Developing new BSL signs for trauma

Psychological trauma is increasingly present in mental health research and clinical services. However, the psychological trauma needs of deaf people are poorly understood. Significant gaps exist in British Sign Language (BSL) to convey experience, knowledge, research and clinical practice with regards to some aspects of trauma informed care. A Delphi study has identified 8 key words that require new BSL signs to be developed.

A working group met in October 2024 to develop signs for the 8 words listed in the Delphi study as needing a new or better sign. The purpose of the meeting was to:

Develop and implement 8 new BSL signs relating to trauma
Produce guidelines for people using these signs in trauma work
Provide some existing English definitions of the 8 words
Develop video resources for the 8 new signs

BSL signs development working group

Colleagues working in a range of disciplines met in October 2024, including Clinical Psychologists, specialists in the Deaf Service, mental healthcare practitioners, and sign interpreters. The team represented both clinical practitioners and those with lived experiences, and the team worked together to pool their recognised clinical, educational and research expertise and knowledge in trauma care or mental health needs, combined with specialist knowledge of working with deaf populations.

Representatives from the following organisations were present:

The Deaf Service at St Andrew's Healthcare
The Centre for Developmental and Complex Trauma (CDCT), part of St Andrew’s Healthcare
The Deaf Health Charity: SignHealth

1. ALEXITHYMIA

Alexithymia, also called emotional blindness, is a psychological phenomenon in which a person has significant challenges in recognizing, expressing, and describing their own emotions. It is associated with difficulties in attachment and interpersonal relations.

2. Alternative counter-transference

FINAL DEFINITION TO BE CONFIRMED:

(Alternative) counter-transference is a psychological phenomenon that occurs when a clinician lets their own feelings shape the way they interact with or react to their client in therapy. Often, countertransference is unconscious, and both the clinician nor the client realizes it is happening. Countertransference is an important reminder that therapists are human beings too and that they have their own biases, history, and emotions which can influence their thoughts and reactions to clients. (Simply Psychology)

3. COUNTER TRANSFERENCE

Counter Transference refers to a therapist’s emotional reactions to a patient. Similar to transference when a patient transfers their feelings about someone else to the therapist, the therapist may have certain feelings about the patient — e.g. feeling annoyed — that might be linked to events and relationships outside of the therapy, such as the patient’s resemblance to another (annoying) person, or the therapist's family.

4. Imagery rescripted

NOTE: I think this might be a typo on our part. I will question the data we have as I am not clear on about this technique used in trauma work - either it means something to do with 'cognitive restructuring' as in CBT for trauma, or it means imagery re-scripting as in EMDR type work. It possibly may refer to both. In which case I will prepare both definitions for us to work on. (Kevin Baker Note)

5. IMAGINED EXPOSURE

Imagined exposure: A technique used in CBT to gradually expose someone to something that makes them anxious through imagining the situations in which this happens.

6. IN-VIVO EXPOSURE

In-vivo exposure: A technique used in CBT to gradually expose someone to something that makes them anxious. This form of exposure uses real life (in-vivo) situations and events, rather than imaginary situations. For example, a person with a phobia about snakes, will be tasked to handle a real snake.

7. MORAL INJURY

Moral injury (or Moral Distress) is the strong cognitive and emotional response that can occur following events that violate a person's moral or ethical code. Such events can include a person's own or other people's acts of omission or commission, or betrayal by a trusted person in a high-stakes situation. For example, health-care staff working during the COVID-19 pandemic might experience moral injury because they perceive that they received inadequate protective equipment, or when their workload is such that they deliver care of a standard that falls well below what they would usually consider to be good enough.

8. TRANSFERENCE

The process by which emotions and desires originating in a client about another person in their history, such as a parent or sibling, are unconsciously shifted to another significant person, especially to a therapist, during therapy. Example: client feels that their therapist does not believe them, just like the client's mother used to make her feel.

Feedback, Review and Communicating the final signs

We are keen to encourage feedback to gauge reaction to the new signs and ensure there are no conflicts with other signs currently in use.

1. Complete the feedback form

A copy of the BSL Trauma Signs feedback form can be accessed at the bottom of this page. If you are not able to access Microsoft Forms please get in touch via CDCT@stah.org and we will be able to provide you with an alternative copy.

2. Submit your feedback form

The completed feedback form needs to be submitted directly via the Forms app. You can also email CDCT@stah.org to ask any informal questions or to request a discussion with a working group leader, to clarify any points relating to the proposed new signs.

3. Review of feedback and refinement process

Feedback will be reviewed by senior members of the working group. Any significant areas of concern or conflict that have been identified will be debated which may result in further refinement of the sign(s). If this is the case, the new/revised signs will be shared for feedback and the review cycle will be repeated.

4. Signs agreed and shared with end users

Following the completion of reviews for each new BSL sign and once a consensus has been agreed, senior members of the working group will confirm these with the BSL. Videos for each word (one with a lip pattern, and one without a lip pattern) will be provided for each of the 8 trauma words.