+1. What is psychotherapy?

Psychotherapy, also referred to as counseling or therapy, is a special process designed to help Deaf people work through any number of concerns or problems they may be experiencing in life.

Some people go to therapy when they are dealing with a particular crisis, such as the end of a relationship or a death. Others seek therapy to help them understand feelings or behavior patterns that may be creating difficulties in their lives. Many people also go to therapy for personal growth and self-understanding. Some people who have unresolved issues from the past use therapy to find ways to make peace with their experiences and move on to healthier and happier lives. Deaf people who experienced communication oppression or abuse while growing up, for example, may use therapy to work through deep feelings related to this.

People with medical issues such as chronic pain, high blood pressure, or ulcers, find that therapy can help with physical, as well as emotional, functioning. Couples go to therapy to learn how to communicate more effectively with each other and enjoy their relationship at a deeper level. Families may participate in therapy when they are experiencing ongoing conflicts that seem to have no solution.

In short, people use psychotherapy to deal with many common and uncommon life issues and transitions. When feelings become overwhelming or when you feel stuck, psychotherapy can help. The relationship between psychotherapist and client involves collaboration, trust, and acceptance. When you work together to understand your emotions, you can learn new and alternative ways of making long-term changes in your life.

+2. How is psychotherapy different from talking with friends and family?

Many people wonder what psychotherapists can offer them that their closest friends and family members cannot. There are many times when a good heart-to-heart talk with a friend can do wonders for cheering up one’s mood and can even bring a new perspective to a problem. You are truly lucky if you have people in your life with whom you can talk. No matter how much they care for you, however, your most cherished friends and family cannot always be neutral when it comes to offering support or advice. They may be affected by whatever decisions you make or they may not understand all of the issues involved. You may not tell them everything you are thinking or feeling. You may want some privacy for talking about certain issues or you may want to discuss problems involving family or friends.

Simply put, a psychotherapist listens to you objectively, with as little bias as possible. A psychotherapist is trained to listen in a special way and to offer direct, honest feedback in a setting characterized by warmth and support. With a psychotherapist, you are less likely to hold back from sharing all of your thoughts and feelings. When you are experiencing ongoing depression or anxiety, or you find yourself facing the same kinds of problems over and over, talking with a psychotherapist can help you understand at a deeper level what is really going on. Therapy is a time for you to focus on yourself without being concerned about taking up someone’s time and without worrying that your secrets will be tomorrow’s news.

+3. Isn't psychotherapy for people who are weak or crazy?

Think about all the different consultants in our society. There are financial planners, lawyers, doctors, nutritionists, personal trainers, interior decorators, and so on. Going to see a psychotherapist for support and guidance in dealing with emotional or interpersonal issues is not much different than going to see one of these consultants for help in another area of your life. Psychotherapy is like getting a consultation for your life. Many, if not most, good therapists themselves have gone through therapy and many do recommend returning to therapy on a regular basis, in much the same way that one may consult with a financial planner or doctor periodically. In general, the people we see in therapy are doing well with most parts of their lives. They may come to therapy to work on a specific issue, to develop a clearer understanding of their lives, or to find alternative strategies for coping with an ongoing problem. Far from being weak or crazy, they are people who have a great desire to live and love to the fullest. And they have the courage to look for more in life.

+4. How often are appointments scheduled?

Most people go to therapy once a week, while others may go twice a week. Having twice-weekly appointments does not necessarily mean that someone has more serious issues or is in bad shape. Meeting twice a week can often work very well when you want to focus intensively on issues. If time is of urgency, such as when someone is very sick or dying, or if an out-of-state family member or friend is visiting and joining you for a limited number of sessions, or if there is a pressing decision or a court matter coming up, going to therapy two or even more times a week can be helpful.

Some people do meet for sessions every two weeks or even once a month. It is important to be aware that while this type of arrangement can be beneficial, it also runs the risk of having sessions turn into “catch up” meetings, when most of the session is spent bringing the therapist up to date on the events of the past two or four weeks. It may be difficult to get to root of the real issues. Still, it may be worth trying biweekly or monthly sessions if this is the only option, given insurance, time, and scheduling constraints. Some therapy may be better than none.

