The information discussed in this article is a result of 10 years of
work with hard-of-hearing people, their families, and their friends, as
well as personal observations as an adult with a hearing loss. The information
was obtained in workshops and classes throughout the United States and
parts of Canada on topics related to coping with hearing loss. This program
is called Living with Hearing Loss.
The initial sequence of events necessary for effectively coping with
hearing loss is acceptance of the hearing loss and a willingness to do
something to compensate for it. Many people who have hearing loss, especially
those whose onset of hearing loss is gradual, are unaware that they have
a problem. Others deny that they have a hearing loss or, if they admit
to having it,deny that it presents a significant problem for them. Others
may admit that they have a hearing loss and that it does cause problems
for them, but they avoid dealing with it for a variety of reasons, for
example, financial difficulties, other serious physical problems, family
resistance, or lack of information about what to do about the hearing loss.
Some people who are hard of hearing have reported that their family physician
or some other professional person has told them, "There's nothing
you can do about it; you'll just have to learn to live with it." Such
advice coming from a person viewed as an authority can prevent the individual
with the hearing loss from seeking help for years.
As a result of nonacceptance, there is resistance to taking action to
alleviate the problem such as acquiring hearing aids. Stories from friends
or relatives about someone having been cheated by a hearing aid vendor
or having been sold faulty hearing aids can deter the person with the hearing
loss from buying hearing aids. Bad personal experiences with improperly
fit hearing aids can have a lasting negative effect. Unrealistic expectations
about what a hearing aid can do can result in disappointment and refusal
to try wearing one again. Being badgered to get a hearing aid by a well-meaning
spouse can have the effect of creating resistance in the person who is
suspected of having a hearing loss.
A person who has been resisting purchasing hearing aids may relent when
informed of the fact that the hearing loss also probably has adverse effects
on family members, co-workers, and friends. Some people will take steps
to deal with the hearing loss for the sake of others, when they will not
do so for themselves. Sometimes, the individual will listen more easily
to a friend, clergy person, or grandchild than to a spouse, parent, or
child. In such cases it is a matter of determining who the person with
the suspected hearing loss will listen to. Another important consideration
is that the person have accurate information about what a hearing aid can
and cannot do. Finally, while it is important to pursue amplification,
it may not always be sufficient to compensate for communication difficulties.
The Living With Hearing Loss program discussed in this article has focused
on (1) better understanding of the effects of hearing loss and (2) helping
participants adopt more effective communication behavior. Because hearing
loss is a communication disorder, speakers and listeners experience problems
when communication breakdowns occur. To achieve the greatest degree of
prevention or reduction of communication difficulties, speakers and listeners
often need to alter their communications behavior. Therefore, the persons
who are hard of hearing as well as their family members and / or friends
are encouraged to participate in the Living With Hearing Loss classes and
workshops.
The three major barriers to success in coping with hearing loss are
incomplete or erroneous information, ineffective communication behavior,
and low self-esteem. Low self-esteem appears to be exacerbated by the communication
problems resulting from the hearing loss and by the strained relationships
resulting from these communication problems. Therefore, preventing or reducing
communication problems results in improved relationships and increased
self-esteem. Incomplete or erroneous information prevents people from learning
about the full range of strategies available for improving communication.
The program focuses attention on providing accurate information about hearing
loss and on teaching effective communication behavior.
ACCURATE INFORMATION
It is important that hard-of-hearing people and their families have
accurate information about the following.
The Myths or Misconceptions about Hearing Loss
There are a number of misconceptions about hearing loss that result
in unrealistic expectations and that keep people from taking the steps
to prevent or reduce communication problems.
The hearing loss is my problem myth has two unfortunate aspects.
First, holding that belief can make the person reluctant to ask others
to change their communication behavior. This erroneous belief may manifest
itself as, "It's my problem, and I can't inflict it on others."
The second problem with this misconception is that it can prevent the person
from recognizing the effects of his or her own hearing loss on others.
A more realistic belief is that hearing loss can affect everyone in
the communication loop. That means that hearing family members, for example,
also experience problems when their relative who is hard of hearing is
not understanding them. It also implies that speakers as well as the hard-of-hearing
listeners, have mutual responsibility in ensuring that communication problems
are minimized. Communication is a two-way process.
The hearing aid myth that hearing aids restore normal hearing
is widely held by the general population and, too often, by people who
are hard-of-hearing themselves. This erroneous belief is based on the assumption
that the effectiveness of wearing a hearing aid is similar to the effectiveness
of wearing corrective lenses that result in 20-20 vision. A related version
of this myth is that hearing aids eliminate all communication problems.
