Bonding with your hard of hearing or late-deafened VR client

2.1 The concept of “liking” or interpersonal attraction

Research on “Liking” or its synonym, “interpersonal attraction,” flourished in the 1960s–70s (Finkel & Eastwick, 2015). In their review and summary of attraction literature over the last 50 years, Finkel and Eastwick (2015) maintained that theories from that period and into the 1990s tended toward one of the following, general perspectives: (a) domain-general reward, (b) domain-specific evolutionary, and (c) attachment. The domain-general reward perspectives focused on the individual being drawn to someone who can satisfy fundamental needs, such as pleasure, belonging self-esteem, and consistency, which may be accomplished through friendship, work, family interaction and activities, and mating. Domain-specific evolutionary perspectives see interpersonal attraction linked to needs specific to reproductive success which can only be addressed in specific ways, e.g., a spouse exhibiting sexual attraction toward the individual; these needs can include hedonic pleasure, self-esteem, belonging, consistency, and self-expansion. Attachment perspectives tend to include elements of both domain-general reward and domain-specific evolutional, but generally view interpersonal attraction as an attempt to reestablish a sense of security in times of distress (Bowlby, 1969).

Ultimately Finkel and Eastwick (2015) suggested the instrumentality principle as the best explanation for interpersonal attraction, subsuming other theories; it is the notion that “people become attracted to others who help them achieve needs or goals that are currently high in motivational priority” (p. 4). Fitzsimons & Shah (2008) stated that it is the tendency to “draw closer to instrumental others, evaluate them more positively, and approach them more readily, while distancing themselves from noninstrumental others, evaluating them more negatively, and avoiding them more readily” (p. 320).

Implications for the VR counselor-client relationship are obvious. The basic purpose of a rehabilitation relationship is to address an identified client need, and to accomplish an agreed-upon goal. The client who meets a VR counselor for the first time and is willing to assume—at least at the outset–that needs and goals will be addressed and achieved, is open to liking that counselor. The instrumentality principle can also apply from the counselor’s perspective—i.e., the counselor liking the client. Viewed from the perspective of job satisfaction, the VR counselor will enter into a relationship with the client for myriad reasons, not the least of which is to satisfy an employer and earn a paycheck (Szymanski, 1995). But Andrew, Faubion, and Palmer (2002) noted that once extrinsic job factors (e.g., administration, work environment, pay and benefits, and supervision) are satisfied, intrinsic factors (e.g., talking, helping, serving clients) are the primary ingredients to job satisfaction, which also appeared to be the conclusion of Szymanski and Parker (1995): while a primary reason for staying with the job was “security,” the most frequently reported reason VR Counselors sought work with the agency included “working with people” (p. 56). Wright and Terrian (1987) similarly determined a higher degree of intrinsic over extrinsic satisfaction in their study of rehabilitation counselor job satisfaction.

Importantly, Capella and Andrew (2004) also found evidence that VR counselor job satisfaction is significantly related to VR client satisfaction. When the client is satisfied, the counselor is likely to be satisfied as well. The instrumentality principle (Finkel & Eastwick, 2015) is evident here as both client and counselor satisfaction occur in the expectation that each will meet the needs of the other.

2.2 The concept and development of trust

Trust is “the client’s perception and belief that the counselor will not mislead or injure the client in any way” (Fong & Cox, 1983, p. 163). Where a client questions the counselor’s capacity to understand, or competence to intervene effectively, a working relationship can be impeded or even halted. And as time is of the essence in developing an effective working alliance (Henry & Strupp, 1994), a delay at the outset due to a lack of client confidence in the counselor, is counterproductive to client engagement and collaboration. Horvath and Greenberg (1994) stated that a “…lack of development of trust within the first three sessions will probably lead to disengagement from therapy” (p.2). A not uncommon example of such an occurrence might be that of a counselor working with a client of a different ethnic or cultural background (Smith, Soto, Griner, & Trimble 2015). In recent years, ethical guidelines were developed to ensure counselors are aware of their responsibility to become competent in serving clients of cultures other than their own; e.g., CRCC and ACA Codes of Ethics provide cautions and guidance regarding the need for cultural sensitivity, respect for values, and competence in addressing needs (CRCC, 2009; ACA, 2014).

