CSWR Spring 2022 




COLUMBIA SOCIAL WORK REVIEW, VOL. XIX  |   47   

Improving 
Communication 
Among Providers 
Serving D/deaf 
Populations In 
Mental Health 
Settings

IMONIE GWALTNEY



48  |  COLUMBIA SOCIAL WORK REVIEW, VOL. XIX  

IMPROVING COMMUNICATION AMONG PROVIDERS SERVING D/DEAF POPULATIONS

ABSTRACT

Mental health is as critically important as physical health. The status of 
one’s mental health can be greatly impacted by environmental, social, 
psychological factors, and traumatic experiences that interfere with daily 
SP]PUN��+LHM�WVW\SH[PVUZ�^OV�\[PSPaL�(TLYPJHU�:PNU�3HUN\HNL��(:3��MVY�
KHPS`�JVTT\UPJH[PVU�MHJL�H�\UPX\L�ZL[�VM�VIZ[HJSLZ�[V�HJJLZZPUN�X\HSP[`�
TLU[HS�OLHS[O�JHYL��HUK�[OL�SHJR�VM�HJJLZZ�[V�LɈLJ[P]L�JV\UZLSPUN�K\L�
to linguistic barriers can contribute to the deterioration of mental health 
symptoms. This paper will guide non-D/deaf mental health clinicians to 
become more familiar with deaf culture and will underscore the potential 
of language accommodation to relieve burdens felt by deaf individuals.

Disclaimer: “Deaf” will be used interchangeably with “deaf” to 
demonstrate inclusivity with the multiplicity of deaf identity; the D is 
JHWP[HSPaLK�[V�ZOV^�HɉSPH[PVU�[V�H�J\S[\YHS�JVTT\UP[`�HUK�OHYK�VM�
hearing people who primarily use ASL for communication.



COLUMBIA SOCIAL WORK REVIEW, VOL. XIX  |   49   

IMONIE GWALTNEY

W
hile strides have been made toward enhancing 
linguistic access for the deaf population in the United 
:[H[LZ��L�N���WYV]PKPUN�JSVZLK�JHW[PVUZ��\[PSPaPUN�
ASL in real time for live reporting, establishing crisis 

hotlines, and improving internet usage for video remote interpreting [VRI] 
services), access remains severely limited for those receiving mental 
health support (NAD, 2022). There is a growing need for clinicians who 
are familiar with deaf culture and can competently serve members of 
the deaf population seeking mental health services. To address the 
gap between hearing practitioners and deaf patients as well as to 
LUZ\YL�LɉJHJPV\Z�[YLH[TLU[��WYHJ[P[PVULYZ�T\Z[�MHTPSPHYPaL�[OLTZLS]LZ�
^P[O�[VVSZ�VM�LɈLJ[P]L�JVTT\UPJH[PVU�MVY�KLHM�WH[PLU[Z��PTWSLTLU[�
inclusionary practices, and focus on increasing cultural knowledge. 
Research has shown that clinicians who strive for and practice cultural 
O\TPSP[`�WYV]PKL�H�TVYL�LɈLJ[P]L�[OLYHWL\[PJ�WYVJLZZ�MVY�WH[PLU[Z�^P[O�
KPɈLYLU[�IHJRNYV\UKZ��-PZOLY�)VYUL�L[�HS����������;OPZ�WHWLY�HPTZ�[V�
assist clinicians in understanding the language needs and cultural 
\UPX\LULZZ�VM�[OL�KLHM�WVW\SH[PVU��HUK�[V�WYV]PKL�PU�KLW[O�N\PKHUJL�
MVY�\[PSPaPUN�(:3�PU[LYWYL[H[PVU�PU�[OLYHW`�ZLZZPVUZ�[V�LHZL�KLHM�WH[PLU[Z»�
hesitancy in accessing mental health services.

THE DEAF POPULATION IN UNITED STATES

Around 30 million people living in the United States have hearing loss 
�/VɈTHU�L[�HS����������;̂ LU[`�[OYLL�WLYJLU[�VM�[OVZL����`LHYZ�VY�VSKLY�
have either mild or severe hearing loss, while moderate hearing loss 
is most prevalent in those who are 65 years old and older (Goman & 
Lin, 2016). The number of people who use ASL as their primary form of 
communication is approximately 250,000-500,000, according to Mitchell 
et al. (2006).

