In the second of a two-part series, Drs Clark and English explore how addressing emotions, embracing silence and managing expectations enhance person-centred care.
As discussed in part one of this article [1], when 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 support, we monitor a patient’s cognitive understanding of the circumstances and decision options.
We further noted that the two aspects of counselling (providing patient education and providing personal adjustment support) are closely intertwined. Continuing where we left off in part one, we examine three additional counselling myths and their impact on our efforts to provide both effective patient education and needed psycho-emotional support to our patients.
Myth #4: We should avoid talking about emotions or difficult topics
Why might we believe this?
There are at least two reasons to account for this myth, one source from ‘top down’ and one from within.
1. Top down: Until relatively recently, healthcare providers were expected to focus only on measurable symptoms and treat them as conditions unrelated to the patient-as-person. For decades, disengagement was valued as professional objectivity [2]. This position was challenged by Engel’s proposal to expand into a bio-psycho-social model of care, taking into account the whole of a patient’s experience, a philosophy we now know as person-centred care [3].
Changes can be slow and, as impressionable students, we may have been strongly advised by respected role models to ignore difficult topics or redirect from patient emotions, and perhaps even been chastised if we didn’t conform to ‘professional’ behaviours. As vulnerable learners at the time, we may not have realised the impact of this philosophy on our patient interactions.
2. From within: We may not be personally comfortable with other people’s emotions or difficult conversations in any context, including audiology appointments. If so, this myth provides ‘cover’ when emotions arise.
What guidance refutes this myth?
Adams and colleagues reported data that clearly refute this myth [4]. They recorded and transcribed 77 physician-patient encounters, identifying 170 instances in which patients expressed emotions. Their analysis identified two kinds of physician responses: 1. those which focused away from (i.e. did not acknowledge) emotions, creating distance and often antagonistic relationships, and 2. responses which were either neutral (‘OK’ or ‘I didn’t know that’) or intentionally focused toward or acknowledged emotional comments. These two types of responses communicated acceptance and an openness to engage, resulting in increased agreement about treatment plans.
Ekberg et al captured similar outcomes within an audiology context [5]. It was observed that when patients brought up emotional concerns, their audiologists typically focused away from those emotions. When concerns were not initially addressed (e.g. stigma), patients frequently mentioned their concerns again, to no avail. Ultimately, where patients’ concerns were left unaddressed, the appointment ended without the patient agreeing to go ahead with amplification.
Simply put, when emotions are ‘in the room’, how we respond matters. When we acknowledge patients’ emotions, they are more likely to feel accepted and more inclined to trust us and our recommendations. If we ignore or dismiss patients’ emotions and concerns because we feel uncomfortable, learning how to manage this discomfort can benefit clinicians and patients alike. One way we can determine if our responses to patient emotions are effective is to request feedback. A new tool called the ‘Feeling Heard Scale’ provides patients with the opportunity to report on their care provider’s responsiveness [6].
Myth #5: We must fill silence with talk
Why might we believe this?
A primary reason we believe this myth is how we have been socialised. Western society is not comfortable with silence in general; when silence occurs in a clinical setting, we tend to experience anxiety and a compulsion to fill conversational gaps. This compulsion is deeply ingrained, and we may not notice that blithely talking through a patient’s silence reflects only our own understanding of the moment, while effectively dismissing the patient’s distress.
A clinical application of this myth is captured in a question posed by Montgomery et al: in a setting where evidence-based practice is focused on ‘doing’, do clinicians view silence as doing nothing [7]? That possibility does seem to track: not staying active, not moving the appointment forward, not ‘being productive’ is anathema to our conventional view of clinical care. We may feel some internal pressure to prioritise our productivity over the patient’s in-the-moment experience.
What guidance refutes this myth?
Even as we find silences uncomfortable, patients who initiate silence are experiencing their own personal distress. Being advised of a life-changing diagnosis, or receiving confirmation that previous problems are getting worse, will significantly and negatively alter their view of the future. In these moments, the mental and emotional resources needed to continue the conversation are not readily available [8].
