Counseling in Audiology and Speech-Language Pathology

Overview

The scope of this page is about person-centered counseling across the lifespan and across disorders or conditions. For in-depth tutorials on counseling, visit the following resources:

Counseling is part of a person-centered approach that helps people learn about and adjust to a disorder, condition, or situation and cope with their feelings, thoughts, and behaviors. Counseling may also include care partners, such as family members, other loved ones, and caregivers. Sometimes, clients and care partners also need to adjust to treatments and their side effects. The goal of counseling is to set realistic and clearly understood goals and improve quality of life (Flasher & Fogle, 2012; Tellis & Barone, 2018). Counseling helps people process their lived experiences so that they can respond with more agency and choice. This can empower and encourage self-acceptance and self-advocacy.

Counseling is as important as the technical aspects of providing audiology and speech-language pathology services. Audiologists and speech-language pathologists can provide the following two categories of counseling (Flasher & Fogle, 2012):

Informational counseling, also referred to as client and care partner education, involves discussing with individuals and their care partners the nature of a diagnosis or situation, assessment and intervention considerations and techniques, prognosis, and community and print resources.
Personal adjustment counselingaddresses feelings, emotions, thoughts, and beliefs expressed or demonstrated by individuals and their care partners (e.g., realization of the pervasive impact of a communication disorder on day-to-day life).

It is important for service providers in audiology and speech-language pathology to recognize that informational counseling and personal adjustment counseling are intertwined. They are provided simultaneously. The clinician infuses simultaneous informational and personal adjustment counseling into all aspects of a clinical encounter—from greetings to goodbyes. It is also important to recognize when referral to a related professional is warranted to best meet any additional counseling needs (see the Key Issues section for more information about referral).

Key Issues

Roles and Responsibilities

The professional roles and activities in audiology and speech-language pathology include clinical/educational services (diagnosis, assessment, planning, and treatment); prevention and advocacy; and education, administration, and research. See ASHA’s Scope of Practice in Audiology and Scope of Practice in Speech-Language Pathology.

It is within the scope of practice of audiologists and of speech-language pathologists (SLPs) to counsel people receiving services and their care partners about communication, cognition, swallowing, hearing, and balance disorders, as well as any thoughts, feelings, and behaviors that arise because of these disorders. Audiologists and SLPs provide education aimed at preventing further complications.

As indicated in the ASHA Code of Ethics (ASHA, 2023), audiologists and SLPs should be specifically educated and appropriately trained to provide the services that they offer. They have a responsibility to achieve and maintain the highest level of professional competence and performance. This includes enhancing and refining their professional competence through lifelong professional development related to their professional activities and skills.

Preferred Practice Patterns in Counseling

According to the Preferred Practice Patterns for the Profession of Audiology (ASHA, 2006) and the Preferred Practice Patterns for the Profession of Speech-Language Pathology (ASHA, 2004), the expected outcomes of counseling are as follows:

enhancement of client and care partner understanding of and adjustment to communication, hearing, cognition, swallowing, vestibular, tinnitus, or related conditions
increased engagement in the management of their disorder
increased autonomy, self-direction, and responsibility for acquiring and utilizing new skills, technology, and strategies related to their goals
enhanced physical and psychosocial well-being and quality of life
improved understanding of how to modify contextual factors to reduce barriers, enhance participation, and facilitate successful life participation
increased use of treatment recommendations
enhanced benefit from and satisfaction with treatment

Counseling involves providing timely information and guidance to clients, care partners, and other relevant people. Information and guidance may be related to the clients’ concerns, the course of intervention, ways to enhance outcomes, coping with the disorder(s), and prognosis (ASHA, 2004, 2006). Counseling may address the following:

evaluation procedures
diagnoses and results of evaluations
informed consent, including risk and benefit analysis of treatment options, modes of communication, and assistive technology
affective/emotional reactions and additional concerns secondary to communication, cognition, hearing, vestibular, swallowing, tinnitus, and related conditions
effects of the disorder on psychosocial and behavioral adjustment, including interpersonal relationships, learning and academic achievement, speech and language development, social activities, and occupational options and performance
development of coping mechanisms, problem-solving skills, compensatory behaviors, and systems for emotional support
development and coordination of individual and family/caregiver self-help and support groups

