John Greer Clark, PhD
The University of Cincinnati
Several years ago, our university went through, what seemed at the time, a major upheaval as we transitioned from a quarter-based institution to the more conventional semester system. In the process several courses in our department that had previously been separate were combined. In subsequent years my teaching of counseling and audiologic rehabilitation have become intertwined which has led to a more hands on, practical learning of both topics.
Preparation of future clinicians within our profession is likely not that different than in other professions in many ways. I am sure that we are not unique in the dilemma that classroom teaching does not always reflect what students practice in their clinical settings. In the 1960s and 1970s we ardently argued that the full management of hearing loss, including the dispensing of products to assist those with hearing deficits, could indeed be done ethically. And we argued that we were the best prepared to provide this service and that we could do it better. I do believe we are better prepared and can fully service those with hearing loss more effectively than other hearing health care professions. However, it is dismaying that we largely adopted the dispensing practices already in place and have not substantially deviated from these over the years to incorporate better use of personal adjustment counseling and to address more fully the rehabilitative needs of patients.
In the classroom, I teach hearing aid fitting and the continued post-fitting needs of the patient with a strong counseling emphasis. My students frequently tell me what I already know: that this is not what is seen in their practicum sites. They seem to have forgotten that I forewarned them of this.
Every Patient’s Story Matters
Clinically, we still fail to engage our patients in the telling of their stories. We believe we can most often predict the impact of hearing loss from the audiogram (Pietrzyk, 2009). But even if we could predict the impact, these are our patients’ stories and our patients have the right to tell their stories to an empathic listener who can guide them through considerations of the impact of the hearing loss through self-assessment measures. While more introspective than other animal species, humans frequently lack the ability to be fully introspective of limitations they do not want to admit or fear to confront. It is normal human nature to avoid what can be perceived as uncomfortable discussions relative to displayed emotions and frustrations. Students need experience in the classroom and in the clinic with broaching these discussions and working toward effective solutions with patients. The teaching of effective hearing loss impact exploration, and using this within motivational engagement work with patients, is now a large part of my combined counseling and audiologic rehabilitation class.
Supporting Change/Using Communication Strategies
Another area I continually expand is discussions and role-play on the provision of communication guidelines to patients. Communication guidelines for patients and communication partners are one of the most effective tools to address the significant hearing deficit that remains for many patients after being successfully fit with amplification (Kricos & McCarthy, 2007). Research continues to indicate that guidelines are not given as often as they should be (Clark, Earl & Huff, in preparation; Stika, Ross and Cuevas, 2002). Hétu (1996) reminds us that one of the driving forces behind any hearing loss coping process often is to avoid being looked at as different. Hindhede (2011) went a step further when he reported that many participants in his study believed that being considered socially incompetent was more acceptable than the negative identity of being viewed as someone with defective hearing. Given these considerations, can we expect patients to effectively make communication guidelines a part of their lives when we give them a printed sheet of suggestions with little discussion? Will they actively tell others about their hearing loss and the accommodations they may need to communicate more efficiently when all they really want to do is avoid being different form others because of their handicap? Clearly, communication management suggestions must be accompanied by discussions that incorporate active cognitive and behavioral counseling. It is likely that when given outside of a full counseling context, the guidelines we provide are not implemented as effectively as we assume.
Counseling instructors are doing a phenomenal job in preparing our future audiologists. These instructors and their former students need to continue to work toward expanding this information outside of the classroom so that our affiliated preceptors can provide counseling-enriched discussions with patients that better align with what students are learning in the classroom.
Clark, J.G., Earl, B. & Huff, C. (2016). Survey of Audiologic Practices/Trends in the US. In preparation.
Hétu, R. (1996). The stigma attached to hearing impairment. Scandinavian Audiology Supplement, Vol 25(Suppl 43), 12-24.
Hindhede, A.L (2011). Negotiating hearing disability and hearing disabled identities. Health, 16(2), 169-185.
Kricos, P., & McCarthy, P. (2007), From ear to there: Historical perspectives on auditory training. Seminars in Hearing, 28(2), 89-98.
Pietrzyk, P. (2009). Counseling comfort levels of audiologists. University of Cincinnati, unpublished capstone.
Stika, C.J., Ross, M., & Cuevas, C. (2002). Hearing aid services and satisfaction: The consumer viewpoint. Hearing Loss (SHHH, May/June), 25-321.