Hearing Loss | Chapter 7: Counseling

Developing the Counseling Experience

Author: Eleanor T. Robertson, Ph.D., Director, School Psychology (Ret.), �԰��

Counseling is an important service offered to all students, but this intervention is of special significance for the child with an auditory impairment. As the school counselor, you may at first be intimidated by the idea of working with children with some unique needs.�� This discussion is intended to offer ideas and suggestions in the hope that your counseling experience will be helpful for your student and professionally satisfying for you.

In counseling the student with an auditory impairment, it is essential to see the child as an individual first.�� Just as we would conduct an initial assessment of any student, we would consider chronological age, developmental level, academic and social strengths and weaknesses, family situation, emotional functioning, cultural identification, and any other factors that may be affecting the child.�� At the same time, we would need to be aware of the impact of the student’s disability as we put the total picture together.

After getting to know the student and situation, it is important to analyze the presenting problem. Do not assume the auditory impairment is the most immediate concern (Yuker, 1994). Remember this student is probably more like fellow classmates than different. The disability will of course need to be discussed, but so will other issues.�� The ability to understand class assignments and the impact of the peer group on social functioning may be the most immediate topics.

An important factor to consider in the counseling situation is your own theoretical perspective. How are you most comfortable working? Have you been most successful with behavioral interventions utilizing contingency contracts? Do you like to approach problems in a more cognitive manner, asking students to monitor their own “self talk?” Is “reality therapy” usually your first choice for teens? Are you most comfortable using the medium of play to explore problems with younger children? The approach with which you have had the most success is the one you should consider first.

In addition to theoretical perspective, you will want to consider modality. Would the problem be best addressed with the child and yourself alone, or is this an issue with which the family could provide important support? Is this a social skill that a group of classmates also need to address? Or is this a problem specific to individuals with auditory impairments and students with similar concerns could be especially helpful?

After assessing the problem and your approach, there are a number of issues that should be considered that are unique first to the child with any type of disability and a second group that are specific to the child with an auditory impairment. First, it is important to consider the child’s self-concept in relation to the auditory impairment. Olkin (1999) places individuals with a disability on a continuum from those who do not consider themselves as disabled, to those who identify as a person with a disability, to those who feel they are a part of the “disability community” and actively work for “disability rights.”�� Children whose parents are non-disabled typically are taught to act as “normal” as possible and identify with the non-disabled (Olkin, 1999; Sevigny-Skyer, 1990). While this may encourage behaviors that promote acceptance by the majority culture, it can also create serious self- esteem issues for the child who observes some differences from peers.

Another reality that needs to be considered in counseling students with disabilities is the likelihood of additional environmental issues. Children with disabilities are more likely than the non-disabled to have more and longer hospitalizations, doctor visits, and school absences. Emotional and behavioral problems are more likely (Olkin, 1999). There is evidence that children with disabilities are at a higher risk for all types of abuse (Westcott & Jones, 1999).�� Additionally, families of children with disabilities are subject to more disruptions such as moving, financial problems, separation, or divorce of parents (Olkin, 1999).

In counseling, keeping a systems focus is important (Kosciulek, 2004). The child with a disability must function simultaneously in a classroom, a school, a family, and a community. Attitudes of others in your school toward the student with a disability are critical. School-wide efforts to incorporate����students into the school environment can have an important positive effect. Encouraging interactions between the child with a disability and the non-disabled can encourage the positive adjustment of the student with an auditory impairment, so the “big picture” should be an important focus of your work.�� In addition to the general guidelines offered for working with the student with a disability, there are some unique considerations for counseling the individual with an auditory impairment. A summary of factors that should be considered is offered here with some specific suggestions for the school counselor that you may find helpful.

Communication

Communication Systems

Communicating with the student with an auditory impairment is the first and most important issue to be addressed in beginning counseling. Unless the student has only recently been diagnosed with a hearing loss, it is likely that a communication system has been established. Individuals who have had a severe auditory impairment since birth have most likely learned sign language. In the United States, this system will most likely be American Sign Language (ASL). In the United States, those who had a hearing loss after language development but at a young age probably also learned ASL but may know English too. English means the use of codes that attempt to represent English and not a separate language. English includes English, Seeing Essential English (SEEI) and Signing Essential English (SEEII), Total Communication (signing combined with lip reading and speech) and lip reading. Individuals with a later onset of impairment may use a variety of communication methods (Harris & Vanzandt, 1997; Olkin, 1999).