Recognizing that trust in a counseling relationship does not occur automatically (Smith et al., 2015), especially where the issues are particularly sensitive, and/or there is wide cultural diversity between counselor and client, then trust may need to be developed or enhanced to be functional. Fong and Cox (1989) suggested that the development of trust may be conceived as a series of exchanges, called “tests of trust,” between the counselor and client. They identified these “tests” as predictable in form and, importantly, need to be well addressed by the counselor, without serious misstep, in order for trust to build and solidify. The steps include (a) requesting information, (b) telling a secret, (c) putting oneself down, (d) asking a favor, (e) inconveniencing the counselor, and (f) questioning the counselor’s dedication and motivation (Fong & Cox, 1989).

Important to this discussion, it may be noted that each test of trust is inherent in an early phase of the state-federal VR process (cf., Maki & Tarvydas, 2011, pp. 98–100, and Scope of Practice for Rehabilitation Counseling, CRCC, 2010, Appendix B.III-IV). The client (a) requests information about services and the likelihood that such services will address an identified need, then makes application through a state-federal VR program; (b) the identified need is presented via medical or functional details not generally privy to the public, but shared with the counselor to demonstrate eligibility for the program–i.e., medical diagnosis, constituting a handicap to employment, with a need for services—and enlists the counselor’s help; (c) intake and related discussion encompass client’s self-view of limitations and hardships; (d) services are discussed and requested to address identified needs and limitations; (e) counselor will often, at some point in the rehabilitation process, be asked or required to take on unexpected challenges to advocate or intervene for the client in order to keep the program moving or modify the plan; and (f) counselor commitment may be periodically questioned or challenged by the client or advocates with delays or missteps.

2.3 The concept of respect

The third component of bonding, “respect,” is often linked to qualities of liking (Bordin, 1994), confidence, understanding and trusting in the literature (see e.g., Lietaer, 1992; Raue & Goldfried, 1994). However Egan (2013) maintained that respect is “such a fundamental concept that, like most such concepts, it eludes definition” (p. 46); it is viewed as foundational to the counselor-client relationship, the basis upon which all helping interventions are built.

Egan (2013) listed behaviors exemplifying respect by counselors for their clients that imply many of the same attitudes and perspectives of liking and trusting in the counseling setting. Respect is demonstrated when a counselor: (a) becomes competent, (b) is genuine (no pretense), (c) makes it clear that the counselor is there “for” the client, (d) assumes the client’s goodwill, and (e) keeps the client’s agenda in focus.

Of note, parallels to these behaviors of respect are generally but easily evident in the “primary values” identified for the VR counselor in the Preamble to the Code of Professional Ethics for Rehabilitation Counselors (2009). Ethical values include: (a) Enhancing the quality of professional knowledge and its application to increase professional and personal effectiveness; (b) Ensuring the integrity of all professional relationships, and respecting human rights and dignity; (c) Advocating for the fair and adequate provision of services; and (d) Acting to alleviate personal distress and suffering, and appreciating the diversity of human experience and culture.

2.4 Sense of common commitment

Bordin (1994) indicated that in addition to liking, trusting and respect, bonding is likely to be expressed and felt in terms of a sense of common commitment to “change goals” (p. 17). Basically, as a component of WA, a change goal is the reason for which counseling is sought. In a rehabilitation context, a change goal may be the outcome expected of an employment or independence plan to change the client’s current circumstances in some way. Within the construct of bonding, a sense of common commitment to the change goal is critical. “Common” means shared by both client and counselor. Once the client’s goal is decided, the client should feel a shared sense a commitment to the goal by the counselor. Bordin (1994) calls this a “key process in building an initial, viable alliance” (p. 21) between client and counselor.