Ethical Considerations

Although counseling is integral to the clinical services provided by audiologists and SLPs, there are times when providers need to refer individuals to mental health professionals or collaborate with mental health professionals. ASHA’s Code of Ethics (2023) includes principles and rules that contribute to determining when referral and collaboration are appropriate:

Principle I, Rule B, states, “Individuals shall use every resource, including referral and/or interprofessional collaboration when appropriate, to ensure that quality service is provided.”
Principle II, Rule A, states, “Individuals who hold the Certificate of Clinical Competence shall engage in only those aspects of the professions that are within the scope of their professional practice and competence, considering their certification status, education, training, and experience.”
Principle II, Rule C, states, “Individuals shall enhance and refine their professional competence and expertise through engagement in lifelong learning applicable to their professional activities and skills.”
Principle IV, Rule A, states, “Individuals shall work collaboratively with members of their own profession and/or members of other professions, when appropriate, to deliver the highest quality of care.”

Person-Centered Counseling

Counseling is an attitude as well as a set of specific skills (Luterman, 2020). It is an attitude that allows clinicians to bring compassion and empathy to all clinical encounters. It is this “counseling mindset” (DiLollo & Neimeyer, 2022) that provides the person-centered context within which the technical aspects of audiology and speech-language pathology services are provided.

The following three conditions can facilitate productive counseling interactions (Rogers, 1961):

The clinician is genuine and transparent when interacting with their clients.
The clinician fully accepts and respects their client.
The clinician practices empathy to understand the world as their client does.

The clinician’s goal is to be person centered and not problem centered (DiLollo & DiLollo, 2014). Counseling moments are naturally woven throughout clinical interactions. They happen spontaneously and are addressed at the time they occur. The clinician responds to the client’s (or family member’s) verbal and nonverbal cues that reflect their thoughts or feelings about a problem or situation (Luterman, 2020).

Cultural Responsiveness in Counseling

Culturally responsive care is another facet of person-centered care. A person’s beliefs about the cause, impact, and appropriate response to diagnoses may conflict with the clinician’s personal beliefs and practices. This includes beliefs about whether a diagnosis is considered a disorder and whether remediation is necessary or appropriate. Services acknowledge and incorporate the client’s perspective when making recommendations and/or providing alternatives for treatment. See ASHA’s Practice Portal page on Cultural Responsiveness for more details about the cultural dimensions that impact service delivery.

Counseling and education, including any materials shared, are provided in the preferred language(s) of the client and their care partners. See ASHA’s Practice Portal pages on Collaborating With Interpreters, Transliterators, and Translators and Multilingual Service Delivery in Audiology and Speech-Language Pathology.

See ASHA’s resource on supporting and working with transgender and gender-diverse people and ASHA’s Practice Portal page on Gender Affirming Voice and Communication for additional considerations when counseling transgender or gender-nonconforming people.

Therapeutic Relationship

The therapeutic relationship is a partnership between the clinician, the client, and their care partners. A productive therapeutic relationship is characterized by mutual trust and by honest, open communication—with the purpose of achieving treatment goals (Rogers, 1961).

A strong therapeutic relationship is a basis for successful therapeutic outcomes in audiology and speech-language pathology by helping alleviate distress and laying a foundation of trust and cooperation (Flasher & Fogle, 2012). Therapeutic relationships are developed throughout the process, beginning with initial greetings. Building a strong therapeutic relationship starts with a person-centered attitude and the use of empathetic listening skills (Luterman, 2020).

Empathetic Listening

Empathetic listening is central to person-centered counseling (Luterman, 2008). It is also referred to as “empathic listening” (Egan, 2002), “active listening” (Gordon, 1970), and “reflective listening” (Rogers, 1961). This type of listening involves more than the clinician simply being quiet and waiting to speak. The clinician is an active listener who is there in service to the other person, listening without judgment (Luterman, 2020).

In essence, empathetic listening involves the clinician being psychologically and emotionally attuned to the client (or family member), listening to both the content and emotion being conveyed, then reflecting both back to the speaker, confirming that they have been heard and validating the emotion expressed. This is the foundational skill for effective counseling and for building the therapeutic relationship that is essential for successful therapeutic interventions (Wampold & Flückiger, 2023).

