Adrian shared some of his background and how profound deafness led him, via the Civil Service and Local Government, to qualifying as a counsellor who has a particular desire to work with clients who are on the hearing loss spectrum.
It is estimated that 1 in 4 of the population have mental health problems as well as 40% of those with hearing loss (HL) and in children with HL they are twice as likely to have such issues than adults. Adrian explained that people may experience hearing loss in different ways. Some are deaf with or without speech (the terms deaf & mute or dumb are not to be used); have hearing and sight loss and sometimes Usher Syndrome (which is a common, sometimes inherited condition which may affect both hearing and vision. The main symptoms being deafness, hearing loss and/or the eye disease retinitis pigmentosa).
When hearing people are speaking with each other conversations tend to flow at roughly 250 – 400 wmp. Experienced deaf people signing would be at 120 wpm. This then drops significantly to 40 wpm when a hearing and a deaf person communicate either by signing, writing or with use of an interpreter. With Usher Syndrome or Deafblind it is the same 40 wpm. All these can be affected by different regional signs, or lack of them, regional accents and dialects plus the impact of contexts, education and comprehension. Adrian’s illustration of how specific signs can mean different words in different parts of the Country proved to be very amusing. We learned some choice words and expressions. It is clear that communication is not straightforward and that misunderstandings could easily impact on the ability to uncover presenting issues and their resultant impact on the client, their family, friends, GP or colleagues. Patience and the Core Conditions are of paramount importance. Therefore, Adrian strongly recommended we be aware and respectful of the following aspects:
Environment: The noise level in the room/vicinity and the type of noise. Some are distracting and hurtful when wearing hearing aids. Avoid visual distractions they may interfere with the ability to communicate. Keep the room clear and light. Arrange the seats a respectful distance apart so each person has a ‘full body view’ of the other as this aids lip-reading and signing. A chair for an interpreter would be positioned in a similar way. The Equality Act 2010 refers to the use of auxiliary aids and services such as induction loops, braille or audio CDs, writing materials and interpreters all being available when needed at no cost to the client.
Communication tactics: To gain some-one’s attention face them, make eye contact, and if no response click the light switch or tap the floor. Speak at a normal pace in short, unambiguous sentences. If needed, repeat what you are saying, rephrase or write it down. Do not cover your mouth, turn away, shout or over enunciate – this will not help. Occasionally therapists may lack understanding of deaf issues or culture and so may feel frustrated or deskilled and perhaps need to take a moment or a breath to remember that just because some-one has HL, it does not mean they cannot read facial expression or body language!
Interpreters: Adrian discussed the issues around the use of interpreters which is sometimes necessary for communication with a client. A client, and sometimes the therapist, may be inhibited by a 3rd person in the room and it is important that interpreters have the appropriate level of BSL (British Sign Language) qualification. Any trust and boundary issues will need to be explored. A client must have the freedom to either choose an interpreter or reject them. Adrian said deaf communities tend to be small and most interpreters will be known to them from other parts of their lives and so they may not wish to have particular ones in the therapy room. Adrian raised an important query here as to whether or not interpreters have counselling or supervision and how do they take care of themselves when they also may be affected by what they ‘hear’? He emphasised therapists must always look at the client and direct questions to them even though the interpreter will assist. Occasionally, interpreters may not always give a true interpretation of the client’s words with information being diluted, lost or misconstrued, so therapists need to be alert for such behaviour.
In respect of theories or modalities, Adrian mentioned that some of the useful ones were Gestalt, Person Centred, use of metaphor, Solution Focused Theory, CBT, the creative especially the visual, normalising feelings, exploring values and expectations. But it is important to bear in mind that boundaries can be blurred for this client group so to hold them in a clear, consistent, sensitive way is beneficial.
With Adrian’s guidance, we explored different case studies which challenged us to identify the approaches needed and any difficult issues around communication. Typical presenting issues for those with HL, he said, included abuse, trauma, discrimination, austerity, parental control, identify issues, rejection and problems around their boarding school history. These may impact the counselling process due to a possible inability to express thoughts and feelings, having poor skills/education, little understanding of the outside world especially employment, lack of self-worth and possible avoidance of responsibility. It became obvious quite quickly how complex and sensitive is this field of work.
A fascinating speaker, knowledgeable and engaging. Feedback included the comments: ‘excellent and thought provoking, depth of presentation, a doorway into a different field, immensely valuable information, brilliant’ – a well-received Talk. Thank you Adrian.
The Equality Act (EA) 2010 – superseded the DDA 1995
The Care Act 2014 including safeguarding. Accessible Information Standard (AIS) 2016.