Mirror, mirror on the wall, am I person-centered after all?

By Helle Gjønnes Møller

“Anyone who thinks they are doing fine is an ideal candidate for reflection,” said Christine DePlacido, a now retired audiologist, counselor, and senior lecturer at Queen Margaret University, Scotland. With this statement, DePlacido implied that while most hearing care professionals may think that they are reflective and person-centered in their approach, this is far from always the case. Without self-awareness, there is often a gap between intentions and reality.

A lack of PCC in appointments

A study by Greenness et al from 2015 on verbal communication between audiologists and people with hearing loss revealed a clear tendency towards biomedical, audiologist-controlled appointments. The study, which was based on 63 audiology appointments, showed that the audiologists initiated the consultations with close-ended questions 62% of the time, interrupted patients after only 21.3 seconds on average, and asked 97% of the questions during history-taking. In summing up, not very person-centered at all.

Considering the typical clinic workday, where hearing care professionals often rush from one appointment to the next without a chance to digest the previous experience, these numbers are maybe not surprising. However, this way of practicing can easily lead to miscommunication, frustration, and inefficient consultations – not to mention feelings of stress, helplessness, inadequacy, and clinical burnout for the professional. 

Help yourself before helping others

For many hearing care professionals, helping clients is what motivates them and why they decided to pursue a career in audiology in the first place. But although it is rewarding to help others, the profession can also bring stressful work environments, big caseloads, and overwhelming scenarios of dealing with strong emotion. One challenge is the lack of vocabulary around professional fatigue and how client exposure may impact clinician wellbeing. Many professionals do not acknowledge that part of being person-centered is to allow themselves, as people, to thrive in their profession. When they struggle and feel weary, they lack the knowledge and vocabulary to look after themselves. 

Reflecting to thrive

According to DePlacido, reflection can help clinicians to acquire new perspectives on the challenges they encounter, gain insight into their own assumptions, and ultimately allow them to thrive as professionals. In audiology, reflection is used as a way of monitoring behavior and improving the quality of interactions between practitioner and client. In Fostering Reflective Skills in Audiology Practice and Education, DePlacido and Cokely establish that the goal of reflection is “to unite thoughts, feelings, and actions for enhanced conceptual clarity and personal insight that leads to self-directed learning.” Conscious and structured reflection enables improved decision-making and more informed actions, benefiting both the client and the clinician – and helping to build a relationship of trust and confidence. 

Reflection in academia

Reflective practice is also an essential skill for educators and students. Associate Professor Dr Deborah Ferrari from the University of São Paulo explains why reflective practice is important from an educator’s perspective: “For someone who is at the beginning of his/her learning curve, things are not obvious. Even small issues can have a deep impact on the students’ sense of competence and trust in their own skills. If you, as an educator, are aware of that right away, then you can provide more customized and effective feedback. It basically gives you insight into what the student is feeling, and what you are feeling as well.”

Giulia Ito Santos, a former SLP audiology student at the University of São Paulo, says, “Reflective practices were undoubtedly a relevant part of my learning process in clinical practice. I remember coming home after eight hours of service provision and having to write in my reflective journal. This was an individual, private, and safe moment where I could analyze each step of the care I had provided, and what I could do differently next time. Before the next appointment, I would review my reflections, my mistakes, or worries as an opportunity to be better and perform differently.” 

Maicon Suel Ramos da Silva, an undergraduate SLP audiology student at the University of São Paolo, says “Reflection in a structured format is very positive and a valuable tool for the student. The transition from theoretical classes to clinical practice is somewhat difficult. We have the theoretical knowledge, but we lack the experience. Being able to reflect and receive feedback in a timely manner during the supervision helped a lot. We were able to be more sensitive, to understand the patient's condition and needs, while understanding that we are also human beings and have our own life issues to deal with.”

Ida’s Reflective Journal

To provide an intuitive tool for quick and structured reflection, the Ida Institute collaborated with Christine DePlacido to develop the Reflective Journal. The journal serves as a self-development tool for analyzing the client encounter – helping practitioners to understand their behavior, learn from experience, and enhance the quality, efficiency, and outcome of future appointments. By raising a few essential questions, the journal helps practitioners to gain a deeper insight into their own behavior and identify areas where there might be room for development. 

The journal also encourages the practitioner to highlight their own strengths and urges them to collect and keep positive feedback. This will help them to grow and thrive as professionals, while preventing work-related challenges from snowballing and affecting mental and physical health. 

Learn more

For further information on reflective practice in audiology, view the CEU-accredited AudiologyOnline course The Art of Reflection in Audiology: Using the Ida Institute Reflective Journal in your daily practice

You can also learn more about Ida’s Reflective Journal and explore Ida’s university course module Clinician Wellbeing: Self-Care in the Hearing Clinic, which sheds light on such aspects as stress and burnout and offers effective preventative strategies.