hl psychosocial aspects & counseling

HEARING LOSS

Psychosocial Aspects & Counseling

The use of a audiologic rehabilitation

model has been in place since the early

1980’s.

The model described in Schow, will be

used to provide a consistent description

for effective professional patient/client

interaction.

The assessment component of this

model is CORE.

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C.O.R.E.

C—Determine patient/client

communication status

O—Determine overall emotional

participation variables

R—Determine related personal factors

E—Determine environmental factors

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Communication Status

• Auditory?

• Visual?

• Language?

• Manual?

• Communication—self report?

• Previous rehabilitation?

• Overall communication?

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Overall Participation Variables

• Psychological/emotional?

• Social?

• Vocational?

• Educational?

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Related Personal Factors

• Personality type?

• IQ?

• Age?

• Race?

• Gender?

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Environmental Factors

• Services?

• Systems?

• Barriers?

• Facilitators?

• Acoustic conditions?

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When attempting effective audiologic

rehabilitation, it is important to consider

how the patient/client’s hearing loss

affects their overall participation

variables i.e. their psychoemotional and

social interactions.

Of course, their related personal factors

(personality type, IQ, age) must also be considered.

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Four Psychosocial Aspects

When interacting/counseling with

patient/clients (at almost any age level),

there are four fundamental aspects to

consider. They are:

1. Self-concept

2. Emotional development (or status)

3. Family concerns

4. Social competencies

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Self-Concept

Individuals are not born with self-

concepts.

Self-concepts are created by input,

feedback, and reactions from those

around them.

These concepts can be modified over

time as social interaction occurs.

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Emotional Development

An individual uses language to describe,

interpret, and understand the abstract

nature of his or her emotions.

Due to progressive hearing loss or

language deficits, limited self-expression

may create a delay in their awareness

and understanding of their own

emotions as well as those of others!

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Family ConcernsOften, the family as well as the patient/client

will experience the “grief cycle” of emotions

as hearing loss is encountered/revealed.

The grief cycle consists of:

• Shock

• Denial

• Depression

• Acceptance/resignation

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Social Competencies

Poor and/or limited communication results in

poor social competence. Social competence

often includes the following skills:

• Capacity to think independently

• Capacity for self-direction and self-control

• Understanding the feelings and needs of others

• Ability to tolerate frustration

• Ability to rely and be relied upon by others

• Maintaining healthy relationships with others

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It is important to understand that,

whether one is born with hearing loss, or

suffers acquired hearing loss in later

years; the patient client will encounter

these four described psychosocial

aspects of hearing loss.

Let’s cover these aspects in more detail

regarding acquired hearing loss.

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Those with acquired hearing loss

generally wait an average of seven

years (after becoming aware of

their communication challenges)

before attempting to access

hearing health care.

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Hearing loss can be a symptom of a

serious health issue—even if benign,

the permanent effects of auditory

deprivation occurs after three years

of hearing loss!

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The psychoemotional reactions to

revealed hearing loss can involve

stress, anxiety, insecurity and anger.

Let’s review page #254 in Schow for

additional psychoemotional

reactions.

Let’s also review Case #7.2 on that

page.

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It is interesting to note, that family members take the brunt of the stress while the person with the hearing loss is attempting to accept the fact that their communication abilities are changing.

Often, the family members are blamed by the individual suffering the hearing loss.

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The affected individual usually does not

realize the burden their hearing loss

places upon their spouse or significant

other.

This often results in a downward spiral to

even long term relationships.

Hearing loss is insidious and family

concerns are often encountered before

the hearing loss has been defined.

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The psychosocial aspects of late on-set

hearing loss can result in past life-style

modifications.

• No longer regularly attend church

• No longer engage in jokes or humor

• Only short “to-the-point” comments

• Other modifications?

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This psychosocial withdrawal has

been shown to lead to depression.

It has been commonly found when

adults begin to modify or change

lifestyles, that gradual hearing loss

may be a contributing factor.

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Several studies have noted that the

more severe the hearing loss—the

more severe the psychosocial and

emotional problems can be!

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Psychosocial Aspects of Deafness

Should hearing babies be born to

deaf couples?

Let’s review page#257 in Schow to

begin this discussion regarding the

deaf culture.

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COUNSELING BASICS

Now that we recognize more

regarding hearing loss and its

psychosocial aspects, let’s better

understand important distinctions for

both effective counseling and

proper referral to other healthcare

professionals.

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Counseling is designed to help people

develop “here-and-now” strategies for

coping with lifestyle modifications,

decision making, and current social or

health problems.

There are two forums for counseling:

1. professional, 2. non-professional

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Counseling events fall into two

fundamental categories, they are:

1. Informational counseling

2. Personal adjustment counseling

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INFORMATIONAL COUNSELING

This form of counseling is often used by

non-professional counselors, it is

commonly use by audiologists and

hearing instrument specialists.

It is easily recognized when the

professional finds that he or she is doing

most of the talking i.e. one-way

communication.

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PERSONAL ADJUSTMENT COUNSELING

This type of counseling involves more

two-way communication. In fact,

counselors call it facilitative

communication.

This approach allows patient/clients an

opportunity to express how they feel—

often revealing their communication

goals.

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There are three steps involved to facilitate this type of counseling process.

They are:

1. Help patient/clients tell their “story”

2. Help patient/clients “clarify” their problems.

3. Help patient/clients take responsibility for their communication problems

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Let’s review page #260 in Schow for better

definition of this process.

Note: pages 261—263 provide more

detail regarding integration of this form of

counseling into audiologic rehabilitation.

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The C.O.R.E. model of assessment

considers patient/client attitudes—

including readiness for change.

An empathetic, non-judgmental attitude

can help patient/clients face their fears

and consider “treatment”.

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Patient/clients can present with a variety

of psychosocial problems.

When attempting non-professional

counseling and you feel like the

counseling may be going beyond your

comfort level, always immediately refer

the patient/client to an appropriate

healthcare professional.

hl psychosocial aspects & counseling

Health & Medicine