Chemical dependency treatment services for alcohol/drug related
problems can be found in most communities, but these services
are rarely culturally appropriate or accessible for Deaf and
hard of hearing individuals. These individuals encounter many
barriers when attempting to secure treatment services. Additional
barriers are faced when trying to adequately serve Deaf and
hard of hearing individuals who represent a racial or ethnic
minority group. Cross cultural competency is necessary if
treatment is to be effective and accessible to Deaf clients
within a chemical dependency treatment program. The purpose
of this article is to discuss the complex issues for clinicians
providing cross culturally sensitive counseling to chemically
dependent deaf and hard of hearing individuals who represent
an additional variety of ethnic, racial or cultural minority
groups. Specific examples will be shared as well as suggestions
for delivering effective clinical services to this population.
What is Culture?
Culture has been defined as: "The shared
values, norms, traditions, customs, arts, history, folklore,
and institutions of a group of people"(Padden,1980).
Leong and Kim(1991) refer to Brislin's (1990) definition of
culture. "Culture refers to the widely shared ideals,
values, formation and uses of categories, assumptions about
life, and goal-directed activities that become unconsciously
or subconsciously accepted as 'right' and 'correct' by people
who identify themselves as members of a society" (Leong
& Kim, 1991, p.112). Schein (1989) reminds us that culture
encompasses institutions, folkways, mores, art, and language.
The intent of this article is not to provide further evidence
that a Deaf culture exists, but to demonstrate the importance
of recognizing therapeutic issues related to cross cultural
counseling within the deaf population. (Padden, 1980; Padden
& Humphries, 1988; Rutherford, 1988).
What is cross cultural counseling and How Can it
be Successful?
Cross cultural counseling is the process of
counseling individuals who are of different culture/cultures
than that of the therapist(Burn, 1992). Much of the information
provided on this topic in professional journals and training
programs focuses on ethnic or racial groups and the impact
culture has on the development of substance abuse problems
and subsequent therapy. The Deaf population as well as other
ethnic and cultural minorities are extremely varied and it
is impossible to make general recommendations regarding counseling
that would accurately apply to all these diverse groups. It
is therefore important not to stereotype any one group based
on general assumptions. It is important for counselors to
be sensitive to and considerate of a client's cultural makeup.
Clinicians encounter many challenging and complex issues when
attempting to provide accessible, effective, respectful and
culturally affirming chemical dependency treatment to a multi-cultural
population of Deaf and hard of hearing individuals.
Recently, counseling of deaf individuals has
gained recognition in the discussion of cross cultural counseling.
Often, tri-cultural counseling situations are encountered
with this population since a deaf client may also represent
various ethnic and racial minority groups in addition to being
a member of the Deaf community. Approximately 75% of Deaf
Americans use American Sign language(ASL) as their primary
means of communication(Vernon, 1991). Therefore, ASL becomes
the primary criterion for identification of membership in
the Deaf community and for promotion of solidarity within
the group. Historically, hearing professionals have had little
knowledge about the Deaf community and were unable to communicate
in ASL. The Deaf community has been subjected to rejection
and domination by the majority(hearing) culture and because
of this, education related to alcohol and other drug abuse
has not matched that of the general population(Rendon, 1992).
Ethnicity and culture is part of each person's
development. Culture is not only a minority experience but
also the experience of members of the majority culture. Therefore,
it is important for counselors to develop an understanding
of culture in two respects. The first, and most obvious, is
to become aware of the client's culture, and secondly for
the counselor to develop an understanding of his or her own
culture including its overt and covert influences. The recognition
of cultural differences becomes critical within the context
of the counseling setting. For example, hearing persons tend
to place personhood ahead of cultural issues while Deaf people
may think of themselves as Deaf first and a member of a specific
ethnicity second. The Rationale which some researchers suggest
is that a common language allows for an ease of communication
which creates a bond and a basis for the transmission of the
culture. Other researchers, however, have emphasized that
for deaf members of ethnic minority groups, the predominant
cultural identity may be the home culture because of the strength
of the traditions in the community and the immediate recognition
of the ethnicity, while the deafness may at first be invisible.(Eldredge,
N. & Hammond S., 1992).
MCDPDHHI Program Description
The Minnesota Chemical Dependency program for
Deaf and Hard of Hearing individuals(MCDPDHHI) is a program
specifically designed and staffed to meet the needs of Deaf
and hard of hearing individuals. Cross cultural counseling
is an integral part of a client's treatment. The program is
part of Fairview Riverside Medical Center in Minneapolis,
Minnesota and serves individuals sixteen years of age and
older from the United States and Canada. Since it's inception
in 1989, the program has worked with over 375 clients from
46 states and 4 provinces in Canada. The MCDPDHHI is unique
in that staff are fluent in American Sign Language(ASL), respectful
of Deaf culture and have expertise working with chemically
dependent individuals who are Deaf or hard of hearing.
