Samuel Trychin, Ph.D.
Erie, Pennsylvania
One major issue that we encounter repeatedly is that many people who are hard of hearing and their family members do not do the things that would enable them to prevent or reduce communication problems that are associated with hearing loss. Examples for the listener and speaker, respectively, include failure to use an assistive listening device, and not getting the person’s attention before speaking.
We find that people who are hard of hearing and their family members also persist in doing things that contribute to communication problems associated with hearing loss, examples for each, respectively, include pretending to understand when, in fact, one doesn’t, and talking to the person who is hard of hearing from another room.
This often leads to strained relationships and affects both the people who have the hearing difficulty and those with whom they interact. Chronic communication problems place the hard of hearing person at risk for being treated as, and, consequently, believing that they are, incompetent, and/or unacceptable. Difficulty understanding what is said and not hearing or misinterpreting environmental sounds also puts people who are hard of hearing at risk for feeling a loss of influence or control over social and environmental events. Family members and friends often report being frustrated and annoyed by having to repeat what they say and/or having what they say misconstrued. The strain on the relationship in families can result in the person who is hard of hearing being left out of conversations or spouses living together as if they were sharing space in a boarding house rather than living as an intimate couple. The consequences of communication difficulties are far from being trivial.
These observations are widely noted among people in varying geographic locations, of varying ages and genders, and with varying levels and types of hearing loss. Often, the people involved have been living with the hearing loss for many years, and one may wonder why they haven’t been able to work things out in a better fashion. One possible reason why people fail to do what they need to do in regard to improving communication is that they do not get adequate information about the potential effects of hearing loss. Another possible reason is that they did not receive the training necessary for learning how to do what needs to be done to compensate for their hearing loss. This lack of information and training is especially debilitating because the effects of hearing loss are primarily social in nature for the majority of people who have it. The person speaking, as well as the listener who is hard of hearing, contributes to communication problems, and the speaker’s cooperation is most often needed in resolving the problem, therefore, both speakers and listeners need the requisite education and training.
In this regard, there are a variety of specific issues to consider when working with individuals and families in which communication difficulty related to hearing loss is an issue. Our work with people who are hard of hearing and their family members over the past 20 years has provided some clues about the kinds of issues that interfere with people taking positive steps to resolve their communication difficulties. The following are ten factors that should be considered in an aural rehabilitation program when attempting to determine what might be preventing a person from adopting effective communication strategies.
Some people don’t believe that they have any problems.
We encounter some people who say that they are doing just fine and don’t really have any problems to report. However, when they hear other people who are hard of hearing report their problems, it rings a bell for them, and they say something like, “Oh yeah! I have had that happen too.” Or, a normally hearing spouse may interject that the person who is hard of hearing has an awful time understanding on the telephone, can’t handle conversations while driving a car, and is always asking people to repeat what they have said. An opportunity to listen to the experience of other people can help an individual become aware of problems they themselves may have been experiencing without realizing it.
This raises some interesting issues about questionnaire responses. If people on their own don’t recognize or admit to having problems related to hearing loss when, in fact, they do have them, summaries of survey questionnaire data may well be underestimating the prevalence of such problems. Failure to recognize the range of problems a person is experiencing at the outset of a program also has implications for pre-post evaluations of program effectiveness.
Some people don’t relate the problems they experience to their hearing loss.
We have seen many people who did not relate the personal problems, e.g., anxiety, depression, or fatigue, they experience to their hearing loss. Some individuals have not even considered that the effects of the communication breakdowns due to their hearing loss may be a factor in the interpersonal difficulties they experience at home or at work. When exposed to a situation that lists and discusses the wide-range of reported effects of hearing loss, including fatigue, such people often become able to relate their problem to the hearing loss. We have heard several people say, “Oh, thank God, I thought I had some un-diagnosable disease; none of my doctors has been able to figure out why I’m tired all the time.”
Some people believe that the problems they experience are related to the hearing loss, but don’t believe that there is anything they can do about them.
