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COUNSELING CULTURALLY DEAF CLIENTS USING THE APS
She is an Advanced Practice nurse (RN-APN) with a specialty in women's health, a BSN in Nursing from Wagner College, a Master of Arts degree in Advanced Nursing Science from New York University and a PhD in Christian Counseling from Cornerstone University.
People from all walks of life facing a crisis, issues, and problems oftentimes find themselves in need of Christian Counseling (CC). This includes a group of people who are considered a linguistic minority, the Culturally Deaf. Culturally (capital D) Deaf people are those who are generally born Deaf, are enculturated into Deaf Culture and who use American Sign Language (ASL) as their primary language. They may have parents who are Deaf and they may be schooled in residential schools specifically for the Deaf where ASL is the primary language used for communication. This group of people should not be confused with (small letter d) deaf, which generally refers to people who have become deafened after the development of linguistic skills and who are enculturated into the hearing world, learning and speaking a distinct voiced language as acquired from their biological family.
Spoken and foreign languages by people of different cultures can more easily be translated into a written language that is easily read and understood by the person fluent in that particular language. As an example, the Arno Profile System (APS) is available in both English and Spanish. A Christian Counselor who is fluent in English and/or Spanish or who is bilingual in both languages is able to manage a Christian counseling session with ease, including administering the APS and offering Biblically based counseling. For the English and Spanish speaking client, the APS, administered in their own language, is an effective tool for temperament analysis profiling necessary for effective Christian counseling.
For the Deaf ASL client seeking Christian counseling, this is not the case because ASL is not a written language, but it is rather a three-dimensional (3D) language that makes use of space, referred to grammatically as Prenominal Reference and/or Sign Space, and sometimes, Listing Technique. Within the ASL 3D grammatical sign space, classifiers (for people, animals, vehicles, objects, geographical locations) are used where all of the following can occur interactionally: dialogue, movement and reference to geographical locations, etc.
As a general rule, Culturally Deaf people who use ASL as a primary language do not understand the grammatical features of the English or Spanish language well. In order to hold effective Christian Counseling sessions with the Deaf, the counselor either needs to be fluent in ASL, or an ASL interpreter needs to be provided. In most states, the American Disabilities Act (ADA) mandates that health care providers and health care facilities must provide a qualified ASL interpreter for each Christian counseling session. It is not always legally advisable for the Deaf client to bring a family member to the session as their interpreter. Although not necessarily against the law, the family member’s skill in interpreting exactly what is said during the CC session may not be accurate and more importantly, the client may have their HIPAA (Health Insurance Portability and Accountability) rights violated with family members at a session who are not specifically part of the counseling process themselves (as in the case of dual client counseling for marriage and family where husband and wife are present).
Because ASL is not word for word English and because the ASL language relies on the use of 3D space as a distinct grammatical linguistic feature, the results of offering the Deaf client a written APS in English or Spanish would more than likely not reflect accurately the temperament of the Deaf client. In addition to the use of 3D space as a major ASL linguistic feature, combined with this is the fact that the grammatical syntax of the ASL language follows a TNAV (Time, Noun, Adjective, and Verb) word order. An example of an English word order sentence transposed into ASL word order would be interpreted in ASL grammatical syntax as follows:
English: If it rains heavily tomorrow, I think I will just stay home relaxed because I hate traveling in the rain.
ASL: Tomorrow (Time) suppose rain, rain, rain (If is interpreted in ASL as suppose and the sign for rain is a Noun that is modulated in space to reflect HEAVY rain so the sign for rain is signed three distinct times in succession), me (personal Pronoun), home (Noun), relaxed (Adjective) remain (Verb), W-Y (in ASL, W-Y/Why is equivalent to the English word, because), Me (Noun), rain, rain, rain, (modulated in space, Noun), travel (Verb), I (personal Pronoun) hate (Verb).
The above ASL interpretation from English into ASL grammatical syntax is offered to show the reader how difficult it would be to re-write the APS using ASL linguistic features required by Deaf people for maximized linguistic understanding.
An Example of a response as written on the currently used APS (60 question) form is as follows: (ADULT APS, response # 9), this response in English reads: I make an effort to have others around me. In addition to the necessary ASL vocabulary needed to clearly sign this sentence, the ASL interpreter would additionally use 3D sign space to clearly portray the statement’s exact meaning. To do this, the ASL interpreter would sign myself, then use a people classifier (portrayed as an ASL d-hand placed in 3D sign space). Next, an ASL people classifier using a 4-hand would be used and moved through 3D space (to) within close proximity of the (already) classified and placed myself d-hand (indicating others around me), followed by two additional signs, I (and) want. The point in sharing the intricate aspects of the ASL Deaf language is for the CC to realize how ineffective the English (Spanish) written instructions and responses currently existing on the APS is to a Culturally Deaf client. Deaf people are a forgotten minority when it comes to health care services, including Christian counseling, but with an understanding of Deafness and the specific ASL linguistic needs of Deaf people, adjustments in how the APS is administered can be easily made.
The heart of our mission is simple. In everything we do, we want to live out Romans 15:13: May the God of hope fill you with all peace and joy as you trust in Him, so that you may overflow with confident hope by the power of the Holy Spirit.
In conclusion, how best can the Christian Counselor effectively counsel the Culturally Deaf client who relies on ASL as their primary language? The guidelines for effective and accurate Christian Counseling and APS administration are listed as follows:
The Christian Counselor realizes that Culturally Deaf people, although a linguistic minority, have their own language which is ASL and this unique 3D language is grammatically and linguistically different from spoken languages, such as English and Spanish.
The Christian Counselor should at all times use a qualified ASL interpreter for each counseling session with Culturally Deaf clients who use ASL as their primary language.
Possibly a qualified ASL interpreter be professionally videotaped for all versions of the APS response forms, including those currently in use for the Adult, Teen and Child. The video is professionally produced and includes a rationale for administering the APS as well as instructions and APS responses for each section listed on the APS form in ASL for viewing by the Deaf client. A separate sheet of paper is provided for the client to write their numerical response to each section of the APS form in use.
Deaf people are made in God’s image and are loved by their Creator. The only thing a Deaf person can’t do is HEAR! The Deaf client’s individual temperament along with identified strengths and weaknesses inherent in their temperament is an important adjunct to effective Christian counseling. Every Christian counseling session is a God-given opportunity for the counselor to present the Gospel to the client, believing that by the power of the Holy Spirit, the client will be saved! May every Christian Counselor be truly blessed as they strive to understand Culturally Deaf people and include them in the opportunity to be counseled within a Biblically-based Christian environment where the Gospel is presented for emotional, physical and spiritual healing and the eternal gift of salvation.
"You are a letter from Christ, the result of our ministry, not with ink but with the Spirit of the Living God, not on tablets of stone but on tablets of the heart." 2 Corinthians 3:3