In this qualitative study, the authors examined the nature of resilience in people with chronic disabilities. Fifteen people with disabilities identified the factors that helped or hindered them at major turning points, and the triggers and resolutions to these turning points. Turning points were emotionally compelling experiences and realizations that involved meaning acquired through the routes of belonging, doing, or understanding the self or the world. The major protective factors were social support, traits such as perseverance and determination, and spiritual beliefs. Three new protective processes were identified: replacing a loss with a gain (transcending), recognizing new things about oneself (self-understanding), and making decisions about relinquishing something in life (accommodating). These protective factors, processes, and ways in which people with disabilities draw sense and meaning in life have important implications for service delivery.

In a qualitative study examining turning points in life, 15 adults with chronic disabilities (cerebral palsy, spina bifida, or attention deficit disorder) provided information about the nature and meaning of their social support experiences. The study revealed three types of psychological support linked to self-perceptions and enabling beliefs: (a) emotional support (valuing and acceptance leading to perceptions of "being believed in" and a sense of self-esteem), (b) instrumental support (guidance and provision of strategies leading to self-efficacy), and (c) cognitive support (affirmation, confirmation, and new perspectives leading to coherence in self-concept and worldview). The findings have important implications for service delivery with respect to understanding client needs for different kinds of support, especially at periods of transition, and for providing optimal experiences and creating supportive environments. In particular, the role of cognitive support deserves more attention in understanding the adaptation of individuals with chronic disabilities.

With increasing expertise, therapists use a supportive, educational, holistic, functional, and strengths-based approach; have heightened humility yet increased self-confidence; and understand how to facilitate and support client change and adaptation by using principles of engagement, coherence, and manageability. Expert therapists use enabling and customizing strategies to ensure a successful therapeutic session, optimize the child's functioning in the mid-term, and ensure child and family adaptation and accommodation over the longer-term.

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The major differences between therapists who attain expertise quickly versus those who remain novices after many years of experience appear to be motivation and complexity of work experiences. Implications for supporting the development of expertise in practising therapists are discussed.