Audiologic Rehabilitation: Counseling Issues

Question 1

Dealing with Grief and Sorrow: definition

Answer 1

• Grief = “Intense mental anguish; deep remorse, acute sorrow or the like”
• Sorrow = “Mental anguish or suffering because of injury or loss; sadness”

Therefore, Grief/Sorrow is an emotional experience triggered or caused by some LOSS. It is a natural and predictable reaction to loss (being emotionally UPSET is natural; and beginning of the healing process)

Question 2

Loss of:

Answer 2

• A significant other or family member
• External objects (losing something that means a lot to you)
• Some aspect of self or illness

Question 3

grieving process

Answer 3

Grief/Sorrow is a complex progression involving many emotions in an attempt to adjust and cope with the loss

Question 4

Grieving Process treatment: • One widely used is the model described by…

Answer 4

Kubler-Ross

•Based on her observations of patients with terminal diseases

Question 5

Points to Remember- grieving process

Answer 5

1) Grief is not a pathology (Not bad to feel bad)
2) Progression through the stages is normal
3) Order and actual progress will vary by individual

Our pts are emotionally upset, not emotionally disturbed

Question 6

Stages of Kubler-Ross Model

Answer 6

• Denial: seek 2nd opinion, deny the facts, not believe diagnosis-test me again
• Anger : at self, others, their condition
• Bargaining : Let’s make a deal, make promises with God in exchange for removal of cause of grief
• Depression/Guilt : I am at fault, deeper level of grief, “Why go on?”
• Acceptance: accept reality, not really “ok” with it but learn to live with it
• Add one more for AR: Positive Action

Question 7

Other Emotions/Feelings

Answer 7

• Fear
• Doubt
• Courage
• Relief
• Devastation
• Disappointment
• Gratitude

Question 8

What do we do?

Answer 8

• It is our job to move these individuals toward positive action
• Therefore, don’t interrupt the grieving process but facilitate movement through the process

Question 9

How do we do this?

Answer 9

• Counseling! – “counseling may be the most important clinical service that hearing professionals provide” (Garstecki & Erber, 1997)
• It’s better to meet a clinician who is better at counseling than someone who can fit a ‘perfect’ hearing aid

Question 10

Allow the patient or the parents to feel grief

Answer 10

• Embracing painful feelings is the first step to healing
• Don’t try to take the pain away or distract them (don’t say: it could be worse etc)
• Don’t overwhelm them with information initially
• Especially true of parents when first learning of child’s diagnosis
• Listen and validate feelings

Question 11

The Professional’s Role

Answer 11

A) First, our role as diagnostician is to convey information
B) Then, we need to switch our role to facilitator and place the responsibility upon the parents.
•There is no meaningful change without ownership of the problem by the patient

Question 12

Counseling

Answer 12

• Counseling = Educating & Guiding through emotional process
• Boost their self-esteem and empower them as they take ownership

Question 13

Support Groups can be extremely helpful

Answer 13

• Why? Not alone, feel validated, be social in a safe environment, learn new ideas and pass along ideas to others, see how other people can be happy and successful
• Time and money: big issue of why rehabilitation doesn’t happen often

Question 14

Types of Counseling

Answer 14

1) Informational Counseling : We do this well
2) Personal Adjustment Counseling: help them adjust to their emotions
- Not so well

Question 15

Informational Counseling

Answer 15

A) The Case History
B) The Results Conference
1) First, your presence-Be professional but not too professional
2) How to start-Go direct (Get to the point), or indirect (Ask them what they think)
3) Be in control, don’t feel threatened by hostility, be patient, don’t rush
• control: topic, your emotions
• separate hostility from yourself as a person: don’t be hurt by it
• tell me what experiences you have and why you’re angry
• show them you’re listening and interested/ listen and ask

4) Determine the right amount of information
• Are they feeling overwhelmed?
• What is the most important thing to go over first? Let’s make it easy for you