The deaf and hard-of-hearing community remains largely 
underrepresented and underserved in mental health in the United 
States. In one research study, about 90 percent of people from the deaf 



50  |  COLUMBIA SOCIAL WORK REVIEW, VOL. XIX  

community have observed that there were relatively few accessible 
mental health services for deaf individuals (Feldman & Gum, 2007). 
Several studies have indicated a lack of understanding about deaf 
culture among mental health clinicians and the language barrier prevents 
[OL�KLHM�WVW\SH[PVU�MYVT�ILPUN�HISL�[V�LɈLJ[P]LS`�YLJLP]L�HKLX\H[L�
support for social services (Steinberg et al., 1998; Mueller, 2006). 

 A 1996 study found that, at that time, there were only 20 registered 
deaf psychologists in the country (Pollard, 1996). As of 2001, there were 
261 programs for the deaf population, including programs in outpatient 
settings, schools, psychiatric hospitals, and community mental health 
centers (Cohen, 2001). However, this number may not accurately 
YLÅLJ[�[OL�HTV\U[�VM�TVKLYU�TLU[HS�OLHS[O�JSPUPJPHUZ�HISL�[V�WYV]PKL�
culturally competent care to deaf patients in ASL. Indeed, the number of 
registered deaf mental health clinicians today is still low, which means 
that Deaf clients are often referred to adjunct services such as programs 
with ASL accommodation in social services.

DEAF CULTURE, LANGUAGE USAGE, & MISCONCEPTIONS
DEAF CULTURE

+LHM�WLYZVUZ�^OV�PKLU[PM`�Z[YVUNS`�^P[O�+LHM�J\S[\YL�TH`�PU[LYUHSPaL�
belief systems about Deaf customs more so than those who identify as 
deaf. Deaf individuals may consider themselves members of the cultural 
and linguistic community rather than a disabled group (Napier et al., 
2017). In the author’s experience, the term “disabled” often feels like 
a forced label: Deaf individuals can feel it gives the false message that 
all deaf persons are “inferior,” “hearing-impaired,” and that they need 
[V�IL�¸Ä_LK¹�PU�VYKLY�[V�IL�JVUZPKLYLK�M\UJ[PVUHS�TLTILYZ�VM�ZVJPL[ �̀�
The culture of Deaf people includes an exclusive set of behavioral 
UVYTZ��]HS\LZ��HUK�ILSPLMZ�[OH[�KPɈLY�MYVT�[OL�NLULYHS�WVW\SH[PVU��.P]LU�
that deaf individuals with profound hearing loss are unable to respond 
to sound without the assistance of auxiliary aids, such as cochlear 
implants (CIs) and hearing aids, it is generally acceptable to tap an 
PUKP]PK\HS»Z�ZOV\SKLY��Z[VTW�[OL�ÅVVY��VY�ÅPJR�[OL�SPNO[Z��KLWLUKPUN�
on the situation, in order to get their attention. Conversations can be 
PUP[PH[LK�^P[O�H�NYLL[PUN�MVSSV^LK�I`�ÄYZ[�HUK�SHZ[�UHTL�HUK�ZJOVVS�

IMPROVING COMMUNICATION AMONG PROVIDERS SERVING D/DEAF POPULATIONS



COLUMBIA SOCIAL WORK REVIEW, VOL. XIX  |   51   

HɉSPH[PVU��0[�PZ�HSZV�PTWVY[HU[�MVY�HU`�WLYZVU�LUNHNPUN�PU�H�JVU]LYZH[PVU�
with a deaf individual to look at their facial expressions rather than their 
hands so as to be able to understand the message they are trying to 
convey. These are a few of the social expectations that deaf community 
members typically adhere to. 

LANGUAGE USAGE

ASL is a visual language consisting of its own grammatical rules and 
syntax, a structure that is fundamentally distinct from English. While 
signing, linguistic information is visibly transmitted and processed in the 
frontal lobe of the brain (Evans et al., 2019). Body movements, facial 
expressions, and the placement and location of the hands are important 
elements in conveying information.

Facial expressions can provide emphasis of interest or convey 
enthusiasm, depending on the nature of the conversation at hand. 
For example, if a lighthearted story or joke is being interpreted, it is 
acceptable—and even expected—that the interpreter smiles. In any 
situation, it is expected that the interpreter will duplicate the emotion 
and tone of the person being linguistically accommodated.  

MISCONCEPTIONS

Treatments in mental health counseling are predominantly designed to 
HJJVTTVKH[L�OLHYPUN�PUKP]PK\HSZ��:[HUKHYKPaLK�[LZ[PUN�VY�L]HS\H[PVUZ�
rarely consider aspects of deafhood. Deaf individuals are more likely 
to experience higher rates of social isolation due to the language 
barrier that contributes to the problem of accessing mental health care. 
;OL�\UPX\L�SPUN\PZ[PJ�HJJVTTVKH[PVUZ�KLHM�JSPLU[Z�YLX\PYL�JHU�SLH]L�
providers reluctant to work with deaf people. 

