem inherent in the counseling process and are as likely to be encountered in the present day as they were in earlier generations. Others occur due to societal advancements and trends, new technologies, or catastrophic events or diseases that lead to increases in prejudice and discrimination. The chapter covers current and debated ethical issues related to AIDS/HIV and duty to warn self-injuring clients, biotechnology advances, wrongful birth and wrongful life actions, decisions related to choosing disability, ethics and private sector rehabilitation, online and Internet counseling, end-of-life counseling, and assisted suicide.

The terms sexual abuse and sexual assault are frequently used interchangeably in the literature to indicate sexual acts with a person who does not give consent. When these acts are also accompanied by physical force, death threats, incapacitating substances, or kidnapping, the term aggravated sexual abuse is applied. Sexual abuse is commonplace, but the actual prevalence of sexual abuse is difficult to determine because there is no central agency responsible for the gathering and assimilation of these data. Abuse can be reported to a number of agencies that do not share information, such as government and legal entities, medical facilities, mental health services. Unresolved sexual abuse may result in somatic reactions, negative thoughts and beliefs about the self, negative emotions, destructive behaviors, and interpersonal problems. A number of additional issues may require therapeutic interventions if the sexual abuse was intrafamilial, including addressing the mother-victim relationship and the perpetrator-victim relationship.

This chapter discusses the impact of disability on the family by examining the reactions of family members to disability, factors that influence adjustment to disability in the family, adjustment models, parenting reaction perspectives, effective family coping, the impact of disability based on the family role of the person with a disability, and cultural influence on family adaptation to disability.

This chapter discusses sexuality in relation to disability, beginning with a discussion of gender identity and sexual orientation. Misconceptions and myths related to sexuality among persons with disabilities are presented along with issues of stigmatization and its impact on body image and self-esteem. This chapter focuses on disability and intimate relationships and differentiates issues based on the type of disability, severity of disability, and type of relationship. In addition, parenting with a disability and sexual abuse of persons with disabilities are discussed. A number of legal and ethical issues of controversy are presented, including cosmetic surgery to mask disability, sexual surrogates, selective abortion based on disability, and forced sterilization.