Effective Counseling Principles in Audiology

Transcription

1 Effective Counseling Principles in Audiology John Greer Clark, Ph.D. University of Cincinnati Clark Audiology, LLC Saturday, September 29, 2012

2 Learner Outcomes: Attendees will be able to outline three counseling approaches that can lead to more effective adjustment to hearing loss and acceptance of treatment plans. Attendees will be able to identify common blocks to effective counseling and patient information retention.

3 Effective Listening A Precursor to Trust Are we listening in a manner that is conducive to an in-touch perception?

4 Do you ever ask people to repeat what they just said, even in a room that is not particularly noisy? Do you ever plan on how you are going to respond (e.g.: fix the problem) to someone when that person is still talking? Do you ever pretend that you are paying attention to someone? Do you ever pay more attention to how the speaker looks, or what words he/she is using, rather than what is being said? 5 always, 4 = frequently, 3 = occasionally, 2 = rarely, 1 = never

5 Do you ever find yourself waiting until a person pauses so that you can let him/her know what your opinion is about the situation? Does your mind tend to wander when you are listening to someone speak about something that you know about? Do you primarily assess the facts presented failing to listen for possible underlying emotion? 5 always, 4 = frequently, 3 = occasionally, 2 = rarely, 1 = never

6 Do you multi-task when listening to someone speaking? Do you get so angry or concerned about what someone is saying that you have difficulty listening to what is being said? Does your mind tend to wander when you are listening to a topic that is difficult for you to understand, uninteresting, or dull? 5 always, 4 = frequently, 3 = occasionally, 2 = rarely, 1 = never

7 Test Score You are a good listener You re OK, but you could stand some improvement You need some work on your listening skills

8 What it ain t or Listening Untruths Listening and hearing are the same Listening develops naturally Listening is dependent on intelligence Listening is passive Effective listening is the responsibility of the speaker Listening means agreement, obedience, or quietness

9 Why is Good Listening Important? Aids comprehension Reduces misunderstandings Enhances critical thinking Aids understanding of both verbal and nonverbal messages Helps determine a person s real needs/concerns Helps translate person s feelings into needs

10 Benefits of Good Listening Improved social and communication ties Improved family relations Heightened self esteem Increased enjoyment Enriched lives Creates trust

11 Listening is a precursor to Trust; Trust is a precursor to Success Are we creating Barriers to Effective Listening and Trust?

12 So, what keeps us from listening effectively?

13 How Does the Effective Listener Respond to Build Trust? The hearing aids look so big on his tiny ears. OR I never should have lived so long. OR I always thought hearing aids were for old people.

14 Avoiding Communication Mismatch Speak to the possible underlying emotions Responding in a manner that shows we have heard

15 Empathy not an easy task given our natural tendency toward egocentrism Our task is not to provide sympathy (feeling sorry for another) Our task is to try to feel what they are feeling this is empathy

16 Emotional Responses to Hearing Loss Alienated Angry Annoyed Anxious Bewildered Bitter Cheated Confused Depressed Disturbed Drained Enraged Fearful Frightened Frustrated Guilty Hassled Hopeless Impatient Insecure Lonely Lost Misunderstood Nervous Overwhelmed Panicked Remorseful Responsible Sorry Spiteful Tense Unsure Unloved Unwanted Useless Wasted Weary Withdrawn Worried... RWS

17 Case Scenario 13 yr old female A mainstreamed student with mild sloping to moderately-severe cochlear hearing loss. Mildly reduced speech recognition in quiet for amplified speech. Uses FM in classroom. Ranked by teachers and parents as a good student.

18 So what do we hear? When this student says: I m not wearing these stupid hearing aids any more. They re ugly and they make me feel different. Audiologist s response?

19 Adolescence Magnified Internal conflict between desire for independence and need for protection This in the midst of growing questions of authority and parental interpretation of arbitrary rules Add to this the turmoil of the challenges of hearing loss and the perceived alienation from being so different, rebellion is harder to suppress

20 We must avoid the communication mismatch of pointing out the obvious An encapsulation of a teen s life quandary affords an opportunity for reflection and exploration that may otherwise be missed and avoids our alignment in the enemy camp.

