I know I’m not alone in caring deeply about my clients and wanting them to value themselves. One of the reasons people become psychotherapists is to help others embrace their self-worth. But at times, as a Black, deaf, queer, female therapist, whether I work with hearing clients using an American Sign Language (ASL) interpreter or with deaf clients using ASL directly, this deep caring has presented me with a therapeutic challenge.
I know firsthand what it’s like to feel excluded and underestimated because of deafness and other identities. In the past, whenever I’ve underestimated myself, I’ve started down a slippery path of doubting my self-worth. Today, I know my worth. I also know many deaf people still struggle with valuing themselves in an ableist society. When I have a deaf client in front of me struggling with their sense of worthiness, I want to jump in and fix things. Obviously, that’s not therapy or how it works.
Because of our shared culture of deafness—and my lived understanding of the anxiety that comes with needing to communicate in a hearing world and not getting our needs met—I’ve struggled to learn how to meet my clients where they are without getting too invested in addressing their anxieties and self-esteem issues. I’ve come to see that mirroring—also known as active or reflective listening—can be one of the most grounding and powerful interventions I can use. Repeating a client’s words back to them and checking to see if I’ve heard them accurately amplifies a client’s voice. It helps them focus their attention on hearing themselves, rather than me. It helps me focus my attention on hearing them, too, rather than my own inner commentary. In my experience, this is especially critical with deaf clients, but that process can get complicated when a client struggles with a history of domestic violence.
This was the case with my client Laura. By the time I started working with her, she’d divorced her abusive ex-husband, Richard, with whom she’d raised two sons—now adults. Although she was dating someone new—a man named Saul—she often expressed doubt about her decision to leave Richard. I knew clients in abusive situations don’t just flip a switch and move on. I also knew I couldn’t tell her what to do, and that it was important to help her make her own discoveries about what she deserved in an intimate relationship. But that was difficult when sometimes it seemed like I cared more about her happiness and well-being than she did.
The Same Modus Operandi
“Is it okay that Saul talks to Chrissy every day and sends her texts with heart emojis? Am I overreacting?” Laura asks me one evening at the beginning of our session. I’d been seeing her weekly for nearly four months. Although she’d come in with the goal of processing feelings of anxiety and depression after her divorce from Richard, we frequently got sidetracked into circular discussions about her new boyfriend, Saul.
Laura has asked me some version of this question about Saul and his relationship to Chrissy—and other women in his life—many times in different forms. What I hear in her question is: Am I entitled to be angry about not feeling respected? Is it okay to set limits?
“I think people can talk to others daily and just be friends,” I say. “But what’s most important is how these texts make you feel. If Saul had said, ‘I’m happy to introduce you to Chrissy if that makes you feel more comfortable,’ would you feel the same way as when you call him out on his texts and he gets defensive?”
Laura shakes her head and gives me a wan smile.
“It sounds like these texts felt disrespectful. Is that it?” I ask.
“Yes, that’s it. When he dismisses how they make me feel or turns it around onto me by saying I’m needy, he’s acting just like Richard,” she signs. “He only sees things from his point of view, not mine.”
It’s powerful when Laura recognizes that Saul and Richard often have the same modus operandi. Her face lights up and she signs, “Wow.” But this has happened before, and just as quickly as the insight arrived, it seems to vanish.
“I just don’t want to be alone,” she says, pushing her blonde, freshly blown-out hair away from her face.
I know our work isn’t linear. It’s more of a tango—three steps forward and two steps back. But when Laura progresses, seeing patterns or recognizing her self-worth, and then slips back into self-doubt and anxiety, it unsettles me. I understand the challenges she faces in the hearing world, and with hearing partners like Richard and Saul. Her fear of being alone makes sense to me.
“Did I do the right thing by leaving Richard?” she wonders, searching my eyes. “At least I didn’t feel lonely with him. Was he really that bad?
