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Sign Language Studies

American Annals of the Deaf

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Ethics in Mental Health and Deafness

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Case 3

A large rural state has retained a skilled, hearing, CODA, feminist social worker who is employed at a nonprofit advocacy center for deaf people to provide direct therapy for clients via “teletherapy.” Teletherapy is an innovative, cost-effective way to link broadly distributed deaf clients with a qualified therapist by secure computer-connected video cameras and phone lines.

This technique permits more deaf clients to be served by a therapist who now spends very few hours driving from one counseling site to another. After some initial concerns among deaf leaders about privacy and confidentiality were alleviated, the new teletherapy program began.

The social worker provided telecounseling for a 48-year-old deaf woman, Jodi, for about eight weeks, excluding several missed appointments. After a slow start, the teletherapy progressed to include discussions of the client’s sexuality and her reports of an emotionally abusive ex-husband who now had custody of their three hearing children.

What could not be seen on the therapist’s monitor were the severely bitten fingernails, the dilated pupils, the body odor and poor hygiene, the slight hand tremors, the slash scars on the wrists, the demonic tattoos, the needle tracks on the deaf woman’s arms, and her restless leg rocking. The client also made what the therapist thought to be a joke about God and heaven in the television box.

Because the client had been so expressive about her sexuality, ex-husband, and children, the therapist felt the teletherapy was succeeding. Three weeks after the last teletherapy session, the client stabbed her ex-husband with an ice pick, and she was hospitalized for a drug/alcohol overdose.

The client and family members sued the therapist for malpractice alleging that the stabbing and overdose were caused by an unethical therapist who, using the experimental teletherapy to cut costs, missed several key indicators of severe psychopathology. The family also alleged in this malpractice suit that a tape of the teletherapy sessions with Jodi was seen by the therapist’s office staff and her graduate feminist therapy class without Jodi’s permission.

Once again review the elements of a negligence/malpractice suit and the malpractice jury question. Where does the social worker stand? How might you have advised her if you were her supervisor?


Beyond a fundamental understanding of the centrality of professional codes of ethics in deaf client malpractice lawsuits against therapists, it is time to start generating proactive strategies to ensure that deaf mental health clients are served ethically and effectively.

1.   The time has come for social workers, psychologists, mental health counselors, and psychiatrists and their graduate training programs to generate and publish addenda to their standard professional ethical codes regarding essential communication and cultural competencies in serving deaf clients.

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