Psychotic disorders, along with other neurological development 
KPZVYKLYZ��HYL�TVYL�MYLX\LU[S`�KPHNUVZLK�PU�KLHM�WZ`JOPH[YPJ�WH[PLU[Z�
[OHU�PU�UVU�KLHM�WH[PLU[Z��3HUKZILYNLY�
�+PHa���������4PZKPHNUVZLZ�
are more likely to occur when clinicians misinterpret aspects of a deaf 
person’s communication and associated behavior. Deaf clients tend 
[V�YLZWVUK�[V�NLULYHS�X\LZ[PVUZ�PU�HU�LSHIVYH[L�THUULY��VM[LU�^P[O�H�

IMONIE GWALTNEY



52  |  COLUMBIA SOCIAL WORK REVIEW, VOL. XIX  

narrative rather than giving a simple answer. This tendency is a common 
conversational pattern in the deaf community: for example, a deaf 
person explaining a traumatic experience to a therapist would focus on 
the nuances of the story, detailing every single plot point leading up to 
the event and demonstrating their reactions through facial expressions. 
A  hearing clinician may interpret this behavior as “unwillingness to 
cooperate” or “inability to focus.” However, facial expressions that 
are crucial grammatical components of ASL can be misconstrued 
HZ�¸PUHWWYVWYPH[L�L_WYLZZPVUZ�VM�HɈLJ[¹��7OPSSPWZ���  �"�3LPNO��������
W�������(Z�H�YLZ\S[�VM�[OPZ�TPZJOHYHJ[LYPaH[PVU��[OL�KLHM�WVW\SH[PVU�PZ�
WYVUL�[V�TPZKPHNUVZPZ�HUK�TVYL�]\SULYHISL�[V�PUZ[P[\[PVUHSPaH[PVU"�THU`�
deaf communities fear these outcomes and some avoid mental health 
services for this reason. (Leigh, 2010). 

Professional mental health care for deaf clients is further undermined 
by common assumptions and misconceptions about deafness. For 
example, practitioners often believe that lip reading/speech reading 
HUK�UV[L�^YP[PUN�WYV]PKL�LɈLJ[P]L�OLHS[O�JVTT\UPJH[PVU��0LaaVUP�L[�HS���
�������;OLZL�JVTT\UPJH[PVU�TVKHSP[PLZ�HYL�VM[LU�PULɈLJ[P]L�MVY�WLVWSL�
who were diagnosed profoundly deaf at birth, or who were not able 
[V�HJX\PYL�SHUN\HNL�H[�[OL�ZHTL�SL]LS�HZ�PUKP]PK\HSZ�^OV�OHK�`LHYZ�VM�
practiced lip-reading/speech-reading. Deaf people who are familiar with 
ZWVRLU�SHUN\HNL�HYL�[`WPJHSS`�VUS`�HISL�[V�\UKLYZ[HUK�HIV\[���¶����
VM�ZWVRLU�,UNSPZO��3PL\�L[�HS����������-\Y[OLYTVYL��UV[L�^YP[PUN�YLX\PYLZ�
SP[LYHJ`�WYVÄJPLUJ`�[V�JVTWYLOLUK�HUK�PU[LYWYL[�[V�[OL�ILZ[�VM�VUL»Z�
RUV^SLKNL�HUK�YLZWVUK�JVOLZP]LS �̀�I\[�H�KLHM�WH[PLU[�^OVZL�ÄYZ[�
language is ASL may not be as literate with written language (Pollard & 
Barnett, 2009). Smeijers and Pfau (2009) further argue that using note-
^YP[PUN�^P[O�H�UH[P]L�ZPNULY��^OV�TPNO[�UV[�IL�Å\LU[�PU�[OL�JVTTVUS`�
used written language, can negatively impact ties of communication. 

Using deaf culture as a foundation for understanding behavioral norms 
JHU�SLZZLU�[OL�JOHUJLZ�VM�TPZJH[LNVYPaPUN�JLY[HPU�JOHYHJ[LYPZ[PJZ�HZ�
Z`TW[VTZ�VM�TLU[HS�PSSULZZ��<UKLYZ[HUKPUN�[OL�\UPX\L�ZL[�VM�]HS\LZ�
in deaf culture, alongside considering the linguistic needs of the deaf 
individual, alleviates medical distress.  

