Jerry L. Yanz, PhD, is senior staff audiologist at Starkey Laboratories, Eden Prairie, Minn, and Kevin D. Amdahl, MS, is an audiologist and owner of Amdahl Hearing, Alexandria, Minn.
In a profession dedicated to rehabilitation of communication problems, it is essential that our own communication with patients is as effective as possible, and it is here that our counseling skills are most important. When testing indicates that our patient’s communication ability is compromised by hearing loss, we recommend interventions—usually in the form of hearing aids. The manner in which we make those recommendations, however, will have considerable bearing on the success of our efforts.
So why is it that, on occasion, we come out of an appointment feeling as though we just weren’t able to get through to a patient or make them understand what we were trying to tell them? Retention of information is one issue, and patients accurately retain only 25% of the information given to them in a medical consultation.1 Are they just not interested in what the doctor or the hearing professional has to say? Maybe they are in denial of their situation.
Or perhaps the nature of our social interaction during the appointment got in the way of meaningful communication and decision making. Our own good communication skills are essential to the counseling sessions interspersed throughout a hearing rehabilitation program.
A previous article2 on improving counseling (October 2006 HR) discussed applying Adult Learning Principles as a tool to increase patient understanding and retention. However, we can’t influence learning unless we can connect with a patient in the first place and communicate effectively. In this second of a three-part series, we will discuss the potential to improve counseling effectiveness by understanding personal social style.
Merrill and Reid3 define social style as “patterns of behavior that others can observe.” Individual social or behavioral styles affect the way in which we interact with one another, and stylistic differences, if they are not understood, may adversely affect the quality of the interaction.
Let’s say I have a counseling session with a patient in which I am explaining test results and recommending hearing aids. I thoroughly lay out all the details about the patient’s hearing loss. I explain the levels of technology available in hearing aids, the functions of advanced digital features, the range of prices and financing options. I explain the process of adjusting to hearing aid use and the important role of family in supporting the rehabilitative process. My patient sits quietly, smiling amicably, never asks any questions the whole time I am talking, and after my very detailed series of explanations, she stands up and says, “Thank you very much, but I really need to think about this and talk with my family.” She leaves without taking any action to resolve her problem.
What happened in this little scenario? I presented all the necessary technical details to give my patient the best possible resolution to her problem, but she didn’t have what she needed to make a decision. The problem was that I was approaching her without understanding or appreciating her particular social style. She is a person who relies on consultation with and reassurance from family or friends before making a decision, and I am clearly a person who assumes that a decision can be made easily if all the necessary technical details are known. My patient and I were oil and water in this interaction.
We’ll return to this stylistic mismatch later, after we discuss social style categories and what we can learn from them.
Categorizing Social Styles
Numerous schemes exist to assess and categorize social styles. Most of them divide people into one of four social style categories, which characterize the dominant behavioral patterns. While four categories are typical, the labels of those categories vary, as shown by the sampling in Table 1. As you look through these descriptors, you may recognize terms you might use to describe yourself, family members, coworkers, or patients.
|Table 1. Sampling of equivalent categories in various social style inventories. Adapted from personality types at 2Hi Helenelund HB (2H), found at www.2h.com/personality-types.html.|
Categorization of social style does not presume to represent an understanding of one’s underlying deep beliefs or values. Nor does it evaluate personality traits. Overt behaviors are quite simply the only data we have to assess what makes a person tick, or at least how they interact with us and with the world.
Merrill-Reid Social Style Inventory
The Merrill-Reid Social Style Inventory has been one of the most used tools for this type of assessment.3 As shown in Table 1, it divides people into four primary groups—Driver, Expressive, Amiable, and Analytical—derived from observations along two behavioral dimensions, pace and focus.
Pace (Assertiveness). Pace represents the rate at which people move, as well as how fast they speak, how they use language, the amount they gesture, their tendency to interrupt, and their overall body language. Pace can be categorized as either Rapid or Measured, and Table 2 lists the general characteristics of each.
|Table 2. General characteristics of people who behave at a measured and rapid pace.|
Pace correlates directly with assertiveness. A rapid-paced, more assertive person is inclined to tell, rather than ask, whereas a person who operates at a more measured pace is more likely to ask than to tell.