Some people are well aware of the relationship between their hearing loss and the social and personal problems they experience, but are resigned to the notion that there is nothing they can do about it. They may say, “I’ve got the best hearing aids money can buy, but I still have all these problems understanding what people say, so, I guess I’m just stuck.” When they learn about other kinds of assistive listening devices and get some practice using behavioral strategies for preventing and reducing communication problems, their lives can improve dramatically.
Some people blame their problems on the hearing loss, when something else is the cause.
Using the hearing loss as an excuse can be a ploy to avoid having to expend the effort to change one’s behavior. Sometimes, for example, we encounter individuals who have relationship problems due to poor interpersonal skills or who don’t understand what is said because they don’t pay attention, but blame their hearing loss for their difficulties. Blaming the hearing loss can be a ploy to get the person “off the hook.” It may be easier to get by with, “It’s not my fault that I have this hearing loss; what can I say?” than to make the effort to pay attention and become more independent in communication situations. Also, family members may find it easier to assume that the relative who is hard of hearing “wouldn’t understand anyway” than to go out of their way to get the relative’s attention before beginning to speak and/or to modify the way they talk to increase the probability that the person who is hard of hearing will understand.
Some people don’t know what to do to prevent or reduce the communication problem.
In our own work, we find a great many instances where people simply do not know what to do to improve communication in a given situation. They have not had the information or training necessary to inform them about what to do. How can people change their behavior when they are unaware of the alternatives? Most of the people we have worked with had never heard of, let alone used, assistive listening devices. The vast majority did not know what to look for in order to determine the causes of communication breakdowns and had not been employing strategies for preventing or reducing communication difficulties.
When doing an assessment with a person who is hard of hearing and/or a family member, it is important to ask questions about what alternative courses of action they might take to alleviate specific communication problems. The answers they give provide information about what they know and don’t know and suggest education/training experiences that will be beneficial. The answers may also suggest modifications of an aural rehabilitation program to meet the specific needs of particular participants.
Some people get in their own way while trying to resolve a communication problem.
Another problem we have observed is that sometimes people know what to do, but do it in such a way that others are repelled. For example, they may make demands instead of requests, or their tone of voice and/or body language may offend others. The result is that they don’t have success in enlisting the cooperation of others. Sometimes, doing the right thing in the wrong way can be even more damaging than doing nothing to attempt to resolve a problem.
When this is apparent, for example, by angry words, tone of voice, or body language, it is important to provide the individual with alternative, more socially appropriate, ways of communicating their needs. An effective way of doing this is through role-playing “right” and “wrong” ways of conveying what one wants from others in a variety of situations.
Some people don’t believe that they can do what is required to resolve the communication problem.
A very large body of research indicates that people need to believe that they are competent to carry out an action before they will attempt it. Research findings (Bandura, 1997) indicate that perceived self-efficacy beliefs specifically influence:
What course of action people pursue.
John does not understand much of what his supervisor says during planning meetings because she talks too rapidly. Does John believe that he can ask his supervisor to slow down when discussing a contract? Irrespective of the facts in the situation, if he doesn’t believe he can, he won’t do it.
How much effort they will expend.
Will John take the necessary time and effort to ensure that his supervisor understands the reason for slowing down? The stronger his self-efficacy belief is, the more effort he will expend.
How long they will persevere in the face of obstacles and failures.
How many times will John remind his supervisor when the latter forgets to slow down when talking? Again, research indicates that the stronger John’s perception of his ability to inform her, the longer will he persevere when she forgets.
Their resiliency to adversity.
Will John try different tactics to get his supervisor to slow down when his initial efforts fail to achieve the desired result? If he believes that he can do it, the probability is high that he might resort to different tactics when she forgets to slow down, such as, using hand gestures or using a written note. If his belief in his ability to get her to alter her rate of speech is low, he will give up easily when things do not go his way.
Whether their thought patterns are self-hindering or self-aiding.
High, perceived self-efficacy would result in thoughts such as, “I can ask her in a nice way, and she’ll slow down, we’ll work it out.” Low self-efficacy beliefs would result in thoughts such as, “I don’t think there’s anything I can say or do to get her to slow down, I think I’d better be looking for a new job.”
How much stress and depression they experience in coping with taxing environmental demands.
