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The role of communication partners in the audiological rehabilitation

In 2005, I wrote a book about hearing loss and communication (Danermark [2005] 2014). At that time there were disturbingly few publications addressing the communication partner. This was surprising because, as Lise Lotte Bundesen writes in her foreword to this book, family centred rehabilitation has been discussed for more than 50 years. Hearing loss often leads to problems in work and family life, and maintaining social bonds with friends and acquaintances is a challenge. A person’s hearing loss has great significance for people in that person’s immediate surroundings. Conversation is an extremely complex social action that is fundamental for human beings. It requires the active participation of all involved; thus the credo ‘‘It takes two to tango’’ in my aforementioned book. I never expected that it would take 13 years before the role of the communication partner in audiological rehabilitation would be addressed in an in-depth, theoretical, empirical and comprehensive manner. The authors of the book are very well suited for such an endeavour. They both have long experience and outstanding insight in adult audiological rehabilitation, both from a theoretical and from a practical perspective. The book is inspired by the framework of the stages of change model, and a method of person-centred audiological rehabilitation initially developed by the Ida Institute and further developed by Manchaiah. The text deals with a number of aspects of the role of the communication partner. In the first chapter, the authors emphasise that hearing loss is a communication problem. It is a medical condition that requires medical competence, but because hearing loss is often also a communication disorder, competencies in communication are needed in the rehabilitation process. The next chapter deals with the concept ‘‘third-party disability’’. A clear understanding of this is essential, and with the help of WHO’s International Classification of Functioning, Disability and Health (ICF), the authors describe the range of restrictions and limitations that the communication partner might experience. The third chapter presents our current knowledge of the positive and negative consequences reported by communication partners of persons with hearing loss. Notably, here one finds a discussion of the positive experiences – often related to personal development and improved relationships – so often disregarded in the literature about hearing loss. Chapter 4 focuses on the aforementioned stages of change model in terms of a journey consisting of seven main phases, going from contemplation to resolution. It is a model that has been used to understand the journey a person with hearing loss undergoes. By applying this model to the communication partner, the authors present a cohesive view of the process the partner experiences. In the following chapter, the authors discuss the importance of and strongly advocate for the involvement of the partner in the rehabilitation process. They also provide the reader with practical tips and tools. Chapter 6 addresses the difficulties people with hearing loss experience maintaining their social networks. The authors discuss this in terms of communication rings, but they find that notion too restrictive and suggest a more elaborate model, communication world. Two crucial elements of person-centred audiological rehabilitation are goal setting and shared decisionmaking, which must also involve the communication partner. In Chapters 7 and 8, the authors provide us with tools and tactics for such. It is not possible to do justice to the breadth and depth of the content in the book, and the theoretical and empirical parts are well written. However, there is one aspect of the book I find disturbing. The authors seem to embrace the traditional – and, in my estimation, old fashioned – view of the communication process in terms of a sender–receiver–medium approach, where communication is seen to be about sending a message that a receiver should (hopefully) be able to take in and understand as the sender intended. This comes to the fore in the last chapter. That approach has been heavily criticised over the past decades, especially from a dialogue perspective, which emphasises interaction and the creation of meaning as a joint activity (see, e.g., Linell 1998). This is the raison d’Être for involving the partner. It would have been interesting if the authors had engaged more in the state of the art of communication theories and research. This comment should not obscure the strengths of the book, however. The importance of this book cannot be underestimated. My experience as a researcher is that, although there is a general understanding of the importance of involving the main communication partner in the audiological rehabilitation, such involvement is often overlooked in the clinical work. There might be many reasons for this, such as lack of willingness from the partner or lack of resources. But after the publication of this book, one cannot claim that it is related to lack of knowledge, theoretical or practical. The book is well grounded in current research and reliable knowledge. It also provides the reader with concrete examples of how to acknowledge the communication partner in the audiological