In the first of a two-part series, Drs Clark and English explore common misconceptions in audiologic counselling and highlight the power of empathy and person-centred care.
As patients sit before us, they experience any number of psychological and emotional states, including expectations, hope, dread, worry, anxiety and cautious optimism. Some patients are easy to read and some are guarded and uncommunicative. They react in different ways to our case history questions, our test results and our recommendations.
Patients may be confused over the diagnosis itself, uncertain about recommended treatment plans and worried about prognostic limitations. In addition, they may experience disappointment and emotional pain for the loss or diminution of hearing abilities. Adult patients may be distressed about changes in their lifestyle, and caregivers of children with hearing loss may feel deeply grieved about their family’s future.
Emotionally-fraught moments such as these demonstrate the need for effective audiologic counselling, which includes not only patient education (content counselling) but also personal adjustment counselling. Both skillsets have long been recognised as a vital component to audiologic care [1]. The two aspects of counselling (providing patient education and providing personal adjustment support) are closely intertwined. As we provide patient education, we must monitor a patient’s psycho-emotional state to determine whether the information is overwhelming or upsetting. As we provide personal adjustment support, we monitor a patient’s cognitive understanding of the circumstances and decision options.
As essential as these skills are, they cannot be taken for granted. For example, UK audiologists recently indicated confidence in informational counselling, but less so in providing support for emotional or social issues [2]. The authors concluded with a recommendation to incorporate counselling coursework in training programmes to address this gap. When programmes seek guidance on relevant learning objectives, we have found it helpful to frame the broad concept of ‘counselling’ to represent an overarching set of interpersonal skills required for person-centred care [3].
"Because the process conveys respect for the patient’s autonomy, SDM is (unsurprisingly) associated with greater patient satisfaction"
We have learned the value of examining common myths about audiologic counselling that could discourage change. For example, 20 years ago, it was assumed that only psychologists, psychiatrists and social workers were qualified to provide personal adjustment counselling; however, the adoption of person-centred care practices and clearly defined boundaries have dispelled that myth. Following are other common myths to consider:
Myth #1: There isn’t enough time to provide personal adjustment counselling
Why might we believe this?
Inarguably, clinical practice can be fraught with immense pressure to see a high volume of patients in a brief time window, especially within the provision of audiologic services in the midst of a busy ENT clinic environment. In routine appointments, we learned to place high value on patient education, but not about health literacy levels or inquiring what the patient wants to know. Our understanding of a ‘productive appointment’ did not include time addressing depression, fear of stigma, or social isolation.
What guidance refutes this myth?
It has been shown that the provision of personal adjustment counselling is not based so much on the amount of time we spend with patients, but rather on how we accept and listen to patients during the limited time we are with them. Several studies indicate that person-centred (or counselling-infused) care does not add more time to appointments [4]. Person-centred clinicians have the same amount of time per appointment, but use that time to develop common ground and explore patients’ experiences with hearing loss, rather than (for example) spending precious minutes providing a ‘crash course’ on interpreting audiograms.
We can disprove the myth by optimising the brief time we do have. In very busy settings, patients feel the same pressures of being rushed that we do; one comment acknowledging that shared experience communicates support. We can actively manage interruptions, display a calm, confident, non-rushed demeanour, and elicit and validate patient concerns; if we don’t, they will likely surface again anyway. We can employ active listening postures (no keyboarding) and respond to patient cues to emotional distress with empathy. We can prioritise balanced ‘talk time’, and postpone less-than-urgent information-sharing and tasks. If pressed for time, we can assure patients that their concerns will have top priority next time.
Person-centred engagement helps us earn patient trust – in other words, a good use of time.
Myth #2: Counselling is all about giving advice and telling patients what to do
Why might we believe this?
Audiology education is steeped in content counselling training, since the majority of the counselling we must provide is educational in nature. So, yes: giving advice is part of the counselling we provide. But there is much more.
What guidance refutes this myth?
This myth is a relic from the era when patients were expected to comply with the ‘doctor knows best’ mantra. Even today, it can be a fallback position when we run short on energy or patience. We now know this ‘expert model’ is the antithesis of shared decision-making, one of the keystones of person-centred care. Shared decision-making (SDM) is a collaborative approach that blends clinical evidence with a patient’s personal context – an inextricable blending of patient education and personal adjustment counselling. Because the process conveys respect for the patient’s autonomy, SDM is (unsurprisingly) associated with greater patient satisfaction [5], reflecting the difference between one-sided advisement and two-way conversations about options and preferences. Note that ‘advice-giving’ is not mentioned. Instead, each behaviour represents cooperative problem-solving and respect for the patient’s capacity for growth, a seismic shift from ‘the professional knows best’ stance of days gone by.
Myth # 3: We need to fix the person’s problem
Why might we believe this?
This myth is based on an overgeneralisation of our ‘fixing’ responsibilities. Our professional training in the hard sciences (anatomy, physiology, physics, assessment methodologies, etc.) qualifies us to literally ‘fix’ many patients’ hard-science problems, e.g. reprogramming a cochlear implant or teaching the home Epley manoeuvre. These straightforward fixes are gratifying, as well as self-reinforcing: it feels good to be helpful.
We might therefore believe our science background also includes the goal of fixing less straightforward, non-technical patient concerns – specifically, hearing/balance-related emotional, social and psychological distress. If we buy into the myth that we are responsible to fix these problems as well, we are overextending our role. For example, if a patient worries that people will think less of her as a hearing aid user, we might instinctively advise, ‘Other people will hardly notice your new hearing aids.’ Our attempt to ‘fix’ this concern is well-intentioned but in reality we are minimising the patient’s concerns and implying we know more than the patient does about her life – the opposite of ‘fixing’. Unexamined assumptions about what we can and should fix prevent us from realising how unhelpful this comment is.
What guidance refutes this myth?
Nobel Peace Prize nominee and psychologist Carl Rogers led the way in refuting the myth about ‘fixing’ people [6]. His research confirmed that in an accepting professional relationship, patients will find their way through their barriers and resolve their own problems. His guidance has shown us how to move beyond this myth: with humility, we can abandon the presumption of expertise in another person’s life. With compassion, we can convey unconditional positive regard and communicate trust in a person’s capacity for self-help. In audiology settings, these clinician behaviours are recognised components of person-centred care, specifically empathy, active listening, using open-ended questions, reflective conversations, involving friends and family members, shared decision-making and taking the time to understand needs and preferences.
Summary
Examining some of the common myths of audiologic counselling is a first step toward effectively providing both effective patient education and needed psycho-emotional support to our patients. In part two, we will consider these additional myths: we should avoid talking about emotions or difficult topics; we must fill silence with talk; and the patient should always leave feeling better.
References
1. American Academy of Audiology Scope of practice. 2023.
https://www.audiology.org/
document-type/scope-of-practice/
[Link last accessed October 2025].
2. Woodward E, Saunders GH. Do UK audiologists feel able to address the hearing, social and emotional needs of their adult patients with hearing loss. Int J Aud 2024;63(11):867–74.
3. Clark JG, English KM. Counseling-Infused Audiologic Care (4th ed). Inkus Press/Amazon.com; 2025.
4. Stewart M, Brown JB, Weston WW, et al. Patient-centered medicine: Transforming the clinical method (4th ed). London, UK; CRC Press; 2024.
5. Milky G, Thomas J. Shared decision making, satisfaction with care and medication adherence among patients with diabetes. Pt Ed Counsel 2020;103(3):661–9.
6. Rogers C. Foundations of the person–centered approach. Educ 1979;100(2):98–107.
Declaration of competing interests: None declared.
