1 Presented By: Heather Morris, Psy.D. Clinical Psychologist PSY25328 The Psychosocial Adjustment to Vision Loss: What Mobility Instructors Need to KnowPresented By:Heather Morris, Psy.D.Clinical Psychologist PSY25328
2 3 Tier Model of Adjustment PublicIntimate RelationshipsPersonal
3 Personal Adjustment to Vision Loss Foundation for all adjustmentAllow client to mourn loss of visionSelf conceptWho am I without vision?Self esteemHow do I feel about myself now that I have lost my vision?
4 Personal Adjustment to Vision Loss Loss of controlMost important issue in adjustmentIssue mobility instructors can influence the mostRegaining independenceLearning to ask for help
5 Adjustment to Vision Loss in Intimate Relationships “Adjustment to vision loss is a family affair” –Robert Jackson, Ph.D.Those closest to the client must adjust their concept of the visually impaired individualManaging expectationsMourning the loss of client’s visionExperimenting with new roles
6 Adjustment to Vision Loss in Intimate Relationships Early on will be dependent on closest family or friendsBoth the client and their caretaker can become stuck in these rolesAllowing their family member to become increasingly independentRole as caretaker must evolve as client adjusts to vision loss
7 Public Adjustment to Vision Loss How does the public view individuals with vision loss?Adjustment to treatment and judgment by the publicResponding to offers of assistance in publicDeciding whether or not to be an advocate for individuals with vision lossCorrecting public misconceptions of vision lossWho is “the public”? people on the street, people in customer service, professional contacts, those in academic environments
8 Depression and Adjustment to Vision Loss Symptoms:Sadness and cryingLoss of interest in relationships and activities that previously provided enjoymentFeelings of worthlessness and guiltPhysical symptoms without medical causeChange in appetiteDisruption of sleepFatigueDifficulty concentrating
9 What mobility instructors can do to help depression Provide empathyYou may be the only person in their life who is familiar with vision lossUnderstand the difficulty of mobility trainingHelp clients set realistic goals that will allow you both see progressStay positive and encouraging, especially in the face of setbacks
10 Clients and Negative Thinking Biggest barrier to increasing independence and confidenceOpportunity to educate that thoughts effect behavior and outcomes of trainingHelping clients change negative thoughtsListening for self-deprecating language“I’ll never learn to cross the street” becomes “That’s not true, you’re learning the skills you need to be able to cross the street and will get there soon!” or “Remember all the progress you’ve made since we first started working together”Make sure your change in language is realistic!!
11 Anxiety and Adjustment to Vision Loss Most prevalent and serious aspect of recent vision lossSymptoms:Feeling a loss of controlExcessive worryUnable to relaxFeeling wound up or restlessDifficulty concentratingIrritabilityMuscle tension
12 What mobility instructors can do to cope with client’s anxiety Being open and honest will allow you to create a relationship built on trust, which will reduce anxietyAcknowledge the loss of control that accompanies vision lossBe aware that mobility training intensifies these feelingsBe calm and clear about the objectives of each mobility lessonLet client know what role you will play in each lesson and what is expected of themAcknowledge that each day unexpected mobility challenges will ariseYou will provide them with the basic tools necessary to respond
13 Relaxation Techniques to Reduce Client’s Anxiety Deep BreathingCan be used prior to or during mobility lesson if client’s anxiety becomes overwhelmingBreathe in for a count of 5, hold for 2, out for 5Can’t focus on breath and worrisome thoughtsVisualizationHave client choose a calming place to pictureSenses: sight, sound, smell, touch, tasteProgressive Muscle Relaxation
14 Techniques to Reduce Client’s Anxiety Possibly allowing a friend or family member to attend lessons, especially early onHelping client to focus only on the task at hand without room to think about all the “what ifs” that accompany anxietyRemind them that the best way to reduce anxiety is to do the feared thing successfully
15 Steps to a successful working relationship with clients Describe the role of a mobility instructorBuild rapportEstablish boundariesSet goalsProvide positive reinforcementDiscuss termination
16 Establishing Your Role as the Instructor Newly visually impaired clients will not know your roleExplain your training and experienceYour role as a teacher and expertThis will be the basis for the boundaries you set later on
