An exploratory study into the skills necessary to provide counselling services to the d/Deaf : a mixed methods study in a South African context

thinking. Most children who are born d/Deaf are born into hearing families where it is often difficult for them to effectively communicate with the family, as many d/Deaf individual’s families do not know or become fluent in Sign Language (Harvey, 1982). This isolation is also a risk factor for mental illness (Fellinger et al., 2005). In adulthood, communication barriers are frequently not © University of Pretoria 11 improved upon, as can be seen by Fellinger et al.’s (2005) report that 75% of a d/Deaf adult inpatient sample they interviewed were not fluent in signed or spoken language. Furthermore, Haskins (2004) stated that the average d/Deaf adult reads at a grade 4 level. In South Africa, the typical d/Deaf school leaver is said to read at the level of an average 8 year old hearing child (Van Rooyen, 2009). The Deaf community is one with its own unique culture and it is said to be very small and cohesive, in that most members spend their time and choose partners from within it (Fellinger et al., 2005; Williams & Abeles, 2004). The Deaf view themselves as part of a distinct community with its own language and culture, and thus do not view Sign Language as a lesser form of communication (COI, 2005). Language development and communication is shown to improve the psychosocial wellbeing of d/Deaf individuals and decrease their susceptibility to mental health difficulties (Fellinger et al., 2012). From the aforementioned it could be concluded that exposing children diagnosed with hearing difficulties to opportunities to develop language, be it Sign Language or oral communication, as well as increasing their opportunities to socialise within the family context and with other d/Deaf individuals, may decrease their vulnerability to developing mental health issues. An argument brought to light by Hoyt et al. (1981) and Remvig (1969) which needs consideration, involves the difference in syntactical constructions between many forms of Sign Language and that of spoken English. Thus when differentiating language skills from distorted or unusual thinking which may be present as part of a psychopathology, one must take heed (Hoyt et al., 1981; Remvig, 1969). Landsberger and Diaz (2010) point out the importance of being aware of necessary assessment and interview differences when working with the d/Deaf, particularly when conveying hearing-based constructs e.g. auditory hallucinations, to a d/Deaf patient. They recommend that one must be certain of the d/Deaf patient’s understanding to avoid them misinterpreting and possibly feigning comprehension so as to avoid the stress of appearing ignorant (Landsberger & Diaz, 2010). © University of Pretoria 12 A study by Landsburger and Diaz (2010) looked at a d/Deaf psychiatric inpatient sample and found that 11-13% of d/Deaf inpatients are diagnosed with psychotic disorders, a number which has decreased since the 1960’s. Previous higher rates of diagnosis are attributed to practitioners’ lack of knowledge of deafness and the linguistic differences present, which is suspected to have resulted in many practitioners using the diagnosis of psychotic disorders as a fail-safe and umbrella diagnosis when they were in doubt or unable to carry out accurate assessments (Landsberger & Diaz, 2010). With inadequate knowledge of language and culture differences one might, for example, be inclined to diagnose a patient with a thought disorder (Landsberger & Diaz, 2010). It is important for mental health services and service providers to acquire greater knowledge and awareness of deafness and the cultural and linguistic differences in the treatment of the d/Deaf, as a lack of awareness could lead to serious implications for d/Deaf patients in terms of assessment, diagnosis and treatment. In therapy, difficulties in communication can lead to misdiagnosis and impact the development of the therapeutic relationship, further reinforcing patterns of isolation, misunderstanding and oppression experienced by many d/Deaf persons (Williams & Abeles, 2004). This, coupled with cultural differences that could be experienced between the therapist and patient (in terms of d/Deaf and hearing culture), may pose a further problem to the course of therapy (Cooper et al., 2003; Roberts & Hindley, 1999). Hoyt et al. (1981) point out that a therapist must be cognisant of the fact that d/Deaf patients are much like other non-hearing impaired patients, and that their deafness is merely a limitation in typical communication, which may not in fact be part of the issue at hand. In some instances it may be the case that their psychological difficulties stem from their disability; however therapists need to be aware of this distinction and be careful of making these assumptions too