The Affective Communication Between Deaf Children, their Families and the Rehabilitation Team

By Louise Roberge, psychologist
Marriage and family therapist
Institut Raymond Dewar

In rehabilitation, the objective is to encourage the development of communication in a deaf child. This child and their parents attempt to communicate, in an affective experience on deafness, with the rehabilitation providers. This attempt to communicate is often made without their knowledge, and in an implicit and non-verbal manner. Phenomena such as the child’s symptoms, transfer and counter-transfer, resonate and are involved. It is important that providers receive and try to decode those messages, in order to better intervene.

The aim of this paper is to make the providers more aware of the importance of affective communication with deaf children and their families, and of the use of their subjectivity as a source of information. Since deafness has both individual and interactional impacts, the task is to present certain intra-psychic and systemic concepts which deal with affective communication and then apply these ideas to interdisciplinary teamwork.

We will first deal with symptoms as phenomena of affective communication. More specifically, we will discuss, at first, the intra-psychic meaning of the child’s symptoms.

According to Maud Mannoni (1967), a child’s symptoms are, in fact, disguised, which is meant to indirectly express life’s difficulties. Through their symptoms, the child therefore attempts to communicate even without the child being aware of it. The symptoms may either express the child’s difficulty to adapt to the realities of deafness, perhaps related to the difficulty in coping with their parents’ separation, or with the arrival of a new child into the family.

The symptoms are also an unconscious attempt to solve a developmental issue, which the child is unable to resolve. They express the developmental impasse that the child finds him or herself in.

Here is a clinical exemplification of this point: temper tantrums of a deaf seven year old child, which appeared at about two years of age, following the diagnosis of deafness. In her tantrums, the child expressed her frustration, anger and powerlessness in facing her deafness and her communication difficulties stemming from it. In strongly opposing her mother, the child also attempts to psychologically separate and distance herself. She has difficulties doing it because, like other children, she is unable to find support on language. Therefore, the aggressiveness indicates a difficulty of psychological separation linked to deafness.

After having presented the possible intra-psychic meaning of the symptoms it is appropriate to approach its systemic meaning. This systemic meaning of the symptoms is linked to the child’s message that they unconsciously express concerning the family’s affective experience. Thus, through the symptoms, the child unknowingly is the loudspeaker, the spokesperson of each and all of the family members.

Through her tantrums, the child is the bullhorn of the affective experience for each and all the family members facing the deafness: their anger, grief and also powerlessness to communicate the complexity of emotions at hand through language.

Another affective communication phenomenon relates to the mechanisms of transfer and counter-transfer. Before providing clinical examples, it is important to explain these mechanisms first.

On the subject of transfer, Freud wrote that any individual possesses a mode of personal being to experience their affective relationships. This characteristic mode of being may be compared to a snapshot that happens and repeats itself in the life of the individual, in their affective relationships. Freud writes: "What the client recreates in transfer is … what cannot be thought (translated) or said. Transfer is fundamentally addressed to someone else … and that is in this address that a truth may emerge." (Freud, 1952/1992, p.50-51)

The concept of transfer, which developed with the framework of psycho-analytic individual psychotherapy, may be useful to understand certain phenomena that occur in the relationships between a deaf child and their caregivers.

The following example illustrates this idea. A deaf child, with still little language capacity, spontaneously contacts his speech therapist in the waiting room, by hitting them in the stomach with a small toy car. Let us add that this child’s playtime favourite is crashing cars.

Later, during the intervention process, the care providers learns a secret about the context that surrounded the conception of this child. They are told that the child was "an accident", using a colloquial word. In addition, the practitioners learn that, since the diagnosis of deafness, the parents hurt and confront each other, which the child witnesses. Then, via their behaviour and symbolic games, the child attempts to express, unknowingly, an affective experience linked to some basic issues within the family.

Let us now discuss the concept of counter-transfer and its evolution. In 1910, Freud mentioned, for the first time, the term counter-transfer, which refers to the affective experience of the therapist vis-à-vis the person whom they are counselling. Until 1950, the emotional reactions felt facing the counselling patient were viewed as being related to personal conflicts of the therapists and as being harmful to the therapeutic relationship.

In 1950, Paula Heimann enriched the idea of counter-transfer by observing, within it, a source of information about the patient. Saint-Pierre et al., reporting on Heimann’s idea, write, "counter-transfer conveys … the patient's external world as it is communicated through the exchanges and transactions within the dynamic field of which the therapeutic situation is."