The actual level of commitment necessary to achieve a goal will vary, however, with the difficulty required to achieve it (Bordin, 1979), as well as the client’s individual ability and personal resources (Gomes-Schwartz, 1978; O’Malley, Suh, & Strupp, 1983). But whatever level of commitment is necessary, while the client should know the counselor agrees with the goal and believes in the client’s capacity to achieve it, actual ownership for its achievement belongs to the client (Egan 2013). Egan (2013) described three possible levels of client commitment to the goal: (a) compliance (e.g., “Well, I guess I’ll have to…”); (b) buy-in (e.g., “Yes, I know it’s in my best interest to change…”); and the highest level of commitment (c) ownership (e.g., “It’s not someone else’s, it’s not just a good idea, it’s what I want to do”).

In the VR context, through whatever means are employed by counselor and client to explore, negotiate and establish a meaningful, feasible goal to change a client’s circumstances, it will be important to assess and encourage the highest level of commitment possible from the client. For if the goal is suggested or directed by someone else (e.g., the counselor or significant other) and accepted by the client, ownership (and commitment) of the plan shifts away from the client, as does responsibility for its outcome–especially if the outcome is failure (Egan, 2013).

2.5 Shared understanding in the activity

Beyond the client’s perception of the counselor personally, in terms of liking, trusting, respect, and a sense of common commitment, Bordin (1994) indicates that bonding will also be expressed/felt in terms of shared understanding of the activity or task(s) to achieve the goal. This differs from the third general component of WA—agreement on tasks (Bordin, 1979)—in the same way the concept of “understanding” differs from that of “agreement.” In the context of rehabilitation counseling, the first, “most important component of the VR process is the collaborative development of the Individualized Plan of Employment (IPE), as that document specifies the type, quantity, and nature of goods and services that are to be provided to assist the individual to reach his or her vocational goal” (Fabian & MacDonald-Wilson, 2012, p. 60). Inherent in the collaboration required to develop the IPE is the expectation that the client is not just a participant in the plan, but a partner (note e.g., CRCC’s Code of Professional Ethics of Rehabilitation Counselors, 2009, A.1.b, p. 3; and A.3.b Informed Consent, p. 4, uses terms such as “work jointly,” and “mutually agreed upon,” to characterize the activity of plan development).

Obviously, the extent to which the client is involved in planning will depend on how well the client understands the tasks necessary to achieve the goal (Bordin, 1994). Recognizing that understanding may not readily or easily occur if there is a disability constituting a barrier to comprehension, the Code of Professional Ethics of Rehabilitation Counselors (2009) nonetheless emphasizes the right of clients to understand, i.e., to be presented information in such a way as to promote understanding. For example, “Rehabilitation counselors have an obligation to review with clients…in a manner that best accommodates any of their limitation…” (A.3.a, p. 3). Further, “…counselors communicate information in ways that are both developmentally and culturally appropriate” (A.3.c, p. 4) and, in cases where the client is “unable to give voluntary consent, rehabilitation counselors seek the assent of clients and include clients in decision-making as appropriate” (A.3.d, p. 4).

For the VR client who is hard of hearing or late-deafened, these ethical considerations take on special significance for the counselor. It is important to forge a collaborative bond to achieve successful VR outcomes (Lustig et al., 2002) with these populations, and communication is likely to be a predominant barrier to doing so (Boone et al., 2012). Yet the ethical guidelines are clear; the VR counselor is obligated to overcome this barrier (CRCC, 2009).

Overcoming barriers to communication can be challenging, however, especially as these challenges may vary considerably among individuals with hearing loss. Eng and Lerner (2011) stated: “Although inferences can be made from interpreting the test results, the degree of impairment is affected by a variety of other factors, including the type, degree, configuration of hearing loss, age of onset, cognitive status, educational background, and the individual’s personality” (p. 217). Still, to provide a basis for this review, a brief overview will be presented of these populations—i.e., those who are hard of hearing, and those who are late-deafened–and how they differ from the culturally Deaf. With variation in hearing function, there can be vast differences in communication and intervention needs.

