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4/26/2016 Communication: Is it Mishearing or Misinterpretation? Alison Freeman, Ph.D. CPA Annual Convention Irvine, California April 18, 2016 For a Virtual Experience Put earplugs in your ears and just notice… what sounds sound like…. Turn to your neighbor on your right and for 3 minutes: Introduce yourself Tell where you work and what your specialities are Tell what you hope to get out of the workshop today Premise of Today’s Workshop Need for clinical assessment of hearing loss in relationships. Need for clinical observation in making differential diagnosis of hearing loss versus communication psychodynamics. 1 4/26/2016 “Blindness cuts us off from things, but deafness cuts us off from people.” - Helen Keller “Hearing loss does not just affect an individual, but also one’s family and friends.” - Michael A. Harvey, Ph.D., psychologist, author of Listen with the Heart: Relationships and Hearing Loss Introduction We are all affected by hearing loss at some time in our lives, in either ourselves, or in someone that we love. World Health Organization definition of hearing loss - not being able to hear sounds of 25 decibels or less in the speech frequencies. Not only affects volume, but more importantly, discrimination (comprehension). Definitions Mishearing - information not being received auditorily v.s. Misinterpretation - problems of perception (mind reading, negative thinking, assumptions) 2 4/26/2016 We’ve all been there… Some instances of miscommunication can often be funny; some common examples are: Pledge of Allegiance “I pledge the allegiance to the flag” …I led the pigeons to the flag.. The Beatles “the girl with the kaleidoscope eyes …” … the girl with colitis goes by Rolling Stones “I’ll never be your beast of burden” …I’ll never leave your pizza burning.. What does a conversation sound like with a hearing loss? Statistics – 48 million American adults have some degree of hearing loss – As baby boomers reach retirement age starting in 2010, this number is expected to rapidly climb and nearly double by the year 2030. – Today, one-third of Americans between ages of 65-74 have hearing problems – One-half of Americans 85 and older have hearing loss. 3 4/26/2016 Lifespan Issues Communication errors in parenting of children Manifestations of poor self esteem in children, adolescents and adults Communication difficulties in dating Sudden hearing loss - in trauma victims Age related hearing loss in baby boomers and seniors Effects of Untreated Hearing Loss Hearing loss is currently untreated in 85% of those affected. Typical manifestations of unidentified hearing loss commonly present as: communication difficulties social withdrawal low self-esteem depression unexplained frustration and anxiety, and frequently result in medical misdiagnoses. Impact on Relationships Marital Relationships Sibling Relationships Parent - Child Relationships School participation, or lack thereof Professional relationships Community involvement 4 4/26/2016 A Game of Catch with a Ball of Clay Metaphor to describe complexity of communication between two people Each time one touches it, they shape it to form their own perceptions based on any number of variables. * past knowledge, family history and experience * race, gender, age and religion * family background * unique understanding of semantics and connotations and then add hearing difficulties? Relationship Stress Men more typically have hearing loss Talking is easier than listening (form of conversation control) Clinically - Reflective listening becomes primary tool • As therapists, we need to entertain the idea that what our clients hear may not necessarily correlate with any objective, external reality. • Rather, it reflects their internal processing where they may impose their interpretations and assumptions. Thus, reflective listening minimizes and/or clarifies this disconnect. 5 4/26/2016 Research: Untreated Hearing Loss In a study conducted by the National Council on the Aging, 2300 Americans over the age of 50 with hearing loss and 2100 of their family members and significant others were asked questions about the effects of untreated hearing loss in their lives. The results yielded significantly higher rates of sadness, paranoia, social withdrawal, worry and anxiety and feelings of emotional insecurity (NCAA, 1999). Invisible Disability The primary disability of hearing loss at any age is that it is a communication disability rather than a mere medical diagnosis of just not being able to hear. This ambiguity is a daily stress that one must continually adjust to, in every situation throughout the day. Struggling to understand conversations, music or professional interactions is a constant stress everyday. The true disability of hearing loss is one where there is a reduction or a lack of communication which leads to social withdrawal, loneliness and/or depression. 6 4/26/2016 Mindreading=misunderstanding? Hearing through the Brain We hear from our brains, not our ears Ears are a pathway to our auditory systems. As such, any sensory deprivation, such as hearing loss, could lead to wider adverse effects on brain vitality. Audiogram QuickTime™ and a decompressor are needed to see this picture. 