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Background Deaf individuals show a high prevalence of comorbid disabilities and mental health problems but there are barriers in the provision of psychological therapy to this population. Objective This study explored how therapists in outpatient departments handle therapy enquiries from deaf individuals and what they consider the prerequisites for successful treatment to be. Material and methods Using a mixed methods design, all psychotherapists from a medium-sized German city were invited to complete a questionnaire (study 1) and a semi-structured interview (study 2). Out of 209 contacted psychotherapists 71 took part in study 1, of which 8 proceeded to participate in study 2. The questionnaire collected quantitative and qualitative data regarding therapists' experiences with deaf people, handling of therapy enquiries and perceived prerequisites of therapy. The interview further explored the prerequisites identified in study 1. Results Many therapists had no previous experience with deaf people (n = 60; p = 84.5%) and were inclined to decline their therapy requests (n = 69, p = 97.2%), stating a lack of knowledge and professional competence in this area. Intent to treat was associated with therapists' experience with deaf people, chi(2) (1) = 6.378, p = 0.012. Study 2 identified barriers to psychotherapy relating to contacting the therapist, communication difficulties, diagnostic processes and treatment. Conclusion Communication difficulties and a perceived lack of knowledge in treating deaf patients are key challenges associated with therapists' inclination to decline therapy requests from this population. Support networks and training are essential means to improve the accessibility of psychotherapy for deaf patients.