Your therapist will help you figure out what works best for you. After attending therapy once a week for a period of time and after you feel satisfied with your progress and goals, you may begin phasing out therapy by scheduling appointments once every two weeks or once a month. You can always go back to more frequent appointments if you need more support later.

+5. How long can I expect to be in therapy?

This depends on a number of things. Some people feel they have reached a desired understanding and change in their lives after several sessions. It is almost comparable to going to see your doctor for a check-up and learning that your body is running fine and you don’t really need to do anything more.

Other people may attend therapy for a longer time. Your goals and expectations of therapy play an important role in determining how long you stay in therapy. It also depends on how much you bring to sessions, what you choose to share with your therapist, and how open you are to working on issues. If you are mostly quiet and avoid talking in session, your time in therapy may be shorter.

There is no right or wrong length of time to be in therapy. Since you can always learn more about yourself, you may want to continue with therapy until you feel you have reached a point where you have gained all that you can. At this time, you may decide to stop therapy. If you are not sure if you should continue or stop, talking with your therapist about your concerns is helpful.

+6. If I have unsure or negative feelings about my therapy or therapist, what should I do?

Communication is what therapy is all about. The best thing to do is talk with your therapist. Being open and honest about your feelings is an important part of the therapeutic process. It can be more difficult to share negative or unsure feelings about therapy itself than to talk about issues and events that happened outside of the therapy office. If you are concerned about hurting or insulting your therapist, it may help to know that your therapist is trained to deal with these types of conversations. Good therapists will welcome your honesty and want to know more about your feelings.

You may experience sharing your real feelings with your therapist as an opportunity or breakthrough in the therapeutic relationship. Your relationship with your therapist can be described as a microcosm of the other relationships in your life. In other words, how you act with your therapist is usually how you act with other people in your life. If you avoid discussing uncomfortable issues with your therapist, chances are you tend to avoid talking about difficult things with everyone else.

Therapy can be a good place to practice new ways of relating to people. Bringing up any unsure or negative feelings about therapy or about your relationship with your therapist may take some bravery on your part, but the results can be worth it. After discussing your concerns with your therapist, you may have a new understanding of things or you may feel reassured about something that was bothering you. If you continue to be dissatisfied or unhappy with the process, you can always end therapy and seek help elsewhere. Your therapist will gladly give you the names of other therapists whom you can contact for an appointment.

+7. Is it possible to become dependent on my therapist?

Many people worry that they will become dependent on their therapist and end up in therapy forever. They may be afraid that the therapist will try to keep them in therapy longer than they want. There is little chance that this will happen. There may be times when clients become emotionally dependent on a therapist for support, feedback, or interpretations, but these are temporary situations. A period of dependency can be a necessary stage in therapy before the next one. If you really think about it, all relationships involve some kind of dependency. There are healthy and unhealthy types of dependence. Competent therapists do not try to make clients dependent on them in unhealthy ways, but rather, help them learn how to depend on themselves.

+8. What makes therapy successful?

In our view, two of the most important factors in successful therapy are that you feel good about your therapist and that you have the right expectations of therapy. If you view your therapist as a warm, open-minded, competent, trustworthy individual, chances are that you are already off to a good start in therapy. Finding a therapist with whom you feel comfortable and respect can take time. Not everyone “clicks” with the same people; this is true for friends and it is true for therapists and clients as well.

The more clearly you understand how therapy works and what you can expect from it, the more likely you are to have a successful therapy experience. When you first start therapy, you may find yourself experiencing a “honeymoon” period, where everything seems to be going well and you feel very comfortable and eager to go to your appointments. Usually, this period will come to an end at some point. You may start feeling like nothing is really getting better after all. You may become disenchanted with your therapist, drag your feet to sessions, cancel appointments more frequently, or keep secrets from your therapist.

Often these are signs that your problems have begun to show up in your therapy sessions. This is actually a good thing since these problems are the reason you sought therapy in the first place. As uncomfortable or painful as it may be to communicate negative feelings to your therapist, or even to attend regular therapy appointments, try your best to do so. The more honest you are about your feelings at this stage of therapy and the more willing you are to face them, the better the chance that you and your therapist will be able to get to the root of your concerns and work toward their resolution.

