Adapting best practices in CBT for deaf and hearing persons with language and learning challenges.

Abstract

This article presents the work of a specialty psychiatric unit for deaf people in adapting best practices in cognitive-behavioral therapy (CBT) for deaf and hearing mental health clients who have severe language and learning challenges. Research cited shows that large numbers of deaf people referred to psychiatric hospitals have severe language impairments (in their best language, usually American Sign Language; ASL), related mainly to inadequate exposure to ASL as a child. These language impairments accompany other kinds of language and cognitive problems found also in hearing persons. Clinicians on the unit adapted the constructivist narrative CBT of Meichenbaum so that it could inform the treatment of these clients. Specifically, the treatment is oriented around the acquisition and development of psychosocial skills. These skills are understood developmentally; that is, early and simple skills develop into more complex coping and conflict resolution skills. All the skills are presented and taught using hundreds of specially developed pictures. Emphasis is placed on interventions that work at a sensorimotor and concrete operational level. A case study is presented along side of a theoretical discussion.

Language deprivation syndrome: a possible neurodevelopmental disorder with sociocultural origins

“…This attention may eventually lead to formal diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders. What appears to be a recognized everyday occurrence in the deaf mental health field and the Deaf community (i.e., “low functioning deaf” [79]) has not garnered significant attention in the general community. Language exposure has an inextricable impact on one’s development across the lifespan.…”

“…Glickman [79] describes the most commonly-used term as “low functioning deaf.” The vocational rehabilitation field offers its own description – a “traditionally underserved person who is deaf,” a subset of deaf people who exhibit limited communication abilities, difficulty maintaining employment without assistance or support, poor social/emotional skills including problem-solving, impulsivity, low frustration tolerance, inappropriately aggressive, and inability to live independently [60]. We recommend the term “language deprivation syndrome” [40,42,43] to highlight the possible cluster of symptoms that result from language deprivation.…”

A qualitative meta-synthesis on the experience of psychotherapy for deaf and hard-of-hearing people

“…Conversely, research conducted into mental health services for deaf and hardof-hearing people has increased in recent years, for example in psychotherapy (Bruin & Brugmans, 2006), counselling (Munro, Philp, Lowe, & Biggs, 2005), applying specific therapeutic techniques (Glickman, 2009;Munro, Knox, & Lowe, 2008), and general therapeutic literature (Cornes & Napier, 2005). The aim of these studies vary, with some examining therapists' perspectives (Oldale, 2008), clients' perspectives (Cohen, 2003), and some examining interpreters' perspectives (Bruin & Brugmans, 2006).…”

Working therapeutically with deaf people recovering from trauma and addiction.

“…Some clients do not initially understand the concepts of “treatment” or “recovery;” i.e., that one talks with a counselor about one's life in order to get better. Thus, there is great need for “pre-treatment” work – education and motivational work to prepare clients to make use of treatment and recovery strategies (Glickman, 2009a, 2009b, 2013b). For deaf clients with PTSD/SUD, educational pre-treatment work may focus on the nature and impact of trauma; safe and unsafe coping skills; common effects of substance use, abuse, and dependence; myths about mental illness and substance use; and, resources such as Twelve-Step programs.…”