HLAA Convention: Communication Therapy - An Integrated Approach

By Bonnie O'Leary

June 2011

This workshop was led by Jimmy Lee, MS, CCC-SLP, who is a Speech Pathologist in the Hearing and Speech Center of the Department of Hearing, Speech and Language Sciences at Gallaudet University. He introduced his program with a quote from George Bernard Shaw which most of us in the audience seemed to relate to with subdued chuckles around the room: "The single biggest problem in communication is the illusion that it has taken place." (This will be duly incorporated into my future outreach presentations!)

Communication model

When communication takes place, there are components to that event: the sender, the receiver, the environment, and the message. The sender "speaks", assigning meaning to the information; the receiver (or the person listening) decodes that information and assigns meaning, giving feedback by answering the speaker. But as many of us know, a breakdown can occur anywhere along the line, creating threats to the success of the communication. Some of these include noise, distance, reverberation, shared language, and speaking skills.

For many years, Gallaudet has used a communication therapy model for students with hearing loss and speech challenges that focuses on global areas: informational and adjustment counseling, technology, and strategies. Integrated therapies include auditory, language, speech/voice, pronunciation, and speechreading skills. (These services have also been available to anyone in the area who needs them, especially late-deafened adults.)

Informational and adjustment counseling

Many areas are addressed in this segment. These include hearing loss, grief, and relationships at home, at school, and at work. An understanding of these areas helps form the basis for recommending options in amplification and communication strategies. Grief is a very important element in the adjustment counseling. Particularly for those who struggle with late-onset deafness, grief is a multi-faceted response to that loss. It has emotional ramifications as well as physical, cognitive, behavioral, and social dimensions, and it is important to understand the impact of grief on the person needing these therapies. Many people who lose their hearing go through the five stages of grief: denial, anger, bargaining, depression, and acceptance, but not necessarily in that order.

Technology

There are many technology options for people seeking solutions to their communication needs. Hearing aids and cochlear implants are usually a first consideration, but depending on the level of hearing loss it could also be advisable to start with assistive hearing technologies such as FM or Infrared systems, hard-wired devices such as PockeTalkers, and alerting devices.

Strategies

Communication strategies are broad and varied, and it takes time to learn to use them. I remember how many months I spent trying to hone my own strategy skills after I had learned the basics in speechreading classes. Anticipatory strategies are useful prior to a communication event; by preparing yourself for possible conversations and what vocabulary might be used, it's easier to focus. Repair strategies are helpful during a communication breakdown; for instance, instead of asking someone to repeat what you didn't understand, you would ask them to rephrase it, or ask for a key word, or how to spell a word you simply cannot understand. Maintenance strategies are simple techniques used during communication, ensuring the speaker that you are continuing to understand what he or she is saying, such as confirming the information every few sentences.

How well we handle strategies is often dependent upon our personality. If we are passive ("Oh, that's okay..."), the likelihood of communicating our needs is more diminished than if we are assertive. If we are aggressive (demanding!) we risk not having our communication needs met because we've managed to make everyone around us defensive and irritated. Being assertive means we are stating our needs in a polite but firm manner, validating the feelings of the person we are speaking to, and making it clear that we want to negotiate so it's a win-win for everyone. Generally, an assertive approach assures a successful outcome for our communication needs.

Areas for assessment

The integrated approach also identifies skill areas that need to be assessed. Auditory skills are evaluated, such as the person's ability to communicate one on one and in a group. Speechreading skills include both visual and auditory. An evaluation of expressive skills covers the areas of speech, voice and pronunciation. Overall language skills assessment focuses on everything from grammatical usage to vocabulary and written language abilities.

If you would like to learn more about Gallaudet's integrated approach to communication therapy, contact Jimmy Lee at james.lee@gallaudet.edu.

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