A multidisciplinary approach is used with the
12-step model as its therapeutic foundation. A variety of
services are offered to individuals in the course of their
treatment including: chemical dependency assessment, communication
assessment, nursing and medical care, chemical dependency
education, coping and decision-making skills training provided
by a certified teacher of the Deaf, psychological testing,
spiritual care, individual and group therapy, occupational
therapy, recreational therapy, access to outside AA/NA meetings,
individualized treatment planning, family therapy, and aftercare
planning.
Therapeutic approaches used in the treatment
of clients are psycho-educational in nature. Flexible and
creative approaches based on the 12 steps of AA/NA are used
to offer clients information they can use to effectively change
their lives. One important reason for choosing a 12 step approach
was the availability of 12 step meetings and groups all around
the country. A visual approach is emphasized and all education,
information, therapeutic interaction and other activities
are adapted to the individual's specific communication needs.
Clients have a wide variety of clinical needs, ethnic and
cultural backgrounds, communication needs/styles, mental health
diagnoses, and other idiosyncratic issues. Staff attempt to
create and implement treatment plans designed to meet the
needs of each individual client entering the program.
The cross cultural therapeutic relationship
When a hearing counselor enters into a therapeutic
relationship with a Deaf client, cross cultural counseling
may very well be considered multi-cultural counseling. A Deaf
clinician who enters a counseling relationship with a Hispanic
Deaf person is also engaging in cross cultural counseling.
A counselor's sensitivity to a client's cultural makeup is
critical in the development and process of the counseling
relationship. At the MCDPDHHI, it is not unusual to have Deaf
clients from extremely diverse backgrounds programming together
within the same milieu. A white female from a rural community
who has hearing parents and attended a mainstream school without
the assistance of an interpreter may be in treatment at the
same time as an African American, inner city, gay male who
grew up in a home with Deaf parents and went to a residential
school for the Deaf. Realistically, it is not possible to
match a given client with a counselor who represents each
of the same cultural and ethnic characteristics of the client,
but it is critical for clinicians providing substance abuse
counseling to this population to be sensitive to the cultural
and therapeutic needs of clients.
Nancy Eldredge has done a great deal of research
in the area of culturally affirming counseling with American
Indians who are deaf. She discusses the difference between
the orientation to time and space within the Deaf, Anglo and
Indian cultures.(Appendix I.) Within Indian cultures the emphasis
is on the present. The legends from the past are valuable
as metaphors for the present, as well. Time is viewed spatially
rather than in a linear sequence of seconds, minutes and hours;
and events scheduled to occur at a specific time may not be
important to many Indian individuals(Everett, Proctor &
Cartmell, 1983). Within Deaf culture, the orientation is to
the past or present. Stories that are told are carriers of
history, ways of repeating and reformulating the past for
the present(Padden & Humphries, 1988). There is an awareness
of time and schedules within the deaf community but there
is a difference in the degree of importance of the schedule
in comparison to Anglos. Each deaf American-Indian deals at
home with a strong tribal culture and at school with Anglo
society and often deaf culture as well. After these individuals
finish school they may need to make a decision about returning
to the reservation which may mean limited communication but
access to their culture or living in urban areas within the
deaf community with limited cultural access. This is an important
perspective which the effective clinician must appreciate.
Often people in the field of deafness or the deaf community
refer to "Deaf Time": meaning that Deaf people don't
start events "on time," which may be because deaf
people put more emphasis on people and relationships than
the time clock(Padden, 1980). If a meeting is scheduled to
start at 8:00, people may arrive and greet each other at that
time, but often the formal meeting doesn't start until 8:30.
The issue of time and space orientation is important
when setting up a counseling schedule which may only allow
for a 50 minute session or on an inpatient treatment unit
where a daily schedule is posted and clients are expected
to be on time for activities. The counselor may need to set
up a contract with the client so they are aware of the time
the session will begin and end. Counselors should be sensitive
to the cultural differences this kind of schedule expectation
may mean to some clients. This may mean clarifying and explaining
why time expectations are important. At the MCDPDHHI, this
may mean that the first or second time a client is late, the
counselor will sit down and explain the expectations. By the
third time, the counselor would hope that with the help of
the client's peers, they would see the importance of being
on time for scheduled activities. The counselor would also
emphasize the concept of respect and wanting to be on time
so they can benefit from the group therapy experience.