Richard was that bad. Once, he’d thrown dinner on the floor because Laura hadn’t been willing to go out in a snowstorm to get his preferred brand of tomato sauce. He’d insulted her and told her nobody would find her food appropriate for human consumption. Another time, he’d broken her phone to keep her from communicating with a longtime friend who lived out of state. His aggression, contempt, and controlling behaviors hurt her—although, when self-doubt snuck in, she tended to brush off these incidents with a smile.
“I wish you’d leave him, mom,” Laura’s older son had admitted to her one day when Richard was away at work. “I hate how he treats you.” For years, Laura had known she deserved better, but in the end, it was her son’s words, and the pained expression on his face, that gave her the strength to seek out an attorney and file for divorce. At first, Laura had thought the divorce would be the hardest part of leaving Richard, but once it was finalized, there were new challenges to navigate.
“I’m having a hard time making ends meet,” she told me in one of our sessions. “At least Richard contributed financially. He’s the only man I’ve ever been with who took care of me. We were together for 30 years. We had fun times together. He bought me flowers for my birthday and took me out to my favorite restaurants. It’s not easy to find someone who laughs at the same jokes as you do.”
I always started to worry when she idealized Richard. What if she went back to him? What if I couldn’t guide her in the direction of setting boundaries, developing more self-respect, and choosing healthier partnerships?
My biggest fear was that I’d fail to be the therapist she needed.
The Voice We Most Need to Hear
Like Laura, I met my own partner when I was 23. Immediately, we were drawn to each other. My wife had immigrated to the U.S. from Ukraine at age 12, and I’d lost my hearing at the age of 14. We both understood what it’s like to have your cultural world turned upside down and still be expected to function in school. We experienced many firsts together, like the death of our grandmothers and buying our first apartment. When I lost my mother, my wife picked me up from hospice and let my boss know I wouldn’t be at work. We shared many successes, such as getting advanced degrees and winning awards in our chosen fields. Now we’re raising two sons. At 42, I’m not sure how I’d feel if I didn’t have her to come home to.
My partner enhances my life, whereas Richard had isolated Laura from friends, put her down, and made her life painful and difficult. Often, I desperately want to tell Laura what it’s like to feel secure with a partner who respects your value and is invested in seeing you flourish. I want to tell her that she can have this if only she’d value herself. I know she sees flashes of this; those flashes are what’s kept her from going back to Richard and moving her relationship forward with Saul. Still, the progress isn’t fast, and she often repeats Richard’s words to me as if they’re reliable.
“Richard says he’s changed,” she tells me, “and that there are men out there who are genuinely abusive. He says he’s just emotional.”
“What do you think?” I ask her.
“I don’t know,” she says. “I can’t figure out if I was really abused or not.”
“About one in four women experience abuse that can be verbal or sexual,” I sign. “Often, they don’t report it. Abuse isn’t always about being physically hit.”
According to the National Coalition Against Domestic Violence, about 20 people per minute are physically abused by an intimate partner. This doesn’t include the cases that aren’t reported, nor does it include emotional abuse, which is often more insidious than physical abuse. After all, if you’re not walking around with bruises, it can be hard to call out abuse for what it is.
As a therapist I know this, but I still worry about Laura hearing—and staying connected to—her own voice. I’ve seen so many clients assume they’re overreacting when they’re not. Many domestic abuse survivors are also childhood trauma survivors. In Laura’s case, her father hit her mother when he got mad, which taught Laura to question her own self-worth and believe that as long as she’s not being physically assaulted, she’s in a healthy relationship. Early experiences like these can contribute to anxious or avoidant attachment styles that make safe connection a challenge. They also feed into a distorted view of love in adult relationships. This was part of why Laura struggled to recognize that she was being abused.
I can’t control Laura’s choices; that’s not my job, I can’t be with her every day. In our sessions, I try my best to listen when she tells me that “maybe Richard isn’t so bad.” But I remind her of the things we’ve talked about repeatedly related to domestic violence, the cycle of abuse, and the power-and-control wheel, a tool for identifying patterns of aggressive, controlling behaviors in a relationship.
