“Moving the chi” is found in many professions, albeit not identified as such. For example, in forensic debate, when you use the opponent’s strength in persuasive argument to your advantage, you produce a paradigm shift. Our role as counselors is to keep patients on track through gentle guidance. While every patient will be different, the most effective counseling is not likely to occur through in-depth interpretation of the audiogram, or explaining algorithms, decibels or cochlear hair cell degeneration. If you do not cut to the core of patient’s resistance, if you cannot see above it, you are talking to a wall, not counseling.

Did you ever have a moment when, for that one second, you felt that all your faculties were working together perfectly—you have the illusion you could break steel with your bare hands? The Chinese call this energy chi (chee), and the Japanese refer to it as ki (key). The concept that all life operates on energy is thousands of years old. It is how we use this energy that makes the difference. For example, a black belt in karate who breaks four inches of wood with a single blow of the hand may not be any stronger than you or me. It is the knowledge of chi that generates the strength.

In oriental medicine, when one is ill, it is believed that one must move this chi—the person’s energy—in order to get well. For example, the pain of the needle during acupuncture is one method of moving chi. When one is receiving acupuncture, one is not supposed to yell, “Ouch!” but rather, “Chi!” The belief is that, without the pain, there can be no movement toward wellness (here the old adage no pain, no gain is starkly apparent). This pain is merely the body’s signal that energy is being shifted.

There are many of us who believe that Western medicine is slowly catching up to these eastern practices regarding energy movement. There are countless examples. When American mothers gave birth in the 1940s, women typically were hospitalized for 1-2 weeks. Now it is known that it is in new mothers’ best interest to get them on their feet the day of delivery. Many are discharged the same day. Similarly, the old philosophy for healing a broken bone was to put it in a cast and forget about it for six weeks. Now, physicians want the bone in use as soon as the patient can endure it, recognizing that, despite the discomfort, this movement promotes healing.

“Moving the chi” is found in many professions, albeit it is not identified as such. For example, in forensic debate, when you use the opponent’s strength in persuasive argument to your advantage, you produce a chi shift. In martial arts, this is known as kuzushi—putting the opponent off balance long enough to use their strength (energy) to gain an advantage.

Kuzushi Counseling

Mr. Smith (patient): I can’t stand the thought of wearing hearing aids, and I don’t think I ever will wear them! So I probably shouldn’t really get them even though I need them, should I?

Dispensing Professional: I certainly can understand your feelings. You know, Mr. Smith, I don’t think I would feel any differently if it were me sitting there instead of you. The last thing I would want to do is have to deal with wearing hearing aids. I mean, I already wear heavy glasses. I have two pins in my leg. My credit cards were stolen recently and I never reported it because the thief is spending less than my wife. My plate is full! I understand where you’re coming from, Mr. Smith.

Mr. Smith: Well…okay.

Dispensing Professional: You can walk right out of here today without hearing aids, but you’ve already shared on the questionnaire many of your feelings about your hearing loss, how it has made you depressed, lonely and angry at times. It’s stressing your relationship with your wife and kids. This is clearly a dilemma for you. It’s a matter of you choosing to make your life better, easier and happier. Do you want a higher quality of life, Mr. Smith?

Mr. Smith: Of course! Don’t we all?

Dispensing Professional: Then is there really a choice? Which decision is in your best interest, and the interest of those who care about you?

The Resistant Patient
How might this information benefit us as dispensing professionals? While there are some patients who receive advice quite well, there are others who have such resistance that it challenges the best rehabilitation specialists. Before we begin questioning our patients though, it is essential that we know with whom we are dealing. This will require a mix of experience on our part, a little knowledge and a little sixth sense. For example, there is the hearing-impaired client who walks in looking to get the instruments “yesterday already,” despite the fact that it took this individual seven years to find your office. Worse, some will walk through your door on a mission: they are going to prove that their family is quite mistaken and that hearing instruments will never work for them.

The resistant patient is someone you can sense on the first encounter; it is almost as visual as the wife dragging her husband in, or the kids in the waiting room in a huddle around grandma. In fact, if you’ve been dispensing for awhile, you may recognize a person’s reluctance at the handshake. There are many other indicators, like greeting your patient with a smile and getting none in return, poor eye contact and/or saddened expressions. Unresolved issues for some patients go beyond these kinds of internalizations and include anything from mild projection of their feelings onto the dispenser, to anger and hostility.

My receptionists have become so good at recognizing these things that they alert me before I see the patient. I’ve come to depend upon their observations and intuition. I’ve often wondered how much significance should be placed on patients who come in knowing they have hearing loss and probably needing hearing instruments, but they conveniently forget their checkbook or refuse to remove their hat, perhaps hoping they “won’t be here long enough.”