In order to be a competent counselor within
a cross cultural setting a clinician must have personal mental
health, self awareness, the ability to communicate with cultural
sensitivity and adequate supervision(Schein, 1989). It is
the responsibility of professionals in the mental health field
to attend to their own mental health and continuously challenge
any existing biases that may exist that can create barriers
to being an effective clinician. In a recent article Sabatini,
Ponterotto, and Borodovsky (1991) discuss the importance of
focusing on not only the client's cultural identity development
but as importantly on that of the counselor. They believe
that developing multi- cultural sensitivity and competence,
particularly for those culturally encapsulated counselors
unaware of their own ethnocentric biases is a long term developmental
task. In Lockes'(1991) Paradigm of Cross Cultural Counseling
he proposes that self awareness is the first step in getting
to know others. He recommends that individuals consider the
following questions as one way of clarifying their self awareness:
1. What is my cultural heritage? What was
the culture of my parents and my grandparents? With what
cultural group(s) do I identify?
2. What is the cultural relevance of my name?
3. What values, beliefs, opinions and attitudes
do I hold which are consistent with the dominant culture?
Which are inconsistent? How did I learn these?
4. How did I decide to become a counselor?
What cultural standards were involved in the process? What
do I understand to be the relationship between culture and
counseling?
5. What are my unique abilities, aspirations,
expectations and limitations which might influence my counseling
with a culturally different client?
It is important for clinicians to think about
each of these issues and have an understanding of where they
stand prior to entering into the counseling relationship with
a client. Susan Cayleff (1986) illustrates the importance
of the need for counselor competence in stating that:
The counselor-client relationship operates as
a microcosm of the larger American social structure and reflects
the beliefs, stratifications, tensions, and injustices that
exist in American society. ... Like the physician-patient
relationship in the medical model,the counselor-client relationship
is hierarchical and thus replicates the power dynamics evidenced
in other nonpeer relationships. Because professional counseling
personnel have only nonspecific ethical guidelines by which
to conduct their interactions with culturally non dominant
populations...counselors should be aware that their own place
within the larger culture-their social status, sex and race
- will probably influence both what they perceive as problems
and the dilemmas and how they respond to them (p. 345).
Fitzgerald and O'Leary (1990) identify essential
personal characteristics for the effective cross cultural
counselor. They refer to Ivey's (1977) depiction of such an
individual as one who has "communication competence,
ability to generate new ways of describing the world and adaptability
to ever-changing situations. The 'multi-cultural person',
is someone who is adaptive, continually in transition, and
grounded in his/her own cultural reality(Fitzgerald &
O'Leary, 1990, p. 239). Sue and Sue (1990) reinforce this
in describing the culturally skilled counselor as one who
works toward the goal of becoming more competent. They identify
three tasks which are involved:
1. Actively in the process of becoming aware
of his/her own assumptions about human behavior, values,
biases and so on;
2. Actively attempts to understand the view
from the clients perspective;
3. Actively involved in developing and practicing
appropriate and sensitive strategies for working with clients.(p.
166).
Finally, Leong and Kim (1991) list three areas
of competencies recommended for the culturally skilled counseling
psychologist:
1. Beliefs and attitudes-be culturally aware,
in touch with own biases about minority clients, comfortable
with the differences and sensitive to situations which dictate
referral to a same culture counselor.
2. Knowledge-including understanding of sociopolitical
factors effects on minorities, specific knowledge about
the group being served and understanding of institutional
barriers for the minority client seeking services.
3. Skills-ability to respond in a variety
of ways verbally and non verbally, ability to send messages
accurately and ability to use appropriate institutional
interventions.
Strategies for Clinicians working with Deaf and hard
of hearing clients
For counselors seeking competence in working
with persons who are deaf, clinicians need to be aware of
cultural issues related to: identity, maintenance of cultural
group boundaries through bilingualism (English and ASL), enculturation
into the Deaf Community, an organized social network and shared
experience of stigma, and potential inferiority stereotyping
by the majority culture. Cultural identity is established
primarily through the use of ASL and promotes unity in the
group. Interaction between deaf and hearing people as compared
to interactions within the Deaf Community are marked by bilingualism.
