Working Therapeutically with Deaf Families

The Issue

‘Deaf families’ are those where deafness is a defining feature of family culture. Those families where a single member is deaf, or where several children are deaf but the parents hearing, tend to have a predominant ‘hearing’ culture. A Deaf culture (e.g., tapping arms to get attention) is likely to prevail where most family members are deaf and, in particular, where the parents are deaf.

In order for hearing mental health professionals to create helpful relationships with Deaf families, it is necessary to strike a balance between particularist thinking (i.e., Deaf experience of family life seen as unique and distinct from that of hearing families) and universalist thinking (i.e., focusing on commonalities of family experience). An acknowledgment of difference, and of the effects of living as an often misunderstood  minority group, needs to go hand-in-hand with recognition of common challenges faced by all families across the lifecycle.

What We Know

Communication difficulties for Deaf families impact on their access to information about support and resources. The barrier to ‘overhearing’ information not specifically addressed to oneself reduces opportunities for incidental learning, and creates confusion and anxiety. Clearer explanations of agency systems and structures are required. Developing effective working relationships with Deaf families thus requires collaborative working relationships with sign language interpreters (there are no Deaf family therapists in the UK).

Deaf awareness involves understanding and taking account of cultural and linguistic differences, such as ensuring good lighting, seating that allows clear sightlines, and using culturally appropriate language. There also is likely to be a difference in what is conceived of as normal (versus inappropriate), in terms of the roles of children in relation to their Deaf parents. That is, hearing and oral-deaf children of deaf parents are often called upon to ‘language-broker’ for parents.

As family attachments can be jeopardised by communication difficulties, deaf members of hearing families may be more vulnerable to attachment difficulties. However, in Deaf families with an effective, shared means of communication, attachment difficulties are no more likely to occur than in all-hearing families. Attachments are influenced by numerous factors, including how parents were themselves parented, security of relationships outside the family, access to support networks, and experiences that either support or undermine mental health. Deaf and hearing families are equally vulnerable to lifecycle events, whether associated with expected transitions or unexpected changes and loss.

Deaf and hearing parents typically intend to do their best for their children, within their own particular means. They harbour similar hopes and fears, and benefit from similar strategies.

What We Don’t Know

What is the impact on families of a core experience of exclusion from the dominant hearing majority, including long-term difficulties with understanding and being understood? This can lead to a widening cultural gulf, characterised by mistrust of hearing professionals, and with Deaf identities being cultivated partly in opposition to the prevailing hearing culture.

What about the extent of conflicting feelings in regard to identity? Pride (e.g., in the directness of expression afforded by sign language) may co-exist with shame and embarrassment around poor spoken language and literacy skills. The value placed on these skills by hearing society creates extra pressures for Deaf people and invites low self-esteem. Parents may feel anxious about managing their children in public, and might avoid interactions with the hearing community. The close-knit nature of the Deaf community may provide a sense of value and belonging, but at the expense of privacy and confidentiality.

The extra responsibilities carried by children, whilst generally accepted as a normal consequence of an atypical situation, may extend to contexts that place children in positions that adversely affect their development and family roles and relationships. Parents may feel dependent, de-skilled and resentful, and children burdened, anxious, and sometimes scornful of an ‘incompetent’ parent.


Given the above, therapists need to:

  • Acknowledge the likely presence of cultural differences, and demonstrate a willingness to learn from the family’s unique experience.
  • Be sensitive to feelings that stem from a history of exclusion and discrimination, avoiding language that can be construed as blaming.
  • Not take offence at strong language or blunt comments that attempt to ‘test’ the hearing professional’s tolerance, acceptance, and understanding through an overt signalling of Deaf identity.
  • Talk about talking – acknowledge potential communication difficulties, be willing to adapt communication, and agree on how to signal misunderstandings. Discuss management of an interpreter’s break while the family completes a task or reflects on the conversation so far.
  • Develop collaborative relationships with interpreters, setting aside time for pre- and post-session discussions about communication.

Posted on October 2, 2018 by
Cathy Taylor
National Deaf CAMHS,
South West London & St George’s Mental Heath NHS Trust

Further reading