3.1 The culturally deaf

Acknowledgement in professional literature that there is a unique, distinct culture called the Deaf, came about in the early 1960s (Glickman, 1996), following “the then-radical claim that the gestural system used by Deaf people was in fact a fully grammatical language capable of abstractions, subtleties, and linguistic development” (p. 3). This group has since been recognized in print as “capital-D Deaf,” to distinguish the descriptive term deaf from the Deaf, a distinct group of people sharing common characteristics:

It should be noted that hearing loss is not necessarily criteria for membership in the “Deaf-World.” In fact, since adult Deaf people usually have hearing children (Calderon & Greenberg, 2003; Mitchell & Karchmer, 2004), whole families intermingle in their social circles whether hearing or not (e.g., Deaf Clubs, places of worship, etc.), and the only basic criteria for membership is the ability to communicate in American Sign Language (ASL). The mores, attitudes and values (Lane, 2002) that further characterize the culture are acquired through socialization, as they are in any culture or society (White House Conference on Handicapped Individuals, 1977).

It is also noteworthy that, unlike persons who are hard of hearing and late-deafened (Luey, Glass, & Elliott, 1995) the Deaf do not typically consider themselves “disabled” (Humphries, 1993). Lane (2002) stated, “Whereas people with disabilities seek total integration into society at large, Deaf people cherish their unique identity and seek integration that honors their distinct language and culture” (p. 369). This is an important point. To facilitate bonding with persons from this culture group, communication needs are addressed as they are for any other culture group where language is the barrier (e.g., Thomas & Donovan, 2015).

3.2 The client who is hard of hearing

According to Watson et al. (2008), “persons who are hard of hearing include those with a hearing impairment resulting in a functional loss, but not to the extent that the individual must depend primarily upon visual communication” (p. 6). Because hearing loss may not be readily observed in an individual, the disability has been labeled the “invisible condition” (HLAA, “Basic Facts About Hearing Loss,” n.d.); indeed, persons who are hard of hearing will often seek to blend in as much a possible with their hearing community to avoid identification and embarrassment, often with mixed success (Armero, 2001; Gomez & Madey, 2001; Hallberg, Erlandsson, & Carlsson, 1992).

In general terms, people who are hard of hearing consider a hearing loss to be a medical problem (Eng & Lerner, 2011; Luey et al., 1995); if they are inclined (or believe they can afford) to seek remedy, they will begin with their doctor, audiologist or a hearing aid professional for help to resolve it (e.g., National Institute on Deafness and Other Communication Disorders [NIDCD], “Hearing Loss and Older Adults,” 2016). Their goal is to hear better so as to more fully enter or re-enter a society of hearing people—e.g., their family, friends, workplace, social groups, etc.—with whom they consider their community (Luey et al., 1995; HLAA, “Hearing Loss Association of America’s Public Policy and Advocacy Agenda: Ten Key Goals and Outcomes,” n.d.).

Functionally, there is wide disparity among persons of this population because, apart from other factors (reviewed below), the inability to hear adequately will vary by intensity (loudness) and/or frequency (pitch) of the individual’s hearing loss (DeBonis & Donohue, 2003). Therefore appropriate individual solutions will also vary. Stone (1993) noted that “along the spectrum of hard of hearing people, there are many different problems, and the method of alleviation may vary. What works in one case may not work in another” (p. 8). But when attempts at remedy through medication or surgery are inadequate, solutions are typically sought in amplification technology. Eng and Lerner (2011) stated “amplification is central to a treatment program of aural rehabilitation. Amplification includes hearing aids that intensify the speech signal to a comfortable listening level for the hearing-disordered person” (p. 218).

To initiate and facilitate the process of bonding with persons of this group, the VR counselor will first consider and address the barrier of communication by improving and/or enhancing the quality of what is heard by the client, supported by visual cues (see e.g., Watson et al., 2008). Specific communication factors will be considered in greater detail below.

3.3 The client who is late-deafened

The individual who is late-deafened will have acquired a significant hearing loss by adolescence or later in life (Mason, 1996), with the level of functional communication dependent on many of the same factors as those for persons who are hard of hearing—e.g., degree and type of loss, age at onset, aptitudes, level of education, extent of adjustment to loss, etc. (Eng & Lerner, 2011). However late-deafness is unique because it “…is adventitious, meaning that it is generally unexpected and acquired later in life rather than at birth, and therefore it will require psychosocial adaptation” (Meyer & Kashubeck-West, 2013, p. 124).