The ideal counseling situation consists of one
where the counselor is able to communicate with the client
in his or her preferred communication style. In order for
effective counseling to occur, both the counselor and client
must be able to send and receive both verbal [signed] and
nonverbal messages accurately and appropriately(Sue &
Sue, 1990). Effective communication, interpersonal sensitivity
and communication skills are imperative in any counseling
relationship in order to establish trust and rapport in the
counseling relationship. These considerations are especially
critical when encountering cross cultural counseling situations.
In order to create a culturally affirmative treatment milieu,
the most important task is to affirm and use the language
of the Deaf Community, ASL(Glickman & Zitter, 1989). Clinicians
working with Deaf clients need to be ale to communicate with
each individual client in ASL, Pidgin Signed English, Signed
English, Cued Speech, gesturing, drawing, spoken English or
written English. A client should not have to change his/her
mode of communication to meet the clinician's proficiency
level while also dealing with a variety of other clinical
issues. Competence in the language of the culture is the chief
component to cultural sensitivity(Glickman, 1983). Westwood
and Ishiyama(1990) feel that it is important when working
with ethnic clients for the counselor to understand the client's
subjective experiences, goals, ways of behaving, life plans,
and other significant areas. Often times, clients from various
ethnic and/or cultural minorities are preoccupied in the initial
stages of counseling while trying to determine if the clinician
will be able to understand them. "We have repeatedly
observed in our clinical experience that ethnically distinct
clients often show therapeutic improvements when a counselor
effectively acknowledges and validates their inner world of
experiences, which were previously neglected or uncommunicated
to others" (Westwood and Ishiyama, 1990 p. 165).
Counselors who fit these descriptions and who
have taken responsibility for their mental health and any
biases they may possess can be effective in a multi or cross
cultural counseling setting.
The process of becoming an effective counselor
who is able to work in a variety of multi cultural settings
is an active process that is ongoing. Clinicians must also
recognize the diversity of the client population being served
and know when to acknowledge personal limitations and/or the
need to improve specific skills.
Chemical Dependency Treatment Philosophy
Chemical Dependency treatment for the most part,
has grown out of the Alcoholics Anonymous movement. The overall
emphasis has tended to be to ignore the individual differences
and similarities of each client in order to achieve a positive
therapeutic outcome. The importance of reaching out to others
and not isolating yourself is stressed through the use of
sponsors and self-help groups such as A.A., N.A. and C.A.
The civil rights movement stressed equality for African Americans
and other minority groups but has been called culture or color
blind by some people because it focused on the importance
of treating everyone the same. Later in the sixties and with
the Gallaudet revolt the theme has been one of recognizing
individual uniqueness as well as striving for individual rights.
Paul Pedersen,(1976) formerly of the University
of Minnesota, has written of what he calls "The Culturally
Encapsulated Counselor." Pedersen states: "As the
counselor works with persons belonging to a life style different
from his own for any length of time, he participates in and
contributes to a process of acculturation by himself and his
clients."
Historically, treatment of deaf individuals
has been culturally insensitive and this situation must change
in order to provide effective counseling services to this
population. Clinicians should make sure that they do not assume
that all Deaf people have the same communication preferences
or that all come from the same background. In a treatment
setting, the culturally sensitive counselor will recognize
and respond to individuals with a range of communication modes
and backgrounds. The following examples illustrate this point.
In an inpatient program for deaf persons the group may include
the following individuals who are all in treatment simultaneously:
a Native American or Canadian, raised in a rural area with
no deaf peers and who communicates using home signs(a gestural
system developed in the home environment for communication);
an inner city, white, Hispanic or African American client
who attended a residential school for the deaf, who uses ASL
as the primary means of communication and who is quite streetwise;
and a client who was educated in a mainstream setting, uses
Pidgin Signed English and grew up in a small town. Such a
wide variety of communication modes and personal experiences
poses a challenge for treatment staff who are attempting to
meet the cultural and communication needs of deaf individuals.
The Deaf population, as well as other ethnic
and cultural minorities, are extremely varied and it is impossible
to make generalizations related to approaches that work with
all chemically dependent individuals from diverse ethnic backgrounds.
This intra group diversity poses particular problems for the
counselor. He/she may work with one minority client who presents
a particular set of behavior, attitudes and feelings and the
next client may be completely different. This should not be
a surprise to a counselor since most of us do not know any
other two individuals who have the same personality traits.