“From what you’ve shared, Richard intimidated you, put you down, and treated you like a servant,” I tell her. “He made light of his own thoughtlessness and cruelty.”
“I know all that stuff!” Laura says, waving her hand dismissively. “We’ve been over that a hundred times. But I still think maybe he wasn’t so bad.”
Moments like these are challenging. I know she needs something I’m not giving her. She’s not interested in psychoeducation. She doesn’t want to be challenged or reminded of things. I sense she wants me to give her space to have her ambivalence and doubt, to be on her own journey, and to reach her own conclusions. So I use a basic technique that requires me to be present, tune in to Laura’s words, and set aside my own agenda. I practice mirroring her.
“What I hear is you’re wondering if maybe Richard isn’t that bad,” I say. (It’s hard to mirror when you want to shout, Don’t go back to him!) “Is that what you’re telling me?” I ask her.
Laura nods. The lines disappear from her forehead, and her shoulders relax.
Even though she’s not aware of it, Laura teaches me to be patient. I’m learning to walk with her, rather than jumping ahead of her.
Helping Laura Tune in to Her Own Voice
Today, Laura has her hair up in a tight ponytail, and she’s wearing extra eyeliner. She sighs and gives me a look that tells me she’s been doubting herself again.
“Do I stay with Saul?” She starts signing so quickly that I almost can’t follow her. “It feels wrong. I know I love him, but he’s not the man for me. I think I’m using him.”
“Tell me more,” I say. I’m not sure where the word using has come from. “How do you feel like you’re using him?”
“He still lives with his mother. He doesn’t have a stable job. I know he can’t handle adult responsibilities.” She signs all this as if she’s defending him for not being the man she’s looking for. “He talks to Chrissy every day. I don’t have a problem with their friendship—but every day? In one text, she said she missed him and wished they could cuddle in front of a fire. That’s flirting, right?”
Is she really asking me this question because she doesn’t know? I wonder. Maybe she just needs to hear herself ask the question. Maybe it’s her way of looking at the truth of what she already knows is happening but hasn’t wanted to see.
“You’re wondering if saying you miss someone and mentioning cuddling by a fire is flirting,” I say, reflecting her words.
“He said they’re just friends and got so mad when I pressed him on it. He started telling me I sounded jealous and reminded him of his ex!”
We locked eyes for a moment. I could see, in my mind, in big, bold, red letters, the word gaslighting flashing like one of those neon motel signs.
When she questions her own worth, it hurts me. I believe she deserves to know how amazing she is. But as soon as I notice I’m thinking like this, I remind myself that there’s a therapeutic benefit to mirroring her. Laura knows she deserves better, but I can’t repeatedly tell her that. The art of mirroring helps me stay focused on guiding her toward her own inner knowing and reminding her of her own insights, decisions, and realizations. When I mirror her by reflecting what I hear her saying, I’m helping her tune into her own voice. For all of us, that’s the voice we most need to hear.
“I’m just so afraid of being alone.” It’s her familiar refrain. “I’ve been divorced for four years now. That’s a long time. Maybe Richard was as good as it gets, and I should’ve stayed with him.”
“I hear your doubts and how afraid you are of being alone,” I say. Then, unable to contain myself, I add, “Do you remember the pasta-sauce incident?”
“Do you remember why you got a divorce?” I continue.
“Because I was tired of how he treated me, and I didn’t want to be around that abuse anymore,” Laura says. Her signing is strong, clear, and paced.
“Has that changed?” I ask.
Laura shakes her head and sighs. “It’s good to be reminded of things when I forget,” she says.
Laura’s in a process of discovering what she wants—and deserves.
Working with her has taught me—and continues to teach me, every time we meet—to listen deeply. I’m always working on truly listening to my clients’ words and understanding what their words mean to them—not to me.
