From disability to human flourishing: how fourth wave psychotherapies can help to reimagine rehabilitation and medicine as a whole.

With disabled patients, clinicians are often mechanistically oriented, limiting goals to bodily improvements of perceived deficits back to species-typical functioning. Psychological goals, when present at all, are often pessimistically narrow, or phenomenologically shallow. Recent research on fourth wave psychotherapies helps broaden clinical concepts of healing and treatment beyond mere deficit remediation, and helps match clinical goals with the richness of human flourishing and the layered complexity of the patient's evolving experience of meaning. This article draws from first-hand accounts of the experience of disability and adjustment to impairment, along with a synthesis of recent theoretical and experimental work in clinical psychology and psychotherapy, to present recommendations for more accurate and ethical notions of rehabilitation for clinical practice. We explain the clinical value of "flourishing": the psychological, social, cultural, existential, moral, spiritual and religious dimensions of the patient in the context of their dynamic narrative existence in meaningful relationship and ritual formation. This approach allows clinicians to personalize and humanize caregiving in line with human strengths, move beyond an aim of mere recovery, more accurately characterize perceived impairments, goals of care, and successful treatment outcomes. These more capacious and experientially-attuned clinical concepts and aims help the clinician accompany and empower patients by understanding what is at stake throughout the illness experience. This flourishing model helps to reimagine the clinician-patient relationship, and the methods and entire purpose of rehabilitation medicine, and clinical medicine more broadly. The condition of blindness is presented as an illustrative case.Implications for rehabilitationAmidst vast medical and technological advances in diagnosis and treatment of disabilities, modern health systems often still approach rehabilitation of disability via species-typical standards of bodily or mental homeostasis as the standard of sound health, without considering the perspectives and experiences of flourishing that are unique to the individual who is sufferingPsychological, social scientific, and religious traditions uniquely explore the inner experiences of individuals and their relationships, and can be used to help patients find individualized paths to recovery, healing, and flourishingFourth-wave psychotherapies, utilizing existential, humanistic, and spiritual/religious philosophies, have resources clinicians can use to help patients aim beyond mere recovery, and allow for the possibility of "ultrabilitation"Attention to the psychological, social, cultural, existential, moral, spiritual, and religious dimensions of the patient in the context of their dynamic existence can promote ultrabilitationDedicated focus on compassion, virtue, dignity, gratitude, contemplative wisdom, and transcendence can enable one to conceptualize flourishing in a way independent or complementary to bodily outcomes in recovery, and sometimes even when illness or disability persists.