C) Information Transfer (Varies based on severity, cause, time of onset)
• Hearing loss/audiogram
• Anatomy/Physiology/Disease Process: speak at their level– simplify
• Implications of the loss, re: speech/language, education, mode of communication
• Amplification: enough information but do not overwhelm

Question 16

Informational Counseling: list steps (3)

Answer 16

1. case history
2. results conference
3. Information transfer: varies based on severity, cause, time of onset

Question 17

With Informational Counseling its important to remember:

Answer 17

•The patient will not remember much of what you tell them

•50% forgotten immediately (40-80% in some studies) and half of what is remembered is remembered incorrectly
- so 25% correct retention

Question 18

What about the really important info?

Answer 18

• Cannot recall 68% of diagnoses in a medical visit
• Some diagnoses were serious or life threatening
• 25% of important info remembered

Question 19

What helps with recall? Patient Factors

Answer 19

• Familiarity w/ the info
• Expected finding
• A welcomed finding
• Moderate anxiety (severe anxiety inhibits recall)

Question 20

What helps with recall? Clinician Factors

Answer 20

• clear language w/ simple sentence structure
• Understanding what the patients wish to learn
• Dialog with listening to the patient and addressing their questions and concerns
• Calm (not overly anxious) clinician
• Organized presentation (repeat most important info)- important? ADRESS FIRST! Say it first → more likely to remember
• Written material, visual graphics
• Clear, specific recommendation

Question 21

Personal Adjustment Counseling

Answer 21

•We’re “nonprofessional counselors” but it shouldn’t be “just the facts”. As facilitators, we’re in the right position to determine the course of action.

Question 22

Factors in Counseling

Answer 22

• Don’t reinforce denial. Be honest but leave some hope
• Don’t punish anger
• Don’t bargain with the person
• Acknowledge realities of the situation and appropriate expectations
• Help them progress through grief cycle and into positive action

Question 23

Approaches to Counseling: Two Basic Theories

Answer 23

1. Carl Rogers Nondirective Therapy

2. B.F. Skinner’s Behavioral Method

Question 24

Carl Rogers Nondirective Therapy

Answer 24

• Patients know what’s best for themselves
• Patient leads the direction of the therapy, clinician listens and talks when appropriate
• You would say stuff like “ok, mmhmm, wow, huh, really”// let the patient decide when to wear hearing aids

Question 25

B.F. Skinner’s Behavioral Method

Answer 25

• Learned behavior which is then reinforced (rewards or punishments)
• Structured treatment plan created by the clinician to the patient w/ follow up
• You would say: wear it everyday- except when sleeping or getting wet
• Reinforcement is our approval or disapproval with their performance of our recommendations.]

Question 26

Combining the Two (Rogers and Skinner)

Answer 26

But, know your comfort zone. Provide support counseling, show that you care, but know when to refer

Question 27

“Parents’ Needs”

Answer 27

• Early Identification and notification
• Skillful and supportive professional
• Unbiased information
• Opportunity to meet other parents
• Time to process information (Remember, poor retention)
• Follow up appointments

Question 28

Counseling Dilemmas

Answer 28

• You may feel that a child’s chronic conditions have been mismanaged or handled too conservatively
• Balance ethics (not crossing into the practice of medicine) and morals (can’t stand by and watch the child being deprived of proper medical care)
• Be respectful but if need to refer, show respect to the doctor BUT refer for a 2nd opinion
• After referring for medical treatment of a conductive hearing loss always arrange for a follow up audiological exam and tympanometry.
• Conductive hearing loss can still persist following medical treatment, even when the ear visually looks healthy
• Medical recommendations for certain hearing aid designs may be inappropriate

Question 29

3 Stage Process of Positive Action

Answer 29

1) Realize, confront, cope: “What can I fix?”
2) Accept unchangeable: “Grin and bear it”
3) Transformation to benefits: “When life gives you lemons …..”