Picasso and the Value of the Counseling Process

Author: Brian Taylor, Au.D.

As the story goes, Picasso, who at the time was a struggling unknown artist living in Paris, sketched portraits of people strolling down the Champs Elysees. Long before he became one of the 20th century’s most renowned artists, he was an unknown 30 year-old artist eking out a living by selling caricatures to passers-by on the street. According to legend, a customer complained about the high price of the sketch that took Picasso less than five minutes to create. “Why are you charging me $100 for less than five minutes of work?” the disgruntled customer asked. Picasso replied, “You’re not paying for five minutes of time, but for the 20 years of experience it took me to create this.”

Like Picasso, hearing healthcare professionals and their support staff provide a service which may take only minutes to create but a lifetime of experience to bring to life for a struggling, stressed out patient coping with the handicapping effects of their hearing impairment. These personal encounters-even those that last just a few minutes-are like those caricatures created by Picasso. They don’t take much time, but the clinician’s experience working with patients trying to overcome the ill-effects of hearing loss is invaluable.

Here is a counseling model taught in many medical schools that can be used to create infinite value for patients-even during a brief encounter. It is popularly referred to as the I-CARE model. It can be used by hearing healthcare professionals and their support staff to inspire confidence and create service value.

I - Introduce yourself and inspire confidence in the patient
C - Connect with the patient and family
A - Acknowledge what the patient has said
R - Review the plan of care and how long it will take to accomplish goals
E - Educate the patient and ensure their understanding

One of the biggest challenges associated with working with hearing impaired adults is getting them to take action. It doesn’t take much clinical experience to realize that no amount of persuading, convincing or cajoling will enable patients to take the necessary steps to get help for their hearing loss. Let’s discuss another type of counseling that takes a bit more practice, but reaps tremendous rewards for both you are your patient.

Motivational interviewing is thought to be an effective way to help people discover their own reasons for taking action or doing something to address a problem. Instead of enrolling in a college level course on motivational interviewing, you can quickly put the power of this technique to work by adapting these six questions into your hearing aid evaluation or consultation process. Michael Pantalone, Ph.D of the Yale School of Medicine has developed this technique. It is readily assessable in his book Instant Influence (2011, Little, Brown Press Co.).

There are six questions in Dr. Pantalone’s instant influence process. They are listed below. Under each question, I have some provided some rationale for asking this question within the context of a hearing aid dispensing practice. Remember the objective of these six questions is to reinforce the autonomy of the patient’s situation and to discover their own reasons for receiving help from your practice. It’s up to you to craft the language of each question, so that it rolls off your tongue smoothly. As you read through these questions, think about how you might introduce the Flex: trial device as a nudge toward behavior change and improved hearing.
  1. It’s a free country, no one forced you to come in for your appointment….why might it be a good idea for you to get help?
    The goal of the first question is to reinforce to the patient that he has autonomy and that you are not forcing him to participate in the process. According to Pantalone, why might you and how could you statements are the most effective at establishing autonomy.

  2. On a scale of 1 to 10, 1 being not ready at all and 10 being totally ready today, how ready are you now to get help for your hearing?
    The goal of this question is to help you gauge the patient’s level of motivation. What’s important is not the number the patient tells you, but beginning the patient’s thought process of why they might want to change.

  3. Why didn’t you choose a lower number?
    This is the question that Pantalone refers to as the irrational, sudden jolt. By asking this question, you are inviting the patient to explore some of the reasons why they might want to take action. Because people are used to being pressured and badgered into doing what other people want, they are often surprised to be asked about what they want. (Pantalone p. 88)

  4. Suppose you have a magic wand. What are some of the benefits of improved hearing?
    The goal of this question is to help the patient deepen their commitment to make a change. This question allows the patient to begin to visualize the positive changes better hearing can make in their daily life.

  5. Why might those outcomes be important to you?
    Like the previous question, the goal is to enable the patient to deepen their commitment to making a change in their current situation. This follow up question will encourage the patient to explore some of them more personal reasons for accepting help from your practice.

  6. Let’s talk about your next steps….how do you see (your recommendation) benefiting you?
    This final question allows the patient to verbalize how an acceptance of your recommendation will have a positive effect on their life. This is also the point in the questioning process where you can introduce a risk-free at-home hearing aid trial, if appropriate.
No amount of technological innovation is likely to replace the human touch of thoughtful questions and deep, selfless listening. If you’re looking for an immediate way to differentiate your services from low cost, direct-to-consumer competition, you’d be wise to adapt these simple motivational interviewing techniques. It will get you on the path to individualizing treatment and follow-up plans.