Several additional communication factors impact the building of a strong therapeutic relationship (Flasher & Fogle, 2012; Luterman, 2008; Tellis & Barone, 2018).

Show consideration for the person and their care partners: The therapeutic environment should be welcoming, comfortable, and barrier-free. When interacting with an individual and their care partner(s), show respect for their dignity, privacy, autonomy, and vulnerability. Clinicians make sure to acknowledge all people in the room versus focusing only on talking to the care partner. For example, clinicians do not talk about the client to the care partner as if the client is invisible (Brady et al., 2016). The clinicians are also responsive to cultural differences and family dynamics that influence the therapeutic relationship. Examples include

using their preferred titles and names,
knocking before entering the room,
introducing yourself to both the new client and their care partner, and
asking (in private) if they want their care partner in the room during service delivery.

a treatment goal or strategy needs to be clarified or modified;
dissatisfaction with progress needs to be addressed;
external issues are mitigating factors; or
there is an imbalance in motivational factors. Motivation can wane when goals are too difficult, are time consuming, are irrelevant to the client’s needs and desires, do not fit with the client’s self-image, or feel very inconvenient.

Baby talk, sometimes called elderspeak—The clinician uses generic terms of endearment (e.g., “sweetie,” “honey”) and speaks in a high-pitched tone (Flasher & Fogle, 2012). Elderspeak can lead to more resistive behaviors from adults with dementia (Williams et al., 2009).
Directive talk—The clinician tries to get the client to comply by using an uncaring tone. Clients can perceive this as the clinician having an uncaring attitude or being too controlling(Flasher & Fogle, 2012).

Note nonverbal communication: Observe the ways in which clients communicate that do not involve speaking. Nonverbal communication may include

physical appearance and proxemics (i.e., personal space and interpersonal communication distance);
seating arrangements (i.e., distance and positioning relative to the client);
eye contact (i.e., direct, indirect, or sustained); and
touch (e.g., seek permission before touching a client).

Know when to refer an individual to mental health professionals: It is beyond the scope of practice of audiologists and SLPs to diagnose or treat individuals for psychological disorders (e.g., depression, anxiety). If a clinician notes behaviors that seem to suggest a psychological disorder, then they should initiate a conversation with the person to see if they would like to be referred to a qualified mental health professional. The clinician refers to a mental health professional in a way that destigmatizes the need for mental health counseling and that humanizes the mental health counselor.

Care Partners

Family dynamics and expectations about who should be involved in conversations with service providers vary among cultures, families, and individuals. Some people may prefer having their care partners present when the clinician explains the diagnosis and treatment options. Care partners might also be present for treatment sessions, especially if the clients are children. See the Counseling Parents and Caregivers of Infants and Young Children section of this document for additional considerations. For example, if a care partner is having difficulty coping with the disorder or situation, the person receiving services may feel isolated or rejected. These feelings can then lead to anxiety and depression. Counseling with the care partners may alleviate some of the stress that the individual is experiencing (English, 2002).

Care partners differ in how they view and engage in counseling activities. Some will want to be intimately involved, whereas others will not want to be involved in any way (Tellis & Barone, 2018). Depending upon the individual’s age, cognitive abilities, or communication abilities, they may need a care partner, proxy, or client advocate to provide information to the clinician and to support emotional needs. All of these considerations are made relative to cultural beliefs and values, linguistic diversity, and language mode (e.g., sign language).

Clinicians may also need to provide individual, in-depth training to the care partner, in the absence of the patient/client. See ASHA’s resource on coding for reimbursement for more information about coding for caregiver training.

