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American Annals of the Deaf

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Psychotherapy with Deaf Clients from Diverse Groups
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m a t e r i a l s  m o d i f i c a t i o n s  t h a t  m a k e  d b t  a c c e s s i b l e

O’Hearn and Pollard (2008) provide details and examples of DBT written materials (workbook and diary cards) that have been modified to accommodate several deaf DBT group skill levels. Minimal modification is made for clients who are fluent in English. A modest number of modifications are needed for clients who are comfortable with a basic, but not advanced, level of English. Finally, major modifications are needed for clients who require materials involving little reading. These materials include more iconic images to represent skills and concepts (O’Hearn & Pollard, 2008). See Figures 1 and 2, which depict diary cards that have been modified for limited readers and for skilled readers, respectively. Note that Figure 1 only shows seven skills and Figure 2 includes all 20 skills that clients are expected to learn over the entire course of DBT skills training. Including all 20 skills in one module might be overwhelming for limited readers, so these groups utilize several diary cards. Therapist can use only skills cards that focus on the current module.

Modifications of DBT materials should not only focus on English-related changes, but should also incorporate material specifically relevant to the Deaf sociocultural experience to foster learning and increase the relevance of such materials for deaf clients (O’Hearn & Pollard, 2008). The DBT interpersonal skill termed “DEAF CAN” provides an example of one such modification. Each letter of this mnemonic stands for a different skill needed to either ask for something or to say no to an unwanted request. In an effort to associate each of these skills with an ASL sign that would translate easily, we modified the mnemonic to become “DEAF CAN.” Not only does this mnemonic relate to a useful, parallel translation of the same DBT concepts, it capitalizes on positive Deaf self-perceptions. (See Figures 3 and 4 for examples of a DEAF CAN worksheet for those with lesser and greater English fluency, respectively.)

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