The need for psychosocial adaptation is a critical characteristic of many persons—especially older adults–suffering late onset deafness (Meyer & Kashubeck-West, 2013). For an acquired disability, adaptation is a process involving progress through psychological stages of adjustment (Livneh & Antonak, 2005), and the struggle may be long and arduous if, in fact, it is achieved at all. A number of professionals contend that “…late-deafened adults never really accept the hearing loss, but rather come to acknowledge it and engage in constructive action to cope with it” (Rothschild & Kampfe, 1997, p. 6). This is because a significant communication barrier—one that presents suddenly or progressively–will impact a lifestyle, separating these individuals from family, social affiliation, and status in the community. The barrier can be a constant reminder of a break from all they know, and may be emotionally devastating (David & Trehub, 1989; Luey, 1980; Rutman, 1989). But speed and degree of acceptance, if not adjustment, will vary considerably from individual to individual depending on such factors as age at onset of hearing loss, various aptitudes, available personal supports, and the individual’s success with coping (Rothschild & Kampfe, 1997). Lucas (2007) determined that adaptation to an acquired disability is not always achieved, and that it can impact happiness, quality of life and well-being.

For the VR counselor to initiate a bond with a late-deafened individual, communication strategies may well require enhancement of both audio and visual cues, with emphasis on the visual (Watson et al., 2008). Specific barriers and accommodations to/for bonding for the late-deafened client will be reviewed below. Once a functional bond has been established, in light of probable psychosocial issues (Meyer & Kashubeck-West, 2013), the VR counselor may need to consider encouraging a change goal (Bordin, 1994) to address adaptation to the disability prior to (or at least concurrent with) a vocational goal.

4.1 Communication and the counseling setting: Factors and suggestions

Strong (1968) conceptualized counseling as an internal influence process, similar to that of opinion-change. Opinion change is an important topic in mass communication and public opinion research (e.g., Mutz & Young, 2011), and verbal communication a critical tool in that process, as it is in the counseling process. Strong (1968) posited:

Boone et al. (2012) confirmed two of these three characteristics, calling them categories with factors that influence how well a client understands verbal communication: (a) speaker factors and (b) listener factors. These echoed Strong’s (1968) characteristics of (a) communicator as perceived by the audience and (b) characteristics of the audience…,” i.e., speaker-communicator, listener-audience. Strong’s (1968) third characteristic, characteristics of the communication appears conceptually addressed in Boone’s et al. (2012) speaker factor, i.e., how communication is conveyed (e.g., language style, accent, dialect or other cultural distinction).

Finally, Boone et al. (2012) specified a third category, that of environment, which refers to those factors specific to neither speaker nor listener, but rather concerns the context or environment within which communication is attempted. I will briefly review these three categories of factors before addressing the issue of bonding between VR counselor and client with a hearing loss.

5.1 Planning for communication factors

Before the first meeting, once the generalist VR counselor becomes aware that a client with a hearing loss has been assigned to him or her, it would be helpful to glean as much relevant information as possible from application material regarding the individual’s communication background and needs; helpful information will include medical, audiological and speech, educational, vocational, and psychological reports (Watson et al., 2008). Is the individual hard of hearing or late-deafened (cf., degree/type of hearing loss, onset, educational background, remediation or personal amplification device)? As with any VR client, other medical issues should also be noted. For the hard of hearing or late-deafened individual, visual acuity takes on greater significance since speechreading is dependent on adequate vision (Atcherson et al., 2015). With this information, the generalist VR counselor can know how to arrange the counseling setting to maximize residual hearing and/or hearing aid function, speechreading capacity or other accommodation (e.g., ALDs not already in the office).

The VR office in which the first session is to take place, should be smaller, and ideally carpeted, with acoustic tile and curtains, to reduce reverberation (Atcherson et al., 2015). Common background noise for the office (e.g., proximity to outside road or pedestrian traffic, break room, public address system, music, ventilation fan, etc.) should also be considered and minimized (Watson et al., 2008). If the VR counselor’s working office is not conducive to meeting with the hard of hearing client, there is time to consider and/or make arrangements to meet elsewhere if possible.