One person’s measure of successful therapy may differ from another person’s. As a general rule, as long as you sense that you are getting something from your therapy, you can be fairly certain that you are on the right track. Defining success in therapy is similar to defining success at the gym. One person may use weight loss as a measure of success, another person may consider improvement in mood, someone else may rely on a change in muscle tone, yet another may calculate calories burned per gym outing, and so on. In the same way, each of us, depending on our goals, defines successful therapy in individual ways.

+9. What are common examples of wrong expectations of therapy?

Therapists can be wonderful sources of support in coping with many of life’s challenges. Some things, however, are beyond the scope of the therapist’s job description. A therapist cannot change other people in your life. Clients who come to therapy expecting the therapist to fix someone else will probably end up disappointed. Take, for example, the parents who want the therapist to “cure” their child of the habit of oversleeping and being late for school. If these parents are not willing to look at their own behaviors that could be contributing to the problem, then they will be unhappy when the therapist attempts to focus on their role in the problem (i.e., letting the child watch television late at night).

Therapists also cannot act as referees in arguments involving couples or family members. They don’t blow whistles and declare who is right and who is wrong, unless there is an obvious abusive or life-threatening situation at stake. In such cases, therapists are required to file a report with child/adult protective services or the police. Therapists cannot order a family member to break up with a boyfriend because no one else in the family likes the fact that he has a criminal background. They cannot make a wife stay home and take care of the children if her husband wants her to be a stay-at-home mother. They cannot force one ex to stop backstabbing the other ex in public. They don’t operate as detectives and try to find proof of suspected wrongdoing. When these types of situations arise, therapists can help the upset parties deal with their feelings and figure out the best way of handling the situation. They can mediate couple or family sessions when everyone involved is willing to listen to and respect each other’s feelings.

+10. Is therapy confidential?

Not surprisingly, this is a question that Deaf clients often ask. Due to the closely interwoven social and professional relationships in our community, Deaf clients are much more likely than hearing clients to bump into their therapist outside of the therapy office. A client and therapist might have children who attend the same school or a client’s best friend might also be a friend of the therapist.

You and your therapist may want to discuss how you would like to handle public encounters, if and when they occur. Some clients prefer not to acknowledge the therapist at all, while others are comfortable talking with the therapist about non-therapy topics. Your therapist will respect your wishes and take great care to maintain confidentiality about the therapeutic relationship.

All members of the American Counseling Association and the American Psychological Association follow the Code of Ethics and Standards of Practice which require therapists to protect the confidentiality of their communications with clients. Maryland state licensure laws also protect client confidentiality. As a client, you are guaranteed the protection of confidentiality within the boundaries of the client/therapist relationship. Any disclosure will be made with your full written, informed consent and will be limited to a specific period of time. The only limitations to confidentiality occur when a therapist feels that there is clear and imminent danger to you or to others, or when legal requirements demand that confidential information be disclosed such as in a court case. Whenever possible, you will be informed before confidential information is revealed.

+11. Is it wrong to see a therapist whom I already know from outside of therapy?

You might wonder if it is alright to work with a Deaf therapist whom you know from a social or professional setting. When the therapist and client have another type of relationship outside of the therapy setting, they are said to have a dual relationship. While it is clearly considered unethical for a therapist to see a client if there is a sexual or romantic relationship between them, when there are other types of relationships between the therapist and client (i.e., business, social, or professional relationships), there is more room for interpretation in deciding on the appropriateness of the therapist and client working together. In a community as small and as closely-knit as the Deaf community, clients may find their only available therapy option is to see someone they already know from another context. Seeing someone you already know may be a better alternative than seeing no one at all. There are no statements in any of the codes of ethics for mental health professionals that state it is unethical for therapists and clients to have nonsexual dual relationships.

Therapy can work very well in such situations, provided the therapist and client both have a clear understanding of boundaries and are able to communicate with each other about issues that may arise in the relationship. In many cases, the therapist being familiar with the client’s background or current life can be helpful in therapy. The client may find it easy to trust the therapist as well.

+12. Will I be pressured to take medication?

No, you will most definitely not be pressured to take medication. Taking medication is an individual and very personal decision. It is not something that we take lightly. Medication is suggested only as a last resort and after other alternatives have been tried. Medication can be helpful in the treatment of serious mental illnesses, including schizophrenia and bipolar disorder, as well as certain depressive and anxiety disorders. Research has shown that medication works most effectively when clients also participate in psychotherapy. There are also natural or homeopathic treatments such as St. John’s Wort that some people find helpful.