What will happen if one day, Laura does go back to Richard, or even keeps dating Saul? I know it’s a possibility. If this were to happen, it would break my heart a little—or even a lot.
I remind myself that Laura’s choices aren’t mine to make for her. Working with her now can’t undo 30 years of being with her abusive former partner, or the messages she internalized as a child watching her mother apologize and stay with her father even after he hit her. But many moments give me hope, like when Laura remembers why she left her ex-husband, or when she recognizes a pattern in her life that she doesn’t want to repeat.
I love it when her face lights up and she signs, “Yes! That’s it.”
By Nerina Garcia-Arcement
Christina Dunams’s case study resonated with me as a clinician and sparked my curiosity. I appreciated a glimpse into a different cultural experience, one that doesn’t receive enough attention in our field. Dunams describes working with Laura, a fellow deaf person, using ASL. I imagine Laura appreciated being in the room with a therapist who could speak her language and truly understand her experience on multiple levels, including how her unique challenges as a nonhearing individual in an ableist world might impact her sense of self-worth. I don’t have a lot of experience working with nonhearing clients. As an outsider, I can only imagine and apply clinical theory, while Dunams is in the room with lived insights and genuine empathy, building trust with Laura as she strengthens their therapeutic relationship.
Years ago, before going into private practice, I worked at the WTC Mental Health Program at Bellevue Hospital. I conducted intake interviews and assessed for mental health problems in 9/11 survivors. At times, I had to use phone translation services when interviewing non-English speakers. Not speaking my client’s language was one of the most frustrating clinical experiences I’ve ever had. I recall when a Chinese client spoke for a few minutes and the phone translator then translated the response with a couple of words. No matter how I pressed the translator to elaborate on what my client had said, they didn’t. I felt both the client and I were ill-served by the disjointed interview and our shared inability to connect through a shared language. I was unable to build true rapport and when the client left, I was left feeling like an intrusive stranger who had pried into deeply painful traumatic memories—something I never felt whenever I interviewed individuals in my native languages of Spanish and English. Dunams’s case study reminded me of that experience and the importance of someone speaking your language in the therapy room.
In addition, I couldn’t help but reflect on my own experiences working with clients in abusive relationships or who are survivors of abusive relationships. I identified with Dunams’s pull to want to save them, as well as with the wish to be able to tell them exactly what you see while they struggle with self-doubt. I’ve had to pull myself back numerous times with clients in similar situations, and I admire that Dunams had the self-awareness to be mindful of her countertransference and actively restrain herself from indulging her impulses as she chose instead to mirror. As she points out, mirroring is a powerful and grounding intervention for our clients—and, I’d argue, for ourselves. It forces us to be in the moment and to verify that we’re understanding what our clients want us to know about them. I believe clients want to be truly seen and accepted for who they are. Reflecting back what they say is one way of doing this.
Dunams’s desire to self-disclose resonated with me as well. Self-disclosure has helped many of my clients feel less alone in their struggles, especially throughout the COVID pandemic, when boundaries became more fluid given the realities of telehealth sessions.
Yet when we identify with a client and feel particularly connected to them, maintaining firm boundaries is essential. This is especially important when you work with clients in abusive relationships, where blurred boundaries are already a problem. These clients need us to model what healthy boundaries look like.
When we support our clients in their process of figuring things out for themselves on their own timeline, we’re modeling respect for their capacities. This isn’t easy when we care about our clients and worry about them and want to protect them. When Dunams recognizes that her internal dialogue doesn’t have to be expressed, she’s enacting a healthy internal boundary. When she highlights Laura’s struggles and mixed feelings, actively reflecting back what she believes Laura is communicating, it’s a far more powerful and valuable way of caring for her than telling her what to do.
Christina Dunams, LMSW, recipient of the 2022 Ackerman Clinical Excellence Award, is a psychotherapist in private practice who also works as a full-time high-school social worker. She’s passionate about exploring the intersection of deaf family therapists and hearing families.