Counseling Instruction Within Audiology Programs: A Major Deficit in Training?

Carl C. Crandell, PhD, CCC-A

April 24, 2000

It has been demonstrated that appropriate counseling is a critical variable in the rehabilitation of individuals with hearing impairment (see Crandell, 1997, Crandell, McDermott, & Pugh, 1996, and Luterman, 1996 for a review of these investigations). Brooks (1979), for example, found patients who received counseling wore their hearing aids more and achieved greater reduction in perceived hearing handicap than non-counseled patients. Despite the obvious importance of patient counseling in the treatment of audiologic disorders, available literature suggests audiologists typically receive limited exposure to counseling instruction through graduate school curricula. This deficiency of formal course work in counseling is presumably a major reason why individuals with hearing impairment, and/or parents of children with hearing impairment, are not highly satisfied with counseling skills of audiologists. With these considerations in mind, this article will address the following areas: (1) present counseling experiences in Graduate School curricula for audiologists; and (2) parental and patient views of the audiologist as a counselor. Based on these data, suggestions for improving counseling skills in audiologists are addressed.

Audiologists and Counseling Experiences in Graduate School Curricula

Generally speaking, audiologists receive limited counseling instruction in Master's degree programs. Culpepper et al. (1994) reported a majority of programs (94%) offered a course in counseling, yet only 22% of the programs required the counseling course. Due to the low percentage of programs requiring counseling courses, the majority of programs indicated less than one-quarter of their students took a counseling course prior to graduation.

Crandell et al. (1996) examined the extent of counseling instruction offered in hearing aid courses within audiology graduate programs. A nine-question survey was sent to 102 ESB-accredited audiology graduate program directors. Results indicated a limited (minimal) amount of counseling instruction is provided in hearing aid classes. Specifically, only 14% of instruction time within such classes was typically devoted to counseling. Moreover, one-half of all audiology programs surveyed reserved only 10%, or less, of lecture time for counseling instruction. Despite this limited amount of instruction, 59% of the ESB-accredited respondents felt students were adequately prepared to meet the counseling needs of patients.

Crandell (1997) examined the availability of counseling instruction within 111 audiology graduate programs via an eight-question survey. Results indicated less than one-half (48%) of the programs offered a counseling course. Reasons provided for not offering a course in counseling included lack of funds, faculty shortages and time constraints within the current (master's) curriculum. Moreover, only 27% of the audiology departments which offered a counseling course required that course to be taken. Thus, of the total program responding to the survey, only 13% required students to take a counseling course. Due to this lack of required course work, programs estimated that only 18% of their students ever took a counseling course prior to graduation. Data from this investigation also indicated audiology graduate students were expected to accumulate approximately two-thirds of their knowledge about counseling from their clinical activities (such as during their Clinical fellowship Year [CFY]).

Parental and Patient Views of the Audiologist as a Counselor

Based on the limited amount of counseling instruction offered to audiologists, it is not surprising parents of children with hearing loss and/or patients who have hearing impairment often do not rate audiologists highly as counselors. Fellendorf and Harrow (1970) indicated that only 50% of parents of children with hearing impairment were satisfied with the information provided to them by audiologists and/or physicians. Sweetow and Barrager (1980) reported approximately 20% of parents of children with hearing impairment felt uncomfortable asking the audiologist questions because they either did not know what to ask, or they felt the audiologist would not take their concerns seriously. Moreover, 35% of these parents indicated the audiologist did not provide emotional support to them in matters related to their child's hearing loss. Williams and Darbyshire (1982) interviewed parents of children with severe-to-profound degrees of hearing loss within one year of their initial audiological evaluation. Results indicated 84% of the parents were unable to comprehend the majority of the information provided by the audiologist. Seventy-two percent did not understand the impact of hearing loss on their child, while 64% of the parents did not understand the effects of the child's hearing loss on their own lives.

Improving Counseling Expertise in Audiology

Results from the above investigations indicate audiology programs currently offer limited course work in counseling theor, application and instruction. In addition, audiologists are often not highly regarded in their counseling instruction by parents or patients. Clearly, these data suggest a need for changes within the curricula of audiology programs that would provide increased coursework in counseling. It appears, however, that relatively few audiology programs have space or funding within their established curriculum for additional course work. Hopefully, as the profession of audiology moves towards the professional doctorate, the importance of counseling classes within on-campus and distance learning programs will not only be recognized, but also translated into increased course work and clinical experiences in counseling theory and application. Counseling can no longer be expected to be learned 'on-the-job' as clinical experiences often deviate widely, even among students within the same program.

To support the potential impact of providing students with additional training in counseling, the University of Florida distance learning Doctorate of Audiology (Au.D.) program recently provided a class in counseling for its students. Students included 335 Master's level audiologists, who averaged 13.5 years of practice in field of audiology. Overall, students averaged 0.8 counseling courses taken in their Master's degree program and 1.03 counseling courses taken at professional meetings. A twenty-five item questionnaire, that asked the students to indicate the impact of the class on their counseling skills, was given to the students the last week of the term. Specifically, students were asked to rate the effects of the class on various counseling areas on a scale of 1 to 5 (1 = this class made my counseling poorer within this area; 5 = this class made a major improvement in my counseling within this area.) All student responses were confidential. Overall, 66% of all respondents indicated a moderate to major improvement in counseling ability. Ninety percent indicated that the course improved their counseling ability to some degree. These data strongly suggest that Au.D. counseling classes can significantly improve the counseling skills of audiologists. Thus, it is highly recommended that all Au.D programs, whether on-campus or distance learning, should incorporate counseling courses within their curriculum.

References
Brooks, D.N. (1979). Counseling and its effect on hearing aid use. Scandinavian Audiology, 8, 101-107.

Crandell, C.C., (1997). An update on counseling instruction with audiology programs. Journal of the Academy of Rehabilitative Audiology, 15, 77-86.

Crandell, C.C., McDermott, D.J., & Pugh, K. (1996). A survey on amplification and counseling skills training in audiology. The Hearing Review, 3(9), 26-29, 48.

Culpepper, N.B., Mendel, L.L., & McCarthy, P.A. (1994). Counseling experience and training offered by ESB-accredited programs: An update. Asha, 36(6), 55-58.

Fellendorf, G.W., & Harrow, I. (1970). Parent counseling 1961-1968. Volta Review, 72, 51-57.

Luterman, D.M. (1996). Counseling the communicatively disordered and their families. Texas: Pro-Ed.

Sweetow, R. & Barrager, D. (1980). Quality of comprehensive audiological care: A survey of parents of hearing-impaired children. Asha, 22(10), 841-847.

Williams, D.M., & Derbyshire, J.O. (1982). Diagnosis of deafness: A study of family responses and needs. Volta Review, 84, 24-30.

Counseling Instruction Within Audiology Programs: A Major Deficit in Training?

Carl C. Crandell, PhD, CCC-A

Carl C. Crandell, PhD, CCC-A

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