Client-Specific Considerations

In addition to the external evidence of evidence-based practice (EBP), appropriate application of EBP also includes using information about the specific client (internal evidence) as well as the client’s values and preferences. See ASHA’s resource on evidence-based practice (EBP). This applies to the counseling aspect of clinical interaction as well as the more technical. For example, the type and progression of a disorder might evoke certain feelings, emotions, and behaviors in individuals and their care partners (Flasher & Fogle, 2012; National Alliance for Caregiving & AARP, 2020; Payne, 2015; Rivera et al., 2007). Consequently, clinicians listen for the following—but not exhaustive—information that can affect therapy progress and related counseling when engaging with a person and their care partner(s):

Is the condition chronic, acute, congenital, acquired, or progressive? What is the patient’s prognosis?
How much time has elapsed between onset and treatment? What impact does this have on their perspective and the success of treatment?
Is the client taking medication that impacts the client’s engagement?
Does the client have additional mental health considerations?
How might this affect the person’s self-image and self-concept? How might it affect the development of self-image and self-concept during childhood and adolescence?
What feelings of anxiety, guilt, embarrassment, stigma, and so forth, might this condition instill in the person and their family/care partner?
How does the condition affect socialization and relationships with peers?
How does the condition affect academic or job performance and perceptions of teachers, employers, colleagues, and so forth?
Are there any cultural beliefs or stigmas associated with the person’s communication that could affect how they are treated by others or how they feel about themselves?
How does the severity of the condition affect the individual and family/care partner?
What kinds of situations may be challenging for the person and family/care partner?

Clinicians access client-specific considerations with a person-centered attitude and using empathetic listening. Clinicians can use one or more of the following methods (DiLollo & Neimeyer, 2022; Strong & Shadden, 2020):

specific questions, such as in a structured case history interview
less structured interviews, such as motivational interviewing (Hoepner, 2024)
more open interactions that ask the client and family/care partner to share their story or personal narrative

Clinicians remember that these client-specific factors are dynamic and, thus, require continued exploration of the client’s and the family/care partner’s experiences and needs related to their communication challenges. For example, clinicians might need to help the client and their families with planning for and coping with potential cognitive decline and potentially problematic behaviors, such as physically grabbing others, engaging in inappropriate sexual behaviors or language, and hitting (Lanzi et al., 2021).

Clinicians can support their clients who have difficulty communicating by providing supports, such as structured conversation frameworks and concrete materials to participate in counseling activities (Murphy et al., 2010). Concrete materials can include objects, pictures, and/or memory books. Clinicians can use the client’s interests, hobbies, and jobs to create meaningful interactions and focus on what clients can still do (Lanzi et al., 2021). Additionally, a client’s psychological and sociological ages may be significantly different from their chronological age. Some people placed in a residential health care facility may be passively compliant because they feel a lack of control of their lives, may have undetected hearing loss, and may be experiencing other comorbidities affecting their health.

When counseling people who have a degenerative disease or a terminal illness, clinicians will need to address growing feelings of grief and loss experienced by the client and family/care partners (Holland & Nelson, 2020). The goal changes from making progress to facilitating meaningful communication for as long as possible. People may experience growing feelings of grief and loss (Holland & Nelson, 2020). See ASHA’s resource on palliative and end-of-life care.

Counseling Across the Lifespan

Stage of life is another significant client-specific consideration. Although the nature of counseling does not change with the client’s stage of life, different life circumstances will present clients and their families with unique challenges. When counseling someone from any stage of life, the clinician maintains a person-centered attitude and practices empathetic listening.

Counseling Parents and Caregivers of Infants and Young Children

Parents or caregivers may experience shock and grief when they receive a diagnosis about their infant or child (Holland & Nelson, 2020). Clinicians can use the following methods to learn about the caregivers’ values and expectations:

Ethnographic interviewing (Holland & Nelson, 2020)—Open-ended questions are used, which encourages interviewees to provide their perspectives without assumptions or judgment from the clinician.
Motivational interviewing (Hoepner, 2024)—Clinicians guide parents to identify their expectations and concerns.
Personal narratives (DiLollo & Neimeyer, 2022)—Caregivers talk about their lived experiences.

Clinicians counsel caregivers to help them focus on their child’s strengths. Clinicians may also need to explain the limitations of diagnostic labels. Although diagnostic labels allow children to receive the skilled services they need, labels can also make caregivers more focused on what a child cannot do instead of what they can do (Holland & Nelson, 2020).

For counseling caregivers of children with hearing loss or after their newborn’s hearing screening, see ASHA’s Practice Portal pages on Hearing Loss in Children, Hearing Aids For Children, and Newborn Hearing Screening. For these caregivers, counseling and education includes the early hearing detection and intervention timeline as well as the modalities of communication and technology choices.