Counselors should also keep in mind that women,gay and lesbian
individuals, Deaf individuals and other ethnic and racial
minorities have been oppressed in this society. This oppression
may present itself in counseling sessions with psychological
manifestations.
When counseling services are provided in the
context of treatment for substance abuse problems, Deaf culture
likewise may have an impact. Similar to many other minority
cultures, experiences of oppression and discrimination result
in a "protective posture" by the community. "The
culture of the deaf often provides a shelter and a barrier
to recovery by encouraging isolation and denial"(Rendon,
1992). Patterns of socialization which are a part of the culture
also impact on the provision of substance abuse services.
Valuing and respecting differences between deaf and hearing
people and having a good understanding of one's own values
and biases are crucial to providing effective counseling services
for deaf individuals. Cross cultural counselors need to be
comfortable with the difference that exist between themselves
and their clients without denying or trying to change these
differences. For example, to many deaf adults, the Deaf club
is the center of Deaf community activities and the primary
opportunity for socialization. However, the sale of alcohol
often is the main source of financial support. The counselor
in such a situation must be sensitive to the struggle this
presents for the recovering deaf person. In treatment, a client
may learn of the need to develop new relationships with sober
people upon their return home. However, many communities have
small numbers of deaf people many of whom may be substance
users or abusers.
Counselors working with deaf clients should
consider working together with other professionals(either
within or outside of their own agencies ) to help meet the
cultural needs of the client. For example, if the counselor
has skills to deal with the deafness aspect but is not able
to meet the other cultural needs of an Hispanic client, he/she
might utilize a Hispanic professional and an interpreter to
address the client's Spanish cultural issues. Similarly, counselors
can utilize cooperative planning to make ethnic cultural events
available to their deaf clients. An example of this might
be providing an interpreter for a Native American client to
attend religious ceremonies(e.g. sweat lodge, smudging, burning
of sweet grass) while in treatment.
As previously mentioned, many deaf individuals
may be bi or tri cultural. An example of this would be a deaf
chemically dependent Native American Individual. It is important
to consider the cultural issues related to an individual's
deafness as well as his/her cultural heritage. At the MCDPDHHI,
clinicians attempt to be sensitive and respectful in relation
to Deaf culture and allow the clients from ethnic minority
groups the opportunity to participate in cultural activities
offered with deaf and hearing clients throughout Fairview
Riverside Medical Center's adult and adolescent chemical dependency
programs.
Prior to entering the MCDPDHHI, clients often
have not been fully exposed to their cultural heritage and
its' various ceremonies or celebrations. An example of this
would be with a client who was Deaf, mentally ill and Native
American. Her father was very prominent within the tribe she
was from and they were fairly traditional. She had been exposed
to a number of different ceremonies such as sweatlodges, burning
sweetgrass and ceremonial dancing. She had not had the communication
provided to her which would enable her to fully understand
the ceremonial meaning. While at the MCDPDHHI, she was exposed
to a variety of cultural opportunities and was able to interact
with other native women through an interpreter. This opened
up a new sense of pride and understanding. Without the communication,
this would not have been possible for her.
Once Deaf and hard of hearing individuals from
various ethnic backgrounds complete treatment, they will need
to decide where to live. An example of this may be with a
recovering African-American individual who may feel more comfortable
returning to the old neighborhood, but there they are more
likely to run into drug-using friends. Recovering individuals
need to select a community to live in which will enhance the
chances for sobriety. Peter Bell(1992) has developed a list
of questions a person should ask when they are making the
decision about returning to the previous living environment.
If I decide to stay in my home community:
-
Have I listed all the places where I bought
or used drugs? How will I now avoid them?
-
Have I been honest with myself about the
need to avoid them? If I used at the barber's, am I being
straight with myself that I need to find a new barber?
Have I thought about where I will go for my next haircut?
-
Do I have a plan for how I will face friends
in my apartment building whom I used with? What will I
do when I see them again? Will I tell them I am recovering?
Will I try to avoid them? Will I make up a story?
-
How will I handle facing people I have harmed
or cheated when I was drinking alcohol or using other
drugs?
-
How will I respond to the put-downs of dealers
when I no longer buy?
-
How will I respond to people who don't believe
I really have changed?
If I decide to move to a different community:
-
Have I considered the loneliness and strangeness
I might feel living in a new area where I know few people?
-
Do I have a plan for how to make new friends?