IMPROVING COMMUNICATION AMONG PROVIDERS SERVING D/DEAF POPULATIONS



COLUMBIA SOCIAL WORK REVIEW, VOL. XIX  |   53   

EFFECTIVE COMMUNICATION 

The language needs of a deaf person vary, as deaf individuals exist 
on a spectrum: one may use oral speech and sign simultaneously, 
while another may not use oral communication and prefer to 
communicate exclusively in sign language. The nuances of preference in 
communication modalities should be taken into consideration when ASL 
interpretation is an option. 

 The 1990 Americans with Disabilities Act (ADA) states that 
accommodations must be paired with anti-discriminatory practices 
[OH[�WYVOPIP[�L_JS\ZPVU�HUK�\ULX\HS�[YLH[TLU[��HUK�[OH[�Z\JO�
accommodations are an institution or business’s responsibility to 
enact. Areas of accommodation include architectural standards, 
WVSPJPLZ�HUK�WYV[VJVS�TVKPÄJH[PVUZ��HUK�JVTT\UPJH[PVU�HJJLZZ��(+(��
2021). This means that mental health care providers are responsible 
MVY�ÄUKPUN�HUK�WH`PUN�MVY�H�X\HSPÄLK�(:3�PU[LYWYL[LY��<UKLY�[OL�(+(��
[OL�NVHS�VM�LɈLJ[P]L�JVTT\UPJH[PVU�PZ�[V�LUZ\YL�IV[O�WHY[PLZ·
[OVZL�^P[O�KPZHIPSP[PLZ�HUK�[OVZL�^P[OV\[·OH]L�LX\HS�HJJLZZ�[V�
legible communication. This underscores the importance of clear 
communication, acknowledging that the deaf client has the right to 
understand the nuances in which messages are conveyed without 
hindrance. 

�(�¸X\HSPÄLK�(:3�PU[LYWYL[LY¹�PZ�KLÄULK�HZ�ZVTLVUL�^OV�OHZ�JVTWSL[LK�
four years of an interpreting program at an accredited college, has 
YLJLP]LK�H�JLY[PÄJH[PVU�MYVT�[OL�9LNPZ[Y`�VM�0U[LYWYL[LYZ�MVY�[OL�+LHM�
�90+���HUK�WVZZLZZLZ�[OL�ZRPSSZ�[V�PU[LYWYL[�LɈLJ[P]LS �̀�HJJ\YH[LS �̀�HUK�
impartially. This includes the ability to decode and convey messages 
(both receptive and expressive) back to either parties involved, using 
HU`�ULJLZZHY`�ZWLJPHSPaLK�]VJHI\SHY`��5(+���������

Deaf individuals possess the legal right under the ADA to obtain, 
through an institution or service provider, an ASL interpreter for services 
[OL`�HYL�ZLLRPUN��,ɈLJ[P]L�JVTT\UPJH[PVU�NYLH[S`�PUÅ\LUJLZ�WH[PLU[�
and client interaction. Ensuring that the deaf individual has access to 
communication that is clear and transparent allows space for both 
WLYZVUZ�PU]VS]LK�PU�[OL�[OLYHW`�WYVJLZZ�[V�IL�LX\HSS`�OLHYK�HUK�
supported.

IMONIE GWALTNEY



54  |  COLUMBIA SOCIAL WORK REVIEW, VOL. XIX  

BUILDING RAPPORT WITH DEAF PATIENTS 

Establishing rapport with deaf and hard-of-hearing individuals is 
critical, as it lays a foundation of mutual trust and respect during 
sessions. A working alliance facilitates the developmental process 
of exploring reasons which bring a person to mental health services. 
)VUKPUN�LSLTLU[Z�Z\JO�HZ�¸YLZWLJ[��SPRPUN��HUK�[Y\Z[¹�PUJYLHZL�LɈLJ[P]L�
[OLYHWL\[PJ�JVSSHIVYH[PVU��.SHKKPUN��������W��������0U�HJJVYKHUJL�^P[O�
LZ[HISPZOPUN�T\[\HS�LɈVY[Z��TLU[HS�OLHS[O�JSPUPJPHUZ�JHU�WYVTV[L�JSPLU[Z»�
comfortability by acknowledging opposing worldviews in session and 
building the professional skills necessary to collaborate with culturally 
KPɈLYLU[�JSPLU[Z��

Cultivating a thorough understanding of deaf culture and learning 
[V�LɈLJ[P]LS`�ZLY]L�[OL�KLHM�WVW\SH[PVU�HYL�UV[�SPTP[LK�[V�WYV]PKPUN�
SPUN\PZ[PJ�HJJVTTVKH[PVUZ��(SZV�YLX\PYLK�PZ�HU�\UKLYZ[HUKPUN�VM�
core values of deaf culture, along with an appreciation and respect 
MVY�[OL�\UPX\LULZZ�VM�LHJO�KLHM�PUKP]PK\HS��3LPNO���������(�[OLYHWPZ[�
who has some familiarity with Deaf culture, but who has minimal ASL 
knowledge, is not an appropriate substitute for an ASL interpreter. In 
one report, several participants maintained that medical professionals 
with negligible sign language communication skills were willing to settle 
for a minimal level of communication with deaf clients which they would 
never tolerate with hearing patients (Steingberg, 1998).

Comprehensible language provides the clinician with direct insight 
into the client’s life; however, when communication breaks down 
PU�[OLYHW �̀�[OL�JSPLU[»Z�WYVNYLZZ�JHU�ILJVTL�QLVWHYKPaLK��<[PSPaPUN�
ASL interpretation for ASL-literate deaf individuals can reduce 
communication disruptions during sessions and help avoid ruptures in 
the therapeutic alliance. 

IMPACT OF INACCESSIBLE ASSESSMENTS

+LHM�WLVWSL�OH]L�H�ZPNUPÄJHU[S`�TVYL�KPɉJ\S[�[PTL�JVTT\UPJH[PUN�
their health needs with primary care physicians and generally feel 
SLZZ�JVTMVY[HISL�NVPUN�MVY�WO`ZPJHS�OLHS[O�JOLJR�\WZ��AHaV]L�L[�HS���

IMPROVING COMMUNICATION AMONG PROVIDERS SERVING D/DEAF POPULATIONS



COLUMBIA SOCIAL WORK REVIEW, VOL. XIX  |   55   

1993). In one study, deaf individuals who did not already have some 
SL]LS�VM�OLHYPUN�VY�SHUN\HNL�HJX\PZP[PVU�THKL�ML^LY�OLHS[O�JHYL�]PZP[Z�
than those who did (Barnett & Franks, 2002). In another, patients with 
OLHYPUN�SVZZ�YLWVY[LK�OH]PUN�SV^LY�ZH[PZMHJ[PVU�^P[O�OLHS[OJHYL�X\HSP[`�
�0LaaVUP�L[�HS����������7YV]PKPUN�KLHM�WH[PLU[Z�^P[O�(:3�PU[LYWYL[H[PVU�
whilst receiving treatment for psychiatric care and substance-use 
counseling is of utmost importance, as study participants who received 
(:3�PU[LYWYL[H[PVU�\ZLK�WYL]LU[P]L�ZLY]PJLZ�TVYL�MYLX\LU[S`�HUK�
YLWVY[LK�MLLSPUN�TVYL�ZH[PZÄLK�[OHU�[OVZL�^OV�^LYL�UV[�WYV]PKLK�(:3�
interpretation (MacKinney et al., 1995). 

Although research related to reading comprehension in deaf adults 
remains limited, it has been demonstrated that, on average, deaf 
students' reading levels did not exceed past grade four (Traxler, 2000). 
Considering the advancement of technology and recent emphasis on 
IPSPUN\HS�LK\JH[PVU��OV^L]LY��[OPZ�ÄUKPUN�TH`�UV�SVUNLY�IL�HJJ\YH[L��
Instead, eliminating barriers of communication by identifying gaps in 
language and addressing misgivings, as many deaf clients are not 
properly informed of behavioral health care standards and procedures. 
:VTL�L_HTWSLZ�PUJS\KL�WYV]PKPUN�JSHYPÄJH[PVU�HYV\UK�TLKPJH[PVU�
use and the need for follow-up care (Hommes et al., 2018). However, 
deaf-inclusive clinical mental health services vary from state to state: 
sometimes no deaf services or clinicians are available at all, in which 
case members of the deaf community often have no choice but to opt to 
use hearing-based services. Quality of care is necessarily diminished in 
these cases.

Since most mental health assessments do not include aspects of deaf 
culture, including ASL, undesired results such as misdiagnosis may 
occur during treatments, or patients may experience discomfort and 
reluctance when accepting medical approaches. It is therefore essential 
that materials are translated into a tangible assessment that allows 
both the client and the therapist to determine the best outcomes for 
treatment. 

