In the therapeutic community (TC), recovery is viewed as a change in lifestyle and identity. It is a view that can be contrasted with the conventional concept of recovery in medicine, mental health, and other substance abuse treatment approaches. In the public health experience of treating opioid addiction and alcoholism, drug abuse is viewed as a chronic disease, which focuses treatment strategies and goals on improvement rather than recovery or cure. The TC view of recovery extends much beyond achieving or maintaining abstinence to encompass lifestyle and identity change. This chapter outlines this expanded view of recovery and details the goals and assumptions of the recovery process. It presents the TC view of right living, which summarizes the community teachings guiding recovery during and after treatment. The terms “habilitation” and “rehabilitation” distinguish between building or rebuilding lifestyles for different groups of substance abusers in TCs.

Therapeutic communities (TCs) are designed to enhance the residents’ experience of community within the residence. This chapter explores how the physical environment of the TC, its setting, facilities, and inner environment, can contribute to this perception and affiliation with community. Its separateness from the outside community in addition to its living spaces, furnishings, and décor are all utilized to promote affiliation, a sense of order, safety, and right living. TCs for the treatment of addiction are located in a variety of settings, which may be determined by funding sources and the external resistance to or acceptance of rehabilitation programs. Within the context of the TC perspective, privacy is considered an earned privilege based on the individual’s social and psychological growth. There are four physical features of the inner environment that instantly identify what is unique about a TC program: the front desk, the structure board, wall signs, and decorative artifacts.

The multicultural movement in counseling and psychology has begun to provide scholars and practitioners with contextually relevant, systems-based ecological approaches to counseling as alternatives to the traditional theoretical models of human behavior and intervention that are based on Western dominant culture. This chapter provides awareness of the complexity of multicultural issues among individuals with disabilities and discusses culturally sensitive strategies to work with people with disabilities (PWDs). It reviews legislative mandates related to diversity and multiculturalism in rehabilitation and addresses the relationship between disability and culture in the scope of rehabilitation practice. The chapter introduces multiculturalism and multicultural counseling models as a therapeutic framework and provides guidelines to help psychologists increase their cultural sensitivity. It also provides strategies to work with individuals with disabilities from minority backgrounds.

This chapter describes spirituality, religiousness, and indigenous/folk belief systems in a multicultural context. The majority of religion and health research to date has primarily focused on persons with life-threatening diseases and conditions, as persons facing death may use religion to help them accept their condition, come to terms with unresolved life issues, and prepare for death. In contrast, rehabilitation patients who suffer acute injuries or chronic progressive disorders may live for decades after the onset of their condition and use religious and spiritual resources to help them cope with their disability, give new meaning to their lives based on their newly acquired disabilities, and help them to establish new goals. The chapter then explains the different ways rehabilitation psychologists can address religious and spiritual beliefs with individuals from different faith traditions.

Rehabilitation providers who work with service members and veterans face significant cultural challenges that may impact the rehabilitation process. Part of this challenge is maintaining an awareness that any individual engaged in rehabilitation could have had prior military service that could impact rehabilitation care. This chapter provides an overview of military culture, including specific aspects of this culture that may affect the rehabilitation process, the various co-occurring disorders that are common in military/veteran populations, and resources and programs that are particularly useful when working with service members and veterans. Service members and veterans face unique challenges and stressors that are over and above some of the routine sources of stress that others face in the workplace. Stress can come from participating in combat, including exposure to traumatic events, risk of injury, and fears about deployment.

This chapter explores the impact of acculturation on three diverse U.S. populations: Hispanics, represented by a specific focus on Mexican immigrants; African Americans; and Native Hawaiians. It reviews relevant acculturation theories developed to explain cultural and psychological changes occurring in racial and ethnic populations in the United States as a result of interactions with the majority racial/ethnic population. The chapter presents Berry’s model of acculturation in particular, as a helpful theoretical model for clinicians working in neuropsychological rehabilitation to use for understanding psychological issues related to acculturation pressures. It also highlights the unique historical context of acculturation for each ethnic group and its effect on their acculturation experience as well as mental and physical health outcomes. The chapter provides rehabilitation psychologists and counselors with culturally relevant assessment and intervention recommendations for working with ethnically diverse clients.

Cognitive behavioral therapy (CBT) with children addresses four main aims: to decrease behavior, to increase behavior, to remove anxiety, and to facilitate development. Each of these aims targets one of the four main groups of children referred to treatment. This chapter suggests a route for applying effective interventions in the day-to-day work of social workers who are involved in direct interventions with children and their families. An effective intervention is one that links developmental components with evidence-based practice to help enable clients to live with, accept, cope with, resolve, and overcome their distress and to improve their subjective well-being. CBT offers a promising approach to address such needs for treatment efficacy, on the condition that social workers adapt basic CBT to the specific needs of children and design the intervention holistically to foster change in children. Adolescent therapy covers rehabilitative activities and reduces the disability arising from an established disorder.

Neuropsychological assessment involves the administration of a battery of tests that assess a variety of cognitive domains to obtain a clinical picture of brain behavior relationships. Within the inpatient rehabilitation setting, neuropsychologists often perform various functions, including neuropsychological assessment, psychotherapy, and assistance with adjustment issues for patients and their families. This chapter discusses some of the common cultural issues that impact neuropsychology in an inpatient rehabilitation setting. It focuses on potential sources of bias that can threaten the validity of neuropsychological tests. The chapter also examines the process of the neuropsychological evaluation within the inpatient setting when working with individuals from diverse cultural backgrounds. It deals with a complex composite of sociodemographic factors that include education, socioeconomic status (SES), race, ethnicity, language, and worldview, all of which interact with one another to influence brain-behavior relationships.