Counseling Children

Audiologists and SLPs may be the professionals who give potentially upsetting information to children about their disorder or situation. It is wise to judge carefully how much information should be given, at what stage of development, and by whom (Flasher & Fogle, 2012). Counseling children usually involves caregivers or members of the family but should still be focused on listening to the child, for instance, understanding the family’s dynamic, who is involved in making caregiving decisions, and cultural norms for parent–child interactions.

When interviewing and working with a child, select words appropriate for their age. Keep sentences short and simple. Use simple words and concrete language. Speak to the child at eye level as appropriate, which can help the child feel more comfortable and less intimidated. Check for different signs that the child is engaged in the conversation. Signs that a child is attending to you can vary based on their cultural background. Clinicians can respond to a child who is talking about a difficult experience by saying, “That sounds really upsetting” or “That sounds like it made you really sad.”

Counseling Adolescents

The clinician focuses on building a strong therapeutic relationship with the adolescent client. Adolescents might be focused on navigating social pressures, friendship dynamics, self-image, and self-esteem. For example, adolescents with hearing loss can feel isolated from their peers and feel judged when they wear their amplification device.

Adolescents may be more receptive to counseling approaches when they get to tell their story. The clinician can facilitate this initially by showing interest in the person from the start—rather than focusing on the problem (DiLollo & DiLollo, 2014; DiLollo & Neimeyer, 2022)—thus encouraging the adolescent to talk about themselves, their interests, and their life experiences. More formal counseling approaches such as narrative therapy (DiLollo & Neimeyer, 2022), motivational interviewing (Hoepner, 2024), and ethnographic interviewing (Holland & Nelson, 2020) can also help clinicians facilitate this way of working with adolescents.

Counseling Adults

Adults have a range of client-specific factors (e.g., age, education, employment status, relationships, occupational or professional background) that can impact their reactions to a condition and/or to the interventions from audiologists and SLPs. When the clinician actively seeks to understand what the client is thinking and feeling, the client comes to better understand what they themselves think and feel as well (Rogers, 1961).

Some adults may be more prone to speak forthrightly about feelings and beliefs (Flasher & Fogle, 2012), whereas others can require building trust and a strong therapeutic relationship before sharing more personal thoughts and feelings (DiLollo & Neimeyer, 2022).

Delivering Counseling Services

Health Literacy

Health literacy ensures that an individual can find, access, and understand basic health information and services. This enables the person to make appropriate health decisions and follow instructions for treatment (Office of Disease Prevention and Health Promotion, n.d.).

Health literacy principles for clinicians include the following:

Monitor the rate of delivery. Take enough time to communicate with the person and their care partners.
Limit technical terms that are specific to a profession.
Include pictures to clarify concepts and emphasize key points.
Use short sentences.
Provide manageable amounts of information and repeat what was communicated to make sure that they understand and remember.
Encourage questions to confirm that they understand.
Ask open-ended questions instead of asking questions that can be answered with “yes” or “no.”
Collaborate with a trained interpreter when working with a multilingual individual or individuals who use American Sign Language or other forms of manual communication. Interpreters must use plain language in the individual’s language and provide examples that are relevant to cultural norms and values. See ASHA’s Practice Portal pages on Collaborating With Interpreters, Transliterators, and Translators and Multilingual Service Delivery for more information.
Avoid providing too much information when emotions are high (Luterman, 2017).

See also the U.S. Department of Health and Human Services resource for health literacy online.

Trauma-Informed Care

Trauma-informed care emphasizes the emotional and physical safety of people receiving audiology and speech-language pathology services as well as the clinicians providing those services. Person-centered counseling inherently encompasses the principles of trauma-informed care. See ASHA’s resource on trauma-informed care for more information.

Clinician Well-Being

Clinicians, by nature, attempt to fully understand the intricacies of clients’ communication disorders and their impact on daily life. Unlike family relationships and friendships, which are mutually beneficial, the relationship between the clinician and the client is unidirectional. The clinician is at the service of the client. The level of combined emotional and physical investment involved can result in the clinician developing compassion fatigue.