If ALDs would be helpful, and the counselor is aware of what these are ahead of time, it is best to have these available and in working order ahead of the first meeting to avoid either (a) putting off the first meeting, or (b) taking the time to find, equip (batteries, etc.) and set up the devices while the client waits. Many times, however, the appropriate ALD or accommodation for a specific client will require a conversation with that client (Watson et al., 2008) or the client’s significant other in order to know what will work. Therefore it would be ideal if, ahead of the first meeting, the client or client’s family is contacted to ask what accommodations might be necessary, so the counselor has the time to appropriately arrange the counseling setting.

5.2 The first meeting

“At the heart of any relationship is communication” (Egan, 2013, p. 19), and from a practical standpoint when they meet for the first time, this will be the first order of business for the VR counselor with an applicant who is hard of hearing or late-deafened. The client should be invited into a quiet, well-lit, distraction-free, environment, with face-to-face seating at eye level and at a comfortable proximity, with appropriate ALDs to hand as necessary (Atcherson et al., 2015). Whatever adjustments or other arrangements need to be made, should be initiated until the client is satisfied with communication arrangements. If the meeting needs to be postponed due to inadequate arrangements, it need not have been a waste of time if better communication arrangements are identified and can be made available later.

Most VR applicants begin their relationship with their VR counselors at the point of intake, a first meeting at which the VR counselor begins the process of eligibility determination for VR services (Maki, 2012). The first meeting is also the point at which the client who is hard of hearing or late-deafened assesses the counselor’s capacity for “partner compatibility” (Bordin, 1994), at least to the extent such compatibility is necessary to achieve the desired outcome. VR applicants obviously approach the VR agency to acquire services and/or technology they hope or expect will benefit them in some way, normally an employment outcome (Watson et al., 2008). But their needs, and therefore services requested, will vary in number, cost, complexity and length (Fabian, MacDonald-Wilson, 2012), so the extent to which they expect to “like” their counselor—one component of bonding—will, according to the instrumentality principle (Finkel & Eastwick, 2015), depend initially on how well they believe the counselor will satisfy their needs. If the client’s perceived needs are minimal (e.g., simply financial assistance toward purchase of hearing aid), the expectations for partner compatibility may be minimal as well; it may be the client’s view in this case the counselor need only say “yes” or “no” to either continue or conclude the relationship. Actually the purchase of a hearing aid may be a familiar scenario in VR offices (Kosovich, 1993), but clients who are hard of hearing or late-deafened are on a “hearing loss journey” (Boone et al., 2012), and needs will vary at different points in time of adjustment, often broader than a hearing aid.

Once good communication is established, whatever the perceived or real need, bonding ideally begins here with “liking” the counselor—i.e., there is the expectation that the counselor will satisfy this need (instrumentality principle, Finkel & Eastwick, 2015). The VR counselor will have (a) asked pertinent questions regarding the client’s communication, educational and vocational background, interests and aspirations (Rubin & Roessler, 2008), (b) explained the counselor’s own role and qualifications (per Professional Disclosure Statement, A.3.a, CRCC Code of Professional Ethics, 2010), and oriented the client to the VR process—i.e., what is required to be successful by VR agency standards (e.g., competitive employment)—and the range of services available (Rubin & Roessler, 2008). Finally, relevant “homework” (tasks) (Henry & Strupp, 1994) may be assigned the client (e.g., to search resources, discuss potential goals with family, consider risks and benefits, clarify interests), and arrangements made to further explore client capabilities and interests through vocational evaluation. By the conclusion of this first meeting, the client should believe there is a: (a) shared understanding of the tasks necessary to achieve the goal; (b) commitment by the counselor to the goal; and (c) the expectation that the counselor has the capacity to fulfill this commitment. Bonding takes shape through this discussion as eligibility is sufficiently determined, or further arrangements are made to conclude the eligibility determination process.