If John believes he is incapable of asking his supervisor to slow down when speaking and, consequently does not,, he will be at risk for feeling anxious when anticipating meetings with her, helpless and incompetent when not understanding during meetings, and, perhaps, depressed when recalling difficulties in a past meeting. Research (Bandura, 1991, pp. 8-9) indicates that avoiding dealing with a problem head on increases the stress one experiences.
The level of accomplishments they achieve.
If John believes that he can ask his supervisor to slow down when speaking and consequently does so, John increases the probability that he will understand more of what the supervisor says, appear to be more competent, and function at a higher level. If John does not believe he can ask his supervisor to slow down and consequently doesn’t, the probability is that John will have difficulty understanding the supervisor, appear incompetent by making errors or asking for frequent repetition of what is said, and function at a lower level.. Therefore, the probability of his success on the job and being given more responsibility is greater when his perception of his self-efficacy in this regard is high.
In summary, asking people a variety of questions about what they think they are able to do now (Bandura, 1997, pp. 42-46) provides information about their perceived self-efficacy beliefs and suggests education/training experiences they might need to increase their sense of self-efficacy in order to actually do what needs to be done. These questions need to cover a wide range of situations graded in terms of their difficulty, because, for example, Marjorie may believe that she is able to ask her family members and close friends to face her when speaking, but may not believe she is able to do the same with a clerk in a store, a coworker, or a supervisor.
The questions also need to cover a wide range of communication behaviors, because, for example, Mark may believe he can inform coworkers that they need to face him when speaking, but may not believe that he is able to frequently remind them when they forget or that he can ask them to use the microphone connected to his personal amplifier.
So, it cannot be assumed that because someone has been observed performing an action in one circumstance that he or she believes they can do it in other circumstances. It also cannot be assumed that because people have been observed performing one communication behavior competently that they believe they can also perform other effective communication behaviors. People’s self-efficacy beliefs determine what they will and will not do and have major consequences for the life-paths they take and the accomplishments that they achieve.
Some people don’t believe that their efforts to resolve the problem will produce the outcome they desire.
A separate, but related, issue that affects whether or not a person executes an action is that she or he also needs to believe that the envisioned action will have the desired outcome. This behavior-outcome relationship is known as means-end congruence. Why would a person go through the trouble of doing something, if it doesn’t seem as though the action taken will produce the effect she or he wants? An example was recently provided by a student who said, “Even if I ask, the professor won’t agree to use the FM system while lecturing.”
If inquiries about a person’s self-efficacy beliefs indicate they believe they can do something, but their means-end beliefs indicate it will not produce the desired result, some means of testing the latter belief is called for. If it is true that the action will not produce the desired outcome, alternative courses of action should be considered.
It is important to find out people’s beliefs concerning specific situations. For example, the student mentioned above might approach the school’s student special services counselor, department chairperson, or dean and ask them to intervene. If that does not succeed, the student might consider transferring to a different section with a more cooperative professor. Resort to legal action can also be considered.
Some people don’t believe that it is socially acceptable, i. e., polite, proper, appropriate, to ask others to do what needs to be done to prevent or reduce communication difficulties.
Also, we have found that sometimes a person will believe that they shouldn’t engage in an action because the behavior would not be acceptable to someone else. In such a case the behavior in question is usually not initiated. Self-efficacy beliefs involve the issue of, “I can or can’t,” while “permissablility” involves the issue of, “I should or shouldn’t.” Some people in our groups have been reluctant to consider asking others for a communication behavior change, e.g., “please slow down.” for fear that it will put other people out. However, when they see the negative effect on others caused by frequent failure to understand what is said and weigh the consequences of each, they often change their thinking and agree to do what is required to improve communication. Just getting the person to see that the inevitable communication breakdowns resulting from competing background sounds are a greater imposition on the hostess than requesting that the music be turned down might provide sufficient permission to enable the person to make the request. Questions should be directed at the person’s beliefs about the correctness, social acceptability, or properness of a given course of action. If this is an issue, some discussion about the pro’s and con’s of both taking and not taking that action should be undertaken.
Performance is punishing in some way.
