Why and How Should Graduate Students in Audiology Be Taught and Trained in Counseling

While studying for my Ph.D. (a long, long time ago), I was pleased that one of the courses offered was Counseling Theories and Methods. No such option was available to me during my master's program. In fact, at the time, few programs in audiology (or speech pathology) offered, and even fewer required, a course purely devoted to counseling. Culpepper et al reported only 22% of the programs required a counseling course and less than one-quarter of the students took a course prior to graduation.[2] Crandell examined the availability of counseling instruction within 111 audiology graduate programs.[3] Results indicated fewer than one-half (48%) of the programs offered a counseling course. English and Weist examined the curriculum of 56 universities with Au.D. programs accredited by the American Speech-Language-Hearing Association's Council on Academic Accreditation in Audiology and Speech Language Pathology and found that 71% required a counseling course in their curriculum.[4] Although these numbers have improved significantly with the advent of the Au.D., much of a graduate student's exposure to the art and science of counseling continues to be limited to a lecture or two delivered during various courses (perhaps in pediatrics, perhaps in hearing aids). English and Zoladkiewicz surveyed 290 Au.D. students regarding concerns they have about communicating with patients and their families.[5] Results of their survey revealed that students are uncomfortable counseling in sensitive situations.

Given the immense importance of counseling in communicating with patients and their families about the impact of hearing and balance disorders, one wonders why university programs do not universally mandate training in this vital aspect of their students' chosen profession. Is it because those in charge of planning curricula do not believe counseling is a critical element for audiologists, or perhaps is it because many professors do not consider themselves qualified to teach the subject?

The value of counseling to patient satisfaction cannot be overstated. There is a clear correlation between time devoted to counseling and patient satisfaction.[1] The quantitative aspect of time spent counseling, however, is not even as important as the qualitative aspect.

Effective counseling entails conveying information and assisting patients in achieving personal adjustment. Obtaining knowledge of audiology does not necessarily translate into good communication and subsequent counseling abilities. It is relatively easy to convey information because that simply requires knowledge of our subject matter. Helping patients to achieve personal adjustment, however, is more complicated because it requires not only our verbal skills, but our auditory skills as well. Counseling is a two-way enterprise consisting of facilitated learning through listening. Not all students (or audiologists, for that matter) are good listeners. A basic tenet of counseling is not to deny patients' feelings or experiences. To accomplish this, the counselor must first be able to help patients, who are often reluctant, clarify their problems and tell their stories. This requires an understanding of coping styles, personality variables, use of silence, assessment of motivation, and understanding the difference between content questions (those seeking further information) and affect questions (those rooted in an underlying emotional need). Effective communication may be hindered if the counselor responds to an affect question with a content answer. Important tools used in achieving these goals include the use of open-ended questions, reflection, understanding resistance, reading body language, eye content, and recognition that the patient knows more about his or her personal experiences than the counselor. In other words, the counselor cannot attempt to be omnipotent simply because he or she possesses an academic degree. Similarly, professors instructing students in counseling should recognize that they must change their role from being the center of attention and the source of all knowledge to being the coach and facilitator of the acquisition of that knowledge. Learning thus becomes student-centered, not teacher-centered. In teaching, the constructivist approach emphasizes the importance of audiologists relinquishing their expert status and focusing on clients as the experts about their own problems. The audiologist does not have to do any interpreting of behaviors or underlying motivations—he or she merely poses questions that may help lead the client toward insights and decision making.[6]

Given this information, two important assumptions merge creating a challenge for the audiology education system. First, it is essential that students need to be educated and trained in counseling. Second, because counseling has only recently begun to be required coursework, many, if not most, professors charged with teaching students may not themselves have been formally trained in the subject. This issue of Seminars in Hearing, which is based on the proceedings of the 2017 University of Pittsburgh “Art and Science of Teaching Counseling in the Classroom and Clinic” conference, explores essential issues for both students and teachers.

• References

• 1 Kochkin S. Reducing hearing instrument returns with consumer education. Hear J 1999; 6 (10) 18-20
• 2 Culpepper B, Mendel LL, McCarthy PA. Counseling experience and training offered by ESB-accredited programs. An update. ASHA 1994; 36 (6–7): 55-58
• 3 Crandell CC. An update on counseling instruction with audiology programs. J Acad Rehabilitative Audiol 1997; 15: 77-86
• 4 English K, Weist D. Proliferation of AuD programs found to increase counseling training. Hear J 2005; 58 (04) 54-58
• 5 English KM, Zoladkiewicz L. AuD students' concerns about interacting with patients and families. Audiology Today 2005; 17 (05) 22-25
• 6 Sweetow R, Davis A, Hickson L. A paradigm shift in audiology education. Audiology Today 2010; 22 (08) 32-36