Focus. Focus is defined by a person’s center of interest and the way a person is perceived as expressing feelings when relating to others. The distinction is whether an individual tends to focus primarily on people or on tasks. A task-focused person tends to control emotions and put a higher priority on achievement, whereas a people-focused person tends to express emotions and put a higher priority on acceptance. Table 3 lists some common behavioral characteristics of people in these two groups.
|Table 3. General characteristics of people who are people-focused and task-focused.|
The dimensions of pace and focus intersect to define the four social style categories of the Merrill-Reid scheme—Driver, Expressive, Amiable, and Analytical—as shown in Figure 1.
|Figure 1. The four quadrants of the Merrill-Reid Social Style Inventory.3|
The Driver. The Driver, who functions at a rapid pace and focuses on tasks, tends to get a lot done in an efficient manner. They don’t spend a great deal of time discussing ideas, analyzing detailed alternatives, or checking out how other people feel about the actions being taken. They just get things done. However, since they don’t examine all factors carefully, they may make a wrong decision that requires correction later on. The Driver gets right to the point and may sometimes come across as a bit brusque.
The Expressive. Operating at a rapid pace with a focus on people, the Expressives tend to be exuberant, are born story-tellers, and express new ideas energetically. They freely discuss feelings and are more influenced by relationships than by facts. The Expressive may sometimes be more inclined to talk about what needs to be done than to actually do it.
The Amiable. The Amiable, who focuses on people and operates at a measured pace, is highly attuned to how people are feeling. Very sensitive, Amiables want to do what is agreeable to others and slowly and carefully checks things out with others before taking action; they make sure that relationships are intact and everyone’s feelings are taken into account. The Amiable is a patient audience for the Expressive’s stories but will not be inclined to act or make decisions quickly.
The Analytical. Interacting with the world at a measured pace and focusing on tasks, the Analytical carefully evaluates all available data pertaining to any issue before making a decision or taking action. Highly detailed people, they play an important role in group processes that mandate precision. While the actions of the Analytical will be well thought out and precise, those actions may not happen fast enough to accommodate all people or all situations.
The characteristics of the four social style categories can be summarized with a set of descriptors representing both positive and negative characteristics (Figure 2). It is important to note that no one style is inherently better or worse than any other; they are merely different, each with their own strengths and limitations. In most group endeavors, whether at work or in leisure time, it is helpful to have all different styles interacting to provide a balanced perspective.
|Figure 2. Typical descriptors of the four social styles.3|
In addition to recognizing positive and negative aspects of each style, it is important to realize that we are not firmly entrenched in one set of behaviors. People may be more or less extreme in their basic social style—highly directive or somewhat directive, extremely analytical or just tending that way, etc.
Furthermore, nearly everyone, regardless of their stripes, adapts their basic social behaviors depending on the audience and circumstances. The Amiable may adopt characteristics of the Expressive, and the Analytical may drive toward completion of a task. We are adaptable creatures. We may be highly driven at work but adopt a more amiable style in a nonwork setting. We may be more expressive when faced with certain conversational topics and quieter with others. In spite of this adaptability, however, most people tend to have a central comfort zone in this two-by-two matrix, in which they tend to operate most easily and most often.
Importance of Social Style in Counseling
How is social style relevant to our work in providing rehabilitative products and services to individuals who have a hearing loss? The interplay between your style and your patient’s style can have a significant impact on the quality of your counseling efforts and the ultimate success of your work. It is here that some insight into social style can serve you well. There are two very basic goals.
Know yourself. The first goal is to understand yourself. Think about the characteristics described above, and determine which category best represents you. You may want to discuss these characteristics with friends, co-workers, or family members, and share observations and insights. Alternatively, you may want to conduct a formal assessment of your style. Many professionals are available who specialize in this and other types of psychological assessments (see, for example, www.legacyfrontiers.com), and such an exploration can be quite helpful.