These misconceptions result in disappointment for consumers who may end
up not wearing their hearing aid. They also result in confusion for others
who cannot understand why the person who is wearing a hearing aid still
does not understand what is being said.
A more accurate conception of hearing aids is that their benefits are
situation specific. They work quite well for most wearers in some situations
(noise-free, one-on-one, close to speaker), and less well in other situations
(noisy, multiple speakers, far from speaker). Also, people need to realize
that not all individuals who have hearing loss can achieve adequate speech
recognition by wearing hearing aids alone.
The lipreading myth is the incorrect idea that people who have
hearing loss automatically become good lipreaders (speechreaders) and that
they will be able to understand everything said by watching whoever is
speaking. This misconception can result in the person who is hard of hearing,
assuming that he or she understands what is being said, when, in fact,
they are either missing a lot or actually misunderstanding. It can result
in confusion for speakers who know that the listener who is hard of hearing
has been looking at them, but still has not understood what has been said.
A more realistic understanding of lipreading (speechreading) is that
people vary in their ability to use it, and that special training is often
necessary to sharpen such skills. Furthermore, as is the case with hearing
aids, there are circumstances that are optimal for speechreading and others
that preclude its use, for example, poor lighting, distance from speaker,
listener has visual problems, or listener cannot see the speaker's face.
The severity of hearing loss myth is the assumption that people
with greater severity of hearing loss are, by definition,at a greater disadvantage
than those individuals who have a less severe hearing loss. This erroneous
belief can lead to expectations that people with severe to profound hearing
loss are unable to function in any situations requiring spoken interaction.
It can also result in underestimating the negative effects of mild hearing
losses in a variety of communication situations.
The severity of the hearing loss is only one of several variables that
need to be considered. Other information about the hearing loss, such as
the type of loss and speech discrimination ability, should be considered.
Another concern is the communication demands on the individual in the variety
of situations encountered throughout the day. Is the person required to
use a telephone, attend business meetings or classes, communicate outdoors
at a construction site, converse while driving a car or truck, learn a
new language, or wait on customers? Additional complicating factors arise
when speakers have foreign accents or regional dialects, there is background
noise, the lighting is inadequate, or people talk from behind partitions
or from great distances? Finally, compensatory skills of persons with hearing
loss also have an effect.
Once people are aware of these commonly held misconceptions about hearing
loss and have more accurate information and realistic expectations regarding
hearing aids and speechreading, they are in a better position to learn
additional strategies for preventing or reducing communication problems.
Their Hearing Loss
It is also imperative that people who are hard of hearing and
their family members understand the specific functional implications of
their hearing loss. For example, it is important that there is a
clear understanding of specific speech and environmental sounds that can
and those that cannot be heard. When family members understand that the
person with the hearing loss will have greater difficulty understanding
these words and sounds and less difficulty understanding those
words and sounds, they often say things such as, "Oh, now I see the
problem." They have also reported experiencing a reduction in anger
and in the tendency to blame and make statements like, "You can hear
me when you want to."
In addition to the specific features of an individual's hearing loss,
there are a variety of other causes of communication problems, and it is
also beneficial for everyone involved to know them.
Causes of Communication Breakdowns
When asked why they did not understand what had been said, many people
with hearing loss will answer, "Because of my hearing loss."
If they accept that as the reason, and if they have the best equipment
available to them, then that is a fairly depressing answer. It leaves them
with little else to do to prevent or reduce communication difficulties.
In fact, there are many other contributors to communication problems. Most
of these are remediable, and when people learn to identify them and minimize
their influence, they are better able to cope with the hearing loss. The
following are some of the major contributors to communication difficulties.
What people who are hard of hearing say when they are not able
to understand what someone else is saying is of critical importance in
their ability to successfully cope with hearing loss. My observation is
that people who are hard of hearing mostly say things like, "Huh?,"
"What?," "Would you repeat that?," "I'm sorry!,"
"Excuse me?," "I didn't get that," or "I didn't
understand you." These are all ineffective responses to a communication
problem because they do not contain any information about what needs to
be done to resolve the difficulty. The speaker is informed that a communication
breakdown has occurred, but has no clue as to what to do to solve the problem.
Put in this situation, many people may opt for ending the conversation
or for ignoring the hard-of-hearing person if it is a group discussion.
