Conducting Psychotherapy From a Wheelchair

By Noel Shami, Psy.D.
November 6, 2017 - Last updated: November 5, 2017

Conducting psychotherapy from wheelchairI never expected my life to turn out as it has. My plan was to graduate college, attend graduate school, obtain my doctorate and become a licensed clinical psychologist. That was how I envisioned my life, and I was determined that nothing was to sway me away from my plan.

Reality, on the other hand, is another matter.

I was content with life. I participated in leisure, recreational and social activities, traveled nationally and internationally. I was living my life. Then destiny intervened. My life was radically altered forever and I was hurled into an unfamiliar world of being confined to a wheelchair.

I began to experience health problems while working on my doctorate. I had difficulty walking, maintaining balance, suffered fatigue and had trouble ascending and descending stairs. I had little knowledge of neurology but I suspected my symptoms had a neurological basis.

I searched for neurologists but was unable to find one who could explain my symptoms. Discouraged, I decided to be examined at the Mayo Clinic in Jacksonville, Fla. Following extensive testing, I was informed that my diagnosis was Motor Neuron Disease. That is on the continuum with the devastating disease, Amyotrophic Lateral Sclerosis (ALS) also known as Lou Gehrig Disease.

Motor Neuron Disease is a very slow progressing but disabling disorder compared to ALS, whose victims have a life expectancy of nine months to five years following diagnosis.

I was able to complete my doctoral studies. I was awarded a Psy.D. in clinical psychology and became licensed in Florida after graduating from Carlos Albizu University in Miami.

President George H. Bush was instrumental in enacting the Americans with Disabilities Act to protect the disabled from discrimination, but unfortunately it will likely always plague our society, whether based on race, ethnicity, sexual orientation, gender, socioeconomic status – or disability.

Discrimination can take the form of not providing accommodations and misconceptions about being in a wheelchair, such as not providing proper construction for easy access to get from Point A to Point B or sidewalk ramps and entrance ways to enter or leave a building.

For example, I was invited for an interview at an inpatient unit. I was amazed to find a 6- to 8-inch step that I had to navigate to enter the interview room, even though the staff members at the facility were well aware that I would be in a wheelchair. I declined to accept the position on the basis of the staff’s nonchalant attitude and, of course, not having a ramp.

Before I was to begin work at another outpatient facility, the recruiter for the position never returned my calls, nor did anyone else with the facility. I learned later from a potential colleague that being in a wheelchair was not an issue. However, requiring special voice-activated dictation equipment and other alterations to meet my special needs was much too costly for the facility. That may be hearsay or coincidence, but I sense it was discrimination.

When I started work as a psychologist, I was very apprehensive. I was concerned about how a client might perceive me as a professional in a wheelchair. My apprehensions were unfounded.

Conducting psychotherapy from a wheelchair was not an issue for most clients. Rather, it turned out to be a learning experience. Some clients were inquisitive as to why I was confined to a wheelchair while others were politely silent.

In many cases, the wheelchair made the client relationship more equal. Many clients felt more at ease disclosing their issues because the chair let them identify me as a fellow human with flaws instead of doctor who is perfect and has all the answers.

The wheelchair sometimes was helpful in making diagnoses. For example, if a client’s reaction to the chair was negative and he/she presents with anger, the reaction gives me preliminary information. Of course, diagnosis entails many thoughts, ideas, analysis and testing (if available). Nevertheless, clients’ reactions to the wheelchair could act as a beginning process of understanding the clients.

My cognitive and clinical skills are intact and continue to be sharp, but due to my illness, my body does not want to cooperate. I find that some people assume that someone in a wheelchair has cognitive deficits. I would like people to judge my work on its merits not on my wheelchair.

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Noel Shami, Psy.D., is a clinical psychologist in Pembroke Pines, Fla. He worked as a master’s level clinician and later as a psychologist in areas such as substance abuse treatment programs, outpatient/inpatient units and correctional facilities. Shami was impacted by Hurricane Irma and currently has no access to email. Messages may be sent to for forwarding to him.

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