Compassion fatigue is deep exhaustion—and even distress—that can come from providing care to another person (Compassion Fatigue Awareness Project, n.d.). A clinician experiencing compassion fatigue may feel overwhelmed, feel a loss of self-worth, question their own competence, and feel depleted. For more information about warning signs and coping strategies, see ASHA’s resource on Connecting Audiologists and Speech-Language Pathologists with Mental Health Resources.

See also the Resources on Mental Health section in ASHA’s resource on trauma-informed care.

Grieving Process

People experience grief when they lose something that they consider precious (Smith et al., 2024). This could include losing (a) a loved one, (b) their health, or (c) their sense of self.

For people who are seeing a counselor due to a serious illness or health event, their experience may also include grieving the loss of the life that they had envisioned before receiving their diagnosis.

Care partners also experience grief and loss. With grief, people and their care partners experience a mix of emotions and reactions that can range from feeling guilty, angry, and depressed to accepting their new life and finding meaning (Kessler, 2020; Kübler-Ross, 1969).

It is important for clinicians to (a) acknowledge the grief and loss that clients—and, equally important, their families and care partners—are experiencing and (b) be ready and willing to engage in conversations that allow such grief to be expressed and shared, typically through empathetic listening. Many clinicians fear losing control when faced with clients and family members who are grieving. Clinicians can share in the grief and loss experienced by their clients in a supportive way, even crying with their clients if appropriate, as long as the focus and intent are in the service of that client.

See ASHA’s resource on palliative and end-of-life care. Visit Coping with Grief and Loss and Coping with a Life-Threatening Illness or Serious Health Event for more information about grief and if you or your loved one is coping with a serious illness or health event.

Group Therapy and Support Groups

Both group therapy and support groups can be implemented in person or through videoconferencing (Dunne et al., 2023; Walker et al., 2018). See ASHA’s Practice Portal page on Telepractice for more details.

Group Therapy

Group therapy provides a structured, supportive venue allowing clients and families to learn from each other and to practice skills they learned in individual therapy (Holland & Nelson, 2020). The group approach to counseling/communication therapy is used commonly, such as when providing aural rehabilitation for adults (Boothroyd, 2007; Hawkins, 2005; Montano et al., 2013) or for people who have had strokes and their families or care partners (Flasher & Fogle, 2012; Strong & Shadden, 2020). Group therapy aims to help clients improve and maintain function. Like individual therapy, clients in group therapy have goals that they aim to progress toward under the guidance of a clinician. See ASHA’s resource on reimbursement for group therapy in speech-language pathology.

Support Groups

Support groups comprise individuals experiencing similar issues and are forums for building helpful alliances (Tellis & Barone, 2018). Members of support groups can focus their discussion on commonly shared feelings such as anxiety and apprehension. Clinicians closely monitor interactions within support groups to identify any dynamics that need to be addressed, dissemination of misinformation, and cultural bias (Tellis & Barone, 2018). Unlike group therapy, support groups tend to be more informal, and participants may not be clients working toward explicit goals. Clinicians can also encourage clients and their family members or care partners to participate in local support groups or online forums (Holland & Nelson, 2020).

Referral

Audiologists and SLPs need to know when a person is presenting with mental health challenges that are beyond the clinician’s scope of practice and professional expertise. It is not necessarily the professional responsibility of the audiologist or SLP to have extended conversations with individuals and their support network about their struggles with uncertainty, sense of meaninglessness, and isolation. The audiologist and SLP could refer to a chaplain, neuropsychologist, psychiatrist, social worker, or case manager. Refer to a licensed mental health professional when individual or family dynamics are outside of the clinician’s knowledge and the client would like additional help.

Additional examples that might suggest a referral to a mental health professional are as follows:

Talks about death in multiple instances.
Reports recurrent thoughts of death.
Reports suicidal thoughts.
Shows signs of persistent depression. See the Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.; DSM-5-TR; American Psychiatric Association, 2022) for symptoms of pervasive or chronic depression.
Shows signs of physical abuse of themselves, a family member, or a care partner. This behavior also warrants alerting law enforcement. Many states consider audiologists and SLPs as mandated reporters if they suspect child abuse or neglect. Please check your state’s manual of mandated reporters.
Shows signs of self-inflicted abuse.
Has a drug and alcohol addiction, gambling or other addiction, and/or financial problems that interfere with therapeutic progress.
Reports behaviors consistent with persistent and/or severe social and/or emotional withdrawal.
Indicates a deterioration in personal relationships.
Reports behaviors or thoughts consistent with personality and character disorders.

