Problem Solving and Identification

A good way to start your Group AR program is to allow participants to identify the challenges that the group will focus on during subsequent sessions. There are two approaches you can use to identify challenges: Pragmatic and Psychosocial. 

Pragmatic Approach

The Concept

The pragmatic approach involves asking each member of the group to identify either one or the top three communication problems that they would like to work on during the course of the program.

Worksheet: Before Session

You can have participants consider their communication priorities prior to the session by providing them a worksheet. The instructions on the worksheet could look something like this:

  • Identify a communication situation where you experienced problems understanding or participating
  • Describe two communication problems that you would like to work on during the program

Ask the participants to bring the completed worksheet to the next session. You can then be available to answer questions and discuss concerns individually as you move from person-to-person around the room.

Useful External Materials

You may want to check out the technique described by Hickson, Worral and Scarinci in their book on the ACE (Active Communication Education) program. In the book, they describe a two-part exercise consisting of a 'communication needs analysis' and a 'nominal group technique' where group members work collaboratively to select important problems identified by group members to work on during group sessions.

You can also help group participants further develop their descriptions of communication problems by using techniques similar to those used when administering COSI (Client Oriented Scale of Improvement). You can adapt the COSI by asking participants to write-down five listening situations where they feel they need help with their hearing. At the conclusion of the 

Group Problem Identification: During Session

At the first or second session, you may want to lead a discussion by asking each participant to speak about communication situation they want to solve during the program.

You can work with each participant to modify each goal to ensure it is appropriate for the class. This may mean focusing a broad concern into a specific problem. Or, you may modify a strictly emotional problem into a communication problem.

For example: "I am afraid I am going to lose my job because of my hearing problem" can be modified to "because I don't hear everything during a meeting I rarely participate and my boss thinks I am not doing my job." In this way, group members feel that their concerns are being met, and you are able to focus the program's agenda.

Psychosocial Approach

The Concept

A psychosocial approach could involve asking group members to offer up problems and general challenges related to their hearing impairment.

The idea is to not focus on communication challenges only, but all types of feelings and problems that may be related to hearing loss. This would create a more free, open-ended conversation than using the pragmatic approach. 

Conducting the Exercise

When a group member identifies a problem or an emotion, you can write it down on a whiteboard/poster and ask the person to expand on the problem. For example, "What is it like for you when this happens?" Or, you can ask if other group members face similar problems.

The purpose of the exercise is to identify communication problems and allow the group members to offer each other psychosocial support. When participants see that their problems are experienced by others with hearing loss, they begin to lose the stigma associated with hearing loss. They begin to understand that their problems are typical and not associated with a personal failure. If participants begin to realize that their communication difficulties are to be expected, they may begin to feel more comfortable admitting that they have a hearing loss in public and advocating for their communication needs in their community.

The psychosocial approach outlined above is described in Anthony Hogan's book "Hearing Rehabilitation for Deafened Adults: A Psychosocial Approach"

Approaches In Practice

Jill Preminger moderates a discussion about the worst thing about having a hearing loss. Participants offer concrete situations where their hearing loss affects their daily lives.

Sam Trychin asks his Group AR participants to contemplate one issue with their hearing loss that motivated them to participate in the program.


The videos above provide examples of problem identification exercises that you can implement in a Group AR session.  

The videos highlight the importance of giving each and every group participant the opportunity to express their perspective on their hearing loss. By tailoring the program in a way that addresses the thoughts and needs expressed by the group, you can help ensure that your Group AR program is valuable to all participants. 

Must Reads

L. Hickson, L Worall, and N. Scarinci. Active Communication Education (ACE): A Program for Older People with Hearing Impairment, London, UK: Speechmark Publishing Ltd, 2007.

H. Dillon, A. James, and J. Ginis. Client Oriented Scale of Improvement (COSI) and its relationship to several other measures of benefit and satisfaction provided by hearing aids. J Am Acad Audiol 8 (1):27-43, 1997.

A Hogan. Hearing Rehabilitation for Deafened Adults: A psychosocial Approach, London, England: Whurr Publishers, 2001.