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This article describes unique study design considerations for psychotherapy clinical trials conducted in the U.S. Deaf community. We synthesized emergent themes from participant exit interviews with feasibility data and real-life challenges that our team encountered when implementing the Signs of Safety pilot clinical trial, conducted from 2019 to 2022. Particularly illustrative participant accounts were selected to demonstrate five major lessons learned\u2014expanding reach for recruitment; formally assessing participants\u2019 ASL fluency; selecting ethically-sound control groups; streamlining video fidelity monitoring; and making crystallized outcome assessments ASL-accessible. These lessons learned informed the design of the first-ever full-scale psychotherapy trial in the U.S. Deaf community, to be conducted from late autumn 2024 through 2028. This trial will potentially validate the first evidence-based therapy for Deaf people and provide a vital roadmap for conducting Deaf community-engaged clinical trials.<\/jats:p>","DOI":"10.1093\/jdsade\/enaf007","type":"journal-article","created":{"date-parts":[[2025,1,31]],"date-time":"2025-01-31T12:24:11Z","timestamp":1738326251000},"page":"315-323","source":"Crossref","is-referenced-by-count":4,"title":["Psychotherapy research in the deaf community: pilot clinical trial lessons learned"],"prefix":"10.1093","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6141-5013","authenticated-orcid":false,"given":"Melissa L","family":"Anderson","sequence":"first","affiliation":[{"name":"DeafYES! 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