Know your patient. We can’t really ask our patients to fill out a social style questionnaire; that falls in the purview of other professionals. We can, however, become keen observers of human behavior.
Observation of social style allows you to begin to understand your patients simply by observing them. Figure 3 shows the four quadrants again, this time with some typical behaviors displayed by each. If you begin observing your patients as soon as you greet them in your waiting room, by the time you have walked to your testing room and completed your initial interview, you should have a reasonably good notion of which social style category they fall into.
|Figure 3. Typical behaviors associated with the four social style quadrants.3|
If we consider the characteristics and behaviors in Figure 3 and recall patients we have known, a sizeable cast of characters may come to mind. For example:
- The gentleman who dominates the conversation with direct expectations (Driver)
- The gentleman who dominates the conversation with stories (Expressive)
- The woman who tries to get an agenda prior to walking back to the room (Analytical)
- The woman who declines to express what she thinks and is only interested in your opinion (Amiable)
- The fellow who tries to show you to the test room (Driver)
- The gentleman who meets you with a wide smile and initiates a handshake (Expressive)
- The woman who wants to know exactly how long this appointment will take, as she has another appointment in an hour and 15 minutes and it takes 23 minutes to get across town (Analytical)
- The woman who keeps looking toward her son whenever you ask a question (Amiable)
- The farmer who tells you about how this weather is nothing like the weather in ’86, when he lost his cows, his barn, and two of his silos (Expressive)
- The farmer who tells you about how this weather is nothing like the weather in ’86, when the temperature was 98° with 94% humidity, the barometric pressure was 29.03 and falling rapidly, the winds were from the NNW at 48.25 mph… (Analytical)
I’m sure you can begin to visualize some of your own patients and add to this cast of typical characters.
No one wants to be pigeonholed. But to a certain extent, we are predictable beings. The good news is that very predictability is what makes social style assessment such a powerful tool. Style assessment, if applied appropriately, can increase the effectiveness of our communication with patients. But what happens if we ignore social style considerations?
Worst case scenarios. Failing to understand the positive and negative aspects of your own social style can lead to failures in the process of communicating with your patients. Let’s say, for the sake of example, that I am a proud, card-carrying member of the Expressive group. I’m relatively loud, I love to tell stories and make analogies, and I am physically incapable of speaking without my hands. So what happens when I take my unbridled expressiveness into my work with members of the other groups?
Let’s start with a Driver. The good news is that, if the patient is a Driver, our overall pace will be about the same; we’ll both be relatively fast walkers and talkers. But the good news ends there. If I don’t control myself, I may get off topic early in the appointment. The moment an item in the patient’s history reminds me of something and I start telling a story, she will begin to think I’m wasting her time. When I try to get her to relate to the story and join in, she gets impatient. She may interpret my trying to be friendly as trying to sell her something. I probably will never get to that point because she will have tired of my antics and left.
If I meet up with an Analytical, I may go too fast, tell too many stories, and not give him the detailed facts he needs. I will ask him to buy before he has collected all of the technical data he needs, and he will leave after giving me the “I’ll need to think about it” response.
Finally, the Amiable who encounters me may be a bit bowled over by my strong lead in the conversation. They tend to acquiesce to my suggestions and listen politely to my stories but are unlikely to make a decision and will likely go home to discuss it with family members.
Clearly, these examples are extreme. But you can see the potential for interactions that are less than ideal if we do not have an understanding of ourselves and our patients. Now most of us, in the natural process of socializing as we grow up, unconsciously learn that we can adjust our behavior to some extent, depending on the person with whom we are interacting.
Be cautious not to over-generalize your observations of social style. Rarely will you find a person who behaves exclusively as one or another of these styles. Instead, while we all have a primary style in which we tend to operate, we also exhibit tendencies of the other styles as well. So I may be primarily an Expressive but also have traits of the Analytical. This overlap is important, in part, because it creates the rich variations of human nature, but also because it means that we all have the ability to adapt to some extent from one social style to another.
