A Diverse Community: Counseling the Deaf and Hard of Hearing

The use of an interpreter is essential when working with deaf individuals.

The use of an interpreter is essential when working with deaf individuals.

Poor mental health is an equal-opportunity illness. Mental health does not discriminate based on age, gender, race, sexual orientation, educational attainment, occupation, ability or medical condition. As such, there is no one-size-fits-all solution to managing mental health across the entire population.

Reflecting the greater need for supporting diversity in mental health care, Troy University offers a range of certificate programs for students who have graduated or are currently studying for a master’s degree in counseling. These certificates focus on supporting individuals with various mental health conditions across multiple settings, communities and populations. This provision includes a specialist graduate certificate in rehabilitation and Deaf/hard-of-hearing studies.

Mental Health in Deaf and Hard-of-Hearing Populations

According to Dr. Joel Willis, Associate Professor in TROY’s counseling program, poor mental health is as much a reality in the Deaf and hard-of-hearing communities as anywhere else.

According to Dr. Willis, there is very little difference in the prevalence of mental health issues between the deaf population and the hearing population. However, those individuals who are deaf are at a much greater disadvantage when it comes to accessing proper mental care services. This disadvantage is primarily caused by barriers in communication both in mental health support and vocational rehabilitation services. Many fail to realize that there are two distinct languages at play between hearing counselors and deaf clients; English and American Sign Language (ASL).

While everyone’s experience is unique, Dr. Willis explains that two common factors impede those who are deaf from accessing mental health services. The first is a nationwide shortage of counselors who lack multicultural competence in working with the deaf population. Secondly, the lack of qualified sign language interpreters with additional training in mental health interpreting. Dr. Willis expressed concern about the neglect in academics of addressing the Deaf Culture. In institutes of higher learning, diversity and multiculturalism are promoted to the exclusion of Deaf Culture.

TROY’s certificate in rehabilitation and Deaf/hard-of-hearing studies aims to redress the balance in favor of the Deaf community relating to accessing mental health services. This process starts by helping students better understand what Deaf culture is.

American Sign Language (ASL) and Understanding Deaf Culture

The Deaf community is as diverse as any other, but is often brought together by a unique and rich language: ASL.

American Sign Language, according to Dr. Willis, provides the communication foundation on which the Deaf culture was built. It is a unique culture built around this language. It was recognized as a distinct culture in the 1960s, and having its own set of social beliefs, behaviors, art, literary traditions, history, and values — and it is all done visually.

According to Dr. Willis, American Sign Language is widely misunderstood by the hearing population. This lack of understanding can lead to under-representation in areas of employment, educational opportunities and healthcare provision.

Many people do not know that ASL is a visual language and is purely a visual/gestural language with no written form. It is not English. Some may forget that individuals who are deaf are Americans, born in this country as citizens, but that “speak” a different language. That language is visual, and difficult to learn.

Dr. Willis also explains that individuals, with ASL as their primary language, are at a disadvantage when communicating in English either written or spoken. This may present problems when counselors or medical professionals automatically assume that deaf clients can communicate effectively using written notes. For example, a doctor may think it is helpful to write medications and dosages on a piece of paper, but in reality, the deaf patient may struggle to comprehend English, and without a qualified interpreter to explain, may be in danger of an overdose.

In this respect, Dr. Willis added, many deaf people may be unable to access movies or television programs using English subtitles, or even newspapers and magazines, highlighting the importance of ASL interpreters and the need for more Deaf and hard of hearing services in the community. For example, weather alerts announced on television using subtitles may not be understood by many ASL users.

Dr. Willis stressed that the lack of understanding between the Deaf and hearing communities can have serious consequences. This is especially true in times of mental health crisis. People unfamiliar with ASL may misinterpret the intentions of deaf people using sign language. For example, a deaf individual is taken to the emergency room. The individual tries, unsuccessfully, to communicate with the staff and nurses and becomes frustrated causing the patient to sign faster. The quick motions of the patient’s hands are misinterpreted as being combative, thus the patient is placed in restraints. This is equivalent to being bound and gagged.

The lack of understanding begins early in life according to Dr. Willis. Historically, 90% of dead children are born to hearing parents, conversely 90% of Deaf parents have hearing children. Past cases suggest that some physicians discourage the parents of a deaf child from using sign language. They instead encourage the parents to focus solely on lip-reading which has been proven to be practically impossible. At best, 30% of what is spoken can be understood from lip-reading. Dr. Willis emphasized that acquiring a primary language early in life is critical for the normal development of a child.

The Challenges of Accessing Therapy for Deaf Populations

As the state coordinator for deaf services in Alabama’s Department of Mental Health, Charlene J. Crump works on the frontlines of deaf mental health services. A graduate of TROY, she holds a master’s in rehabilitation counseling and postgraduate certificates in clinical mental health counseling, and rehabilitation and Deaf/hard of hearing studies. As such, she can identify several challenges on both sides of the therapeutic relationship.

“Because there are so few qualified sign-fluent therapists to serve the Deaf community, and because clients have diverse and unique needs related to therapy, the sign-fluent therapist finds themselves needing to work within a vast range of settings and people,” says Crump.

