Carolyn Edwards, M.Cl.Sc., M.B.A.

Auditory Management Services

Toronto, Ontario Canada

Most of us as human beings do not invite change into our lives as a natural part of each day. The reality is that we fall into pattern and that pattern is comfort and security. We do anticipate some natural progression in our work or personal life but when unexpected events change the course of our lives, most of us resist that change at the outset.   The way we resist change takes many forms.   We can stay in denial or surprise, we can blame others or we can fight against the change. Specifically resistance may come in the form of delaying – give me more detail, flooding others with the details, intellectualizing, moralizing, OR impulsive action – everything is suddenly fine, I need a solution fast, blaming others without warning OR sustained confusion or denying the impact (I’m not surprised).   Over time, if we accept the changes that have occurred, we can find a flow, and change becomes an ally rather than the enemy we originally perceived.

Resistance is the outward expression of fear – I am afraid – of being vulnerable, of having to change, of losing control, of not knowing what to do, of being different and being rejected because of the difference. Each of us has our own fears based on our life experiences, and yet the underlying fear of the unknown is understood by all of us.

Listening to our clients’ responses is essential to determine where they are in the process of change, because the reality is the diagnosis of hearing loss brings change.

Addressing Resistance

When we are resisting change, we cannot hear others and often we cannot hear themselves either. We may be aware or unaware of our resistance; we can feel the fear and don’t know what it is.   Resistance becomes the only way we know how to communicate at the moment. As professionals, when you are observing resistance in your clients, it is often more effective to address the actual behavior at the outset than the fear itself. For example, the behavior may be the inability to attend the scheduled appointments, the lack of questions, a parent’s inability to follow through with agreements to work with their child, a child’s rejection of support, the desire to talk about the same concerns repeatedly, the disinterest in follow-up appointments, or an adult’s consistent use of amplification or assistive listening devices. The underlying fears will often emerge out of those discussions.

Often professionals have confided to me that they are afraid to speak and confront the obvious resistance and yet the reality is that there is no other place to begin.   ” I notice that you don’t want to attend sessions any longer. I feel frustrated because I’m not seeing any change in Emma”s listening skills . What are you feeling?” or “When you stay silent and don’t say anything, I feel alone in the planning and I wonder if we are on the right track.”   Notice that what is important is for professionals to risk speaking honestly about the impact of the client’s response on themselves rather than avoiding or deflecting to another topic. The former will necessarily create change while the latter will hold the status quo in the professional-client relationship. Our job is to take the first risk in sharing; that is what will open the door to a more honest communication.

Resistance is our response to the fear of loss of control or vulnerability. Chungliang Al Huang and Jerry Lynch in their book Thinking Body, Dancing Mind (1992) describe fear as a clue to assess the risk you are facing and prepare for it properly. They describe fear as a friend to acknowledge and embrace so that you can open to the knowledge that you need to in order to align with the changes.   Those fears will emerge each time there is a transition – from one device to another, from preschool to school entry, elementary to high school, college to first job, changes in relationships or work environment, retirement and aging challenges.

Honour resistance when it arises. Resistance is a teacher for professionals, clients and their families. Brooke Medicine Eagle (1991) once described how she made decisions – “If it’s not a yes, it’s a no.” I have revised that for myself to say -“If it’s not a yes, it’s a no or I don’t know.” Said differently, when you are hesitating or when you are refusing an option, honor that decision. It may be a signal that you need more time or more information or more support or more finances than you currently have. The degree of resistance on the part of professionals, clients or their families is a good barometer of the efficacy of intervention strategies. Mary Pat Moeller, Director at Boys Town Institute for Communication Disorders, offered professionals this sage advice- use time as an ally, not an enemy. Resistance is usually is a clue to slow down, listen more carefully and ask different questions.

Paradoxical Theory of Change

When we finally confront feelings, people, or situations we do not want in our lives any more, we want to get rid of them and move on with our lives. How many readers have stopped smoking or lost weight only to find the behaviors return again at a later date. There is an intermediary step that is essential to change and that is the paradoxical aspect of change. Only when you accept who you are now is change possible, known as the paradoxical theory of change (Beisser 1970). Otherwise you are always trying to change to something new by rejecting who you currently are. When children with hearing loss want to feel their similarities to normal hearing peers, they will not make the transition without first accepting their difference. When they can accept their difference as a child with hearing loss, then their ability to accept themselves as a whole person is possible. When adults refute their identity as a person with hearing loss, use of amplification and other rehabilitation strategies can never be fully embraced.

The audiologist needs to be alert to the client’s attitudes towards hearing loss and bring in their families or communication partners to discuss and explore support as needed.

 As professionals, it is vital that we acknowledge the role of change as a key component in the habilitation process, and strategize with clients and their families to address the issues arising from diagnosis and management of hearing loss.

Revised and excerpted from:

Reflections on Counseling, Loud and Clear, A Cochlear Implant Rehabilitation Newsletter, Issue 2, 2003,   Advanced Bionics Corporation Publication