Jessica Holton, a licensed clinical social worker in private practice based in Greenville, North Carolina, works primarily with adults dealing with trauma, addiction, anxiety, grief and loss. But one of her other specialties happens to be working with clients who are deaf and hard of hearing.

SocialWorkLicenseMap.com chatted with Holton about her path to becoming a social worker and her decision to practice in a specialized area.

I didn’t get a bachelor’s in social work, but I decided to do a practicum while earning my undergraduate degree. While doing that, I was connected with therapists and discovered that they were social workers. They let me know that since I wanted to pursue therapy, social work was a pretty good option. Like so many other folks that I encounter today, I didn’t even really know what an MSW program was or what a clinical social worker did. It’s amazing how often I have to explain that.

When I was in undergraduate school, I also took American Sign Language as my foreign language. When I was looking for social work graduate programs, I knew I wanted to study in the South. (I’m originally from northern Arizona and was going to school in southern Arizona.)

At the time, East Carolina University here in Greenville, North Carolina, had a grant program where you could earn your MSW with a deaf and hard of hearing certificate. As far as I know, that was the only program in the nation that offered that at the time. Luckily, I was accepted to the MSW program and the deaf and hard of hearing certificate program. It was by happenstance but good synchronicity.

I had taken a few years off from signing after I took my required undergraduate courses for foreign language. Even though I took additional courses, there were still a couple of years that I didn’t sign very often, so becoming proficient again in sign language was pretty interesting.

I was super-fortunate to have a graduate school classmate who was deaf, so in any of the classes that I had with her, I observed the interpreters and watched them to learn different signs.

One of the things I wished my program would have had is training on how to do an assessment in sign language: What are some of the signs to use or what is the sign for schizophrenia? If I had not had that opportunity to watch the interpreters, that would have been a huge piece missing from my training.

We did talk about deaf culture and talk about what different mental health diagnoses could look like for someone with deafness. For example, how does someone describe schizophrenia when they’re deaf and hearing voices? That’s going to be very different from someone who has their hearing when they’re hearing voices.

My internships had to be in an agency that worked with deaf and hard of hearing individuals. My first short semester-long internship was at a psychiatric hospital, and I think there was one deaf client who came in during that time. Then, my year-long internship was at an alcohol and substance treatment center, and they had a deaf and hard of hearing unit. That treatment center doesn’t have that program anymore, but I was very lucky that I was able to get that experience.

Because I am a clinical social worker, I do therapy with them. However, my caseload isn’t as big as what I might have thought it would have been, and my goal in graduate school wasn’t ever to be in private practice.

When I worked at the treatment center, I was the main therapist or counselor who worked with the deaf clients, both male and female. My hearing clients were male. I would do their assessments, run groups and work with the interpreters. If the interpreters were running behind, I would do simultaneous communication where I was signing while talking. That could be difficult until the interpreter showed up. The treatment center was more well-rounded treatment.

In private practice, a few things have happened. I graduated in 2003, when cell phones were becoming more popular but not smartphones. Since then, video relay has exploded with the deaf population; teletherapy has since gotten more popular, too. So, when it comes to brick-and-mortar therapy, I very rarely have deaf clients now.

When folks do reach out to me, they typically do so because they know that I’m fluent. They don’t want to go through an interpreter, because even though Greenville has about 90,000 people, it’s still a rural area. When you think of the deaf population and interpreters who work with the deaf, interpreters do have a code of ethics, and they’re supposed to keep things confidential. But there’s still a mistrust. I find that when folks contact me, they want to get help with anxiety or grief, but they just don’t want to go through the interpreter. The difference between me and another therapist would be that I can communicate with deaf and hard of hearing clients directly versus having to use another party. 

One is outreach. How do folks even know that I exist? When I worked for the treatment center and had downtime, I worked on making sure to contact folks. That’s when sharing website links was really big. I’d say, “Here we have this resource. Don’t know if you knew about it.” I think I helped contribute to the unit getting more clients.

As a private practitioner, I’ve not put as much energy into advertising other than putting it on my website or indicating elsewhere that’s my specialty because there are other resources, and the deaf and hard of hearing are able to access care in a different way.

Another challenge: If someone knows home sign, which is not American Sign Language, or if they have a cognitive deficit, it’s a little more difficult to communicate with them. Since I’m not immersed in the deaf culture anymore, I would say that’s been a bit of a deficit. There are silent socials and different things that people can attend, but as a therapist, I have felt that I didn’t really want to stay immersed with the deaf culture. I would think, “What if the people at social events need therapy? Would that feel weird?” I’m trying to balance my boundaries.

The one thing that I really, really admire about deaf individuals is that as long as the hearing person to whom they’re coming to for support is making an effort, they are so kind, patient, smart and willing to make that connection. They very much are about connection and about honesty and being direct. Of course, each person would vary, but because they just get right to the point, there’s some benefit there. One of the other things that I enjoy is getting to be that liaison for them and helping them understand.

All of them are, even the ones that are challenging. For instance, I might be dealing with an adult child. Their parents may still be involved because maybe they’re still living at home. Whether working with hearing or deaf clients, dealing with multi-participants in the system can be a challenge. But still, I would say it’s all pretty rewarding to see folks change and evolve, especially with my deaf clients. I know the discrimination that they experience. So often, the term “deaf and dumb” is still used, which is appalling because hearing has nothing to do with intelligence.

I’m fortunate to meet these people, speak the language that they use, and receive their patience and their grace when I do make errors or need some support in my language ability. It’s rewarding to have this niche.

I would definitely say go into it with the passion and the hopes and the dreams that you have, but also be open to change. When I was going in to get my master’s degree and wrote my personal statement, I said that I was going to work with children and families doing art and play therapy. Fast-forward to present time and, even before I graduated, I have worked primarily with adults specializing in trauma, addiction treatment, anxiety, grief and loss. I do not work with children and families in the capacity that I thought I would when I wrote my personal statement.

Be ready for growth, and be ready for evolution. Hopefully that happens throughout your work because it’s a really empowering field to be in if you let it.

This interview was edited for length and clarity.