Cognitive-Behavioral Therapy for Deaf and Hearing Persons with Language and Learning Challenges (review)

Abstract

Reviewed by: Cognitive-Behavioral Therapy for Deaf and Hearing Persons with Language and Learning Challenges Martha A. Sheridan (bio) Cognitive-Behavioral Therapy for Deaf and Hearing Persons with Language and Learning Challenges, by Neil S. Glickman (New York: Routledge, 2008, 420 pp., paper, $46.76, ISBN 978-0-8058-6399-4) In his groundbreaking new book, Cognitive-behavioral Therapy for Deaf and Hearing Persons with Language and Learning Challenges (2008), Neil S. Glickman has established himself as one of the world's most progressive mental health professionals working with deaf people. The book, which focuses on the psychiatric treatment of people who are deaf, will shape the work of mental health professionals working with this population for years to come. Glickman's passionate and intelligent commitment to his work leaves no excuse for the "custodial care" (Vernon and Daigle-King 1999) that deaf people in psychiatric facilities have historically received. He makes a sincere, concerted effort to reach traditionally underserved clients with an in-depth, critical assessment of the process, and he attempts to teach others to do the same. The culmination of twenty years of developing a treatment program and a consistent assessment of what does and does not work, this how-to book reads in part like an ethnography by taking us into the minds of the clients and the staff at Westborough State Hospital, where Glickman works. Glickman bridges the gap between theory and effective practice with a language minority. He provides the most comprehensive [End Page 105] discussion to date of the history, research, diagnostic and treatment complexities, and challenges of working with a segment of the population of deaf people, which he describes as language and learning challenged (LLC) due to developmental language deprivation. An important premise of this book is Glickman's assertion that the majority of deaf clients in psychiatric in-patient facilities are not mentally ill, although some may experience mental illness in addition to the developmental challenges they face. Rather, they are language dysfluent. He affirms that language dysfluency, the result of language deprivation in the developmental environment, leads to problems in behavior, social interaction, and cognitive functioning yet is largely preventable. He argues that deaf people who are language dysfluent and those with borderline and mild mental retardation, traditionally referred to as low functioning or underserved, provide the greatest challenges for professionals in mental health, rehabilitation, and education. The perspectives and stories that Glickman shares in his book finally articulate what mental health professionals working with deaf people have been trying to both understand and explain for years. He illustrates power dynamics in mental health treatment that can retraumatize deaf people who have experienced oppressive forces in their developmental environments. Well-meaning but misinformed professionals may mistakenly label language dysfluent clients as psychotic as a result of their overreliance on language-based assessment tools. Believing that deaf clients are poor candidates for psychotherapy rather than recognizing themselves as poor candidates for the profession of psychotherapy, these professionals often refer deaf clients to specialized mental health facilities with culturally and linguistically specialized staff. However, Glickman admits that even specialized mental health facilities with staff members who are deaf are hard put to meet the needs of language-deprived and language-dysfluent deaf persons. He asserts that effective treatment with this population must move beyond the necessary cultural affirmation, accessible communication, and American Sign Language skills and that simply providing an interpreter is insufficient. Rather, a concerted effort to modify our assessment, theoretical, and programmatic approaches; a professional self-awareness of our practice competencies; and an understanding of the clients' unique developmental and cognitive abilities are required. [End Page 106] In an exhaustive and enlightening discussion of this subject, Glickman addresses the long-standing and perplexing question of auditory hallucinations among deaf people with mental illness. In particular, he explores the concept and nature of auditory hallucinations and the way in which they are diagnosed and expressed by deaf consumers who may not have the language skills to describe the experience. He offers guidelines for a culturally informed assessment of hallucinations and delusions in deaf people that involves multiple measures rather than a sole reliance on language-based assessment. Glickman presents case...