IMONIE GWALTNEY



56  |  COLUMBIA SOCIAL WORK REVIEW, VOL. XIX  

USING ASL INTERPRETERS 

*SPUPJHS�WYHJ[P[PVULYZ�HYL�MYLX\LU[S`�\UH^HYL�VM�OV^�[V�LɈLJ[P]LS`�\[PSPaL�
interpreters in mental health settings. Common mistakes include the 
clinician speaking too fast or addressing the interpreter instead of the 
JSPLU[��:[HUZÄLSK��� ��"�3LPNO���������:WVRLU�HUK�ZPNULK�SHUN\HNL�
interpreters share a similar fundamental goal of ensuring messages 
IL[^LLU�[OL�SPZ[LULY�HUK�ZWLHRLY�HYL�LɈLJ[P]LS`�[YHUZSH[LK�PU�UH[P]L�HUK�
[HYNL[�SHUN\HNLZ��*OYPZ[VɈLSZ�L[�HS��������!�P[�PZ�PTWVY[HU[�MVY�[OL�JSPUPJPHU�
to understand that common goal.

It is generally recommended that the clinician briefs the interpreter with 
information before sessions with deaf patients in order to ensure the 
following: 

1. interpreter placement 
1.1. The interpreter should be placed where they can be clearly   
 viewed by the client without any visual interference, and where   
 the interpreter's voice is audible to the therapist. 

��� SHUN\HNL�JSHYPÄJH[PVU�
����� 0M�HJYVU`TZ��QHYNVUZ��\UPX\L�]VJHI\SHY`�VY�HU`�V[OLY�\UMHTPSPHY�� �
� [LYTZ�^PSS�IL�\ZLK�K\YPUN�ZLZZPVUZ��JSHYPÄJH[PVU�PZ�ULLKLK�� �
 before the session. 

��� IYPLM�YL]PL^�VM�JVUÄKLU[PHSP[`
����� 0U[LYWYL[LYZ�HYL�YLX\PYLK�UV[�[V�YL]LHS�PUMVYTH[PVU�KPZJ\ZZLK�PU�� �
 session with external sources.

In addition, a break in session, though not generally common in spaces 
where clients are receiving direct support, is important when using 
interpreters; unlike clinicians, interpreters are rarely trained to “hold” and 
process intense emotional or relational experiences in the same way. 
A session break can occur with interpreter input: when the interpreter 
PZ�OH]PUN�H�KPɉJ\S[�[PTL�KLHSPUN�^P[O�[OL�JVU[LU[�VM�[OL�ZLZZPVU�VY�PZ�
overwhelmed by the intensity and speed of the client’s statements, 
they may need a moment to collect themselves and it is not clinically 
inappropriate to allow them to do so. However, it may become clinically 
inappropriate if the clinician feels the interpreter’s emotional responses 

IMPROVING COMMUNICATION AMONG PROVIDERS SERVING D/DEAF POPULATIONS



COLUMBIA SOCIAL WORK REVIEW, VOL. XIX  |   57   

HYL�PU[LYMLYPUN�^P[O�[OL�JSPLU[»Z�X\HSP[`�VM�JHYL��;OPZ�PZ�^O �̀�HZ�KPZJ\ZZLK�
earlier, establishing boundaries to avoid emotional inference during the 
session is important and best done beforehand. 

It is also imperative that interpreters comply and adhere to the code of 
conduct as stated by RID (2007):

7YVMLZZPVUHS�JVKL�VM�JVUK\J[�JLY[PÄLK�HUK�X\HSPÄLK�PU[LYWYL[LYZ�T\Z[!�

��� (KOLYL�[V�Z[HUKHYKZ�VM�JVUÄKLU[PHS�JVTT\UPJH[PVU��
��� 7VZZLZZ�[OL�WYVMLZZPVUHS�ZRPSSZ�HUK�RUV^SLKNL�YLX\PYLK�MVY�[OL�� �
� ZWLJPÄJ�ZP[\H[PVU��
��� *VUK\J[�[OLTZLS]LZ�PU�H�THUULY�HWWYVWYPH[L�[V�[OL�ZWLJPÄJ�� �
 interpreting situation. 
��� +LTVUZ[YH[L�YLZWLJ[�MVY�JVUZ\TLYZ��
5. Demonstrate respect for colleagues, interns, and students of  
 the profession. 
6. Maintain ethical business practices. 
7. Engage in professional development.  