-
Have I thought about transportation to my
job, arrangements for child care, proximity to shopping
areas? How can I begin dealing with these issues and avoid
being overwhelmed? Who can help me?
-
If I have left the black community, do I
feel guilty and, if so, how will I deal with this guilt?
Variables to consider when selecting appropriate
Counseling Services
Many variables need to be considered in determining
the most appropriate kind of counseling services. First, the
desires of the client need to be known. Whether to use a hearing
or deaf counselor is an important as well as difficult issue,
since each may have strengths and skills to offer the client.
The choice of recovering vs. non-recovering counselors is
also significant. One should be aware of the difficulty in
finding deaf counselors trained to work with mental health
and c.d. issues. This task becomes even more challenging when
attempting to find deaf minority individuals to work in these
areas. There is a tremendous need to prepare and train individuals
to work in cross cultural or multi-cultural counseling situations.
The reality of the current situation is that
in most parts of the country, many clients will work with
therapists or counselors who are culturally different. While
efforts are made to train qualified deaf counselors, hearing
counselors can continue working toward developing beliefs,
knowledge and skills which will enhance the effectiveness
of their counseling relationships. Advocacy for multicultural
counseling and substance abuse training for members of the
Deaf community is essential for the promotion of cultural
diversity in the counseling field.
Recommendations for more effective cross cultural
counseling
1. As a counselor, openly address issues of
ethnic and or cultural differences. When the counselor raises
issues such as deaf/hearing status, or ethnicity, it conveys
a message of sensitivity and openness to these differences.
The counselor's recognition and willingness to discuss these
issues can facilitate the development of a therapeutic relationship.
Counselors should also be honest about what they know or don't
know about a client's information if the counselor indicates
openness to learning from the client.
2. The counselor should evaluate the degree
of either the client's status related to culture (i.e. integration,
immersion, acculturation) acculturation or multicultural fluency
by using cues from dress, daily activities, communication,
language, family involvement, community involvement and body
language and eye contact(Eldredge,1992). The counselor should
also evaluate the clients' behaviors within the context of
their predominate cultural identities.
3. When the client and counselor have significant
cultural differences, the development of trust may be expected
to take a longer time. A deaf client who has had repeated
negative experiences with hearing teachers for example, may
have a difficult time trusting a hearing counselor. A white
deaf woman may be uneasy working with a deaf African American
therapist if she has experienced racial difficulties in her
home town. Even in such situations, trust can develop, although
it will probably happen slowly. Allow time for trust to develop
before focusing on deeper feelings. Spend some of the initial
session talking about neutral topics before focusing on counseling
issues.
4. The standard counseling approach of establishing
and maintaining eye contact also may have cultural implications.
A Native American client, for example, may find eye contact
uncomfortable based on the Indian culture. This may be especially
perplexing for deaf clients who need to maintain some level
of eye contact to access visual communication. The counselor
should be aware that even if the client does not maintain
eye contact, this does not mean that they are being disrespectful
or not paying attention. Be sensitive to the fact that some
cultures avoid eye contact and that the counselor should still
use eye contact.
5. Confidentiality is an important and standard
part of the counseling process. In serving members of the
Deaf community, this is an especially crucial area. Members
of the deaf community may be apprehensive about entering a
counseling relationship for fear of the information shared
in the session being told to others within the deaf community.
A grapevine type of communication has been common in the deaf
community so deaf clients are often hesitant to discuss personal
issues for fear that "everyone will know". The concept
of confidentiality is foreign in the deaf community so deaf
clients will need time to develop trust and experience that
confidentiality can work.
6. A counselor who wishes to work with deaf
clients needs to know the current climate and issues of concern
in the Deaf community. For example, if the deaf community
is currently supporting a bilingual, bicultural educational
approach, these issues may surface in the therapeutic process.
The culturally competent counselor will be aware of these
dynamics and be able to understand this as a context for the
client's issues.
7. The culturally competent counselor will be
aware of cultural factors that actually are barriers to treatment
and recovery and those that are not. For example, although
it can be difficult for a recovering deaf person to find a
deaf sponsor, a hearing sponsor can be accessed through a
TTY, interpreter or relay service. The scarcity of recovering
deaf people can be a barrier to recovery but is certainly
one that a motivated client can overcome with information
and support.
8. Pursue supervision with a professional who
is knowledgeable about multi-cultural counseling issues. It
is also helpful to cultivate a relationship with other professionals
who can serve as a resource and as a support. Ideally, these
other professionals will include some professionals who are
deaf.
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