Then, the person who is hard of hearing will probably blame the hearing
loss, when in fact it was their ineffectual response that produced their
being shut out. A much better response to a communication breakdown would
be to offer a solution to the problem, that is, "Please slow down"
(or "Face me when you speak" or "Raise your voice a little").
This provides the speaker with something concrete to do to be better understood
and increases the probability that they will continue the conversation.
Unfortunately, many people who have hearing loss and their family members
are unable to identify the causes of communication breakdowns and need
to be taught to do so.
Speaker, environment, and listener factors interact with hearing
loss and cause or exacerbate communication problems. Family members, supervisors,
co-workers, friends, and people who are hard of hearing themselves need
to understand how these factors operate in communication situations. Otherwise,
faulty attributions about someone's failure to understand are made and
relationships are too frequently damaged as a result. For example, a frequent
complaint of family members is, "I don't understand the variability
in his ability to understand me; sometimes he understands everything I
say and other times nothing. This is very upsetting for me." This
confusion often leads to the statement, "He can understand me when
he wants to" or "She has selective hearing."
The reason that people experience this kind of confusion is that they
do not know the specific causes of communication breakdowns, that is, the
speaker, environmental, and listener factors. Speaker factors include such
things as not speaking clearly, speaking too rapidly, or speaking too softly.
They also include other characteristics of the speaker, such as, foreign
accent, distracting mannerisms, and beards or mustaches that obscure the
lips. Environmental factors include background noise, lighting conditions,
and acoustics. They also include factors such as visual or auditory distractions,
ventilation, and seating arrangements. Listener factors include facts about
the individual's hearing loss such as severity, type and onset characteristics.
They also include the listener's ability to pay attention, emotional status,
and distracting body sensations or thoughts. A major goal of the training
is to enable people to identify these factors when they occur. Once people
are able to identify the specific causes of communication problems, they
are in a better position to suggest solutions to them. These factors and
suggestions for reducing their effects are discussed in greater detail
in Staying in Touch (Trychin & Albright, 1993).
Misunderstanding is an active, creative process and it is important
that people who are hard of hearing and their family members know the difference
between not understanding and misunderstanding what is being
said. In the former case the person with hearing loss knows that he or
she did not get what was said. This situation is relatively easy to remedy
by identifying the reason(s) that the message was not understood and suggesting
a solution as discussed previously under speaker, environmental, and listener
factors.
Misunderstanding, however, is much more difficult to resolve because
it is believed by the listener that the message was understood, when it
was not. This is particularly difficult to resolve because misunderstanding
is an active, creative process. The following anecdote illustrates this
point.
'I (the author) was listening to the radio during the Clinton presidential
campaign. I heard the reporter say, "Voters don't like politicians
who take aspirin." I thought that was a strange statement and listened
more carefully for awhile. It became apparent that what the man had said
was, "Voters don't like politicians who take action."'
My brain heard the a and the n of the word action
and actively filled in the gap between them with a word it found in its
lexicon, that is aspirin. Notice, my brain did not say, "Whoops,
I missed the part between a and n", nor did it say,
"Whoa, I didn't get that last word." What it did was to creatively
fill in the gap between the parts it received. In this instance, the result
did not make a lot of sense, so it was easy to ascertain that I needed
to listen more carefully to determine whether what I thought I heard was
what had been said.
However, there are many misunderstandings that fit the context and do
make sense even though they are not what was actually said. The following
incident illustrates this point.
'At breakfast during an Elderhostel in Virginia,I asked a hard-of-hearing
man who was standing behind me, "Where is the syrup?" He said,
"It's right around that corner on the shelf above the silverware."
I went looking for the syrup, and there was none where he had indicated.
However, boxes of cereal were lined up there.'
His brain had picked up the syr of syrup which sounds exactly
like the cer of cereal and filled in the missing part with a word
that fit the context, but happened not to be what I had said. There are
many instances in which misunderstandings do fit the context, and, therefore,
people who are hard of hearing do not check them out. Many times, people
with hearing loss do not even check out the misunderstood words or phrases
that do not make any sense and assume that the speaker is at fault for
talking nonsense.
Misunderstandings happen on a daily basis to people who have hearing
loss and often have a negative impact on relationships and can also cost
people their jobs. Because misunderstanding is an active, creative process,
people are often convinced that what they heard has been correctly understood.
When asked if they understood what was said, they will, of course, reply
in the affirmative. Therefore, asking people who are hard of hearing if
they understood what was said is insufficient for determining whether or
not they actually did. What is necessary is tat the person needs to repeat
the key elements of what they understood as in, "You said Friday night
at 7:00 at the Jones'?" That way if something has been misunderstood,
the speaker is in a position to correct it.