People don’t persist in doing things that result in their being punished. If asking others to repeat what they said has resulted in being rebuffed, insulted or punished in some other way, the chances are good that the individual will stop making those requests and resort to bluffing. It is important to determine if punishment is a factor when the person is not doing something they are, in fact, able to do. If that is the case, they should be helped to determine if the punishing consequence is a result of what they ask or how they make the request, e.g., demanding language, tone of voice, or body language, that might arouse resistance in others. If so, provide practice in making requests in ways that are more likely to result in cooperation.
One woman refused to wear her hearing aids. After some questioning, the reason was uncovered--the ear-molds hurt her ears. When they were correctly fitted, she wore her hearing aids. Many times, the solution is that simple.
In each of the previous ten factors the result is the same—the person doesn’t take effective action to resolve a problem. But, the root cause in each case is different, and each requires a different solution. In working with people who are hard of hearing and their family members, it is essential to do an assessment to determine why it is that someone is not doing what would seem to be in her or his best interest.
Once the assessment is made and the source(s) of the problem is determined, an effective intervention can be formulated. For example, if the person does not know about assistive listening devices or how to use them, an education/training experience can be implemented to resolve that problem. If the person is unaware of the effects on others of his or her demanding behavior, an experience can be designed to help the individual recognize and alter that behavior.
The objectives of designed interventions should be:
- To provide required education or training to raise participants awareness of the problems they are experiencing and the relationship of their hearing loss to those problems,
- To provide participants with opportunity to practice more effective communication strategies, to increase their self-efficacy and/or means-end beliefs, and
- To provide participants with permission to do what they need to do to prevent or reduce communication problems.
The overall program goal is to enable the participants to do the kinds of things necessary for improving communication and being included as a functioning member of his or her social world. We believe that a group format is the most efficient and effective way to accomplish these kinds of assessments and interventions. The assessments we have carried out in the past have been accomplished by asking the participants in our groups a series of questions and by observing their behavior during the group sessions. The assessment has been very informal and unstructured. We are currently in the process of developing a more formal measuring instrument to provide a more comprehensive assessment that will enable us to pinpoint the source(s) of communication problems earlier and tailor interventions in a more focused manner for each participant in our groups.
In terms of interventions, the group format makes it possible to observe participant’s actual communication behavior, bring ineffective behavior to their attention, and have them practice more effective alternative behaviors. Research (Bandura, 1997, pp. 370-373) indicates that self-efficacy beliefs are strengthened by enactment-- by practicing the behavior in question and by vicarious experience-- by observing a model, i.e., someone successfully executing the behavior in question. The group format provides participants with frequent opportunity practice effective communication behavior and receive feedback regarding their performance both during the sessions through role-playing and outside the group session through weekly homework assignments. This practice and feedback reinforces their beliefs in their ability to execute a variety of effective communication behaviors.
Participants also learn vicariously by observing effective communication strategies displayed by others, e.g., the group leader, the other group members, and models on the videotapes that are shown. This has the double effect of increasing self-efficacy beliefs and of providing permission to do the things that are necessary for improving communication.
Each session also provides an opportunity for participants to practice using assistive listening and other devices, learn more about their hearing loss, and receive information about national and local resources.
Bandura, A. (1991). Exercise of personal and collective efficacy in changing societies. In Bandura, A. (Ed) Self-efficacy in changing societies (pp. 1-45). New York: Cambridge University Press
Bandura, A. (1997). Self-efficacy: The exercise of control. New York: W. H. Freeman and Company
Schwarzer, R. and Fuchs, R. (1995). Changing risk behaviors and adopting health behaviors: The role of self-efficacy beliefs. In Bandura, A. (Ed.) Self-efficacy in changing societies (pp.259-288). New York: Cambridge University Press
Much of the content of The Living With Hearing Loss
program is contained in:
Trychin, S. (2002). Living with hearing loss: workbook.
For information contact samtrychin@adelphia.net or see
trychin.com
Contact Dr. Trychin at samtrychin@adelphia.net or by phoning (814)897-1194. Mailing address is Sam Trychin, Ph.D., 212 Cambridge Road, Erie, PA., 16511.
©2003 Samuel Trychin, PhD
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