Home' Accord : Accord October 2016 Contents Feature 21
16 HEARINGREVIEW.COM I AUGUST 2016
RESEARCH // FAMILY-CENTERED HEARING CARE
Audiologist: You’ve talked about this before
[they nod] and it’s become a sore spot? [They nod
again.] Let’s change gears a bit: it would help me to
learn a little bit about what is important to you as
a family. What kind of things do you do together?
Mr Roberts: Not much together these days. I’m
retired now and Joe works. But I fill in as babysitter a
lot; I’ve got three grandchildren, they keep me going.
Son: They love hanging out with you. Yesterday
I told them about how you and I used to fish togeth-
er on weekends, and they said they’d like to try that.
Mr Roberts: That would be great... [He makes
eye contact with the audiologist but she waits for
Joseph to finish his thought.]
Son: But Dad, maybe you don’t realize why we
stopped doing it. When we’d fish, we’d also talk for
hours—well, whisper, of course. To me, that really
was the best part. But the last time we fished, I had to
raise my voice for you to hear me—practically shout-
ing—and that kept the fish away. We didn’t catch a
thing and we just stopped trying.
Mr Roberts: [Facial expression changes, realiza-
tion sets in. The audiologist waits again, resisting the
impulse to take control of the conversation.]
Son: This is what I’m getting at, Dad. It’s not
about fishing. I like talking with you; I want you to
hear me, hear the kids.
Mr Roberts: [Nods.] Those were good times.
Fair enough. I guess I can give it a try. [He and Joe
turn to the audiologist.] Where do we start?
Initially, the audiologist’s ability to help
was blocked by family emotions (defensive-
ness, frustration). We cannot directly change
those emotions, but we can provide opportu-
nities to help both parties talk to each other
about what hurts, what matters, and what they
want. Try as we might, there is no avoiding this
truism: feelings are at the very core of these dif-
It may seem efficient to
leapfrog over emotions into problem-solving
mode, but rushing the process is counterpro-
ductive since, ultimately, “unacknowledged
feelings do not disappear. They fester.”
What Helped This Difficult
The audiologist carefully employed four
behaviors to advance this conversation:
1) Acknowledging the emotions in the
room. “You’ve talked about this before and
it’s become a sore spot?” It is tempting to over-
look the tension in an appointment and stay
in our “comfort zone” (testing and explaining
results). However, when we do so, we risk
patient disengagement and the decision not
to adhere to our recommendations.
opportunities to earn patient trust are few and
time-constrained, but we can optimize the
opportunities by honestly addressing patient
and family emotions.
2) Using open-ended queries. “What kind
of things do you do together?” This question
is an invitation to both parties to co-develop
the family story. The initial responses may not
include listening challenges, but soon the son
will allude to the reason for the appointment:
there are times when hearing problems have
impacted the quality of their family lives.
3) Providing the opportunity to reframe
the situation in the family’s own words. The
open-ended query allowed Joseph to explain
how his father’s hearing loss has affected him
and their relationship. Family members often
focus on what frustrates them (the patient
won’t answer the phone, turn down the TV,
or admit there is a problem), resulting in
accusations and resentment. Family members
may not yet have articulated why they are
frustrated: the quality of their family life is
diminishing, and because the patient doesn’t
seem to care, it feels like rejection.
When reframed as a quality-of-family-life
concern rather than a personal failure, the
patient is more likely to see the situation within
the family context and realize, “I had no idea
that this is what you were experiencing.” This
kind of revelation can provide motivation for
4) Waiting. When Mr Roberts makes eye
contact, he is expecting the audiologist to take
over the conversation, but she can tell Joseph
still has more to say, and she waits for him.
Reviewing the dialogue, we can appreciate
how much would not have been said had she
jumped into the conversation at that point.
Waiting is probably a more professionally con-
gruent concept for audiologists than “clinical
silence” as employed by professional counsel-
ors, because it feels comfortable and courteous.
We merely elect to slow down, observe the
other speaker, and determine if he has more to
add but needs time to gather his thoughts, or
is somewhat overwhelmed and needs time to
compose himself. At a later point, the audiolo-
gist waits again; from his facial expression, she
gathers that Mr Roberts needs a moment to
process what his son is saying.
Our experience tells us not all fami-
ly conversations are as straightforward as
this example. The first challenge we have
addressed here is engaging both patient
and family member in a conversation that
quickly gets to the “heart of it all.” But addi-
tional complications can surface as well, for
instance the misconceptions that both par-
ties may have about hearing loss.
Son: He says he can’t hear on the phone and so
he never takes messages for me. Sometimes when
we are home he just doesn’t answer me. Then I hear
him having a great old chat and laugh with his mate
over the phone.
Mr Roberts: Some voices are easier to follow
than others. Bob has a voice that I can hear over the
phone. I have known him for 35 years.
Son: You can hear when you want to. You just
ignore me. [Mr Roberts throws himself against the
back of his chair, crosses his arms, and glares at the
wall clock, appearing angry and hurt.]
Audiologist: [Acknowledging Joseph:] That’s
what it feels like to you...[Facing Mr Roberts:]
Would you say that’s the whole story? [He shakes
[Speaking to both:] So there’s more to it, but we
don’t know what that is yet, exactly. Let’s find out.
Our starting point is to evaluate Mr. Roberts’
hearing. Next, as a team, we want to understand
just how complicated hearing and hearing loss is.
It can look like “selective listening,” which upsets
those feeling ignored. [Joseph nods emphatically.]
But that’s just the tip of the iceberg. [Mr Roberts
slowly nods, realizing he doesn’t know what else the
“iceberg” entails.] Several situations add even more
stress to hearing abilities—even soft music in the
background, or a change in our overall health.
[Addressing Mr. Roberts:] You can teach us
about this. Your thoughts?
Mr Roberts: It would be great to find out what
is actually going on.
Son: [Nods with relief.] Whatever it takes, Dad.
As before, the audiologist first took a
moment to recognize each person’s emotional
reactions. By giving credence to both experi-
ences, as well as providing a brief preview of
Waiting is probably a more pro-
fessionally congruent concept for
audiologists than “clinical silence”
as employed by professional
counselors, because it feels more
comfortable and courteous.
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