Crump explains that deaf people often have a very different worldview from the hearing population. This difference can impact their mental well-being.

“For example, an individual who is hearing may view time together with their nuclear family, such as the holidays, as a time to get together, eat, talk, bond, argue, etc.,” says Crump. “Whereas a person who is deaf may view this time as an expectation of being with people they love but also one of isolation.”

This problem is compounded when parents of deaf children cannot sign at a conversational level.

“When most conversations occur at a command-response level, this can lead to language deprivation, which is shown to have the same potential lifetime indicators as other childhood traumas,” says Crump. “Lack of effective communication can have an impact on attachment with family during their formative years and their relationships with others as adults.”

According to Crump, these breakdowns in communication may lead to challenges in sharing basic information when a person comes into therapy, leading to gaps in mutual understanding within the therapeutic relationship.

“The non deafness-trained therapist will come into the interaction thinking that the Deaf person shares the same fund of information, when in fact they don’t,” says Crump. “This has two consequent impacts. First, assuming understanding is happening when it’s not, or at least not at the same level. And secondly, potential misdiagnosis.”

Qualified ASL Interpreters

Under the Americans with Disabilities Act (ADA), Deaf people are entitled to access qualified sign language interpreters when accessing mental health services. However, according to Dr. Willis, this doesn’t come without its challenges.

Dr. Willis explains that in the counseling process, the counselors first goal is to develop a therapeutic relationship with the client. This relationship is built on trust between the two, the counselor and the client. Also, each counselor abides by a strict code of ethics founded, in part, on confidentiality. Therefore, a counselor unfamiliar with deafness may be uncomfortable sharing the counseling session with a third person, the interpreter. This may sometimes seem unethical and a possible breach of confidentiality.

The use of an interpreter is essential when working with deaf individuals. Any individual wishing to become a professional interpreter must have a required level proficiency in ASL. the individual must also obtain specific certifications and licensure. Professional ASL interpreters are held to the same ethical standards of confidentiality as other health care professionals.

Dr. Willis gave the following example: An interpreter living in a small town will have many opportunities to exercise their ethics. The smaller the town, the smaller the Deaf community. It is difficult not to encounter customers that have used interpreting services in the past. Interpreters must be aware of this, and strongly adhere to the ethical codes of confidentiality.

Understandably, many deaf people would prefer to work with deaf counselors, but in reality, there aren’t enough of deaf counselors to provide the required coverage. Working with counselors who understand the complexities of Deaf culture is the next best thing. It is the aim of TROY’s graduate certificate in rehabilitation and Deaf/hard-of-hearing studies to prepare mental health professionals to become more accessible to the Deaf community.

What Characteristics and Skills Are Needed to be Successful in this Field?

Crump explains that she was initially inspired to work with the Deaf community through family and personal relationships with deaf people.

“Having an aunt who was hard of hearing and a friend who was Deaf initially began my journey of interest in learning sign language,” says Crump. “I began my professional career as an interpreter working within hearing and Deaf populations. After I began working with the Alabama Department of Mental Health, my interest in working with individuals in mental health settings grew.”

According to Crump, in addition to clinical competence, proficiency in sign language is one of the primary skills needed to work with deaf individuals in mental health settings.

“Humility would be another characteristic that individuals working in this field should have or strive for,” says Crump. “The work is complex, and individuals in this field must invest time in pursuing competence.”

Students entering the interpreter certificate program are required to score at least an intermediate on the Sign Language Proficiency Interview (SLPI). While the faculty can guide potential students to resources to achieve this goal, Dr. Willis advises that to be genuinely fluent in ASL, students must learn the language and immerse themselves in Deaf culture. Unfortunately, some people think that by completing a few sign language courses they will be fluent in ASL. Nothing could be further from the truth.

Crump describes her journey toward learning ASL as a “significant investment.”

“I learned sign language through both a program and through interactions with members of the Deaf community,” says Crump. “Linguistic competence takes approximately eight years to obtain, which is a significant investment for anyone wanting to achieve this goal.”

Some people may find it easier than others.

How Can TROY Help You Achieve Your Goals?

Crump cites both the master’s degree and graduate certificate programs at TROY as instrumental in helping her achieve her career goals.

“TROY’s master’s program increased my understanding of rehabilitative techniques and clinical knowledge,” says Crump. “The certificate program gave depth to my ability to understand both historical influences and current research and practices as well as adapt practices to fit the Deaf population.”

These are skills that Crump relies on in her professional career.

“I currently work as a State Coordinator for the Alabama Department of Mental Health and oversee programming and training for individuals who work in the mental health field with individuals  who are deaf,” says Crump. “In this role, I supervise staff across the state working both in the community and facilities, developing and monitoring standards, and providing training for clinicians and interpreters working with Deaf and hard of hearing populations in the mental health field.”

Describing her experience at TROY as “remarkable,” Crump is a keen advocate for the University.

“I strongly recommend the TROY program,” says Crump. “I have referred several staff, interns and colleagues to the program and look forward to the future impact their training through this innovative program will have on the field of deaf mental health care in our community.”

Learn More

To learn more about how a graduate certificate in rehabilitation and Deaf/hard-of-hearing studies can help you better understand and serve the Deaf population’s mental health needs, visit the program page on our website.