Guidance regarding silent moments: first, we wait. To help suppress the urge to continue the conversation, we can learn to view silence as normal pauses. A pause of 10 seconds might cause us genuine distress, but it also actively focuses us fully on the patient. With practice, our distress lessens and our composure increases. More importantly, from a patient’s point of view, when we honour their moments of silence, our committed presence conveys empathy, respect, support and a nonverbal sharing of their distress, which has been found to increase rapport with the clinician [9].
Myth #6: The patient should always leave feeling better
Why might we believe this?
In part one, we discussed how clinical training often promotes a culture or desire to provide an immediate fix. As members in a ‘helping profession’, there might be unspoken expectations that every patient should leave feeling better because, if not, we have somehow failed. The fact that an immediate resolution to a problem is not always available adds more pressure to this myth.
What guidance refutes this myth?
As frequently seen in hearing healthcare, given that technology cannot fully restore hearing, a perfect and immediate fix is not always possible. Even when aware of hearing problems, adult patients may not ‘feel better’ following an appointment when their hearing loss has been confirmed. Their previously held identity of being complete and whole has been shattered; they realise that a full measure of hearing help may require more work on their end than they had expected; and they are told that a full restoration of hearing is not possible. It goes without saying that a child’s diagnosed hearing loss, even if suspected, is never a ‘feel better’ experience for parents, no matter how well they understand the situation and their next steps.
Clearly, patients and family members will not always leave appointments feeling better. We can, however, strive to ensure they do not feel alone, especially when we can recommend relevant support groups [10]. When they know that we see and support them as persons, ideally they will at least leave with trust in the situation and new insights to aid their processing of new information and the goals ahead.
Conclusion
Both content counselling/patient education and emotional support counselling are integral to patient success, foundational to person-centred care, and lead to greater patient trust and adherence to recommendations. Counselling myths regarding the types of counselling audiologists provide can impede optimal patient care. A critical examination of these myths is frequently necessary to ensure that we provide the full range of audiologic counselling so many of our patients need.
References
1. Clark JG, English K. Dispelling myths about audiologic counselling: part one. ENT & Audiology News 2026;34(6):36–7.
2. Bourke J. Pain, sympathy and the medical encounter between the mid eighteenth and the mid twentieth centuries. Hist Res 2012;85(229):430–52.
3. Engel G. The need for a new medical model: A challenge for biomedicine. Science 1977;196(4286):129–36.
4. Adams K, Cimino J, Arnold R, et al. Why should I talk about emotion? Communication patterns associated with physician discussion of patient expressions of negative emotion in hospital admission encounters. Pt Ed Counsel 2012;89(1):44–50.
5. Ekberg, K, Grenness C, Hickson L. Addressing patients’ psychosocial concerns regarding hearing aids within audiology appointments for older adults. Am J Aud 2014;23(3):337–50.
6. Clark J, English K. Do our patients feel heard? Introducing a new self-assessment tool for clinical practice. Aud Today 2025;37(5):34–45.
7. Montgomery M, Luca M, Gordon‐Finlayson A. The shifting sound of silence: A constructivist grounded theory. Counsel Psych Res 2024;24(1):275–85.
8. Weston WW, Brown JB. Challenges in learning and teaching the patient-centred care clinical method. In: Stewart M, Brown JB, Weston WW, et al (Eds.). Patient-centred medicine: transforming the clinical method. 4th ed. London, UK; CRC Press; 2024:240–266.
9. Sharpley C, Munro D, Elly M. Silence and rapport during initial interviews. Counsel Psych Q 2015;18:149–59.
10. Haddad KL, Steuerwald WW, Garland L. Family impact of pediatric hearing loss: Findings from parent interviews and a parent support group. J Early Hrg Detec Interv 2019;4(1):43–53.
Declaration of competing interests: None declared.
