Behavioural awareness, interaction and counselling education in audiological rehabilitation: development of methods and application in a pilot study.

In conventional audiological rehabilitation, the hearing therapist interacts with the hearing-impaired person and with significant others. In order to strengthen the personality and self-confidence of the hearing-impaired individual, a different strategy was designed and implemented whereby the pedagogic interaction was directed only towards the hearing-impaired individual, who in turn worked as a tutor/aid/counsellor to the communication partner. On the basis of an interactive communication model, new methods for rehabilitation of subjects with moderate hearing impairment were developed and evaluated in a pilot study on 13 men with noise-induced hearing loss. A course programme was developed with three main active components: (1) increased insight and knowledge; (2) education as counsellors with the ability to focus on the problems of the communication partner; and (3) motivation to change through group discussion and reflexive conversation. Increased insight and knowledge were obtained through test and training experiences in a sound environmental chamber, tutorials and discussions. The pedagogic training focused on helping the hearing-impaired subjects to become able communication counsellors in relation to their interlocutors. An act-react, offensive-defensive paradigm was used in conjunction with transactional analysis. Results of the pilot study were evaluated using questionnaires, interviews and a method of dialogue analysis. The results were evaluated for the hearing-impaired and the partner and in recordings of conversations in the home environment. There were clearly positive cognitive and emotional effects seen in the inquiries and interviews. The observations from the dialogue analysis indicated only small effects, with the exception of the two individuals with the most pronounced functional impairment, for whom dialogue was improved after the course. It was concluded that these new methods could contribute new possibilities in rehabilitation programmes, emphasizing the shared responsibility for communication and the unique competence and abilities of the hearing-impaired person.