Hearing care professionals new to the field sometimes can take this resistance personally. Early in my career, I would feel that I or my receptionist must have done something to upset this person—someone we had never met before. But it doesn’t take long to realize that some individuals simply resent the fact that they have no choice but to seek hearing care. Pleasing them is one of our greatest challenges. Some may never get as far as the hearing instrument fitting, but eventually—when their communication deteriorates to a point that they return as willing partners in their own rehabilitation—they will be better equipped to understand that we are there to help.

Movement of the Patient’s Chi and Hearing Health Care
For those persons who are already through the door, but sitting in the chair glumly staring at me with all their resistance intact, one worthwhile approach may be to ask, “Where’s the chi?” Resistance becomes the center of their chi. How can one shift this energy? Resistance is resistance no matter the label. That is, whether chi is
focused around price, social stigma, trust or emotional issues, the resistance is often easily recognizable to us, but surprisingly it is often not recognizable to the patient. They see their resistance as justified.

The resistance must first be identified, then transformed by carefully peeling it away. This can leave some patients feeling somewhat vulnerable and can be disconcerting if you, as the professional, are ill-equipped to handle it, and if the patient is not ready to confront the reasons for his/her resistance. In extreme cases, it can even lead to your patient breaking down in tears, an outburst of anger or even unkind accusations about your intentions.

On the other hand, you could trigger insights for your patients that allow them the opportunity they seem to have always been denied, and perhaps even withheld from themselves. How you address their moment-to-moment processing influences their outcome. Fundamentally, for people who have suffered with unresolved hearing loss for years, they come to you wounded. They have been through years of communication battles. This is no small thing. These battles could have led to divorce, unemployment, low self-esteem, isolation, depression and other major problems in their lives. Coming to you can be much like stepping into the enemy’s territory—a statement of defeat. They have lost their battle of hiding the hearing loss, keeping the secret. For many resistant patients, sitting with you is acknowledgment of their defeat. For patients receptive to your help, it is acknowledgment of resolution. In either case, it is you who must bring the patient across their own barriers to rehabilitation.

Through your guidance they can “move their chi” back to its rightful center, and you can provide this fragile bridge by means of direction and positive feedback. That is, they express resistance, you acknowledge you understand what they’ve said and return with a benefit around the issue. It’s not easy, and it’s not always painless.

As with the example of acupuncture, there is often pain associated with moving chi. When confronting a patient relative to their resistance, it need not be in the form of an argument, no matter how thoughtful your position. In any such argument, you will almost always lose, even if the potential client ultimately purchases hearing instruments. By presenting your excellent argument (i.e., winning), you’ll win them over to an idea of something they may never practice (i.e., they won’t use the aids). Their negative experience will not benefit anyone.

Arguments are settled by agreement, and the hearing care professional needs to direct the discourse. This is the role of a counselor. The best way to achieve this type of verbal kuzushi is to agree through compassion. What this means is you acquire the energy of the patient’s resistance, no matter what the issue(s), acknowledge to them through compassion that you know the issue exists and that you do understand (and you must understand!), and may even agree with them.

Agreement is the hallmark of resolution. A patient can only resist in the presence of opposition. Remove the opposition (“I think hearing aids are expensive too…”) and the resistance disappears. What remains is what might be thought of in Buddhist or Hindi terminology as prana: breath, peace, tranquility, centeredness. You have just directed their chi back to their center. This movement of chi is a process in counseling that leads to rehabilitation. If the sensorineural hearing loss itself cannot be healed, what it has done to their lives needs to be healed.

Our role as counselors is to keep patients on track through gentle guidance. Most of our patients, in my opinion, return to us not because we are a walking textbook of knowledge and our competition isn’t, but because they admire something about us (a familiarity or comfort, our humor, communication skills, style, etc.). This assumption being true, you can spend more time on what will mean the most to them, and on what will achieve the most rehabilitation. While every patient will be different, the most effective counseling is not likely to occur through in-depth interpretation of the audiogram, or explaining algorithms, decibels or cochlear hair cell degeneration. If you do not cut to the core of their personal issues, if you cannot see above their resistance, you are talking to a wall, not counseling.

The best counseling advice a dispensing professional can offer is to let the decision for purchasing the hearing instruments remain the patient’s. In doing so, the professional places on the patient the onus of responsibility for wearing them, versus the patient blaming the dispensing professional for the instruments gathering dust in a dresser drawer. When you stop to think about it, we all prefer to make our own decisions. Respecting the same need in our patients gives them the latitude to see that we are operating in their best interest.

f06a.jpg (6135 bytes) Richard E. Carmen, AuD, is editor of The Consumer Handbook on Hearing Loss & Hearing Aids: A Bridge to Healing ( www.hearingproblems.com ). He also maintains a private practice in Sedona, AZ.

Correspondence can be addressed to HR or Richard Carmen, AuD, Northern Arizona Speech and Hearing Center, Plaza West, Ste. 210, 2155 W. Highway 89-A, Sedona, AZ 86336; email: [email protected].