It is important that family members, supervisors, co-workers, and friends
know that while misunderstanding is an active, creative process by the
brain, it is not voluntary on the part of people who are hard of
hearing; they are not trying to make mistakes and irritate and frustrate
the people with whom they are speaking.
Effects of Reactions to Communication Problems
Once an obvious communication breakdown occurs, the speaker and the
listener will react to it in some way. Some of the things they might do
are constructive, they help to resolve the problem. Other things they might
do in response to a communication problem will serve to make the problem
worse. One of the goals of the training is to help people eliminate reactions
that are unproductive and replace them with those that are more effective
in improving communication.
Some examples of frequently reported, unproductive reactions to communication
difficulties are becoming emotionally upset, (i.e., angry, anxious,
depressed, or guilty), withdrawing from the situation, bluffing, tensing
up, dominating conversations, ignoring the person who is hard of hearing,
and / or tuning out. None of these is helpful in resolving the current
communication problem and none is helpful in developing strategies for
preventing or reducing future communication difficulties. More effective
responses to communication breakdowns are identifying the cause(s) of the
problem, that is, speaker, environmental, and / or listener and offering
a solution to the problem (Trychin, 1993; Trychin & Albright, 1993).
Available Assistive Technology
Assistive listening devices either in conjunction with or independent
of hearing aids are an indispensable component for successfully preventing
or reducing communication problems for many people who are hard of hearing.
These devices place the microphone at or near the speaker's mouth and reduce
the negative effects of background noise and distance on the listener's
ability to understand what is being said. People who are hard of hearing
should thoroughly understand the different devices available, for example,
FM systems, induction loops, infrared, and various hard-wire systems. My
experience is that many people need considerable hands-on experience with
these devices to become comfortable using them in situations outside of
their own homes. Some of the most dramatic results in terms of improved
communication, increased self-esteem, and reduced negative emotions can
be observed when people use these devices.
Alerting devices including hearing-ear dogs are often essential
in increasing the hard-of-hearing person's sense of physical security and
providing necessary information about the occurrence of important environmental
events.
National and Local Resources
There are resources in many communities that can provide information
and services to people who are hard of hearing and their families. Speech
and Hearing agencies, Resource Centers for People Who are Deaf and Hard
of Hearing, and some university and hospital audiology departments often
provide special programs.
National organizations such as Self Help for Hard of Hearing People,
Inc. (SHHH) and Association for Late-Deafened Adults (ALDA) provide essential
services for people who are hard of hearing or late-deafened by offering
places to go to encounter other people who are experiencing similar problems.
They also provide a wealth of invaluable information for people who belong
to them or subscribe to their publications. All people who experience communication
difficulty related to hearing loss should belong to one or bot of these
national organizations and attend their local chapter meetings.
Informing Others That They Have a Hearing Loss
Many people who are hard of hearing are reluctant to inform others about
the fact of their hearing loss. When people who are hard of hearing fail
to understand or misunderstand what someone says, it is in their own best
interest that the speaker knows the listener has a hearing loss. Otherwise,
they run the risk of others perceiving them as being obtuse, peculiar,
unsocial, incompetent, unreliable, lazy, etc. For example, consider the
following scenario:
Sarah: "My sister passed away last week."
Marty (hard of hearing and thinking the speaker had said, "My sister
passed this way last week"): "Oh, that's nice."
What is Sarah likely to think about Marty if she does not know he has
a hearing loss? What might be the effect on their relationship? Had she
been informed or reminded about Marty's hearing loss and the possibility
of a misunderstanding, her reaction to his response might well be quite
different.
What people say when they inform others about their hearing loss is
also an important consideration. It is easy to inform others in such a
way that they will not want to continue the interaction. My experience
indicates that people need some practice in informing others about the
fact of their hearing loss before they can do it in such a way as to put
the other person at ease and also feel comfortable themselves when doing
it. Staying in Touch (Trychin & Albright, 1993) contains some
exercises for people to do as practice in informing others about their
hearing loss.
Informing Others About What To Do To Be Understood
As discussed previously, it is not helpful when people who are hard
of hearing say things such as, "What?," "Huh?," "I'm
sorry," "Would you repeat that?," etc. Rather, they need
to learn to identify the cause of the problem and offer a specific solution
to it such as, "I need you to face me when you speak." or "It
helps me to understand when you speak a little louder." Communication
Rules is a videotape and manual developed to give people practice in
identifying the causes of communication breakdowns and in making suggestions
for correcting them (Trychin & Boone, 1987).