Therapists may bring up the possibility that a client consider trying medication if they believe the client may benefit from it. If willing, the client will be referred to a psychiatrist for an evaluation. The psychiatrist may then prescribe medication and schedule follow-up appointments to monitor the client’s reaction to the medication. Medication works differently for everyone, thus it is very important to work closely with your therapist and psychiatrist to make sure you are benefiting from any medication or homeopathic treatments you may take.

In some cases, depression, anxiety, or other symptoms can be caused by physical disorders. Your therapist may refer you to your doctor for a check-up to rule out the possibility that your symptoms are caused by a physical condition. Hypothyroidism, for instance, can cause mood changes, low energy levels, and poor concentration.

+13. What is videophone therapy?

Videophone therapy is a therapy session in which the therapist and client communicate with each other using videophones. Although it is always desirable to meet face-to-face for sessions, videophone therapy can be an effective alternative when this is not an option. The biggest advantages of videophone therapy are convenience and accessibility for clients. If you live in an area where there are no signing therapists or if you are unable to travel, you may want to consider videophone therapy. Videophone therapy can also ensure your privacy when you want to see a therapist who lives outside your community.

It is important to be aware that technical difficulties can sometimes cause problems with videophone therapy. Another difficulty can be the lack of nonverbal cues (i.e., the therapist may not be able to see your leg bouncing up and down out of anxiety). Videophone therapy is not appropriate when clients are thinking about hurting themselves or others or if physical or sexual abuse is happening. Some professional licensing boards or state mental health boards may not allow a therapist in one state to do videophone therapy with a client in another state. In this case, you may want to consider videophone life coaching, which can be done across state lines. Since health insurance does not cover life coaching, out-of-pocket payment is required.

+14. Isn't it better to see a hearing therapist than a Deaf therapist?

Sadly, there are some people, Deaf and hearing, who have internalized the idea that hearing people are smarter or more qualified than Deaf people. These people may decide from the outset that they would not benefit from seeing a Deaf therapist. This attitude is referred to as audism, “the notion that one is superior based one’s ability to hear or behave in the manner of who hears” (Humphries, 1977). A more recent term that specifically refers to Deaf people who hold this belief is “dysconscious audism” (Gertz, 2003). The danger in audism lies in its oppression of Deaf people, through stigmatizing and limiting them based on their ability to hear or speak. It is important to be aware of this type potential pathological thinking. Not surprisingly, given cultural and societal attitudes toward deafness, both Deaf and hearing people can be audist in their belief that hearing people make better therapists than do Deaf people.

In all forthrightness, there are no fundamental differences between the qualifications and skills of Deaf and hearing therapists. Both complete the same graduate training programs and adhere to the same professional codes of ethics and standards of practice. Both Deaf and hearing therapists can work effectively with Deaf clients – hearing status is not a determinant of or a barrier to successful therapy.

An important criterion for a healthy therapeutic relationship is that the client and therapist are a good match. For some Deaf clients, there is a certain level of comfort found in seeing a Deaf therapist from a similar background, with similar linguistic and cultural experiences and a shared familiarity with the Deaf community. Being able to relax and know that the therapist understands or “gets it” can go a long way in helping create a trusting therapeutic relationship. So, too, does the ease of communication facilitate an environment conducive to therapy.

Some Deaf clients do worry about a Deaf therapist’s ability to maintain confidentiality. As Deaf therapists, we are very much aware of and sensitive to the need to keep our relationships with clients confidential. Our reputation and credibility as therapists depend on this, perhaps even more so than they do for some hearing therapists, who may not spend as much time working or socializing in the Deaf community. As Deaf individuals, we know how quickly word travels in the Deaf community and we understand, as Deaf therapists, just how protective we need to be about client confidentiality. Our clients can be assured that their privacy is always respected and upheld.

Clients and other mental health professionals who believe that a hearing therapist can interpret family sessions involving Deaf and hearing members should know that it is considered unethical for a therapist to function in this way. As in any professional situation involving Deaf and hearing individuals with different communication needs, a qualified interpreter should be present to ensure clear communication and to allow the hearing therapist to focus solely on therapeutic issues. A therapist trying to function in dual roles, as a therapist and as an interpreter, will fall short of engaging fully in either role, depriving clients of quality services.

