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American Annals of the Deaf

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Ethics in Mental Health and Deafness

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Codes of ethics are always catching up with practice. For this reason, most experienced therapists know that a commitment to ethics begins with a grounding in the fundamental principles that are the “roots” of all human services codes of ethics. Those principles are nonmaleficence, beneficence, client autonomy, fidelity, and justice (Thompson, 1990). Ethical code language evolves and branches in every direction from these five “roots.”

Since the word deaf does not appear in any therapist code of ethics, negligence/malpractice suits brought by deaf clients are likely to be resolved at the code principles level rather than in the code itself.

Nonmaleficence

Nonmaleficence, or “do no harm,” is appropriately the first ethical principle. Nonmaleficence is not a platitude, particularly with deaf clients. Well-intentioned and not so well-intentioned therapists have harmed deaf clients through pseudoscientific assumptions (“deafness is a pathology,” “deaf mothers are unfit,” “deaf parents are unfit to raise or adopt hearing children”), invalid psychodiagnostics (“deaf people are innately paranoid”), inappropriate therapeutic interventions (e.g., an inappropriate assignment to a hearing Gestalt encounter group), and through early terminations. Some not so well-intentioned therapists are sexual predators (Chester, 1997).

Beneficence

Beneficence means we work to promote the welfare of the client. But the welfare of the client is not always easy to determine. In the service of deaf clients there are no greater assaults on beneficence than paternalism, the encouragement of dependency, and ignorance about the existential phenomenology of deafness and the Deaf community experience. Beneficence means fostering the competency of the client. Beneficence means a strong commitment to clinical supervision and our own professional continuing education.

Client Autonomy

Client autonomy, the ultimate expression of respect for the client as well as his or her personal and cultural differences, means the therapist aspires to neutrality in facilitating client adjustment goals, insights, choices, and problem solving. Our respect for clients includes our respect for client choices and strategies we think are likely to fail. We leave our baggage at the door. Hearing, deaf, hard of hearing, and children of deaf adults (CODA) therapists, particularly those working without supervision, can have different but equally harmful baggage in working with deaf clients. Meaningful informed consent, including an effective explanation of the limits of confidentiality and treatment options is the centerpiece expression of the client autonomy.

Fidelity

Fidelity simply means therapists keep their promises. We accurately represent our skills and ourselves. The credibility of our profession rests on keeping client information confidential, particularly in the Deaf community.

Let me divert your attention for a moment. One of the stepping-stones of legal literacy for therapists is knowing that confidentiality is a therapeutic term, not a legal term. Privilege is a legal term. They are not the same.


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