“Not a Day Goes By That I Don’t Think About Listening with My ‘3rd Ear’”

(Recent comment by an AuD graduate who has been practicing for several years)

Judith Blumsack, PhD

Associate Professor Emerita

Auburn University

Those of us who teach counseling to Au.D. students can look to a variety of sources as we develop coursework. Descriptions of approaches used by professional counseling educators, colleagues in other health professions who are teaching counseling, and our own colleagues are available to us, and efficacy studies in audiology are beginning to appear (e.g. English & Archbold, 2014). During the time I taught counseling, I used a variety of learning activities. I have no efficacy research to report, but perhaps my experiences with these learning activities and my thoughts about them might be of interest to readers of this forum.

Inviting Visitors to the Class: Patients

Patients Can Be Guest Speakers

Patients and Parents as Guest Speakers

One of the learning activities I used involved inviting patients to visit the class. Each semester, through networking, I located patients who would be willing to join the counseling class for our afternoon group meeting. I should mention that our class met once each week and was three hours long to avoid constraints imposed by the standard 55 minute class session. In scheduling patient visits each semester, I arranged for one of the visitors to be an adult with hearing loss and one visitor to be a parent of a child with hearing impairment. We began each session by briefly introducing ourselves individually and asking the visitors to then do the same. The visitors, though, would keep talking. They would tell us things they thought would be helpful for students to hear. These visits were all memorable, and sometimes they were very moving. The visitors understood that the purpose of their visit to our class was to create a situation where they would be the teacher while the student, with no white coat on, could truly be a student and not a student clinician. Students were encouraged to ask questions. The visitors knew that they could decline to answer a question if they wished, but it is notable that, without exception, the visitors seemed to welcome the opportunity to share their experiences. Here was a situation where listening and understanding was the very purpose of the encounter, not testing, not interpreting results, not making recommendations…….just listening. It was my hope that the students would learn not only about the specifics of that visitor’s experience, but that they would see that patients have much to teach them.

Inviting Visitors to the Class: Professional Counselors

I also thought it might be helpful to invite professional counselors who had taught counseling courses at the graduate level. One benefit of such visits was my being able to observe teaching by an experienced counselor/teacher. One of these visitors had expertise in Motivational Interviewing, which is rooted in Rogers’ person-centered counseling and includes partnership and acceptance in the process (Miller & Rollnick, 2002). That faculty member provided both didactic instruction and a role-playing exercise. Student comments afterward indicated that the class session was very valuable for them.

On another occasion, I was very fortunate to be able to arrange for a video visit from Dr. David Luterman. We moved the class from our usual round table to a “tech room” that was arranged so that Dr. Luterman was able to see the students and talk with them. Immediately after that session concluded, I asked students to discuss and also write down their thoughts. It was clear that Dr. Luterman had provided us all with an experience that was meaningful and memorable.

 in expending file pocketsCase Sharing

While being careful to maintain patient confidentiality, the students in my counseling class were encouraged to share counseling-relevant experiences that they had encountered during the preceding week. Although each class session had a designated theme (e.g. breaking difficult news, issues unique to older adults, etc.) students were encouraged to discuss experiences from the previous week that were fresh in their mind, regardless of topic. The students often commented on the value of the feedback and questions they received from their peers through this opportunity to share with each other.

Role Play

In my classes, we occasionally used role-play as a springboard for discussion or as a practice opportunity. If a student expressed lack of confidence in a specific situation, we might use role-play to give that student an opportunity to “try out” responses and receive feedback in a safe, supportive environment.

Other Activities

Over the course of the years I taught the counseling class, we engaged in a variety of other learning activities. These included:

  • Keeping a personal journal to be read only by the student and to be used for future reference
  • Journal article sharing on a particular topic such as use of translators, tinnitus, etc.
  • And of course reading textbooks (e.g. Clark & English, 2014; Luterman, 2008) which themselves contain suggestion for learning activities.

If I were still teaching, I would consider adding methods such as video demonstrations and use of simulated and standardized patients.

During the process of teaching counseling, I frequently sought student comments about the various learning activities we used and made modifications as seemed warranted. As a profession, we are in the early stages of conducting the needed research to determine which teaching methods best facilitate growth in counseling skills and transfer readily from classroom to clinic (English & Archbold, 2014).

Aside #1: Scheduling the Counseling Course

One could argue that a counseling course would be important for a student to take early in the clinical education process. Those of us who have taught beginning students know, though, that their attention is often focused on learning testing skills, test interpretation, etc. In addition, they may not have an opportunity to encounter many of the issues addressed in counseling courses. I believe that Au.D. students are better able to appreciate counseling course content after they have mastered basic clinical skills and have encountered patients with a variety of concerns. During the clinical rotations that typically occur in the 3rd and 4th year of Au.D. programs, the student encounters many patients and also may be working with clinical supervisors who model different counseling skills, depending on their background and training. Offering the counseling course in the 3rd or 4th year of an Au.D. program provides students with an opportunity to relate these contemporaneous experiences directly to the counseling course content.

Aside #2: Grading

Before finishing this post, I would like to comment on assessment of student performance. For me, assigning a grade for performance in my Au.D. counseling class was very challenging, because I know that learning to become an effective counselor is a growth process that can require a long period time. It has occurred to me that assigning a grade in the counseling class could actually be counterproductive. For different classes, I used different strategies for assigning grades, but I wasn’t comfortable with any of them. Early on, I had tried to arrange with the university for the class to be designated a pass/fail course, but that effort was unsuccessful. In my opinion, pass/fail is an appropriate designation for this course.


It is my hope that the foregoing comments about teaching counseling will be of value to readers who are now or will be teaching this course and that future research will help us to select teaching methods that achieve the overall objective of improving counseling skill.


Clark, J.G. & English, K.M. (2014). Counseling-infused audiologic care. Pearson, NJ.

English, K. & Archbold, S. (2014). Measuring the effectiveness of an audiological counseling program. International Journal of Audiology, 53(2), 115-120.

Luterman, D.M. (2008). Counseling persons with communication disorders and their families (5th ed.). Pro-Ed, Austin, TX.

Miller, W.R. & Rollnick, S. (2002). Motivational interviewing: Preparing people for change (2nd ed.), Guilford, New York, NY.