Suggestions:

Because of communication issues, the first choice for a counselor of a student with a hearing impairment is an individual who is conversant in the student’s communication system. If this is not possible, obtain an interpreter familiar with the system.
If the student lip reads, do not assume complete understanding. Lip readers typically comprehend less than half of verbal interactions (Olkin, 1999). If this is the type of communication utilized, be sure to face the student and provide an unobscured view of your mouth. Do not eat or chew gum. Minimize extraneous movements (Harris & Vanzandt, 1997).
In using any communication system, since the visual is critical, have good lighting and do not distract with hand or body movements (Olkin, 1999).
Speak in a natural manner with clear but unexaggerated articulation. Avoid yes or no questions. In order to insure the student’s understanding, ask the child to repeat information to you (Harris & Vanzandt, 1997).
Respect the communication system of the student. Make every attempt to communicate with the child in the manner with which the child is familiar.

Interpreters

Since you may need to utilize a sign interpreter, there are several basic principles to remember.

Suggestions:

Arrange seating in an isosceles triangle with yourself and the interpreter on the short side and the student opposite. The student can sign to both you and the interpreter and the interpreter can then speak to you (Olkin, 1999).
Be sure to look at the student most of the time and not the interpreter.
Make sure only one person speaks at a time. If you wish to interrupt, signal with a hand motion (Olkin, 1999).
If the student writes or draws, wait to speak because attention cannot be given to the interpreter.
Pay attention to face and body movements. Those who communicate with sign language use lots of gestures and what might appear to be exaggerated movements. This is normative, so do not interpret this as overly dramatic or histrionic. (Olkin, 1999).
Sign language utilizes direct communication patterns. This may appear somewhat blunt and impolite to a person from another culture. The Deaf Community, in contrast, may view hearing people as evasive and too tentative. Keep these factors in mind in interactions (Harris & Vanzandt, 1997).
Speak in clear, complete sentences. Use synonyms and, if clarification is necessary, opposites to illustrate meanings. Do not be afraid to dramatize if this will aid in communicating (Harris & Vanzandt, 1997).
Be aware that your counseling sessions may need to be shorter than those for hearing students since it is tiring to communicate through an interpreter because of the amount of attention and concentration required (Harris & Vanzandt, 1997).
Use questions often to assure understanding. If repeating statements does not clear up any confusion, change the language system, try using pencil and paper to write or draw your communication, and eliminate any idioms (Strack-Grose, 1992).
Be aware of how to obtain an interpreter through a registry system and make note of the individuals who are especially helpful. Several countries maintain registries of interpreters with certifications for specific purposes, such as artistic performances or legal settings (Schwartz & Turner, 1995).

Communication Etiquette

In addition to either learning a communication system or utilizing an interpreter, you should be aware of several characteristics unique to individuals with hearing impairments.

Suggestions:

Interactions are direct and lack the nuances of conversation between hearing individuals. Student questions may appear blunt and overly intrusive at times. For example, initial inquiries may include “Are you deaf?” “What school did you go to?” “Where are you from?” (Harris & Vanzandt, 1997). The student with a hearing impairment may consider communication between persons without impairments as unclear and ambiguous at times (Olkin, 1999).
Consistent with the direct quality of the content of communication with the student with a hearing impairment, there may be other physical aspects of interactions that are not common for hearing individuals. For example, eye contact and physical proximity, greetings and goodbyes may all seem intrusive to you; however, this is normative for individuals with hearing impairments. To interrupt, the individual with a hearing impairment may use a physical gesture such as holding the other person’s hand (Steinberg, 1991).
Pay attention to the movements of a signer’s eyes, face, and head as these add to the communication (Murphy & Dillon, 2003). Specific facial and eye movements can modify the meaning of communication (Steinberg, 1991).
An individual communicating in sign language may be erroneously viewed as having a tic or poor interpersonal boundaries since touching other people, waving an arm, or stomping the foot may be methods of gaining attention. Eye contact may also be intense and continuous (Steinberg, 1991).

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Many individuals with hearing impairments consider themselves to be a part of the Deaf Community and adopt attitudes and practices unique to this group. These characteristics define a specific deaf culture that dictates many aspects of the individual’s life. Support of deaf social and political organizations and participation in deaf clubs, deaf church services, deaf sports teams, and deaf group activities are important (Harris & Vanzandt, 1997).