(U`�JVUJLYUZ�HIV\[�[OL�PU[LYWYL[LY»Z�HIPSP[`�YLNHYKPUN�JVUÄKLU[PHSP[`�
should be addressed with the mental health center’s Human Resources 
department, if one exists. In addition to being ethical best practice, 
taking these steps before and during mental health sessions also 
removes the burden of providing interpreter guidance from the client, 
especially if they are in a place of emotional distress. 

+LHM�WLVWSL�YLX\PYL�SPUN\PZ[PJ�HUK�J\S[\YHS�HKQ\Z[TLU[Z�KPZ[PUN\PZOHISL�
from their hearing counterparts. Practitioners familiar with deaf culture 
HUK�^OV�\[PSPaL��YLHJO�V\[�[V��WH`�MVY��HUK�KL]LSVW�^VYRPUN�YLSH[PVUZOPWZ�
with) ASL interpretation to assist in communication are rare. Integrating 
such practices allows the deaf individual to remain in the client role, 
which includes receiving comprehensive care from the clinician, while 
ZPT\S[HULV\ZS`�TPUPTPaPUN�[OL�JSPUPJPHU�Z�\UJLY[HPU[`�VM�[OL�PU[LYWYL[LY�Z�
role prior to and after sessions. When clinicians become empowered 
to increase their familiarity with and cultural capacity for the varying 
and nuanced linguistic and cultural needs of the deaf population, they 
provide deaf people in their region with an important mental health 
resource that this population too often lacks.

IMONIE GWALTNEY



58  |  COLUMBIA SOCIAL WORK REVIEW, VOL. XIX  

INTERPRETER RECOMMENDATIONS

The recommendations for this section are optional but strongly 
LUJV\YHNLK��*SPUPJPHUZ�TH`�ZJYLLU�[OL�PU[LYWYL[LY�MVY�[OLPY�X\HSPÄJH[PVUZ�
by performing a brief check-in with the interpreter before the 
PU[LYWYL[LY»Z�ÄYZ[�ZLZZPVU��;OPZ�PU[LYHJ[PVU�HSSV^Z�[OL�JSPUPJPHU�[V�
KL[LYTPUL�PM�[OL�PU[LYWYL[LY�PZ�H�NVVK�Ä[�HUK�PZ�LTV[PVUHSS`�LX\PWWLK�
to handle ongoing sessions, given that discussions about the client’s 
trauma and adverse life experiences may be discussed. While 
interviewing interpreters, the clinician should decide if the interpreter 
has: 

�࠮ The ability to refrain from making personal statements during 
ZLZZPVUZ��L�N���VɈLYPUN�VWPUPVUZ�[OH[�[OL�KLHM�JSPLU[�TH`�VY�TH`�UV[�
have expressed).

�࠮ ;OL�HIPSP[`�[V�LɈLJ[P]LS`�KLJVKL�TLZZHNLZ�MVY�[OL�ZWLHRLY�HUK�
the listener and to accurately transcribe messages in spoken and 
signed language.

�࠮ A neutral reputation in the deaf community of being able to remain 
unbiased and maintain anonymity.

�࠮ A clear understanding of the roles involved (i.e., the role of the 
clinician, client, and the interpreter themselves).

�࠮ The ability to remain professional; personal emotions should not 
impede the session. 

0M��H�UL^�PU[LYWYL[LY�PZ�ULLKLK�MVY�HU`�YLHZVU��[OL�JSPUPJPHU»Z�ÄYZ[�Z[LWZ�
should be to inform the deaf/HoH client before their next session and 
[V�WYV]PKL�H�IYPLM�L_WSHUH[PVU�MVY�YLX\LZ[PUN�H�UL^�PU[LYWYL[LY��HUK�PM�
possible allow for client input and feedback. The clinician should be 
transparent in their reasoning for the ASL interpreter replacement, 
because transparency is the foundation of a trusting therapeutic 
alliance. Allowing the client’s input in the decision-making process 
ensures the client’s autonomy is intact while making sure the interpreter 
chosen has the ability to remain impartial and maintain emotional 
boundaries. 

