closed for business…

Nothing is more challenging for doctors or therapists than patients who come to the office with the “let’s get this over with” look on their face.  The teenage girl who’s not afraid to let you know through body language that her bubble is being disturbed my mere presence.  The 9 year old boy who would much rather be cleaning his room or washing dishes than hearing about his eyes.  The child who preaches “my mom made me come here”, implying they would rather be somewhere else, anywhere else. So let’s just face it, coming to a doctor’s office to work does not sound like a whole lot of fun. It’s why our positive approach becomes so important.

I wrote in a previous post about some advice Dr. Carl Hillier shared regarding validation, and how powerful a tool it can be with the frustrated patients.  Dr. Hillier’s words have helped me out of more than a few jams over the years, and his ideas on validation remain a front runner in my arsenal of helping patients adjust to the benefits Vision Therapy.  Subsequent to that post, I received the below email from a Vision Therapist whom I have never met, and only know by name.  Since it brings up a valid point, I thought it might be fun to share it here. In the interest of anonymity, I have removed the identifiers:

Dear Robert, 

Thanks very much for your post “there’s nothing wrong with me”.  I am really enjoying your blog, and have learned a lot by reading about your experiences.  I have a patient that works hard when he is alone in the VT room, but anytime his mom or dad come in, he turns into a devil child and says he’s “closed for business”.  When I ask him why he is misbehaving, he crawls under the table and will not talk.  We end up losing the session. My doctor suggested I leave mom and dad out of the room, but they want to come in and watch. I don’t know if you’ve ever had to deal with this, but I am wondering if you give me some suggestions?   I’m not sure what to do.

This is a tough one.  To make you feel better, I once had a 9 year old boy drop an F-bomb during vectograms, throw some lens flippers at me, and run out of the office.  Since his mom had gone shopping during his session, I had to chase him for fear he would get hit by a car.  That particular office was on a major street consisting of three lanes of traffic in both directions. I was positive I’d be fired by the time I caught up to this kid. Our receptionist witnessed the entire thing and quickly called mom, without a word from me.  On the phone, mom was unscathed, and calmly instructed “don’t worry, he’ll come back”.    We didn’t know where to go from there.

Most parents have a vested interest in their child’s success, and extra curricular interventions such as VT, only magnify that interest.  I always want to respect the bond between parent and child.  You cannot account for parenting styles though, and in the VT room managing the environment is crucial, and at times he best thing you can do is create momentary separation.  There are diplomatic comments you make to the child, which any astute parent will pick up on. For example:

A parent that continually gives their child the answer: I say to the child: “now I know what your mom thinks, tell me what you think” – My message is for the parents to allow their child to answer

A parent who needs to repeat my instructions to their child: I say to the child: “I noticed your mom/dad keeps repeating my words. Do you know why?” – The message is for the parents to stay quiet.  Sometimes, it’s just a matter of calling it to their awareness.

In extreme cases, such as described in the email, my approach would be more direct.  Pull mom and dad aside and be honest about what you see.  Often times they can offer insight on the sudden change in behavior, since they have known the child their entire lives.  They may even be aware that their presence aggravates the situation, so I always ask how they handle it at home.  Ask mom and dad to work with you in terms of when they are in the VT room, and not. Perhaps telling their child that you’re going to invite mom and dad in the last five minutes so he has time to prepare mentally, and when they are in the room, arrange an opportunity for him to show off.   Flip it into a positive.

Sometimes being a good Vision Therapist means managing their family dynamics during our sessions. It stinks, I know.  But in the final analysis, we cannot be faulted for trying if we are working towards a common goal.  A successful patient.


  • Your experience is one reason I rarely had parent(s) in the VT room during work time. I always made time after the session to talk with them regarding the progress of the session, any problems and how to structure time and conditions for the homework. There were about 50% of the parents who did not want to be involved and who hired a retired teacher, etc. to conduct the homework 7 days a week. I also had the parents come in at the last 5 minutes or so and had the patient demonstrate his/her BEST VT work – I always made sure to lavish much praise and the patients were able to bask in their acomplishment.


    • You make a great point, Diana. Managing parental access during session is important. Personally, I allow parents to stay if they request it, but I am also not shy about asking them to leave if it becomes disruptive. Usually though, with some coaching, it works out. A lot of it based on comfort level though, and some may not feel as bold as I can sometimes get 🙂


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