Documentation

Privacy and security of documentation must be maintained in compliance with the regulations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the Family Educational Rights and Privacy Act of 1974 (FERPA), and other state and federal laws. As stated in the ASHA Code of Ethics (ASHA, 2023), audiologists and SLPs protect their clients’ confidentiality and disclose confidential information when it is legally authorized or required by law. For more information regarding documentation, see ASHA’s Practice Portal pages on Documentation in Health Care, Documentation in Schools, and Documentation of Audiology Services.

Resources

ASHA Resources

Other Resources

This list of resources is not exhaustive, and the inclusion of any specific resource does not imply endorsement from ASHA.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

American Speech-Language-Hearing Association. (2004). Preferred practice patterns for the profession of speech-language pathology [Preferred practice patterns]. https://www.asha.org/policy/

American Speech-Language-Hearing Association. (2006). Preferred practice patterns for the profession of audiology [Preferred practice patterns]. https://www.asha.org/policy/

American Speech-Language-Hearing Association. (2023). Code of ethics [Ethics]. https://www.asha.org/policy/

Boothroyd, A. (2007). Adult aural rehabilitation: What is it and does it work? Trends in Hearing, 11(2), 63–71. https://doi.org/10.1177/1084713807301073

Brady, N. C., Bruce, S., Goldman, A., Erickson, K., Mineo, B., Ogletree, B. T., Paul, D., Romski, M. A., Sevcik, R., Siegel, E., Schoonover, J., Snell, M., Sylvester, L., & Wilkinson, K. (2016). Communication services and supports for individuals with severe disabilities: Guidance for assessment and intervention. American Journal on Intellectual and Developmental Disabilities, 121(2), 121–138. https://doi.org/10.1352/1944-7558-121.2.121

Compassion Fatigue Awareness Project. (n.d.). What is compassion fatigue?. https://compassionfatigue.org/index.html

DiLollo, A., & DiLollo, L. D. (2014). Re-storying hearing: The use of personal narratives in person-centered audiologic rehabilitation. Perspectives on Aural Rehabilitation and Its Instrumentation, 21(2), 38–45. https://doi.org/10.1044/arri21.2.38

DiLollo, A., & Neimeyer, R. A. (2022). Counseling in speech-language pathology and audiology: Reconstructing personal narratives (2nd ed.). Plural.

Dunne, M., Hoover, E., & DeDe, G. (2023). Efficacy of aphasia group conversation treatment via telepractice on language and patient-reported outcome measures. American Journal of Speech-Language Pathology, 32(5S), 2565–2579. https://doi.org/10.1044/2023_AJSLP-22-00306

Egan, G. (2002). The skilled helper: A problem-management and opportunity development approach to helping (7th ed.). Brooks/Cole.

English, K. (2002). Counseling children with hearing impairment and their families. Allyn & Bacon.

Family Educational Rights and Privacy Act of 1974, Pub. L. No. 93-380, 20 U.S.C. §§ 1232g et seq.

Flasher, L. V., & Fogle, P. T. (2012). Counseling skills for speech-language pathologists and audiologists. Thomson Delmar Learning.

Gordon, T. (1970). P.E.T.: Parent effectiveness training. Wyden.

Hawkins, D. B. (2005). Effectiveness of counseling-based adult group aural rehabilitation programs: A systematic review of the evidence. Journal of the American Academy of Audiology, 16(07), 486–493. https://doi.org/10.3766/jaaa.16.7.8

Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191, 42 U.S.C. §§ 201 et seq.

Hoepner, J. K. (2024). Counseling and motivational interviewing in speech-language pathology. SLACK Incorporated.

Holland, A. L., & Nelson, R. L. (2020). Counseling in communication disorders: A wellness perspective (3rd ed.). Plural.

Kessler, D. (2020). Finding meaning: The sixth stage of grief. Scribner

Kübler-Ross, E. (1969). On death and dying. Macmillan.

