A Family Therapy Program in Finland

By Pirjo Leino, Finland

It is a pleasure for me to be with you all for a second time already in a short period. Last summer I was in Montreal at the World Congress of the World Federation of the Deaf, and now I am here in Ottawa to bring you greetings from Finland. I would like to thank you for the invitation to come to this conference.

When I was planning this presentation of mine, I was thinking what would be that essential issue, which I should be addressing at this conference. Should I tell you how we in Finland have organized services for deaf people and to give it a bit wider perspective, or should I try to awaken thoughts and emotions in you all, and ask you to think about and deal with them.

We usually talk about rehabilitation services, about rehabilitation. Generally we associate a functional disability to the word ‘rehabilitation’, for which a rehabilitation plan is made for the patient to be rehabilitated and to be able to function independently after that. Usually one recovers from an illness with the help of care and maybe medicines. A mental health patient going through rehabilitation often needs therapy services to support the medical services in order to be rehabilitated back to a functional member in society and to become independent in social skills. How this is all connected with deafness, with a deaf person, when we use the words ‘rehabilitation’ or ‘adaptation training’. I would like to discuss this issue with you all in this presentation of mine, when I at the same time am telling you about the work among deaf people in Finland.

I myself am a sign language user through my family. I have grown and received my elementary instruction in a family brought up by three deaf-blind persons. Later on I received a deaf stepfather and sister Ulla who also is deaf-blind. From 1978 on I have worked in the Finnish Deaf-blind Organization as a field worker for the deaf-blind people. In 1988 I moved to work as a habilitation counsellor for the deaf in the social and habilitation department of the Finnish Association of the Deaf. Since 1995 I have worked as a family, couple and individual psychotherapist, and in 2000 I moved to work as a full-time therapist in the HANDLE project (family therapy project in sign language). I have been fortunate to have an interesting job and have been able to participate in many challenging tasks, where we have been planning how to develop services for the deaf sign language users in Finland.

I have been involved in planning different kinds of adjustment course activities for deaf people, training for sign language interpreters, and at the moment, how to support the parenthood of deaf parents and develop mental health services with the means of therapy.

When we plan services for different populations groups in society, it is very important which language we use, and what we actually mean by it, and what kinds of impressions we create in the majority of the population as well as in the users of the services in question. I am not talking as a researcher to researchers or as a teacher to those who are planning the services, but I am trying to touch you all in one way or another from the grassroots level of a field worker. I have understood that we who are gathered here today are from very different backgrounds; there are deaf, deaf-blind, their family members, fieldworkers and specialists among the participants. When we plan and build services, we should keep the entity in mind. We should remember that each one of us is a physical, mental and social being, a human being. In the work among the sensory impaired people we cannot cut people down into ears, eyes or minds, which could be researched separately. We should first look at our own perception of a human being, and how much we tolerate someone being different, or if we are in a frenzy of curing and correcting everything first. If this is the case, we cannot see humanly.

In the work with the deaf-blind persons in Finland the service provision was changed, when it came to who is paying for the services, from society into internal rehabilitation within the health sector. I remember the first meeting where I invited the senior chief ophthalmologist, senior chief otologist and the doctor responsible for the rehabilitation. The objective was that we could start working with a whole human being. This is how it should be in all working; to work with a whole human being, the whole family with the welfare and equality of everyone to be a member in society as our objective.

Even in Finland we have discussed for years about rehabilitation and adaptation training. The terms stay in use and are misleading. However, we have moved a bit forward and we are talking about "resources for the families" courses instead of adaptation. These courses are paid for by society. The course takes 8+4 days and we organize three of these kinds of courses every year. The basic idea is that we have a structure and time-table for the programme of the day. But the course is built on the resources of the participating families and individuals. We ask them how they are doing and where they need help to get by in their everyday lives. These courses are organized for hearing parents who have deaf or hearing-impaired children, and separately for deaf parents with their children. More than anything else, the families have needed from the workers "big ears" to hear, eyes to see and feelings to feel. Simply said: their being present for them. If we as workers can show that the family is the expert in the situation and to convey respect by giving them the needed space, the gates are open to us for a good and positive co-operation together. I will not use more time to go through the content of the courses in detail because you can read it in this project report. This programme will be successful and develop further, if we are creative during the planning phase.

Through my work I have been thinking of a way of working, which I have described like this (power point). What is the essential issue in this and the in depth observation of where the problem is. It is LANGUAGE, is it not? We are lacking a common language. Sign language is a language, but a mother tongue of such a small minority that deaf people are always facing a language barrier, which they cannot cross because they do not hear. We, the majority of population know sign language so little/badly, so it is the easiest for us to try to make deaf people into hearing. This is not a standpoint on Cochlear Implant-discussion. I am surfing deep because from there I can find grounds for developing services for deaf people on different levels, on the individual level because I am a psychotherapist by profession. As a psychotherapist I have been thinking a lot about the issue of understanding. I understand (I know) sign language, but, do I understand what my client is trying to say/signing. Understanding a language and understanding the issue are two separate things in my opinion. How can I measure how much I understand and if my client understands my ‘handwriting’ so that she or he could be helped with therapy.

Psychotherapy work and developing methods for that work by analyzing is a new, big challenge in my work. I do therapy in sign language every day. I reserve 90 minutes for the families and couples, and 60 minutes for individual therapy sessions, and 45 minutes for remote therapy via video phones. The therapy sessions can take from 10 sessions of crisis therapy to 3-5 years of intensive therapy. What I have written in this report, I will not repeat, but would like to raise ethical and moral discussion besides these issues, discussion that could lead to professional development. My clients have different levels of linguistic competence depending on their education and social skills, interaction skills. I have a few (2-3) hearing clients who are undergoing long therapy. I video record my therapy sessions and compare my own ways of working, if they differ depending on when the client is hearing or deaf or not. I have also training as a therapy supervisor. How do I do research and what do I research in order to supervise other therapists in therapy work with deaf patients?

We are quite alone in our work. With my many years of experience I am thinking what to say, how to phrase my opinions and how to network professionally. This also is a field which often raises emotions because we hearing experts do not always see when we are using our power over an individual person and a family. Is there room to breathe and to sit and think of the services when they are being developed from different viewpoints? I will return to the issue I already mentioned before. How do people get by in their everyday life, which our limited knowledge does not suffice for, but we have to take our clients along in order for us to make services for deaf people in a professional way?

In the end I would like to throw out a question for us all to think about: are we serving deaf people or the good will of hearing people towards deaf people? That which might feel good to us, is not always necessarily good or right for the deaf client or his/her family. That I have learned in my work and I still do have a lot more to learn about and also we have to learn from one another. I do hope that this conference will be able to build this hope a bit further, to develop better services than before and to create fruitful interactions with one another.