21 Use of Self-Assessment Master s Audiologists Never used: 33% Used less than 25% of the time: 34% More than 75% of the time: 7% Au.D. Audiologists Never used: 28% Used less than 25% of the time: 31% More than 75% of the time: 10% From Pietrzyk, 2009

22 Does the Audiogram Tell it All? Too often we view patients in terms of their technology needs Style of hearing hearing aids Directional microphones Number of programs controls Bilateral or unilateral fitting Compression, etc 40.5% of surveyed audiologists state the patient s needs can be predicted from the audiogram

23 Questions that Patients and Parents Ask Content Confirmation Affective Based

24 It s not just in our responses to questions Our counseling efforts often get stuck in the content arena as well. Research shows that audiology graduate students respond to expressions of psychosocial aspects of hearing loss with technical information 88% of the time English, et al, 1999

25 Overcoming our Hang-Ups Moving Beyond the Content Trap What might make us uncomfortable?

26 When we see patients they may be Confused over the diagnosis Uncertain about the rehabilitative recommendations given Worried about the prognosis of the condition Disappointed and experiencing emotional pain

27 Counseling Defined Content Counseling: Explains, defines and gives direction.

28 WHAT YOU WANTED TO SAY WHAT YOU SAID WHAT THE PATIENT HEARD WHAT THE PATIENT LISTENED TO WHAT THE PATIENT UNDERSTOOD WHAT THE PATIENT ACCEPTED WHAT THE PATIENT REMEMBERS People remember about 15% of what you say Your expression conveys 59% Your tone of voice conveys 34% Your words get the balance of 7%

29 From: Watermeyer et al Caregiver recall and understanding The results of this study seem to contradict recommendations in the literature that encourage the use of diagrams and pictures to supplement verbal explanations in some cases they led to misunderstanding.

30 Whilst it may be essential in some cases to explain the impact of a hearing loss on speech perception using the audiogram, this study demonstrates that lengthy explanations about the hearing mechanism and each assessment procedure may not be necessary or efficient.

31 Information related to the audiogram was not recalled correctly or even at all by some of the caregivers, and in some cases this part of the feedback session led to further misunderstandings and increased caregiver anxiety.

32 Most of the caregivers correctly recalled and understood information related to the final diagnosis and recommendations, which suggests that this was their primary focus for the session. The audiologists on the other hand seemed to have a different focus which involved trying to get the caregivers to understand the hearing mechanism and the assessment procedures.

33 These results highlight the need for audiologists to align the information they provide towards the needs of the patient or caregiver using patient-centered practice in order to better help our patients to help themselves.

34 When we complete our testing, patients should be given the results a) Immediately following the evaluation b) In sufficient detail that the patient can understand why speech is unclear c) In the presence of a significant other d) All of the above e) I don t really know

35 Readiness for Information What we observe: Clients do not effectively problemsolve when they are upset Evidence: PET, MRI show the amygdala is the emotional center of brain and the neocortex is the problem-solving center The neocortex cannot be accessed if the amygdala is filtering KME

36 Why do we stay in the realm of content counseling? We frequently have an unclear mental differentiation between personal adjustment counseling and psychotherapy

37 Counseling Defined Content Counseling: Explains, defines and gives direction. Personal Adjustment Counseling: Builds upon renewed perceptions of encountered difficulties. Psychotherapy: Addresses intra-personal conflicts that may have little basis in subjective reality.

38 Counselor Attributes and Successful Clinician Attributes Congruence of Self Unconditional Positive Regard Empathic Understanding/Empathic Listening

39 Clarifications of Reflective Listening In other words. It seems to you that As I understand it you are saying So you believe that I gather that

40 Cognitive Counseling (Albert Ellis): Forward movement toward rehabilitative goals may be impeded through basic irrational beliefs.

41 Questioning Assumptions What is the worse thing that would happen to you if? How do you know that would be offensive to those you talk with? What is it that makes that so terrible? What would it take to convince you that the effectiveness of outweighs the disadvantages you foresee?

42 Not just beliefs, but also linguistic constraints Can t vs. Choose not to but vs. and I am vs. I have done I should vs. I want to or I do not want to

43 What is our goal in Personal Adjustment Counseling? Personal Adjustment Counseling: Builds upon renewed perceptions of encountered difficulties. Does this begin to reach toward that goal?

44 Behavioral Counseling B.F. Skinner May use counter-conditioning programs to achieve environmental changes that may produce positive behavioral change.

45 Our associations code of ethics dictates that we must use every resource available, including referral to other specialists as the need arises.

46 Why might we avoid making a referral recommendation? Uncertain of the need due to a lack of training in family dynamics May not want to appear as if we are handing care over to someone else Our own social misgivings about counselors Concern of stigmatizing an already fragile family or individual

47 Referrals to Professional Counselors Why? Persistent intolerance of residual difficulties Persistently unrealistic expectations Unabated guilt, denial, anger or depression How? Refer with confidence Share concerns early to avoid surprises Be simple & straightforward with reasons Referral semantics Provide follow-up

48 The Power of Reflective Journaling We live our lives in foresight; we understand our lives in hindsight Source: Unknown