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The Psychosocial Adjustment to Vision

Loss: What Mobility Instructors Need to Know

Presented By:Heather Morris, Psy.D.

Clinical Psychologist PSY25328

3 Tier Model of Adjustment

Personal Adjustment to Vision Loss

Foundation for all adjustment

Allow client to mourn loss of vision

Self concept Who am I without vision?

Self esteem How do I feel about myself now that I have lost my

vision?

Personal Adjustment to Vision Loss

Loss of control Most important issue in adjustment Issue mobility instructors can

influence the most Regaining independence Learning to ask for help

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 individual Managing expectations Mourning the loss of client’s vision Experimenting with new roles

Adjustment to Vision Loss in Intimate Relationships

Early on will be dependent on closest family or friends Both the client and their caretaker can become stuck

in these roles

Allowing their family member to become increasingly independent Role as caretaker must evolve as client adjusts to

vision loss

Public Adjustment to Vision Loss

How does the public view individuals with vision loss?

Adjustment to treatment and judgment by the public Responding to offers of assistance in public

Deciding whether or not to be an advocate for individuals with vision loss Correcting public misconceptions of vision loss

Depression and Adjustment to Vision Loss

Symptoms: Sadness and crying Loss of interest in relationships and activities

that previously provided enjoyment Feelings of worthlessness and guilt Physical symptoms without medical cause Change in appetite Disruption of sleep Fatigue Difficulty concentrating

What mobility instructors can do to help depression

Provide empathy You may be the only person in their life who is

familiar with vision loss Understand the difficulty of mobility training

Help clients set realistic goals that will allow you both see progress

Stay positive and encouraging, especially in the face of setbacks

Clients and Negative Thinking

Biggest barrier to increasing independence and confidence

Opportunity to educate that thoughts effect behavior and outcomes of training

Helping clients change negative thoughts Listening 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!!

Anxiety and Adjustment to Vision Loss

Most prevalent and serious aspect of recent vision loss

Symptoms: Feeling a loss of control Excessive worry Unable to relax Feeling wound up or restless Difficulty concentrating Irritability Muscle tension

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 anxiety

Acknowledge the loss of control that accompanies vision loss

Be aware that mobility training intensifies these feelings

Be calm and clear about the objectives of each mobility lesson Let client know what role you will play in each lesson and

what is expected of them

Acknowledge that each day unexpected mobility challenges will arise You will provide them with the basic tools necessary to

respond

Relaxation Techniques to Reduce Client’s Anxiety

Deep Breathing Can be used prior to or during mobility lesson if

client’s anxiety becomes overwhelming Breathe in for a count of 5, hold for 2, out for 5 Can’t focus on breath and worrisome thoughts

Visualization Have client choose a calming place to picture Senses: sight, sound, smell, touch, taste

Progressive Muscle Relaxation

Techniques to Reduce Client’s Anxiety

Possibly allowing a friend or family member to attend lessons, especially early on

Helping client to focus only on the task at hand without room to think about all the “what ifs” that accompany anxiety

Remind them that the best way to reduce anxiety is to do the feared thing successfully

Steps to a successful working relationship with

clients

Describe the role of a mobility instructor

Build rapport

Establish boundaries

Set goals

Provide positive reinforcement

Discuss termination

Establishing Your Role as the Instructor

Newly visually impaired clients will not know your role

Explain your training and experience

Your role as a teacher and expert

This will be the basis for the boundaries you set later on

Establishing your Role as the Instructor

What the mobility instructor-client relationship is: You are there to teach clients mobility and keep

them safe You are there to help them reach mobility goals You are there to listen to fears and concerns about

mobility You are there to help them overcome the challenges

they will face in regards to mobility You are there to improve mobility skills to increase

independence

Establishing your Role as the Instructor

What the mobility instructor-client relationship is NOT: You are not a friend You are not a therapist You are not responsible for client problems beyond

mobility You are not a social worker

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 successful

If 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 necessary

Ask about their adjustment to vision loss and if they have thought about what their new life will be like

Boundaries

Clients need to be clear that this is professional not a personal relationship

This will require assertiveness on your part as an instructor

These boundaries will upset clients at times, but you have to remember it is in their best interest to maintain them

The goal of rehab after vision loss is to increase independence, consistent boundaries are one of the best ways you can do this

Boundaries

Have consistent and clear times on how and when clients can contact you Do not return phone calls or emails outside of these hours

Policy on absences How many are allowed prior to termination? Sick policy?

Help clients problem solve mobility issues on their own with you as a guide

Do not allow clients to manipulate you to act outside of your role as a mobility instructor

Setting Mobility Goals

Tailors instruction to the individual client Each client will have a different level of desired

independence

Allows both the client and the instructor to see measurable progress

Provides a guide for termination when goals are met

Goals should be re-evaluated throughout mobility instruction Goals may need to be added or removed in response

to life circumstances

Providing Positive Reinforcement

Understanding that you may be the only one in their life that provides encouragement or belief in their abilities

Difficult clients will challenge your patience and look for ways to create a negative response

Negative reinforcement does not work! When you do get frustrated, apologize and explain.

Make corrections by telling/showing clients the proper way Try not to get caught up in what they’re doing wrong Always notice what they’re doing right

Termination

Any relationship with an emotional, relational or experiential component should be provided a formal end

Let clients know early on when their last lesson will be and remind them frequently

Some clients will be resistant to ending the relationship Maintain the boundaries of the relationship you

established Ask them about their concerns

Early Termination

If clients have not adhered to the attendance policy

If clients have stopped progressing in lessons

If the client is not respectful or you feel threatened in any way

If life circumstances are affecting their ability to learn mobility

When to Refer a Client for Counseling

Any thoughts or feelings of suicide This may require immediate attention

If you have mental health staff available, ask for an evaluation

Can call 911 and ask for the Psychiatric Emergency Response Team that will come to the patient for evaluation

Clients unable to provide themselves food, shelter, or clothing

Poor hygiene

Unsafe or unsanitary living conditions

When to Refer a Client for Counseling

Severe depression

Panic attacks

Flashbacks of trauma

Responding to voices or noises that are not there

Self Care

Helping professionals use emotional and physical energy on the job daily, you must have a way to recharge

Having a ritual before leaving work to help you leave the day behind

Having a peer or mentor in the profession to discuss particularly stressful or difficult cases

Being aware of the possibility of burn out and slowing down if symptoms appear

Self Care

What to do to recharge? Spend time with loved ones Spend time alone doing an activity you enjoy Get exercise outside of work Take a vacation or day trip, it doesn’t have to be big

or expensive! Learn to meditate Go for counseling Read or listen to books Get out into nature

Questions??

Feel free to contact me at morrispsychology@gmail.com if you think of anything after the conference!