As reported in The Hearing Review online (November 6, 2015), Phonak has convened a select group of hearing healthcare experts to provide evidence-based recommendations to hearing care providers on how to better engage family members. Chaired by Dr Louise Hickson, the objective of this group is to facilitate family involvement throughout the hearing remediation process. The group proposes an audiologic treatment shift from a site-of-lesion focus to a family-centered care perspective as a means of increasing the value of our services and the uptake of hearing devices. This paper is the first in a series of several common (mis-)beliefs about the approach, which will be challenged by the authors.
The first entry in the series “Myths about Family-Centered Care” addresses perhaps a clinician’s greatest concern: that family-centered care (FCC) will require more time than we can spare.1 A close second to that concern might be the “married couple challenge:” that is, when the family is a combination of patient and spouse/partner who pull us into discussions about relationship problems, and away from our scope of practice and professional boundaries.
Without question, when a spouse is included in an appointment, we are given the opportunity to include another perspective and attend to the family as a unit.2 That said, the mere act of inviting another individual into the room may complicate the interpersonal dynamics, especially when the couple has differing perspectives about communication problems and solutions. Heart-to-heart conversations about the impact of hearing loss on a couple’s relationship and quality of family life can be eye-opening and cathartic. On the other hand, when a couple’s relationship is not built on respect and mutual support, the appointment can be stressful, confusing, and ultimately, unproductive.
It is now, of course, that we must acknowledge that we are not marriage counselors! We are not expected to somehow “fix” a couple’s marriage by “fixing” a hearing problem. By using a classic and familiar counseling strategy, let us reframe this worry from “what we are not” to “what we can do.”
What We Can Do
Hold regular, team-based discussions and role-playing sessions with colleagues regarding professional boundaries as they relate to FCC and couples. For instance, per Stone and Olwang:3
Content: What we talk about. During “couples conversations,” our topics may include feelings about diagnosis, concerns about treatment, or doubts about decisions directly related to the communication problem. Relative to FCC, we can discuss a couple’s shared lives: What improvements do they seek in daily communication, family events, social, and community venues? What are their mutual communication goals? How will each person help the other reach those goals?
Dynamics: How we talk about these topics.4 The topics mentioned above must include respect at all times. The clinician strives to support a couple’s autonomy and capabilities, and ensures that both patient and spouse are active participants in the process. When a party cannot maintain a respectful interaction, or pulls us into relationship problems, we must clearly indicate that our shared focus is only on hearing problems. We can counteract uncomfortable feelings with empathic listening and validating the emotions in the room, even if we do not agree (eg, by nodding to what has been said, by stating “I understand”). When emotions fly high, we want to keep ourselves calm while actively calming down a situation by keeping a relaxed body posture and by speaking in a calm, friendly tone, softer than the conversational partner.
Practicing potential scenarios and reflecting on past experiences can help us remember our role: to keep the conversation focused on family life and shared outcomes.
1. Montano J, English K, Hickson, L. Mythbusters myth #1: I would like to do more counseling but time just won’t allow for it. Hearing Review. November 13, 2017.
2. Epley P, Summers JA, Turnbull A. Characteristics and trends in family-centered conceptualizations. Journal of Family Social Work. June 2010;13(3): 269-285. doi: 10.1080/10522150903514017
3. Stone JR, Olswang LB. The hidden challenge in counseling. ASHA. June-July, 1989; 6-7: 27-31.
4. Phonak. Infographic: How to manage difficult conversations. Phonak website. https://goo.gl/TJ3dDz
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About the authors: Nerina Scarinci, PhD, is Head of Speech Pathology in the School of Health and Rehabilitation Sciences at the University of Queensland, Australia; Kristina English, PhD, is Professor of Audiology at the University of Akron/NOAC, Ohio; and Ulrike Lemke, PhD, is Senior Researcher at Phonak.
Mythbuster #1: I Would Like to Do More Counseling but Time Just Won’t Allow It, by Joseph Montano, PhD, Kris English, PhD, and Louise Hickson, PhD