;OLYHWPZ[Z�JHU�HSZV�JOVVZL�[V�VW[PTPaL�[OL�\ZL�VM�[OL�PU[LYWYL[PUN�ÄLSK��
as ASL interpretation is not one-dimensional, and D/deaf individuals vary 

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COLUMBIA SOCIAL WORK REVIEW, VOL. XIX  |   59   

PU�[OLPY�L_WLYPLUJL�HJX\PYPUN�WYVÄJPLUJ`�PU�(:3"�ZVTL�OH]L�[OLPY�V^U�
preferred communication style (National Institute on Deafness, 2019). 
Depending on local availability, there can be a variety of interpreters 
^P[O�ZWLJPÄJ�RUV^SLKNL�HUK�ZRPSS�ZL[Z�[OH[�TH`�IL�\ZLM\S�MVY�H�NP]LU�
JSPLU[»Z�ZWLJPÄJ�[OLYHWL\[PJ�JVU[L_[��9LX\LZ[Z�JHU�IL�THKL�IHZLK�VU�
cultural or linguistic needs, because some among the deaf population 
TH`�YLX\PYL�HKKP[PVUHS�SPUN\PZ[PJ�HUK�ZVJPVJ\S[\YHS�JVUZPKLYH[PVU��
Black American Sign Language (BASL) is one example of an ASL 
]HYPH[PVU��(�KLHM�TLU[HS�OLHS[O�JSPLU[�^OV�PKLU[PÄLZ�HZ�)SHJR�VY�
African-American may prefer to work with an interpreter who is from a 
similar racial group, not only because they may feel more comfortable 
communicating with them, but also because the client may feel the 
interpreter is more familiar with the nuances of BASL. This preference 
JHU�HSZV�HWWS`�[V�KLHM�TLTILYZ�VM�V[OLY�THYNPUHSPaLK�NYV\WZ�^OV�ZOHYL�
common cultural struggles and experiences.  

0U[LYWYL[LYZ�JHU�ZOHYL�H�\UPX\L�ZLUZL�VM�JSVZLULZZ�^P[O�[OL�TLU[HS�
health care client when they are from similar linguistic and cultural 
communities that experience social oppression and discrimination. 
Having a connection to the person interpreting can result in greater 
empathy and trust between interpreter and client, since the interpreter 
JHU�LTWH[OPaL�^P[O�[OL�JSPLU[�Z�L_WLYPLUJL��0U�[OH[�JHZL��JVTT\UPJH[PVU�
between the interpreter, mental health care clinician, and client becomes 
TVYL�WYLJPZL�HUK�OHZ�H�TVYL�JVTMVY[HISL�ÅV �̂�

CONCLUSION 

;OL�TLU[HS�OLHS[O�ÄLSK�PZ�ILJVTPUN�TVYL�H^HYL�VM�[OL�KLLWS`�
KPZY\W[PUN�PTWHJ[Z�[OH[�[YH\TH[PaPUN�L_WLYPLUJLZ�JHU�JH\ZL�HJYVZZ�H�
person’s experience of daily life, but more light needs to be shed on 
[OL�[YH\TH[PaPUN�LɈLJ[�VM�UV[�OH]PUN�WYVWLY�HJJLZZ�[V�TLU[HS�OLHS[O�
care due to discriminatory barriers. This experience is common and 
readily apparent with D/deaf populations in this country, and can have 
H�ZPNUPÄJHU[�ULNH[P]L�PTWHJ[�VU�[OLPY�TLU[HS�OLHS[O��(KKP[PVUHSS �̀�NP]LU�
[OL�SPTP[LK�YLZLHYJO�VU�LɈLJ[P]LS`�ZLY]PUN�KLHM�WVW\SH[PVUZ�HUK�[OL�
ZOVY[�Z\WWS`�VM�(:3�ZWLJPÄJ�SPUN\PZ[PJ�HJJVTTVKH[PVUZ�UH[PVU^PKL��
resources to ameliorate this issue remain scarce. The author calls for 
more research addressing linguistics gaps in mental health care on 

IMONIE GWALTNEY



60  |  COLUMBIA SOCIAL WORK REVIEW, VOL. XIX  

the following topics: providing accessible assessments for treatment 
WSHUZ��PUJYLHZPUN�KLHM�YLWYLZLU[H[PVU�PU�[OL�TLU[HS�OLHS[O�ÄLSK�I`�
hiring psychologists from a similar cultural background, and expanding 
resources for deaf populations to receive mental health support. 

Ultimately, ASL interpretation must be provided by behavioral health 
JHYL�WYV]PKLYZ�[V�LUZ\YL�LɈLJ[P]L�JVTT\UPJH[PVU�IL[^LLU�[OL�JSPLU[�
and therapist. It is also critical for clinicians to better accommodate the 
client by learning about cultural dissimilarities and determining treatment 
approaches with cultural considerations in mind. D/deaf and hard-
VM�OLHYPUN�JSPLU[Z�ILULÄ[�^OLU�TLU[HS�OLHS[O�JHYL�JSPUPJPHUZ�LK\JH[L�
themselves and thoughtfully provide culturally responsive care for this 
underserved population.

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IMONIE GWALTNEY