Suggestions:

If the student’s parents are deaf, it is more likely that the child will be familiar with this community and its culture. You will probably need to utilize a sign interpreter and it may also be important that you have contacts in the community to whom you can refer if needs outside the educational environment become apparent.
Individuals within the Deaf Community prefer face-to-face meetings because so much communication relies on total body language. This insistence on in-person interactions should not be interpreted as being overly demanding or narcissistic since this is normative in the culture (Olkin, 1999).
An important tenet of the Deaf culture is that individuals with hearing impairments are not viewed as “disabled” or “impaired” but rather members of a minority Deaf culture with its own language and community (Harris & Vanzandt, 1997).

Individuals who identify with the Deaf Community will want referrals to deaf church groups, sports clubs, and other groups for the deaf, so it is important that you familiarize yourself with these organizations. It would be a good idea to visit at least one of the activities sponsored by the Deaf Community and establish contacts.

Developmental Level

An important characteristic to be considered for the child with a hearing impairment is developmental stage. This issue is especially important if you are counseling the child individually, since you will not see peer interactions in your office. The development of a youngster with an auditory impairment is closely connected with the availability of an effective communication system since this can make experiences available to the child. Language allows an individual to organize and make sense of the environment and to develop a separate sense of self.�� The ability to see a situation from another’s perspective is the result of social understanding developed early in life through interactive experiences (Woolfe, Want, & Siegel, 2002). Social development may be an area that is lower than same-age peers due to fewer opportunities for interaction both within and outside the family. For the adolescent, an additional developmental issue is the struggle for independence. The teen with a hearing impairment will most likely always require some dependency upon others so analyzing how to ask for assistance when needed and ways to develop independent functioning are unique challenges. An especially difficult area for the adolescent with an auditory impairment is coping with the need to “fit in” and not call attention to the self in ways that are odd or outside the acceptable norms. Again, the necessity for some assistance may make the teen uncomfortable and lower self-esteem.

Suggestions:

Group therapy is especially good for teaching social skills. Since you most likely won’t have enough students with auditory impairments to create an entire group, select those with comparable levels of maturity, but perhaps different needs in the area of skill development. If you are not conversant in the communication system of your students, be sure to select an interpreter who is experienced in working with groups.
It is important to have the teen focus on areas in which control has already been established. Encourage the student to make decisions about how necessary assistance is to be provided. Work out situations ahead of time so the student does not have to re-negotiate each request.�� If a buddy is needed for physical education, make the assignment before the student starts the class. Role playing in your office may be especially helpful.
Talk with teachers about ways to make certain the student understands assignments without drawing attention to the individual.

Characteristics of Auditory Loss

The cause of the auditory impairment should not be the first topic of discussion. However, you should be attuned to this issue since the time and circumstances surrounding the origin may affect the child. Was the auditory impairment from birth or did it occur more recently?�� Has the family had time to make necessary adjustments around the child’s needs or are these still being negotiated? Did the hearing loss occur through an accident, disease process, birth complications? A teen who was the victim of an accident will have different emotional issues to face than the youngster who is deaf from birth due to health problems. How severe is the auditory impairment? Can the student hear in a limited way or is there total loss of hearing? Was the loss progressive? Again, these factors can influence how you as a counselor approach the topic.

Suggestions:

Have the parents fill out a background information form so you can review the history of the child’s auditory impairment before the initial meeting. This will prepare you for how you approach counseling. If the loss of hearing was recent, you may need to bring basic information for support services in the community. This will also give you an opportunity to read about any medical conditions with which you are unfamiliar.
Although you will want to wait until the initial meeting to establish goals for the counseling, the history will give you some possible issues to explore. In advance, you might research materials to use with younger children who may need some “prompting.”�� For example, even if stories do not include individuals with hearing impairments, literature that describes youngsters dealing with challenges may be useful.
Information about the degree of usable hearing is helpful since you can prepare the counseling environment with appropriate materials. Toys that involve tactile and visual senses may be especially appealing to the student who is very restricted in hearing.

Difficult Concepts

Because the student with a hearing impairment has had some unique experiences, understandings in several areas may differ from same age hearing peers. It may be helpful to address these in a planned counseling session or just discuss them as appropriate in the context of other school situations.

