Many hearing professionals are uncomfortable about taking their counseling into the realm of anything approaching “therapy” or interpersonal counseling. They feel ill-equipped to delve into these more intimate areas. While I agree that “psychological” counseling is certainly beyond our scope of practice, “communication” counseling is clearly not. In fact, when it comes to this kind of counseling, hearing professionals are uniquely qualified.
Those of us who work with patients suffering from chronic sensory hearing loss understand the consequences of disordered communication better than any other health-care professional. Other than mental health workers, I can think of few health professions where long-term relationships in which occur intimate discussion of patients’ private thoughts, frustrations, relationships with family and friends and emotions related to the frustration, anger, depression even paranoia frequently associated with chronic, long-term sensory hearing loss.
By our training and experience we are exquisitely attuned to the importance of communication.
The brains of human beings are wired for sociability. It was the advent of larger communities 75,000 years ago, when social relationships became much more complex and critical to navigation of ever more complicated societies, that precipitated the sudden growth in the intellectual abilities of homo sapiens. (Read Social by Matthew Lieberman).
Since the primary mode of social interaction is speech and hearing, our sense of hearing is of paramount importance to all human beings. We should embrace and respect our privileged role as facilitators of communication in the lives of our patients.
Helping Facilitate a New Conversation
One way that we can accomplish this is to facilitate a new kind of conversation between our patients and their primary communication partner (PCP – I prefer this to “significant other” or “third party” because it highlights the role of communication in their relationship.) This can not only create a more positive environment for the couple but can help to move the patient “in denial” (in the grip of ambivalence) toward acceptance of help to improve their hearing.
What is the quality of most of the conversations of people with hearing loss and their primary communication partners around hearing? In my experience, these conversations are frequently negative, tinged with anger, nagging and recrimination. “You need to get hearing aids!” “I’m sick and tired of hearing ‘what’, ‘huh’, ‘what did you say?’.” “The TV is always on so loud the neighbors can hear it.” “You never pay attention to anything I say.” And on and on.
These kinds of “discussions” attack the autonomy of the person with hearing loss, frequently causing them to dig in their heels and become even more resistant to the idea of acquiring hearing instruments. They also tend to be one-sided “conversations” that violate the naturally reciprocal nature of communication.
By engaging the PCP in a more positive conversation with their hearing-impaired partner, epiphanies have been known to occur. Other than experiencing frustration and anger, your patient has likely not encountered some of the more compassionate and nurturing emotions being experienced by their PCP. In order to be able to show your patient what their communication partner is experiencing emotionally, we must be willing to ask. This is likely territory into which the couple has never ventured, overwhelmed by the usual blast of frustration and anger. When a more positive conversation is facilitated, these more supportive emotions can present themselves.
When the PCP is present at a hearing aid evaluation, in the words of a Watergate attorney, they should not be treated as a “potted plant”. Since communication is reciprocal, the PCP has as much a stake in a positive outcome for the patient as does your patient. They should be an active participant in the process.
Any problems that are affecting your patient are mutually affecting their PCP. They are certainly experiencing frustration and anger but are also watching a person they love suffer with hearing loss. This is certain to cause them some pain, of which your patient may be oblivious. So, we can help make this known to both parties.
The dialog below is paraphrased and derived from dozens of conversations I have had or observed over the years. It illustrates the kind of epiphany that can be revealed when we enable a more positive conversation.
Hearing Care Provider (HCP) – (to primary communication partner, or PCP) Have you noticed Mr. Smith having trouble with his hearing?
PCP – Oh, yes!
HCP – In what kinds of situations?
PCP – Family gatherings have become a real problem for him.
HCP – Have there been any situations like that recently you could tell me about?
PCP – Well, just last week we had a lot of family over for a birthday party. Jim spent the whole afternoon sitting in his chair and I don’t think he talked to more than 2 or 3 people the whole time.
HCP – And that’s unusual?
PCP – Oh, yes. He’s usually the life of the party.
HCP – What was going through your head as you were observing this?
PCP – I was mostly sad. He just looked so cut off from everything. I know he would have preferred to be more involved, but his hearing loss is just getting in the way more and more.
Patient – I had no idea you felt that way.
PCP – Well, I know. I guess I should have said something. But you get so upset when I say anything about your hearing.
Patient – I guess I do.
HCP – I can help you to be able to hear better in that kind of situation. Would that be something you would be interested in.
Patient – It would be nice to be more involved when the kids come over.
PCP – Absolutely!
This is likely a conversation this couple has never had. It was positive, empathetic and was facilitated by a compassionate hearing care provider.
The HCP asked open-ended questions that encouraged the PCP to tell the story of a recent event (details and any emotional content were fresh in mind) related to the patient’s hearing loss. Relevant details were elicited. The PCP was asked specifically how the situation made her feel (by asking what was going through her head, a less direct formulation of the question, it was easier for the emotion of the situation to be expressed). A solution was offered by the HCP and agreement that the solution would be a positive outcome was expressed by both parties.
This patient is much closer to a decision for better hearing than he was when he arrived at that day’s appointment. Have confidence in your ability to help the couple before you communicate in a different way, if only in the context of your comparatively brief encounter with them.
Facilitate a new conversation and you will help more people to better hearing.
Paul U. Teie, MS, has been an audiologist since 1991. He has spent much of his career in direct clinical care but has filled other roles in the hearing care industry as sales representative of a special instrument dealer and a hearing instrument manufacturer. Since 2007 he has provided sales and clinical training for large hearing care networks and currently trains for HearUSA/HearCanada.