Ethics in Mental Health and Deafness

5. Ethical Considerations for Counseling Deaf and Hard of Hearing Older Adults

68 5 Ethical Considerations for Counseling Deaf and Hard of Hearing Older Adults Janet L. Pray When mental health professionals discuss issues specific to counseling and psychotherapy with deaf and hard of hearing people, older clients or patients are not typically a major focus (Pray, 1989, 1992). This is not surprising since the mental health field does not focus as much attention on older persons as it does on other age groups. This reality is of concern since the aging population has been increasing steadily (Butler, Lewis, & Sunderland, 1998), and between 2020 and 2030, approximately one in five U.S. citizens is expected to be over age 65 (U.S. Bureau of the Census, 1996). Older persons are also more likely to have hearing loss than any other age group (Schein & Delk, 1974; Hotchkiss, 1987), and among older adults, hearing loss is the third most commonly reported chronic condition (National Center for Health Statistics, 1986). It is likely that in the course of professional practice, a mental health professional whose clientele includes those who are deaf and hard of hearing will be involved either directly or indirectly with older people. It is almost inevitable that those providing services to an older clientele will find themselves working with people who have hearing loss, including those who seek counseling or therapy because of adjustment problems stemming from hearing loss associated with aging. There are many conditions commonly found in the aging population (which includes deaf and hard of hearing older persons, of course) for which mental health services can be beneficial. The incidence of depression among older adults is high, and disability has been found to increase the risk of depression (Steffens, Hays, & Krishnan, 1999). Because people are living longer, Alzheimer’s disease is a growing mental health concern, and there is a need at times to determine whether an older person has Alzheimer’s, depression, hearing loss, or some combination of two or more of these conditions . Medical conditions such as stroke and Parkinson’s disease frequently produce psychological changes in addition to the physical changes, adding to the challenge of successful adaptation. This chapter identifies a number of issues in the area of values and ethics about which mental health practitioners working with older deaf and hard of hearing clients should be aware and examines approaches to dealing with these issues. CONTEXT FOR IDENTIFYING THE ETHICAL ISSUES Ethical issues, dilemmas, and conflicts in practice with older deaf and hard of hearing people arise within the context of societal attitudes, the personal values and attitudes of the professional, and professional values and ethics articulated in the codes of ethics of professions such as counseling, medicine , nursing, psychology, and social work. Professionals are not immune to attitudes in the social context in which they were reared and in which they practice; thus, the personal values of the professional will often reflect attitudes predominant in society. For instance, in the United States, we live in a society characterized by “ageism,” a concept first described by Butler (1969). Ageism is characterized by prejudices, stereotypes, and devalued status based on age, which are akin to attitudes rooted in racism and sexism . Butler et al. (1998) note that “Mental health personnel not only have to deal with leftover feelings from their personal pasts, which may interfere with their perceptions of older persons, but they must also be aware of a multitude of negative cultural attitudes toward older persons, which pervade social institutions as well as individual psyches” (p. 208). In a similar vein, Orr (1982) earlier notes parallels between children, youth, and older adults as having in common being treated with paternalism and having limited participation in decisions affecting their lives. Orr notes that, “To be identified with an age community is to become a member of a peculiar minority group, whose precarious social status is made even more problematic by the fact that it is not one that historically has been identified as disenfranchised ” (p. 256). We live in a society that also stigmatizes deaf and hard of hearing people and makes assumptions about people with hearing loss. Wax (1982), writing about aging and hearing loss, suggests the concept of “double and multiple jeopardy” for people who have more than one kind of devalued status or stigma. Other writers have minimized the effects of hearing loss 69 Deaf and Hard of Hearing Older Adults 70 Janet L. Pray among older persons. Erikson, Erikson, and...