Resultados de la entrevista semi-estructurada inicial a los estudiantes

Empathy, counselling, and relationship-centered care (discussed in Section 4.6.2) are three behaviours for audiologists to demonstrate for which reflection seems to play a role in development. These behaviours are common topics for reflection, which suggests that they may be further developed through reflection. For example:

I found that if you showed the client your genuine concern for their well-being that they would be more willing to open up to you […] Once this caring relationship was established with them, all subsequent interactions would go much more smoothly (1015-1)

Audiologic counselling develops through experience even more so than

assessment techniques, according to participants in this study. Note that in this context, counselling refers to the explanation of results, etiology, implications and education about treatment or (re)habilitation options. Counselling is a skill that involves attention to the individual needs in the moment and of the client. It could be argued that counselling is inherently more difficult to teach through classroom lessons for these reasons, as one participant notes:

As with a lot of counselling aspects, it seems like something that you can’t be taught by reading a textbook or listening to a lecture, it is more of learning through a combination of experiences that will perfect the skill (1007-2).

Perhaps for these reasons, counselling is a very common area of practice

implicated by students in terms of when reflection is helpful and necessary, even in terms of frequency of the type of experiences reflected upon. Supervisors also closely tie counselling to reflection and reflective practice, citing the tacit,

experiential, client-centered nature of developing competence and expertise in counselling. The indeterminate zones presented by counselling pose reflective opportunities. For example, the following quotation comes from a supervisor who feels that counselling is an aspect of practice that students feel more uncertain about:

…then I think students always feel that they have greater difficulty sort of

stepping into the counselling roles because I think they feel that they don’t have enough knowledge and what happens if they ask a question that I can’t answer (2002-2-interview).

The next two examples demonstrate students’ use of reflection to learn from a supervisor the importance of some essential counselling approaches including being attentive and sensitive to the client’s unique needs.

She reiterated that since they found the hearing loss early and would get him hearing aids he would likely develop age-appropriate language skills before he went to school. I was surprised by how often she relayed this point.[…] I

understood why near the end of the appointment when the mother asked the audiologist if her son was completely deaf or if he would learn how to speak. […]This showed me that the news was so overwhelming for the mother that even though it seemed like she was following and understanding what the audiologist was saying that she really wasn’t. The news was just so upsetting that she could really only focus on the fact that her son had a hearing loss (1005-2).

I wanted to tell the client what I knew about Amikacin and about the nature of the hearing loss which I understood a bit better than I think my supervisor did because I had just taken a course about it in school. However, I held back and let my supervisor take initiative in this regard. I now realize that the information I

wished to provide would have been futile and more stressful for the patient at that point in time, so I am glad I did not say anything (1008-1).

A supervisor’s perspective on the usefulness of reflection in improving counselling follows:

I think the Aural Rehab [AR] group stuff has allowed us to see it from a very different point of view um and to reflect again so I can think of people that are my patients that have then been part of an AR group with and I’ve thought about what happened in the interaction, and I think I’ve given them what they need, and I’ve maybe have felt good about that and then I listen to them … in those groups and I hear things that I’m very surprised by sometimes … um and so then there’s a deeper level of reflection cuz oh I thought I had done a really good job of

explaining this to them I thought they really understood this and that they’re sitting sharing with a group that they don’t know something (2002-2-interview).

The supervisor, in the example above, runs AR groups with individuals who have hearing loss. Reflection and the relational element of the AR groups interact to help her see differently as she notes that she is “very surprised” by what she hears sometimes when she observes her patients “sharing with a group that they don’t know something.”

In sum, reflection is a potentially useful tool toward developing the professional behaviours and skills of empathy, counselling, and relationship-centered practice.