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Wednesday, April 8, 2020

Enhancing the Psychological Benefits of Audiologic Care During the COVID-19 Pandemic

Editor's note: This article is published ahead of print. Send comments to hj@wolterskluwer.com. 

By Michael A. Harvey, PhD, ABPP

This was a routine psychotherapy visit with a woman with significant hearing loss, except it was conducted online—so-called telehealth. I was expecting to discuss Sue's anxiety concerning the coronavirus pandemic, but I wasn't prepared for her unmistakable self-assurance. In contrast to many of us remaining on constant red alert for coughing, sore throats, fatigue, etc., she had never looked happier! Could this be an artifact of online therapy or a sudden leap of growth from our psychotherapy sessions, I wondered, admittedly with a bit of hubris? 

She could discern my bewilderment even on her computer monitor. "I saw my audiologist last month and he said my hearing has gotten worse!" 

"Huh?"  More bewilderment. "Uh, uh, please continue." A standard therapist response when we don't know what else to say. 

"Dr. Jones is more than an audiologist who just tests my hearing," she began. "After the exam, when I started to freak out, he reminded me of how several years ago, I had garnered the strength to cope with my newly diagnosed hearing loss and then of my strength as a mother of a child with Down syndrome. Dr. Jones listens to me. He cares!  He asks me how I'm doing and really wants to know my answer!" A tear came to her eyes.

It seems so simple, doesn't it? Listening, affirming, showing compassion. 

When people are stressed (a world-wide pandemic qualifies as stress), your transformative power1 increases logarithmically, well beyond diagnosing and treating hearing loss. By transformative power, I mean that you have the ability and means to connect with patients in times of personal crises; that they may share their fears, hopes and dreams; and, at some point, when they begin to trust you, they take in your warmth and knowledge. And, in turn, they experience a better quality of life, including, but not limited to, successfully managing their hearing loss.   

I asked Sue when she was going to be fitted with new hearing aids. Her countenance abruptly changed. She shook her head sadly and said that Dr. Jones's office was closed due to the virus so everything was on hold. Then, with an unexpected beaming smile, she perked up and said, "But you know what he did?  (I shook my head). He called me to ask how I'm doing! I told him I'm having trouble adjusting the hearing aids that I have now so then do you know what he did?"  (I shook my head). "He did online videoconferencing with me and actually showed me what to do. And then guess what? (I shrugged). He took the time to ask me how I'm doing, and we talked about how we're both coping with the coronavirus!"

Her countenance remained lit up as she relived those magical moments. "I told him what scares me the most is being isolated. Do you know what he reminded me of?" (I shook my head). "He reminded me of all the stories I have told him about feeling isolated in a crowd, not being able to understand what people are saying. And how I managed to survive all that and finally get hearing aids. He said that in terms of coping with isolation, I've been there, done that. He said that I'm prepared for it; I'm ahead of the curve!"   

"And you know, he's right," she continued. "Also—and I just thought of this—in a way I'm less isolated in quarantine because I don't have to feel lost in a crowd of unintelligible noise. Everything is accessible to me via texting or one-to-communication at six feet."

It is important to note the ripple effect across the time of Dr. Jones' emotional support, as exemplified by Sue's spontaneous— "I just thought of this" —realization about the benefits to her of social distancing. It's as if she continued to have conversations with Dr. Jones in her head and to gain comforting insights.

"And do you know what the last thing was that Dr. Jones said to me?  (I shook my head). 'Please stay safe.'" 

It was clear that Sue's appreciation of our sessions was pale in comparison to her exuberance of that brief telehealth exchange with her audiologist. She offered an explanation with a smirk: "No offense, doc, but you get paid to discuss my feelings. Dr. Jones doesn't."

She was correct. Because of the pandemic, most insurances are now paying for telehealth psychotherapy visits, but it's my understanding that this is not the case for audiologic treatment. "No offense taken," I responded.  "How do you feel about that?" (My attempt at humor). 

