A Phenomenological Study into British Sign Language Users’ Experiences of Psychological Therapies

Abstract

The provision of mental health services for Deaf people in the United Kingdom is mostly from secondary and tertiary health care that caters for the moderate to severe spectrum of mental health issues with little provision from primary care such as psychological therapies. Improving Access to Psychological Therapies (IAPT) was launched in 2008 and found not to be accessible for Deaf people; this resulted in a new BSL IAPT service being set up in 2011. Deaf people were not able to access the BSL IAPT service because of how each Clinical Commissioning Group (CCG) commission services for their local population. Commissioners do not have evidence to show the impact on Deaf people who access therapy with an interpreter versus with a Deaf therapist, and the literature on Deaf people’s experiences in psychological therapies is very limited.

The aim of this study was to investigate the BSL users’ relationships with their therapists by exploring their experiences of therapy alliance in Deaf/Deaf therapy and Hearing/Deaf/Interpreter therapy and to identify best practice for BSL users’ who require psychological therapy.

This qualitative study uses Smith, Flowers and Larkin’s Interpretative Phenomenology Analysis (IPA) approach. Data were collected from 8 participants (7 females and 1 male), who formed two groups: Group 1 had experienced therapy with a Deaf therapist and Group 2 had experienced therapy with a hearing therapist via an interpreter. Semi-structured interviews were conducted with all participants to explore their experiences of psychological therapies. Data were analysed from transcripts and these were coded using NVIVO where themes emerged.

The findings identified 6 broad themes along with 12 overarching sub-themes such as translation problems, the lack of cultural competency, holding back information, issues with there being three people in the room, and feeling safe/unsafe in therapy situations. Some participants reported they use SSE instead of BSL due to the interpreter not capturing the essence of their disclosure. It seems that the client-interpreter-therapist triad and the therapist’s lack of cultural competency causes complications such as therapeutic rupture and making clients feel insecure, frustrated and vulnerable. The benefits of having a Deaf therapist were also apparent, their ability to share their similar experiences, making clients feel validated and less isolated. Combining cultural competency with the sharing of experiences appears to promote a strong therapeutic alliance.
Some of the findings suggest that Deaf people receiving therapy from a hearing therapist via an interpreter encounter negative experiences that are minimised or eliminated in the context of receiving therapy directly from a Deaf therapist. These findings are of importance as they contribute to the evidence around issues that can arise from the triad and the benefits of direct therapy for Deaf people.
The study identified four recommendations for further research. (1) perspectives of Deaf people regarding Deaf therapists, (2) to investigate if the interpreters process of strategic omission removes the essence of the Deaf client, (3) look at the cause and effect on having a third person in the room and (4) explore the views of Deaf people who have experienced both hearing and Deaf therapists using the same approach as this study.