5.3 The second – third meeting

The second and third meetings will continue the process of eligibility as necessary—e.g., reviewing the results of outside evaluations (e.g., medical, psychological, vocational)—and of discussing ramifications of evaluation results on client interests and goals (Rubin & Roessler, 2008). With all relevant information in hand, planning for services can begin (Maki, 2012). The bonding elements of trust, respect and confidence in the counselor’s capacity to fulfill this commitment continue to grow through positive, supportive interaction (Saunders, 1999; Sexton, Hembre, & Kvarme, 1996). Again, as the VR process continues over coming months, the bond may undergo some challenges from time to time if timelines or meetings are misunderstood, overlooked or delayed raising questions and possible frustration, as part of the “roller coaster” effect of the bonding experience (Horvath & Greenberg, 1994). But to maintain trust especially in the beginning, formative stage of the relationship, violations to trust need to be quickly and appropriately addressed (Fong & Cox, 1989).

Obviously, if client abilities, interests and service needs are accurately identified, planning becomes a relatively simple process of researching resources and arranging services. The VR case management system is structured for this process (see e.g., Individual Plan of Employment [IPE], 29 U.S. Code §722(b) et seq., of the Rehabilitation Act of 1973). But Hansmann, Parker, Saladin, and Thomas (2012) noted that the actual goal of rehabilitation counseling is to “empower people with disabilities to achieve their highest personal, social and work potential…To ameliorate each consumer’s unique set of problems…The variability of consumers’ characteristics, needs, values, aspirations, cultures, environments, and other factors dictates that counselors must be flexible in their approach to rehabilitation counseling” (pp. 125-126).

For the hard of hearing or late-deafened individual this is no less true. Watson et al. (2008) identified myriad services that could be useful in the goal of empowering clients with hearing loss on an individual basis, specific to degree and type of hearing loss, educational or vocational aspirations, location and availability of services, family situation, cultural identity, financial status, etc. Services to address these are equally myriad and will always involve vocational counseling and guidance. But specific to the individual’s situation, these may also include financial support for hearing aids, ALDS specific to school or job, job specific training (postsecondary education, on-the-job, etc.), job readiness training, independent living skills training, rehabilitation technology for the home, job shadowing opportunities, job coaching and job placement services (Watson et al., 2008).

Frank, open discussion of the range and reason for services with each individual, with a focus on risks and benefits, constitutes respect for the client’s autonomy—the ethical principle of encouraging each client to make independent decisions and act in his or her own best interest (Gatens-Robinson & Rubin, 2008). But to be honest with information the client may not wish to know—in order to guide goal-setting in more productive or realistic direction—it is critical to have in place a good, basic bond of liking, trust and common commitment. Egan (2013) asserted that the counselor should “challenge only after you have spent time and effort building a relationship with your client” (p. 190). But it is important to get to this point as quickly as possible to ensure bonding begins for a functional counseling relationship. Respect is a critical element in bonding (Bordin, 1994), and useful in the overall goal of rehabilitation counseling to empower the client (Hansmann et al., 2012). Informed choice is simply the provision of relevant information, pros and cons, about service options and goals and allowing the client to choose (see e.g., CRCC Code of Ethics, A.3.b, 2009). To respect the client via informed choice, the VR counselor needs to be clear with the client about (a) assessment results (e.g., from interview, medical/psychological reports, vocational evaluation), (b) time, cost, location, and other logistics regarding services undertaken, and (c) the VR counselor’s own role in service provision, i.e., what he or she will and will not do, when, for how long, etc. With this information, the client can make the best choice for him- or herself (Watson et al., 2008).

By the conclusion of the second meeting, the client should be armed with information necessary to consider and make some decisions by/at the next meeting. And by the third meeting, activities related to eligibility and planning (Maki, 2012) may be well underway or nearing completion depending on the extent of research and complexity of expected services (Hansmann et al., 2012), and time and activity between meetings. Bonding will continue to stabilize (Kivlighan & Shaughnessy, 2000) as counselor competence, reliability and support are validated through positive, counselor interaction (Saunders, 1999; Sexton, Hembre, & Kvarme, 1996), and service provision (Henry & Strupp, 1994).