Gertz, E.N. (2003). Dysconcious audism and critical Deaf studies: Deaf crit’s analysis of unconcious internalization of hegemony within the Deaf community. Unpublished doctoral dissertation. University of California, Los Angeles.

Humphries, T. (1977). Communicating across cultures (deaf/hearing) and language learning. Unpublished doctoral dissertation, Union Graduate School, Cincinnati, Ohio.

+15. What are art, sand tray and play therapies?

Expressive therapies such as art, sand and play therapies are alternatives to traditional talk therapy. Each of these types of therapy enables clients to gain deeper self-understanding by creating an object or scene that reflects their inner and interpersonal worlds. Working with one’s hands and body allows access to feelings that words sometimes cannot reach. Through the freedom experienced in expressive therapies, clients learn more about themselves and grow in emotionally healthy ways.

Art therapy
Art therapy uses paints, crayons, glue, paper, clay, and other materials to make a picture or object that illustrates the client’s feelings and experiences. It is the process of forming the art that serves as an outlet for communicating these feelings.

Sand tray therapy
Sand tray therapy involves placing miniature people or animal figures and objects in sand-filled tray to create a scene or story. Working with the objects and figures enables clients to have a sense of freedom and control. Healing takes place as the client’s inner world and life experiences become visible in the tray and begin to make sense to them. The therapist uses guided questions to facilitate understanding.

Play therapy
Play is the first way children learn to express their feelings, thoughts, experiences and understanding of the world around them, even before they learn to communicate through language. In play therapy, children select toys to play with, while the therapist observes, asks questions, and joins the play. Parents may also be asked to participate. Just as adults tend to vent and “talk out” their problems, children use play to express their innermost concerns and feelings.

+16. What is life coaching?

Life coaching is an ongoing relationship that helps Deaf people rise to extraordinary levels of fulfillment in their personal and professional lives. Coaching is centered on helping people discover exactly how they can best achieve greater clarity, energy and balance in their lives. When you are considering making changes in your life or trying to solve a particular problem, coaching can help you identify and prioritize your choices. Coaches ask challenging questions that encourage new and alternative ways of thinking. They share honest, constructive insight and feedback to help you reach your full potential and enhance the quality of your life. Many Deaf people can benefit from life coaching. Someone with ADHD, for example, may find a coach invaluable in keeping organized and staying on track for successful professional development. A person who has many great ideas but just can’t seem to get started in making them happen can get a jumpstart by working with a coach. A couple who wants to enjoy greater relationship intimacy and fulfillment can experience this by learning and practicing highly effective communication skills with guidance from a life coach.

Coaching can be done via email, videophone, or telephone. It is an excellent option for Deaf people living out-of-state who wish to make use of the services offered at Deaf Counseling Center. Life coaching is not appropriate when clients are thinking about hurting themselves or others, when there are serious mental health issues, or when physical or sexual abuse is involved. Psychotherapy should be utilized in such cases.

+17. As a hearing person who is interested in counseling Deaf people, how can I best prepare myself to enter the field?

If you have had a chance to read through the Deaf Counseling Center’s website or view some of our blogs, you may already know that Deaf Counseling Center’s philosophy is to empower Deaf clients by pairing them with Deaf therapists. We feel strongly that this type of therapeutic relationship offers many benefits for clients, not the least of which is the opportunity to do therapy with a professional who “understands” the Deaf experience and who shares the language and culture with the client. The clients who see us tend to be clients who are specifically looking for a Deaf therapist. One of the first things they share with us is an immense relief at being able to let go of Deaf-hearing emotional baggage when they step into our offices and start the therapy process on an “equal” footing with a Deaf therapist.

Please know that our philosophy is not intended to be “anti-hearing” in any way – all of us at Deaf Counseling Center have many wonderful and cherished hearing family members, friends, and neighbors. We also have the greatest respect for our hearing colleagues who have already been in the field for some time and who were there for the Deaf community when there were almost no Deaf therapists available anywhere. To them, we accord a “grandfathering” status.

