Module 2 Counseling by the Speech-Language Pathologist and Audiologist

Back then, and even now to some extent, SLPs and Audiologists have utilized this model in their approach to counseling

Medical Model

How is the Medical Model set up?

Typically, an interview is conducted by the clinician with the client/client’s family. A series of reading questions from a list of prepared items is read while the client’s responses are recorded and prior to the test examination.

After the test examination, clinicians tend to report their findings and create recommendations for management.

What are five problems that the medical model faces?

1. The underlying assumption that the professional has gotten all of the needed information and experience to treat and diagnose

2. Oftentimes confirms family’s or client’s perceptions on their limitations

3. May suggest that the parents are incapable of effectively making decisions and are week

4. the family or clients never take responsibility for their own behavior

5. reinforces feelings regarding inadequacy

Flahive and White (1982)

In a questionnaire study of 226 audiologists, they found that a great proportion of their respondents’ time was spent in information counseling as opposed to personal adjustment counseling.

Many audiologists and speech-language pathologists receive no training in

counseling

McCarthy, Culpepper, and Lucs (1986) surveyed training programs accredited by the American Speech-Language-Hearing Association (ASHA). They found that

only 40% of the programs offered a course in counseling within the department. 36% had an out-of-department course, and 23% had no offering at all.

the most telling finding was that although the overwhelming majority of respondents felt that counseling was an important skill for speech-language pathologists to acquire, only 12% felt that programs were effective in training students in counseling

Crandell (1997) did survey of audiology training programs. What did he find?

Only 48% of the programs offered a course a course in counseling. He found the lack of training in counseling alarming, “as it is well accepted that appropriate counseling is a critical variable in the rehabilitation of individuals with hearing impairment”

Phillips and Mendel (2008) surveyed clinical fellows and found that ____

80% of the respondents reported that no course in counseling was offered by their institution

Williams and Derbyshire (1982)

Questioned 25 parents of children under age 11 with severe and profound hearing impairment within 1 year of their having been seen by an audiologist.

The result of the questionnaire study and personal interviews are startling and rather disheartening.

The responses indicated that

• 84% of the parents were unable to understand all the information they were given

• 72% did not know what hearing loss would mean to their children

• 64% did not have a realistic appreciation of how hearing loss would affect their own lives

• When asked by the investigators to restate the audiologist’s explanations of the implications of hearing loss, 40% could not do so at all and 24% attempted explanations that the investigators felt were incorrect

Martin, Krueger, and Bernstein (1990)

• Conducted a questionnaire survey of 35 adults with hearing impairment shortly after they had been given an audiological examination and had received content counseling from an audiologist.

• The authors concluded that “even when audiologists feel they have adequately covered all of the information during the audiological examination, the hearing-impaired adults’ knowledge of this information is still lacking

• Incredibly, not one respondent in their survey knew what an audiogram was after having just completed the examination

Haggard and Primus (1999)

Found that the standard methods of classifying a child’s hearing loss may undermine parent’s understanding and concluded that the standard way of classifying hearing loss evolved because of the needs of the clinician rather than the needs of the patient

Margolis (2004)

Commented on how little patients remembered what he had told them and wished he had spent more time on personal adjustment counseling

Lerner (1988)

• In an unpublished master’s thesis, he interviewed in depth the parents of a young deaf child (diagnosed at age 2 months) and the audiologists who had tested the child and counseled the parents.

• The parents were sophisticated

• The father was a physician and the mother was a computer programmer

• The audiologists were very experienced, both with doctoral degrees and 10 to 12 years of experience

• The audiologists felt that they had done a good job conveying the necessary information

• The parents, on the other hand, were very dissatisfied, feeling that the jargon was inappropriately used

• For example, they felt the term severe-profound in describing their child’s hearing loss was useless to them

• What the parents most remembered was the tone of the comments, which to them was negative and pessimistic

Saunders and Frostline (2013)

found that a 30-minute information-based follow-up several weeks after the initial diagnostic and a fitting session with adult hearing aid users was effective in increasing the use of and satisfaction with the hearing aid

Duchan

• In a well thought out article, asked whether audiologists are too wedded to the medical model

• She noted that the medical model has an emphasis on the physical cause and the cure of the disorder and promotes the professional as the expert, all to the detriment of the psychological and social aspects of the hearing loss

• She argued that while aspects of psychological and social issues can be incorporated into a medical model, they are usually given a minor role

• She made a strong case for audiologists to consider social and narrative models of client-professional interaction that have a large component of personal adjustment counseling

English (2000)

Made a case for audiologists to be concerned with personal adjustment counseling. She considered it an essential skill.

Erdman (2009)

In a paper on the use of groups in aural rehabilitation, had this to say about audiology:

Despite our roots in the social and behavioral sciences, audiology as a profession has made scant use of the invaluable knowledge there-in. Our failure to do so is linked, in part, to having been ensconced and a technological armamentarium that is continuously updated. But the challenges facing audiologists, and health care in general, requires [sic] a shift in perspective that places the person rather than the hearing impairment or the hearing device at the center of our clinical focus.

Ekberg, Greenness, and Hickson (2014)

• Videotaped and analyzed the clinical interactions between audiologists and 63 elderly hearing aid clients

• They found a mismatch in many cases between the psychosocial concerns expressed by the clients and the responses of the audiologists

• They found that the audiologists did not address the clients’ emotional and social needs but continued in content-based communication

• The authors concluded that a greater emphasis on personal adjustment counseling within audiology could result in improved outcomes from hearing health care services and improved overall cost effectiveness in services

Cienkowski and Saunders (2013)

• examined the counseling content of audiologists during a hearing aid fitting and found that over 66% of communication by the audiologists was information based

• they concluded that clients would benefit greatly if audiologists became more comfortable with personal adjustment counseling

Like audiologists, speech pathologists also use

the medical model, but perhaps a little less so, as they are less likely to be located in a medical facility

Zeine and Larson (1999)

• A study done on pre- and postoperative counseling for persons who have had laryngectomies.

Assignment due dates for this module

Saturday 1.27 at 11:59