17 Establishing your Role as the Instructor What the mobility instructor-client relationship is:You are there to teach clients mobility and keep them safeYou are there to help them reach mobility goalsYou are there to listen to fears and concerns about mobilityYou are there to help them overcome the challenges they will face in regards to mobilityYou are there to improve mobility skills to increase independence
18 Establishing your Role as the Instructor What the mobility instructor-client relationship is NOT:You are not a friendYou are not a therapistYou are not responsible for client problems beyond mobilityYou are not a social worker
19 Building Rapport Be honest, open, and genuine with your clients Mobility instruction can be extremely stressful for some clients, they must feel that they can trust you to be successfulIf they ask about you, tell them things you’re comfortable sharing.If you’re not comfortable with sharing the info they want, ask them why it’s important to them and re-evaluate if necessaryAsk about their adjustment to vision loss and if they have thought about what their new life will be like
20 BoundariesClients need to be clear that this is professional not a personal relationshipThis will require assertiveness on your part as an instructorThese boundaries will upset clients at times, but you have to remember it is in their best interest to maintain themThe goal of rehab after vision loss is to increase independence, consistent boundaries are one of the best ways you can do thisMost difficult and important step to a successful helping relationship
21 BoundariesHave consistent and clear times on how and when clients can contact youDo not return phone calls or s outside of these hoursPolicy on absencesHow many are allowed prior to termination?Sick policy?Help clients problem solve mobility issues on their own with you as a guideDo not allow clients to manipulate you to act outside of your role as a mobility instructor
22 Setting Mobility Goals Tailors instruction to the individual clientEach client will have a different level of desired independenceAllows both the client and the instructor to see measurable progressProvides a guide for termination when goals are metGoals should be re-evaluated throughout mobility instructionGoals may need to be added or removed in response to life circumstances
23 Providing Positive Reinforcement Understanding that you may be the only one in their life that provides encouragement or belief in their abilitiesDifficult clients will challenge your patience and look for ways to create a negative responseNegative reinforcement does not work! When you do get frustrated, apologize and explain.Make corrections by telling/showing clients the proper wayTry not to get caught up in what they’re doing wrongAlways notice what they’re doing rightMirror neurons create a bond between humans that allows them to experience what the other is feeling. If you’re feeling angry, negative and frustrated-most likely the client is too.
24 TerminationAny relationship with an emotional, relational or experiential component should be provided a formal endLet clients know early on when their last lesson will be and remind them frequentlySome clients will be resistant to ending the relationshipMaintain the boundaries of the relationship you establishedAsk them about their concerns
25 Early Termination If clients have not adhered to the attendance policy If clients have stopped progressing in lessonsIf the client is not respectful or you feel threatened in any wayIf life circumstances are affecting their ability to learn mobility
26 When to Refer a Client for Counseling Any thoughts or feelings of suicideThis may require immediate attentionIf you have mental health staff available, ask for an evaluationCan call 911 and ask for the Psychiatric Emergency Response Team that will come to the patient for evaluationClients unable to provide themselves food, shelter, or clothingPoor hygieneUnsafe or unsanitary living conditions
27 When to Refer a Client for Counseling Severe depressionPanic attacksFlashbacks of traumaResponding to voices or noises that are not there
28 Self CareHelping professionals use emotional and physical energy on the job daily, you must have a way to rechargeHaving a ritual before leaving work to help you leave the day behindHaving a peer or mentor in the profession to discuss particularly stressful or difficult casesBeing aware of the possibility of burn out and slowing down if symptoms appear
29 Self Care What to do to recharge? Spend time with loved ones Spend time alone doing an activity you enjoyGet exercise outside of workTake a vacation or day trip, it doesn’t have to be big or expensive!Learn to meditateGo for counselingRead or listen to booksGet out into nature
30 Questions??Feel free to contact me at if you think of anything after the conference!