Suggestions:

Because language is important to the understanding of time, young children who have not developed a communication system, may have problems delaying gratification. For the student with a hearing impairment, immediacy and the present is of primary importance and impulsivity may be a problem (O’Connell & Casale, 2004). In counseling, as in the classroom, use distraction whenever possible to focus the child on a more goal-oriented task. For example, a simple re-direction to bring the student’s attention back to a topic or activity can be accomplished by communicating a question or by handing a child a crayon to encourage completion of a drawing.
Make sure the student is appropriately challenged in the activities you plan. A review of the child’s educational records, teacher interviews, and classroom observations can give you a good idea of the student’s abilities and interests.
Related to the child with a hearing impairment’s difficulties with understanding the process involved in the evolution of events, cause and effect may be difficult concepts (Rieffe, Terwogt, & Smit, 2003). Parents and teachers may not have taken the time to explain the reasons behind others’ behaviors and the necessity of certain rules. This approach may encourage the child to adopt a rigid application without exceptions. It would be helpful to spend time explaining why important class and school rules were established and the consequences of not having limits.
Although communication around many topics may be blunt for the individual with a hearing impairment, interactions around emotions may be avoided or simply not addressed. Children with hearing impairments lag behind hearing children on affective role-taking (Howley & Howe, 2004). Adults in the child’s life may not have taken the time to interpret and explain others’ emotional reactions so the student with a hearing impairment may not be well-versed in the subtleties of these topics (Rieffe, Terwog, & Smit, 2003). Explanations of the characteristics and manifestations of emotions would be appropriate, especially if these can be presented in a straight-forward, concrete manner.
The student with a hearing impairment’s self-esteem may be less positive than that of other students (Moores & Meadow-Orlans, 1990) so you will need to plan some specific activities around encouraging the development of a positive self image. Focusing on strengths and abilities is especially important in the counseling situation.

Amplification Devices

The availability of a variety of technological devices can have a positive impact on counseling and on the general functioning of students with auditory impairments. You should familiarize yourself with the options most appropriate for the child’s age and needs.

Suggestions:

Hearing aids may be used by the student who needs amplification. With this device, all sounds in the environment become louder to the individual with the same intensity. Individuals may hear sounds better but be unable to discriminate words well (Harris & Vanzandt, 1997). Keep this in mind as you speak to the child with a hearing aid.
If you need to contact a student by telephone, several helpful devices are available. Telephone receivers may be equipped with a volume control that allows a person with a hearing loss to amplify incoming messages. A teletypewriter (TTY) is a device at each end of a telephone that types messages on a paper roll or displays the words on a panel screen that looks like a calculator. Phone relay services are available that provide an operator to facilitate communication between a person using a telecommunication device on their phone and someone with a regular telephone (Harris & Vanzandt, 1997).
You may want to suggest programs or videos on specific topics. Television sets may be equipped with closed-caption devices that display sub-titles. Films are also distributed through various agencies with sub-titles.��
Be aware that teachers may utilize electronic amplification systems consisting of a microphone/transmitter for the instructor and a receiver for the student that allows personal amplification in the classroom (Harris & Vanzandt, 1997).
To assist students in detecting situations requiring an immediate response, alarm systems using flashing lights or vibrations can be used to warn of fire, signal ringing doorbells, or provide a wake-up signal. Specially trained dogs can also be utilized to respond to sounds in the environment.��
Never touch an adaptive device without asking permission. This would be like touching a body part uninvited.

Transitions

Many students with disabilities need to plan ahead for transitions. The student with a hearing impairment will especially need more time to locate your office, get settled, and begin counseling.

Suggestions:

Allow extra time for class changes and getting to appointments. Permit the student to leave early for the next class.
In counseling discussions, focus on preparing for changes as a life-long task.
If you are expecting a student with a hearing impairment, leave your door open since the child may not be able to hear you say, “Come in.” Also, closed doors are interpreted in the Deaf Community as signifying isolation and a closing off of communication (Olkin, 1999).

Hearing Loss as a Concern, Involving the Family & School

Hearing Loss as a Concern

The auditory impairment may or may not be the focus of counseling. It is important to remember that students with hearing impairments have all the problems and concerns of others at their level of development.

