The Line

This simple, effective tool is based on a line, two questions, and the clients’ responses. The first question allows you to assess how important your client feels it is for them to improve their hearing. The second one helps you appraise how confident they are that they can follow through with recommended treatment. 

You can use the Line in the first session with your client, in a follow up appointment, or repeated over time. It is often used with first-time clients or to increase the motivation of those who are no longer wearing their hearing aids. 

Step 1

1.    Ask your client, “How important is it for you to improve your hearing right now?”

2.    Have them mark their response on the Line with a number 0-10.

3.    Help your client reinforce their motivation and reasoning by asking them why they chose that particular number. For example, if they mark a 3, ask, “Why did you choose a 3 and not a 7?” This helps you understand their ambivalence. 

Step 2

1.    Ask your client, “How much do you believe in your ability to use…” (hearing aids, communication strategies, etc.)

2.    Have them mark their response on the Line with a number 0-10.

3.    Ask them about the reasoning for their answer, e.g. “Why did you choose a 3 and not a 7?”

Tips and suggestions

Give your client time and space to elaborate on their scores — the discussion is important, not the scores themselves. Ask them follow up questions such as:

  • "What would it take to increase your score from 4 to 8?” 
  • “What can I do to help you go from 4 to 8?”  

Listen carefully to your client’s responses. Avoid telling them that their concerns are unfounded; they are real to them.

Discuss the issues they’ve raised and assure them that most things can be managed. Their concerns could include things like having to make lifestyle changes, fear of being less attractive with hearing aids, lack of faith in technology, or lack of perseverance when it comes to forming new habits. 

Note that if the score is low on the first question and the client does not appear to take an interest in improving their hearing, asking them to elaborate may reveal that there are situations in which they do in fact wish to hear better. If the score is high, this conversation can help your client articulate their thoughts and strengthen their motivation.

If your client gives a high ranking on both questions, they are likely motivated to improve their hearing. 

If the client expresses ambivalence, use the Box to get a more complete picture of their thoughts and motivation to act on their hearing loss.

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The Line clinic handout

The Line clinician helper sheet