Psychological aspects, counseling and professional issues Flashcards
Designing and executing an ar plan for adults
6 components:
Assessment
Informational Counseling and Emotional Counseling
Development of a plan
Implementation of plan
Assessment of outcome
Follow-up
Step 1: Assessment
Assessing hearing loss
Complete Audiological Evaluation including case history, pure-tone audiometry, speech audiometry, immittance testing, Otoscopic exam, determine need for referral and follow-up, counsel patient/family on results and recs, assess candidacy and motivation for amplification
Medical clearance for amplification
Hearing-related difficulties
Interviews, questionnaires, self-reports, structured/unstructured assessments
COSI (next slide)
Expectations and significance of each difficulty to patient
Activity limitations
Participation restrictions
Individual factors
Non auditory needs assessment: expectations, risks, cognitive status, manual dexterity, visual acuity, prior experience with amplification, general health, tinnitus, occupational demands, support systems
STEP 2: counseling
Two types:
Informational counseling
Explaining the results of the audiologic evaluation
Personal adjustment counseling
Minimizing the effects of the hearing loss
Informational counseling
Summary of Assessment
Discussions about expectations
Attitudes and motivation
Considering listening devices
Commitments
Costs
Non technical interventions such as comm strategies training
Once the patient has this info they….
May want to act on it right away
May want time to talk with family/friends
May be in denial not want to do anything
Emotional counseling
Emotional counseling just as important if not MORE important than informational counseling
Hearing Loss Across the Lifespan
No matter when or how the hearing loss occurs, there can be psychosocial impacts
Areas Impacted:
Self Concept
Emotional Development
Social Competence
Family
Growing Up with Hearing Loss
About 2 to 3 out of every 1,000 children in the United States are born with a detectable level of hearing loss in one or both ears.
More than 90 percent of deaf children are born to hearing parents( Mitchell & Karchmer 2004).
90% of these families have no background in deafness or connections to the deaf community
“The key to a successful integration of hearing loss into a family is the degree to which parents are able to integrate hearing loss into their lives” (D. Luterman, 2006)
Since hearing loss in childhood is often associated with communication disorders, many of the psychosocial issues stem from communication difficulties.
Rawool VW, Kiehl JM. (2009)
Hearing aids reduce psychological, social, and emotional effects of hearing loss.
Only about 1 in 5 adults with hearing loss seek treatment.
Untreated hearing loss has been associated with emotional, physical, social, cognitive, and behavioral problems.
Hearing loss can negatively impact personal safety as well as negatively affect significant others.
Some unaware of their hearing loss, while others in denial.
Reluctance to acknowledge hearing loss may be an adaptive process to prevent rejection and it may take 5 to 15 years before people with hearing loss seek help.
Untreated hearing loss can cause increased tension, irritability, frustration, feelings of inadequacy, being prematurely old, diminished, handicapped, and, as a result of these feelings, many people with hearing loss avoid social situations and gatherings.
Acquired Hearing Loss
Many of the same variables are at play with acquired hearing loss.
Only a small portion of individuals with hearing loss are born with hearing loss.
Approximately 15% of American adults (37.5 million) aged 18 and over report some trouble hearing.
Age is the strongest predictor of hearing loss among adults aged 20-69, with the greatest amount of hearing loss in the 60 to 69 age group.
About 2 percent of adults aged 45 to 54 have disabling hearing loss. The rate increases to 8.5 percent for adults aged 55 to 64. Nearly 25 percent of those aged 65 to 74 and 50 percent of those who are 75 and older have disabling hearing loss.
Men are almost twice as likely as women to have hearing loss among adults aged 20-69.
Acquired Hearing Loss
Self Concept
When people get to the audiologist they have waited an average of 7 years (5-15 years).
Only 25% of people who could wear hearing aids end up purchasing and wearing them
Stigma associated with wearing hearing aids
Acquired Hearing Loss
Psychoemotional Reactions
Isolation
Paranoia
Anger
Stress
Acquired Hearing Loss
Family Concerns:
Blame
Isolation
Impaired Relationships
Acquired Hearing Loss
Social Impacts:
Social Impacts:
Avoidance
Isolation and withdrawal
Feeling less fulfilled from social interactions
Inattentiveness
Distraction/Lack of concentration
Problems at work
Problems participating in social life and reduced social activity
Problems communicating with wife/husband, friends and relatives
Problems communicating with children and grandchildren
Loss of intimacy
Counseling Basics
Enhanced understanding of hearing loss and it’s effects on communication
Better self-disclosure and self-acceptance
Greater knowledge about how to manage communication difficulties
Reduced stress and discouragement
Increased satisfaction with aural rehab services
Increased motivation to minimize listening problems
Stronger compliance with AR plan
Informational counseling
After testing with audiologist, discuss results and next steps (AR PLAN)
Information counseling provided by audiologist
Patient’s only retain 40-80% of what you tell them
Remember up to half of it incorrectly
Don’t give too much information
Provide written supplements to bring home
Repeat the most important information
Specifically address the patient’s reason for hearing evaluation
Personal adjustment counseling
Emotional counseling
Focus on permanence of the HL and the healthy incorporation of hearing loss into a patient’s self-image
Not usually enough time for this type of counseling in a busy hearing aid clinic.
Might make people uncomfortable.
Psychosocial reaction to hearing loss
Behavioral Reactions:
Bluffing
Withdrawal and Avoidance
Domination of conversations
Emotional Reactions:
Anxiety
Depression
Anger
Guilt
Cognitive Reactions:
Difficulty thinking, concentrating, or focusing attention
Specific thoughts that can contribute to communication difficulties
Physical Reactions
Muscle Tension
Fatigue
Interpersonal Reactions:
Frustration
Demands instead of polite requests
Put downs
Making the other person feel bad
Personal adjustment counseling
Different approaches:
Cognitive approach
Modify thought process the way they think about the HL
Behavioral approach
Modify behavior
Affective approach
Modify emotion accept the HL
Cognitive approach
The cognitive approach in psychology is a relatively modern approach to human behavior.
Focuses on how we think. It assumes that our thought processes affect the way in which we behave.
Use of logic to direct and redirect individuals thoughts
GOAL: Eliminate cognitive distortions and replace them with positive thoughts and positive perspectives
Behavioral approach
Human behavior is learned, thus all behavior can be unlearned and new behaviors learned in its place.
Focuses on learned vs. unlearned behaviors.
Repair behaviors and strategies.
May focus on the physical response to stress and giving patients sense of control.
Encourage HA use.
Affective approach
Affective Approach-focus on feelings
Focuses on emotions and adjustment
Clinician creates an empathetic accepting environment
Congruence with self: clinician doesn’t put on a façade but instead is honest and sincere with the patient
Unconditional positive regard: assume patient knows self best and can overcome feelings
Empathetic understanding: clinician listens carefully using reflection and clarification.
honest, person-centered approach
Counseling Basics
The Counseling Process
The Counseling Process
Help pts tell their story
Help pts clarify problems
Help pts take responsibility for their listening
Help pts establish their goals
Develop an action plan
Implement the plan
Conduct ongoing assessment
Narrative therapy
Help patient’s tell their story (but not letting them ramble)
Centers people as the experts in their own lives
Clarification of information
Validation of patient’s feelings
Reassurance that they can handle their hearing loss and health issues.
Allows PTs to get some distance from the HL to see how it might actually be helping them, or protecting them, more than it is hurting them.
Research
Patients more likely to use HA’s if they received counseling
Improvement in confidence
Most patient’s reported their audiologist didn’t cover psychosocial aspects of hearing loss