Suggestions:

If appropriate, ask about the auditory impairment; however, keep it in perspective. For example, if a youngster expresses frustration with not being able to keep up with assignments, it would be logical to ask if difficulties with hearing are affecting productivity, but do not make the assumption that this is the only problem.�� Disorganization and poor time management may be the more important factors.
Unless there is a relevant reason (e.g. to use their help in accessing a service), do not tell about others you know who have this disability (Olkin, 1999).
Help the student learn to explain the disability and related needs in a clear, straight-forward way, since this will enable productive engagement with others (Yuker, 1994).

Involving the Family

Many research studies point to the importance of family involvement in schools (Henderson & Berla, 1994; Olmscheid, 1999).�� For example, collaborations between home and school have led to increases in student achievement, behavior improvements, better attendance, higher self-concept and more positive attitudes toward school and learning (National Association of School Psychologists, 1999). It is especially important for the family of a child with a hearing impairment to feel comfortable with the school counselor and to be informed of any work conducted with the student.�� Of course, this will vary with the type of problems addressed and the age of the child.�� It is likely that the student with an auditory disability is closer to family members than others of the same age since dependency not typical for peers has most likely been necessary.�� This can present a number of unique challenges for the counselor. The necessity of keeping the family involved must always be balanced with the need for the child to establish a sense of independence and separateness.

Suggestions:

Inform the family immediately of any plans to work with the student in a counseling situation. It is helpful to have a written explanation of general guidelines you use in counseling all students. This explains the types of problems you address, the reasons you would like to keep some issues confidential, the situations about which you would immediately inform them, and your telephone number should they wish to contact you. In addition, articulate some specific goals for this student.
With younger children, it is helpful to have a parent meeting before beginning any type of counseling to establish a sense of trust with the family and to gather some background information.
��In some counseling sessions, you may wish to include the parents with the student if the issue relates to family interactions. Even the manner in which parents respond to school problems can be of concern to the student and may need to be discussed with all present.
Don’t forget siblings of the student with an auditory impairment. So much focus is placed on a student with a disability that the brothers and sisters may feel forgotten and have their own problems around this perceived neglect. If possible, meet the siblings and determine for yourself if individual counseling with them would be helpful or if a session to include all the family members is sufficient.
Although involving parents is important, be careful to maintain the student as your primary client. Parents of students with hearing impairments may be so accustomed to making decisions for their children that the student may not have achieved an independent sense of identity. Provide situations for students to make decisions on their own.
If parents contact you, be sure to let them know you will share the conversation with the student, and if necessary, invite them into your office to discuss the issue further. It is a judgment call on your part as to whether holding the session with all present would be helpful. If at all possible, include the student since it is essential that you are viewed as an advocate and do not share confidences with others. Trust is critical in any counseling situation but this is especially important with the student with a hearing impairment since so many factors in life are out of the child’s control. For this student, establishing a sense of personal empowerment is always an important goal.

Involving the School

The school is the larger system that needs to be involved in assuring a positive experience for the student with a hearing impairment.�� The climate of this environment can have a tremendous impact on the student’s attitude and adjustment, also providing an opportunity for students without disabilities to develop an appreciation of commonalities despite differences.

Suggestions:

As a counselor in the school environment, you are in a unique position to foster relationships among students.�� Create opportunities for all students to work together outside the classroom. Invite students with auditory impairments to work on projects with other students, assigning tasks with which they feel comfortable, so you can promote a sense of collaboration.
Provide opportunities for the student with a hearing impairment to communicate personal experiences in a small group so others can understand both the uniqueness and similarities of struggles and needs.
Establish a group for students with disabilities who are functioning at similar cognitive levels to provide a sense of support. The student with a disability needs to be aware of membership in the larger community of the school, but also to be able to share common experiences with others.
If the family is not familiar with groups dedicated to serving the needs of individuals with hearing impairments, provide information to the family and student about groups within the immediate area as well as the state and nation.�� It is important to determine the family’s perspective on the Deaf Community since there may be considerable differences in levels of identification. Parents who have hearing impairments themselves may already be involved and can serve as resources for others. If this is the first experience with this impairment, families may need to be introduced to available resources. Their level of acceptance of their child’s disability and the degree of identification with the Deaf Culture may be an issue to be addressed in an on-going manner throughout the student’s progress through the educational system. It is important for the student and the family to have a sense of empowerment and utilize their energies in productive ways.

References

continue to Chapter 8

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