I wasn't at all offended, competitive, begrudging, or jealous (okay, maybe a little). In fact, patients routinely report significant psychological benefits from their non-psychotherapist health care providers who listen, affirm, and show compassion.  It's commonplace for me to ask patients about what their doctor said and instead to hear that S/he was very nice!" Moreover, for Sue, the emotional impact of her virtual audiologic visit was much greater because, in words, "Dr. Jones asking me how I feel was above and beyond only talking to me about my ears. He values me as a person! I'm worth it!"  

TRANSFORMATIVE POWER OF AUDIOLOGY

Dr. Jones had made a powerful psychotherapeutic and transformative intervention without practicing psychotherapy. As an analogy, I can recommend eating healthy without practicing medicine.  

Why do you have this transformative power? Although in this case, the pro bono arrangement of her telehealth exchange may have been one explanatory factor, I do not believe it was the major ingredient. So-called traumatic transference is an important factor. I have discussed traumatic transference in detail elsewhere.2 Briefly, in this context, it's a psychological dynamic that imbues you with a heightened stature that causes patients to idealize you as an omniscient and omnipotent figure; the expert who has the power to make everything better; like a young child whose mother can make the boo-boo go away. 

Unexpected acts of kindness and compassion in our "new normal" COVID-19 era, even seemingly trivial ones, make for traumatic transference on steroids. In other words, such acts have a much greater psychological impact in times of crisis, even without face- to-face contact. This horrific pandemic offers important opportunities for audiologists to render powerful, even transformative, psychological interventions without going beyond professional boundaries, without practicing psychotherapy. As audiologists, John Greer Clark and Kris English noted, long before this pandemic, in their seminal text, Counseling-infused Audiologic Care, "If patients leave feeling that they have been understood and accepted as individuals, the session will have fostered increased self-esteem and nurtured confidence and readiness to tackle the problems ahead."3

TIPS FOR TELEHEALTH INTERACTIONS

I offer the following recommendations for remote interactions with patients:

  • Take a few minutes before getting down to business to inquire how patients are coping emotionally with the pandemic. It's what they will remember most and cherish and will solidify your relationship when this crisis is over. In business terminology, consider a long term means of building your practice.
  • Be human. Within appropriate limits, it's professional and validating for patients to hear the struggles and fears you are having. We're all in this together. 
  • Remind patients that they have already demonstrated exemplary bravery and resilience; that unlike approximately 66 percent of the U.S. population who have resigned themselves to untreated hearing loss,4 they have acknowledged their hearing loss and have sought treatment. Also, remind them that their bravery and resilience can serve them well across a variety of different crises, including CODIV-19. 
  • Encourage patients to access the information and webinars from hearing health advocacy groups such as the Hearing Loss Association of America (HLAA) on coping with coronavirus.

***

I emailed Sue this article.  During our next virtual appointment, she read it and kept nodding her head approvingly.  When she finished, she looked up at me, made solid eye contact, and said, "I think it's interesting that you felt the need to show me this professional article of yours. Are you sure you're not just a wee bit jealous of Dr. Jones?"

ABOUT THE AUTHOR: Michael A. Harvey, PhD, ABPP is a clinical psychologist in Framingham, MA. His most recent books are The Odyssey of Hearing Loss: Tales of Triumph and Listen with the Heart: Relationships and Hearing Loss, both published by Dawnsign Press. Feedback is welcome at mharvey2000@comcast.net.

REFERENCES:

1. Harvey, M.A. (2000). The transformative power of an audiology visit. Hearing Journal.  53(2), 43-47.

2. Harvey, M.A. (2018). Paving the clinical road: managing and utilizing patients' traumatic transference.  Hearing Journal. 2018;71(5):12-13.

3. Clark, J.G. & English, K.M. (2019). Counseling-infused audiologic care, Third edition. Cincinnati, OH: Inkus Press/Amazon.  

4. MarkeTrak 10: Patients; Providers; Products; and Possibilities. February, 2020; Volume 41(1).