Adaptability. We cannot change our stripes. But we can be aware of our innate tendencies and be observant of others. Knowledge of social style categories is useful for the insight it gives us into how to adapt our own style to meet the needs of the people we are serving.
Go back to the example at the beginning of this article. As a hearing care professional, I was highly Analytical and gave all the detailed analysis of the situation that would lead a fellow Analytical to the obvious conclusion: I need to purchase hearing aids. But had I been more observant and attuned to my Amiable patient’s style and needs, I would have adjusted my interaction by adding a more human element—perhaps some stories of people with problems like hers. I would have inquired more about the implications of her problem in interactions with friends and family. I would have made sure that a family member was with her when she came for her appointment. I would have adjusted my Analytical tendencies to meet my Amiable patient’s needs.
Now, if I am an Analytical working with a Driver, I must be careful not to get into more detail than my patient can tolerate. Find out their expectations and proceed efficiently in meeting those expectations, offering firm reassurance along the way that more detail is available if they would like it. This patient will ask for what they need; wait for their cue before giving too much detail.
As an Analytical working with an Amiable, I need to remember the importance of the human element in the process of receiving information about the hearing loss and recommendations for intervention. I should be ready with some personal stories about patients I have worked with and how the rehabilitative process has helped them. The common recommendation to have a family member or close friend accompany a patient to an office visit is especially important for the Amiable patient; indeed, this patient is likely to rely on consultation to complete the decision-making process.
Finally, if my patient and I are both Analyticals, then we will be operating on the same social style wavelength. In this case, and in the other cases where styles are the same, my patient and I will be quite compatible, and I will likely not have to adjust my behavior from my innate comfort zone. It is in these cases where we have the potential to feel like a kindred spirit with a patient and our interactions will be most natural.
Now, in your mind, envision other variations on the theme. Take yourself through other scenarios of how each of these social styles might interact with the others and how, as a hearing professional, you might increase awareness of your behaviors and adjust them to better meet the needs of your patients.
Table 4 lists some precautions that members of each social style should keep in mind as they interact with members of the other three groups. While this listing is not exhaustive, hopefully it will provide you with some food for thought as you encounter various patients in your practice. Examine yourself, observe the people you serve, and develop an awareness of how best to bridge the gap between the two.
|Table 4. General communication strategies for dealing with the various personality types discussed.|
To a certain extent, we automatically adjust our behavior to accommodate the characteristics of the people with whom we interact. Adjusting to different social styles without realizing it is basic human nature.
But a heightened awareness of these adjustments may serve us well. Especially in a professional role in which good communication is the desired outcome, an emphasis on good communication during the process can be especially important. Every interaction with a patient is a component of the counseling process, defined earlier as “the process of giving and receiving information in a way that is meaningful, memorable and usable, changes behavior and facilitates a successful rehabilitative outcome.”2
We do not need to become psychologists. But with some basic understanding and attention to human behavior, we can become better tuned into our patients’ inherent styles and needs. Through more effective counseling and meaningful communication with our patients, we may help them to understand the implications of their hearing loss and our rehabilitative recommendations in a language they understand easily and naturally. Ultimately, we have the potential to make each patient’s path to successful hearing rehabilitation more streamlined and more successful. Everyone, patient and practitioner alike, will benefit.
The authors thank Jacob R. Gibbs, MA, FLC, and Robert Flynn, LMF, of Legacy Frontiers Inc, Dellwood, Minn, for their training and insights into the importance and assessment of social style.
Correspondence can be addressed to [email protected] or Jerry Yanz, PhD, at .
- Margolis B. Informational counseling in health professions: what do patients remember? Available at: www.audiologyincorporated.com; January 2004. Accessed October 11, 2007.
- Yanz J. Improving patient counseling, Part 1: Tools to improve adult learning. Hearing Review. 2006;13(11):26-33.
- Merrill DW, Reid RH. Personal Styles and Effective Performance. Boca Raton, Fla: CRC Press; 1999:2.