7 4/26/2016 Intake Considerations As psychotherapists, it is important to consider the possibility of hearing loss when communication difficulties are the presenting problems and/or when dealing with certain high risk groups such as baby boomers, veterans and seniors. Therefore, during intakes, we must not assume that the client will tell us about their hearing loss as they may not realize that they even have a loss. Clinical Manifestations Social withdrawal Depression Low self-esteem Unexplained frustration and anxiety Decrease in typical assertive behavior Increase in relationship stress Monopolizing conversations Memory issues (due to insufficient auditory input vs. organic causes) Symptomatic similarities between Alzheimer’s Disease and untreated hearing loss ALZHEIMER’S DISEASE Depression, anxiety, disorientation UNTREATED HEARING LOSS Depression, anxiety, feelings of isolation Reduced language comprehension Reduced communication ability Impaired memory (esp. short-term memory) Reduced cognitive input Inappropriate psychosocial responses Inappropriate psychosocial responses Loss of ability to recognize (agnosia) Reduced mental scores Denial, defensiveness, negativity Denial, defensiveness, negativity Distrust and suspicion regarding other’s motives Distrust and paranoia (e.g. belief that others are talking about them) * Chartrand, M. Hearing Health and Alzheimer’s Disease in Hearing Review, November 2001. 8 4/26/2016 Factors Contributing to Shame and Denial Embarrassment - symbolizing being “old” • Financial Burden • Medicare coverage for hearing aids • Would you rather be called “stupid” or hard of hearing? • “Fakery” / “bluffing” • Cultural factors - certain cultures view hearing loss as shameful, more resistance to wearing hearing aids • Strategies for Optimal Communication Setting the “stage” Lighting and Windows - do not sit in front of windows Carpeting/upholstery/drapery - absorb sound Enunciation and Eye contact -use of non verbal cues Pacing and speed - speaking slowly as naturally as possible Use of visual materials - drawing, technological aids Ask for rephrasing or repeating of what you said What did you hear me to say and what does that mean to you? vs. sounding critical by just saying “what did I say?” Examples of mishearing Called my friend and asked how she was because she was sick, and she responded with, “I had an awful night” and I responded “I am so glad to hear that” and she laughed, knowing fully aware that I misheard it. I had filled in the blanks by guessing and knew that I had a 50% of guessing correctly. 9 4/26/2016 Hearing Assistive Technologies Use of technology and apps to help with communication and lessen stress of hearing. CTAP – free phones 1-(800) 806 -1191 Hamilton Captel phones Subtitles Viewer apps - iphone Clear Captions - tablets/phones Closed Capp - (3.99) android Live Caption (3.99) apple and android Dragon Remote Microphone - free The Deaf and Hearing Impaired - android app http://www.interpretype.com - use of two mini computers for two way conversation - both must be able to type Resources Hearing Loss Association of America (HLAA) www.hearingloss.org local, state and national chapters with national journal as well as local newsletters. HLAA provides free webinars. * HLA-LA - local chapter - www.hlaa-la.org Hearing Loss Californian - free newsletter National Center on Deafness at CSUN www.csun.edu/ncod Greater Los Angeles Association for the Deaf (GLAD)- www.gladinc.org www.About.com.deafness - Laurent Clerc (Gallaudet) National Deaf Education Center clerccenter.gallaudet.edu Weitbrecht Communications - Santa Monica - California Telephone Access Program (CTAP) - free phones http://ddtp.cpuc.ca.gov References Amieva H, et al. Self-Reported Hearing Loss, Hearing Aids, and Cognitive Decline in Elderly Adults: A 25Year Study. J Am Geriatr Soc. 2015 Oct; 63(10):2099-104 Chartrand, M.S., (2001B, November). Hearing Health Care and Alzheimer’s Disease: The role of hearing healthcare in treating patients with Alzheimer’s disease. The Hearing Review, pp.26-29 Freeman, A. (2012) Emotional Aspects of Hearing Loss. Hearing Loss Californian. May/June. Freeman, A. (2013) What…Me Hard of Hearing? The California Psychologist. Nov/Dec; Volume 46, Number 6. Freeman, A. (2014) Hearing Loss Across the Lifespan at www.zurinstitute.com Freeman, A. (2015) Shouting Doesn’t Help! The Psychological Impact of Hearing Loss on Baby Boomers and Veterans. Presentation to California Psychological Association Annual Convention, April 2015. Hampsten, K.(2016) How miscommunication happens and how to avoid it. Retrieved from ed.ted.com/.../how-to-avoid-miscommunication-katherine-hampsten Hearing Loss: Facts and Statistics. Hearing Loss Magazine, Mar/Apr 2016. Lin FR, Niparko JK, Ferrucci L. Hearing Loss Prevalence in the United States. Arch Intern Med. 2011;171(20):1851-1853. doi:10.1001/archinternmed.2011.506 Lin FR, Metter EJ, O’Brien RJ, Resnick SM, Zonderman AB, Ferrucci L. Hearing loss and incident dementia. Arch Neurol. 2011 Feb;68(2):214–220. Mener, D., Betz, J. Genther, D., Chen, D. , Lin, F. Hearing Loss and Depression in Older Adults. J Am Geriatr Soc. 2013 Sep; 61(9): 1627–1629.doi: 10.1111/jgs.12429. Saks, O. (1989) Seeing Voices: A Journey into the World of the Deaf. NY: Vintage Books 10 4/26/2016 Contact Information Alison Freeman, Ph.D. 310 712-1200 [email protected] www. Dralisonfreeman.net “Hearing Loss across the Lifespan” at Zurinstitute.com (2 CEU’s course) 11