Our position advocating Deaf therapists today is simply based on the fact that we see too many Deaf-hearing issues and power imbalances – political and personal, systematic and individual – tangled up in many Deaf people’s lives, all of which can affect the therapeutic relationship, directly or indirectly. In the same way that African American people may seek African American therapists, or women may seek women therapists, or lesbian/gay people may seek lesbian/gay therapists, as Deaf therapists, our philosophy is for Deaf people to work with Deaf therapists. When it comes to Deaf children in therapy, in particular, it is especially important for them to have access to Deaf therapists who are fluent native signers and able to understand the slight nuances in children’s signing and communication.

Instead of going into the counseling field to work with Deaf people, we strongly encourage hearing people who want to work within the Deaf community, to become interpreters and allies. There is a serious shortage of interpreters all over the US. Hearing people can be great allies by educating their agencies and schools about the value of hiring Deaf therapists or referring Deaf clients to Deaf therapists.

+18. What is relay interpreting?

The Certified Deaf Interpreter (CDI) is an individual who is deaf or hard of hearing. In addition to proficient communication skill and general interpreter training, the CDI has specialized training and/or experience in the use of gesture, mime, props, drawings and other tools to enhance communication. The CDI has knowledge and understanding of deafness, the Deaf community, and Deaf culture. The CDI possesses native or near-native fluency in American Sign Language.

+19. What are 10 ways to improve your mental health?

Taking care of one’s mental health and well-being begins with following these common-sense guidelines.

1. Take care of your basic needs.
Eat regularly and as healthily as possible. Drink water. Make sure you get enough sleep. A body that is well-fed and well-rested will be in better shape to deal with the emotional ups and downs that touch our lives.

2. Exercise.
Walk, run, swim, bike, spin a hula hoop, throw balls for your dog to fetch. Anything that gets your body moving can help elevate your mood. Exercising regularly is associated with the release of positive chemicals in the brain. Be sure to consult your doctor before beginning a serious exercise program.

3. Assess your use of any mood-altering substances or behaviors.
Take an honest look at how much caffeine, alcohol, tobacco, sugar, prescription drugs, or street drugs you use and whether you are oversleeping or overeating. While these substances and behaviors may give an immediate sense of relief to stressful or depressed moods, in the long run they cause more depression and other emotional symptoms. If you feel you may have an addictions problem, seek help. Taking care of harmful habits can free you to focus on improving your mental health.

4. Talk with friends and family.
Reach out for support from people. Sometimes just sharing your worries or concerns can be cathartic. You may find that others have experienced similar feelings or situations and take some comfort in knowing that you are understood.

5. Vent your thoughts and feelings in alternative ways of expression.
Draw a picture, write in a journal, sculpt something out of clay. Pound on a drum, dance in the kitchen, hit a punching bag. Let your feelings out.

6. Be one with nature.
Spending an hour or two in a beautiful, natural setting can be soothing and inspiring. Take a walk through the woods or hike a trail to a scenic view. Get up early in the morning and watch the dew on the grass. Wade a stream or walk in the waves. Plant some daffodil bulbs with your bare hands. Slowing down and taking in the beauty of the natural world reconnects us to our inner selves.

7. Get involved with life.
Take action by joining a committee for an organization or school. Sign up for a karate class or rock-climbing lessons. Finish the photo album you have been putting off. Clean out the shop or linen closet. Doing something for yourself can be empowering.

8. Keep a schedule.
Following a regular schedule as much as possible every day brings stability to your life. Try to eat, sleep and exercise at roughly the same times every day. Life is unpredictable and chaotic in many ways. The more you can make things familiar and predictable, the less anxiety you will feel.

9. Increase your knowledge.
Read books, magazine articles, or web sites related to any special concerns or issues you may be experiencing. Learning from others about how they coped with similar problems can be healing. You may feel less alone in your pain and get some ideas about things you can do to make things easier for yourself.

10. Breathe deeply.
When you are stressed, upset, or overwhelmed, take a moment or two to breathe deeply and slowly. This simple technique can help reduce your anxiety level, and best of all, you can do it anywhere. Learn to meditate or do yoga.

+20. Are sessions recorded or videotaped?

Sessions at Deaf Counseling Center are NEVER recorded or videotaped. Some university counseling centers that use students or interns to provide services are required to record their sessions for learning purposes.  Deaf Counseling Center only uses licensed professional clinicians.  You can be assured that you get the most privacy here with us.

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