Lanzi, A. M., Ellison, J. M., & Cohen, M. L. (2021). The “counseling+” roles of the speech-language pathologist serving older adults with mild cognitive impairment and dementia from Alzheimer’s disease. Perspectives of the ASHA Special Interest Groups, 6(5), 987–1002. https://doi.org/10.1044/2021_PERSP-20-00295

Luterman, D. M. (2008). Counseling persons with communication disorders and their families (5th ed.). Pro-Ed.

Luterman, D. M. (2017). Counseling persons with communication disorders and their families (6th ed.). Pro-Ed.

Luterman, D. (2020). On teaching counseling: Getting beyond informational counseling. American Journal of Speech-Language Pathology, 29(2), 903–908. https://doi.org/10.1044/2019_AJSLP-19-00013

Montano, J. J., Preminger, J. E., Hickson, L., & Gregory, M. (2013). A new web-based tool for group audiologic rehabilitation. American Journal of Audiology, 22(2), 332–334. https://doi.org/10.1044/1059-0889(2013/12-0082)

Murphy, J., Gray, C. M., van Achterberg, T., Wyke, S., & Cox, S. (2010). The effectiveness of the Talking Mats framework in helping people with dementia to express their views on well-being. Dementia, 9(4), 454–472. https://doi.org/10.1177/1471301210381776

National Alliance for Caregiving & AARP. (2020). Caregiving in the United States 2020. https://www.aarp.org/pri/topics/ltss/family-caregiving/caregiving-in-the-united-states.html

Office of Disease Prevention and Health Promotion. (n.d.). Health literacy in healthy people 2030. U.S. Department of Health and Human Services. https://health.gov/healthypeople/priority-areas/health-literacy-healthy-people-2030

Payne, J. C. (2015). Diversity among caregivers. In J. C. Payne (Ed.), Supporting family caregivers of adults with communication disorders: A resource guide for speech-language pathologists and audiologists (pp. 35–62). Plural.

Rivera, P., Elliott, T. R., Berry, J. W., Grant, J. S., & Oswald, K. (2007). Predictors of caregiver depression among community-residing families living with traumatic brain injury. NeuroRehabilitation, 22(1), 3–8. https://doi.org/10.3233/NRE-2007-22102

Rogers, C. R. (1961). On becoming a person. Houghton Mifflin.

Smith, M., Robinson, L., & Segal, J. (2024, August 21). Coping with grief and loss: Stages of grief, the grieving process, and learning to heal. HelpGuide.org. https://www.helpguide.org/mental-health/grief/coping-with-grief-and-loss

Strong, K. A., & Shadden, B. B. (2020). The power of story in identity renegotiation: Clinical approaches to supporting persons living with aphasia. Perspectives of the ASHA Special Interest Groups, 5(2), 371–383. https://doi.org/10.1044/2019_PERSP-19-00145

Tellis, C. M., & Barone, O. R. (2018). Counseling and interviewing in speech-language pathology and audiology: A therapy resource. Jones & Bartlett Learning.

Walker, J. P., Price, K., & Watson, J. (2018). Promoting social connections in a synchronous telepractice, aphasia communication group. Perspectives of the ASHA Special Interest Groups, 3(18), 32–42. https://doi.org/10.1044/persp3.SIG18.32

Wampold, B. E., & Flückiger, C. (2023). The alliance in mental health care: Conceptualization, evidence and clinical applications. World Psychiatry, 22(1), 25–41. https://doi.org/10.1002/wps.21035

Williams, K. N., Herman, R., Gajewski, B., & Wilson, K. (2009). Elderspeak communication: Impact on dementia care. American Journal of Alzheimer’s Disease & Other Dementias, 24(1), 11–20. https://doi.org/10.1177/1533317508318472

About This Content

Acknowledgments

Content for ASHA’s Practice Portal is developed through a comprehensive process that includes multiple rounds of subject matter expert input and review. ASHA extends its gratitude to the following subject matter experts who were involved in the development of the Counseling in Audiology and Speech-Language Pathology page:

Citing Practice Portal Pages

The recommended citation for this Practice Portal page is:

American Speech-Language-Hearing Association. (n.d.). Counseling in audiology and speech-language pathology [Practice portal]. https://www.asha.org/Practice-Portal/Professional-Issues/Counseling-For-Professional-Service-Delivery/

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