A second issue in informing others about what to do to be understood
is how it is done. Some people know what to do, but do it
in such a way that the other person does not want to cooperate or even
continue the conversation. For example, if the person who is hard of hearing
says something like, "How many times do I have to tell you to slow
down?" or "Speak up stupid!," the other person might well
react negatively. It is more productive for the person who is hard of hearing
to say something like, "Because of my hearing loss, I need you to
talk a little more slowly." Saying it that way reduces the probability
that the speaker will feel criticized and become defensive. It also provides
an occasion for the speaker to be helpful, and many people do respond positively
when such an opportunity arises. Did I Do That?, a videotape and
manual, was developed to help people become aware of the nuances of human
interactions that serve to help or hinder their ability to elicit cooperation
from others (Trychin, 1987).
Reminding Them When They Forget
Changing behavior is difficult for most of us. Changing communication
behavior is especially difficult because most of us have been talking the
way we do since early childhood and how we talk has become unconscious
and, therefore, involuntary and resistant to change. Unfortunately, many
people who are hard of hearing have the erroneous assumption that all they
need to do is to inform a speaker once about their communication needs,
for example, "Please slow down," and that person should remember
to do it forever more. The reality is that speakers will remember to do
what was requested until they once again become more interested in what
they are saying than in how they are saying it. Usually this will
be about 15 to 30 seconds after resuming talking. Then the person who is
hard of hearing has to interrupt again to remind the speaker, and this
cycle continues until one or both become tired of it and terminate the
discussion.
An effective alternative is the use of hand signals or signs used as
reminders of the communication needs of the person who is hard of hearing.
Once, a participant in one of the groups taped paper to both sides of a
Ping-Pong paddle and wrote, "Please slow down" on one side and,
"Thank you!" on the other side. This approach was helpful and
precluded the necessity of verbally interrupting speakers. One participant
in a group I conducted had the 12 guidelines for speakers from the Communication
Rules manual printed on a tee-shirt (Appendix A). He told us that this
was a most helpful technique for reminding his three grandchildren about
what to do so that he would be able to understand them without a lot of
repeating. Other people have posted signs around the house at Thanksgiving
or other holidays as reminders to visiting family members about what to
do to be understood by the relative who is hard of hearing.
Modeling the Communication Behavior They Desire in Others
Additionally, it is of the utmost importance that people who are hard
of hearing learn to model the communication behavior they want from others.
If Jack wants Jill to stop talking to him from another room, Jack needs
to be sure that he goes to where Jill is located when he wants to initiate
a conversation. This serves the dual function of teaching by modeling the
desired behavior and instituting an element of equity into the situation,
that is, whoever initiates a conversation goes to where the other person
is.
People who are hard of hearing also need to learn to talk at the volume
level and rate of speech that they can best understand in others. This
seems simple enough, but, as is the case with changing other aspects of
communication behavior, it requires some practice.
Identifying and Altering Dysfunctional Thoughts
Finally, people who have hearing loss are at risk of harboring certain
negative thoughts that can have the effect of preventing them from adopting
strategies that would enable them to compensate for their hearing loss
and function more effectively. Thoughts such as, "I'm not competent
to do this job any more" prevent the individual from looking further
for positive approaches to communication problems on the job. Saying to
oneself, "The hearing loss is my problem, and I don't want
to inflict it on others" may well have the effect of preventing the
person from asking others to alter their communication behavior to be better
understood. Believing that, "There is nothing I can do about my hearing
loss; I'll just have to learn to live with it" again precludes taking
steps to compensate for the hearing loss and ensures that the person will
experience often unnecessary communication failures. Is That What You
Think? (Trychin & Wright, 1989) identifies many other kinds of
dysfunctional thoughts related to hearing loss. It also contains some procedures
found to be effective in altering nonproductive thinking.
CONCLUSION
Preventing or reducing communication problems related to hearing loss
requires accurate, realistic, and complete information. It requires communication
behavior change on the part of both the people who have the hearing loss
and those with who they regularly interact. Learning about the specific
functional implications of the hearing loss and practicing strategies for
preventing and reducing communication problems empowers the people involved
and often results in decreased negative emotions, increased self-esteem,
and improved relationships. However, changing aspects of communication
behavior requires practice over an extended period of time, and those involved
need to have realistic expectations about this and willingness to engage
in a cooperative effort that will ultimately benefit everyone involved.
REFERENCES
