Idea 9

Traumatic Brain Injury
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The following is an on-line version of text from The Brain Injury Handbook:
A Guide for Rehabilitation Providers. Text and formatting have been modified for
viewing in various browsers. Look for a PDF version of selected Ideas in the coming months!

Idea # 9. There’s no effective inoculation against stereotypes.

Stereotypes are mostly unfair generalizations about different types of people. Where do they come from? They arise naturally from people’s efforts to understand and explain people who are different from themselves. Stereotypes generally arise within cultural, religious, ethnic, societal, gender, and professional groups. Some professionals have stereotypes that relate to patients’ age groups, disease types, chronicity, and prognosis.

In the rehabilitation field, stereotypes can have negative and positive effects on service delivery and treatment outcome. Most of the time, stereotypes are negative and have a potentially adverse effect on our commitment to help. Professionals tend to agree that stereotypes are inappropriate. However, their effects are often subtle and difficult to discern. Patients are not the only victims of stereotypes. Treating professionals may also be victims of stereotypes held by patients and family members.

Imagine that you have been referred two different cases. How might you or your colleagues react and treat these two patients differently?

Consider the significance of the following statements overheard between patients or staff on a rehabilitation unit.

Limiting the development and promotion of stereotypes is a tremendous challenge. They are pervasive and part of every culture. Some were presented to us as children. Many are reinforced by social groups outside the rehabilitation setting. Television, radio, newspapers, and magazines do much to reinforce stereotypes. Many stereotypes are subtle and hard to recognize.

Fortunately, there are means of limiting the negative effects of stereotypes on rehabilitation. If you are concerned that a patient’s negative stereotypes will harm your therapeutic relationship:

Don’t take it personally. The patient hasn’t had an opportunity to get to know you. Research shows that many people give up their stereotypes when they get to know people on an individual basis.

Understand that stereotypes are more a negative reflection on the person that holds them and not on you.

Carefully explain to the person about your expertise, how your expertise relates to their rehabilitation needs, and how you’d like to help. Most patients are willing to put aside their negative beliefs in exchange for much needed help.

If all else fails, offer other choices. Most rehabilitation programs are unable and unwilling to assign therapy staff based on concerns about stereotypes. Nevertheless, if all else fails, reassignment of the patient to another therapist may be the only way to achieve a positive outcome. In extreme cases, you may wish to consider discharging the patient and referring elsewhere.

You can also limit the potentially negative effects of stereotypes on the services you provide:

Monitor your positive and negative feelings about each patient. Negative feelings, especially early in the relationship, may be a "caution" sign warning of a stereotype’s influence.

Recognize that you are not immune to generalizing about types of patients and types of people.

Try to appreciate the unique and positive aspects of the individual.

Regularly reflect on your past difficulties with certain "types" of patients. Identify the kinds of patients that you find hardest to work with and work extra hard when treating them.

Ask colleagues for feedback and suggestions when concerned that you’re not doing your best. Give your colleagues constructive feedback when your concerned that they’re not recognizing patients’ individual attributes.

Focus on implementing the treatment plan rather than your feelings.

As a last resort, refer the patient to another therapist.

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Last updated - 06/06/2008