The subjective experience of the caregiver in their relationship with the deaf child and family may therefore constitute a source of information making it possible to better understand one’s clients. In the presentation, clinical examples are submitted.

When a caregiver team intervenes between a deaf child and their parents, systemic concepts become very pertinent in order to understand the emerging phenomena of affective communication.

In the systemic approach, the first cybernetics, which appeared around 1950, gave major importance to the caregiver’s objectivity. The caregiver was considered as a neutral specialist outside of the therapeutic system. Let us, however, recall that the systemic approach was born in reaction to psychoanalysis, which valued transferential and counter-transferential phenomena.

The second cybernetics, which appeared in the early 1980s, considers that a new system is constructed in the relationship between the caregiver (or group of caregivers) and the family served. This new emerging system constitutes the therapeutic system. The second cybernetic confers more value on the caregiver’s subjectivity. New concepts, such as self-reference and resonance, are witnesses of it.

Concerning the concept of self-reference, Maurizio Andolfi wrote:

"The therapist’s motivations and expectations can … neither be neutral, nor of generic order, but they are characterized, on the contrary, by autoreferentiality and are guided by one’s personal beliefs and value system." (Andolfi, 1995, p.130).

As for the concept of resonance, Mony Elkaïm wrote:

"I call resonances those specific assemblies, made up of the intersection of elements that are common to various individuals or human systems, which are mutual constructions of the realities of the therapeutic system; these elements seem to resonate under the effect of a common factor, somewhat like matter that begins vibrating under the effect of a given frequency". He goes on saying: "the feelings that emerge within any member of the therapeutic system have ... a meaning and a function with respect to the system itself where they appear." (Elkaïm, 1995, p.602).

By applying these ideas to counselling with deaf children and family members, one may believe that they awake and amplify specific particular elements, thus resonances, in the team’s caregivers. The subjective experience of the caregivers is, therefore, a major source of information.

Elkaïm wrote:

"We can have a particular feeling, in a specific situation, only if, somewhere, a sensitive string vibrates with ourselves. In my eyes, therefore, the meaning and the function of the vibration of the string should not be sought only in the economy of the individual: they are linked, at the same time, to the system within which the individual finds themselves living this feeling." He adds, "I do not believe that what we feel … is a handicap: those so called handicaps, conversely, seem to me, capable of being transformed into work tools, which constitute valuable assets. (Elkaïm, 1995, p.602).

Other elements of information related to the clinical example, just mentioned, can illustrate the concept of resonance. The young deaf child, referred to above, collaborates little to speech therapy by opposing a lot, notably when both parents were present. The speech therapist and audiologist did not dare to tell the parents that the intervention was going nowhere, that the child did not progress according to the prognosis established based on objective criteria, such as the degree of corrected hearing and hearing loss and the age at the time of the hearing aid. The secret, therefore, gradually established itself between the caregivers and the parents. Later, the caregivers learned that there was also a secret within the family.

Other resonance phenomena produced in relation to this family may also be mentioned. The speech therapist made efforts to quickly obtain results with the child, in resonance with the implicit request of the mother, who worried a lot about the speech development of the child. The audiologist, in resonance with the father, had good hopes that the child would make progress, given the time.

In conclusion, the intervention aims at symbolizing what is not said and what is implicitly experienced first between the caregivers during clinical discussions among themselves and then with the family. What must be done is, therefore, to name what, until then, had been impossible to name. Thus, the counselling attempts to re-establish an essential process of communication development that was shaken by deafness.

In a paper yet to be published, Benoit Virole clearly formulates this idea as follows:

"One of the most important contributions to the study of deafness is the realization that language does not develop on a ‘proto-phonological’ basis, but as an extension of child’s interactional skills in relation to their parental environment. The first critical instance in the life of a deaf child is the establishment of early affective relations. It is known that the establishment of early affective relations is constructed on a biological modality of attachment, and that it cannot be reduced to that alone. … These relations establish themselves through an unconscious process. … Schematically, what the child feels as dangerous and toxic with its primitive view must be pushed to the exterior via behaviour … the contents of these expulsions must be understood by the mother, symbolized by her, and transcribed back into another mode in which her own child may be able to interject their psychic make-up. This process … is jeopardized by the existence of deafness. … Effectively, the fact of the post-diagnosis depression in the mother, whether manifested or hidden, unconsciously and gradually generally alters these exchanges. The child and mother cannot move ahead together into a synergy of unconscious exchanges." (Virole, B., et al., 2003, p.7)

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