Counselling in Audiology

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Counselling in Audiology

• Taupo 2009
• Andrew Thompson

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Kindness
Honesty
Respect
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What is counselling?

• By listening attentively and patiently the
  counsellor can begin to perceive the difficulties
  from the client's point of view and can help them
  to see things more clearly, possibly from a
  different perspective. Counselling is a way of
  enabling choice or change or of reducing
  confusion. 

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What are the benefits of good listening

• Increases patient clinician satisfaction
• More accurate diagnosis
• Can save time
• Increases patient adherence to treatment
• Better patient outcomes
• Improves relationships
• Less complaints from patients
• Patients want someone who will listen and
  understand me
• Patients expect a high skill level
• Your practice thrives

Dr. Richard Fox
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What is the problem?

• Situation Problem Solution

?
Perfect Baby Hearing loss or

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What is the problem?
Situation Problem Solution
?
Teenager Non-compliant
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THE 4 PART PROBLEM

• The problem
• The ultimate outcome
• The intermediate outcome what do we need to do
  to facilitate the ultimate outcome.
• Interventions that need to be taken by self or
  patient

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Survival KitChange position

• Shifting position from expert to learner during
  difficult conversations.

?
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The Tear in the Eye.

• It is an art to share painful news with any
  patient
• Patients often stress that (it) was the sense
  of empathy which counted more than the immediate
  tragedy of the news...
• It was the reassurance that there was a glimpse
  of hope
• The tear in the eye

Elizabeth Kubler-Ross
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Communicating with Patients

• RIGHT BRAIN FUNCTIONS uses feeling "big
  picture" oriented imagination rules symbols and
  images present and future philosophy religion
  can "get it" (i.e. meaning) believes
  appreciates spatial perception knows object
  function fantasy based presents possibilities
  impetuous risk taking

• LEFT BRAIN FUNCTIONS uses logic detail oriented
  facts rule words and language present and past
  math and science can comprehend knowing
  acknowledges order/pattern knows object name
  reality based forms strategies practical safe

LEFT
RIGHT
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Are you left or right brained?
Hopefully both!
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Offer and state confidentiality

• Ensure you state who you discuss your clinical
  consults with e.g. the team, my supervisor
• It builds trust
• Accelerates disclosure about difficult issues
• Start with a statement about confidentiality and
  if you think the patient has spoken about
  difficult matters reiterate the
  confidentiality.
• If in doubt, check with the patient. Who can I
  share this information with?

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The key to good Listening Skills

• Be prepared to take your time and listen to the
  patients experience.
• Learn about the patients world - from the
  patients viewpoint.
• Demonstrate through language, care and feedback
  that you have some understanding

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Survival KitOpen-ended questions
What is your current understanding of whats
happening? I am not quite sure what you have
been told?
Do you have any questions? often did not elicit
questions? Using open ended questions that
encouraged exploring often did work?
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Survival KitAcknowledging emotion
this is horrible I know this is hard
Would you like me to stop for a while?
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Mirroring or reflecting

• When you reflect back people will often
  continue to talk.
• Summarise what you understand so far, and check
  it out
• Is this right..?
• Am I understanding you?

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Reflecting

• Rather than just repeating their words, ask for
  interpretation of unusual words and familiar
  clichés.
• Find meaning and make sense of what is said and
  reflect this back.
• As you make sense together the patient will
  also move forward in their understanding.

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Pause
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Survival KitAddressing guilt and regret

• You are not to blame, nobody is at fault.
• There was nothing that you could have done to
  stop this

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Authenticity

• The heart of good listening is authenticity
  Authenticity means that you are listening because
  you are curious and because you care, not just
  because you are supposed to.
• The issue then is this Are you curious? Do you
  care?... If you think you already understand how
  someone else feels or what they are trying to
  say, it is a delusionThere is always more to
  learn.
• (Stone, Patton and Heen, 1999)

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THE BIG QUESTIONS?
What will help you most? What is the most
important thing for you?