I vividly remember the last family I saw for a diagnostic evaluation. As I prepared myself to inform the parents of their child's significantly reduced hearing thresholds, the clinic's otolaryngologist knocked. I exhaled and excused myself to answer. Dr. ENT said, “Hurry up!” He had a dizzy patient for me to see and his schedule was backing up. I distinctly recall the looks on the nervous parents’ faces as I turned back to re-engage. Mom's hopefulness nearly broke my heart. Dad wasn't making eye contact; he was bouncing his leg, tapping his fingers, and scanning the room. Was he looking for escape routes? Did they realize that this day would be etched in their memory forever? Like many previous patient encounters, I was acutely aware that no part of my graduate education (nor my life) prepared me to work with clients this personally, this intimately.
Despite knowing that generations of audiologists may have traversed these waters, I struggled to find resources to help me make sense of my experiences. Is it this intense everywhere? When will I feel like I know what I'm doing? Wait…what am I doing? Do all audiologists feel like the room is collapsing as they prepare to tell a family that their child is deaf? How do parents handle this? Is “handle” even the right word? I want to run out of the room, or cry, or quit. Is this normal?
I resolved that if I ever found ways to feel less unmoored, I would try to describe, normalize, and illuminate the early difficulties of this work for those who choose to enter this field. Here's what I wish someone had told me before I started this journey into relational audiology. These tips and cautions might have lessened some of my worries and meanderings, and could have helped me feel more anchored and less alone.
- You learn to do this work at the expense of the clients and families you serve. There is something deeply unfair about that for your early clients, yet there is no other way to do it. You can make amends to the cosmos by doing your best each day and then striving to do better.
- This is intimate work. The worst part requires being in close proximity to pain. It's horrible to sit in a tiny room, feet from someone clearly anxious or suffering. At first, you may feel like you are being pulled around the room by the centrifugal force of your close contact with clients. You may feel the need to dig your heels into the floor or create excuses to leave the room to avoid being overpowered by someone's grief. Soon, the pull of your own gravity makes it easier to sit in your chair. For a while—a long while—sitting that close to someone in pain is going to be awful. But hang in there. You're not the only one who goes through this, and it gets better.
- Tip: Invite engagement and input from clients frequently. Ask permission before giving advice.
- Tip: There is no right way for parents to respond to a diagnosis. The whole emotional spectrum (in an individual string of emotions, or multiple emotions simultaneously) is all fair game. Normalizing emotional responses can establish trusting relationships.
- What you do with your own emotional responses makes all the difference. The intensity and power of grief, confusion, anger, and other emotions in parents may cause you to experience very strong feelings and sensations in your own body. You're allowed—even encouraged—to feel whatever you feel.
- Tip: Explore how you feel about feelings, and continuously identify and process emotions. You may shield yourself or blame your clients for the emotions they evoke in you. You must be aware if the latter happens, or you will not survive your career with your empathy intact. The seeds of burnout are planted here, and nothing makes them grow faster than blaming clients for your own distress.
- Tip: Work with your body. Ground yourself by finding your feet and your breath. Regulate your emotions, and find your calm center. Doing so will silently invite your clients to do the same.
- Caution: Don't rush toward trauma, but don't run from it either. Some of the biggest mistakes early in your career will likely include overlooking the role of trauma in your clients’ reactions.
- It's all trauma. Every difficult thing you will see may be attributed to trauma. You were never prepared for families to come to you with significant traumatic histories, or taught that revealing their child's diagnosis can cause or perpetuate trauma. It may be the worst thing that has happened to them, or it may remind them of the worst thing that happened to them. This can be a terrible realization; trauma happens everywhere all the time. You know that it exists, but you don't fully realize how ubiquitous it is until you begin listening open-heartedly. You find out that trauma may happen to your clients—those abused by fathers who were community leaders, or who were in a car accident while they were pregnant, or those who lost a sibling to cancer. Any previous trauma, that feeling of powerlessness and loss of control, can resurface when discovering or adjusting to a child's diagnosis.
- Caution: Being a mindful and empathic relational audiologist makes it harder for you to do what others do to cope with the reality of trauma—to deny that it's real. You can't. Many of the families you work with may swim in it. You swim in it. You begin to see it for the massive, global, and long-standing public health crisis that it is. You may feel it gnawing at your hope, faith, or optimism.
- Tip: Seek counseling or try to process this reality by talking to the most empathic colleague you can find. It may be difficult to have productive conversations about this issue with non-therapists until audiologists change the culture of how trauma is discussed and processed in the field.
- Tip: Listen and validate. When you don't know what to do, listen. Listen without planning a response or judgment, then validate the experience of your patients and their families.
- Armoring up is not what you or your clients need. There may be a lot of misdirection from people who are supposed to help guide you. Many professors and supervisors may keep their defenses up after suffering from or absorbing trauma. Senior audiologists in your organization may be severely burned out, and vicarious trauma may have played an important role in that bitterness. You will notice this through the way they speak about their clients. They may use timeslots (my one o'clock), diagnoses (the bilateral atresia), or technology (the implant kid) instead of pronouns or names. Most of their advice is based on assumptions and judgment, but cloaked as “informed by experience.” Most of their advice will be about what you can't do for the families. They may defend you from “difficult families” rather than help you process and address that difficulty. They may not be glad to see you when you have questions. I have come to believe that burnout is infectious, and zombie audiologists often run the show.
- Tip: Don't let them near you. Find and listen to colleagues who still have access to their empathic hearts.
- You will make a lot of mistakes. The best audiologists are aware of their mistakes. They own and learn from them, and are even brave enough to share their blunders and realizations. Watch for the tendency to blame the situation, environment, or worst of all, the patient's family for your mistakes.
- Tip: You will not have all the answers. It's okay that some children will not respond to technology in the ways you expected. It's okay to know little about ASL and still support a parent's choice to learn about and use it. It's okay if you find yourself at a loss for words; silence may even be what clients need in order to process the information.
- You are doing incredibly important work. The difficult aspects of the job can sting, while the good parts may bounce off like Nerf arrows. It is like this for everyone.
The voyage to professional competence in relational audiology can feel dark and lonely, with hardly visible stars to guide you. Let these tips illuminate the waters as you find your way.