The Psychosocial Adjustment to Vision Loss: What Mobility Instructors Need to Know

1. The Psychosocial Adjustment to Vision Loss: What Mobility Instructors Need to Know Presented By: Heather Morris, Psy.D. Clinical Psychologist PSY25328

2. 3 Tier Model of Adjustment

3. 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?

4. 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

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

6. 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

7. 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

8. 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

9. 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

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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

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 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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

27. When to Refer a Client for Counseling • Severe depression • Panic attacks • Flashbacks of trauma • Responding to voices or noises that are not there

28. 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

29. 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

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