A Sit Down – with Robert Nurisio COVT
This post appears as part of a series called Sit Down – candid conversations with real people detailing their journeys and experiences with Vision Therapy.
A Sit Down – with Robert Nurisio COVT
Interviewed by: Karen Danoski COVT
Let me begin by congratulating you upon becoming COVT of the Year in 2013! For the benefit of our readers, can you explain how you first became involved with Developmental Optometry?
Thank you very much. Receiving the award was truly something special. Having that many people who I respect and admire come together into one room to stand and applaud for me was a pretty incredible feeling. It was truly my honor.
I started in VT as a patient in Dr. Carole Hong’s office in San Carlos, CA in 1997-98. I grew up with a dream of playing professional golf on the PGA tour and through my high school and college years got pretty good at it. Professional sports require so much precision and I was having trouble advancing beyond the “semi-pro” circuits. My mom worked at Dr. Hong’s office as a receptionist back then and suggested I go in for an exam. Dr. Hong diagnosed me with Convergence Excess and prescribed VT to improve spatial awareness. It helped tremendously. Unfortunately, I was involved in a serious automobile accident in October 1999 and injured my back which derailed my golfing dreams, but I was intrigued by what VT had done for me. Not long after, Dr Hong was looking for a Vision Therapist and hired me. That was November of 1999.
I currently work in Cedar Park, Texas (a suburb of Austin) for Dr. Mary McMains.
Where does your empathy come from?
I’m probably the poster child for the nature and nurture conversation with regards to empathy. Part of it is genetic I think. My internal rhythm is just happier when people around me are feeling good and doing well. I think many people have this sensitivity, but mine seems to be at more heightened levels. If my friends or colleagues are struggling, it takes a toll on me. It even happens at the grocery store when I see people who can’t reach the top shelf or an elderly person struggling with something, I’ll offer to help. It’s probably why I have such a core issue with Western Medicine’s idea of professional distance. You can be empathetic and professional; they are not mutually exclusive in my mind.
On the nurture side, my younger brother is developmentally delayed. He’s 34 in body, but probably 15 in mind. Growing up in an environment filled with doctor and therapy visits, where making special arrangements or compensations for someone who didn’t understand things as well as I did really was just the norm, I was programmed to be helpful and empathetic. I learned from an early age that when it comes to giving extra to those who may be struggling, a little bit goes a long way. It’s probably why I’ve chosen the career paths I have; first Paramedics and now Vision Therapy. Helping people is just what I do.
Most of the kids who come to see me for VT are struggling in their own way, and I want very much to help them without passing judgment on their particular challenges. My family has been on the other side of that coin where doctors told my parents that my brother was “retarded and stupid” and I’ve witnessed the fallout first hand. Those are definitely wounds that not even time can erase and they are the reason I have a pretty strong aversion to the idea of labeling kids with any acronym indicative of their symptoms.
With my patients, I just feel like I am a spoke in their wheel of success and if I do my best to understand where they are and adjust VT to benefit them; hopefully it will improve their life.
Who was your MOST challenging patient and what can you tell us about them?
When I lived in California I had a little 7 year old boy in VT who was diagnosed with the proverbial alphabet soup. ADD, PDD, PPD…you name it. On top of that, his parents had recently divorced and he was very angry about it all. One day he went from totally calm to a fit of rage in a matter of seconds and threw an Aperture Rule Trainer at my head when I wasn’t looking. He then called me many names that little boys shouldn’t say, ran out of the office and across a busy street. Since his mom had gone to the grocery store, I ended up chasing him for a few blocks to no avail. By the time I got back to the office, fully expecting to be fired or arrested or worse, his mom had already called to say he made it home safely. That day taught me a lot about controlling the environment in the VT Room and also how to be a better communicator when probing parents about their children’s challenges. His mom was aware of his outbursts but hadn’t listed them in any of his paperwork, probably out her own denial. Lucky for me, it all ended up well. After that, he did VT with me for over a year and did very well once I better understood how to manage him. I still correspond with his mother and understand he will graduate from high school in the spring. He’s a great story.
Which of your VT patients taught you the most about yourself?
Without question or hesitation, it was Abigail Holland.
Who is Abigail Holland and why has she been so important?
Abby is the subject of a blog post I wrote in February 2013 named una bella vita, which is Italian for a beautiful life. The post details her journey from being hired into our VT practice to train as a Vision Therapist, to her serious car accident and major concussion, right on through her making a great recovery after a year of struggles, thanks in part to Vision Therapy.
Her significance in terms of my VT education is pretty simple; she’s the only person I’ve known before and after a TBI. As head therapist in charge of managing her VT program, I witnessed first hand the long and painful damage and recovery process she went through. It was a pretty powerful education.
As the Head Therapist, I had to learn quickly how to balance empathy, compassion, leadership, and professionalism. It was not easy. She and I had many arguments after her accident about what was best. She was pushing herself harder and harder to return to normal, which became counter-productive because we know stress is not the friend of someone suffering from the effects of a TBI; and I was trying to manage her performance and abilities with what was realistic and beneficial for the practice. Dr. Ann Voss was incredibly helpful in navigating these waters and was patient in allowing growth all around. There was no road map and much of was trial by fire, but I learned so much from the experience both about management of people and Vision Therapy. Pictured from left to right: Abby Holland COVT, Robert, Dr. Marcia Moore and Natesha Conley COVT
On a human level, Abby is pretty amazing. Knowing where she was before her accident, witnessing first hand her struggles in the year following, and seeing what an amazing fighter she became during her COVT process, I could not be more proud of her. After everything she’s been through, it was pretty awesome that she completed her COVT and I was awarded COVT of the Year at the same meeting. It was my pleasure to mentor her and I have a feeling we’ll be friends for a long time.
If you could speak to the Robert you were 10 years ago, what would you tell him?
Be a better listener. So much great information has crossed my path thanks to the incredibly smart folks I’ve come across. I spent almost 5 years working with Dr. Bob Sanet and he was so gracious in sharing his incredible wisdom; I wish I would have absorbed more of it. As I get older, I’m realizing that I have a different set of eyes, a different set of ideas and I even view things differently than I did when I started in VT, and having knowledge is much more valuable to me now than it used to be. With that, improved listening skills are something I work on daily.
Has your philosophy about VT changed from when you first started in 1999?
In the beginning, so much of our “philosophy” is mechanical. We are concerned with the properness of the activities and the line of questioning. Should patients see SILO or how long should I allow them to view the blocks? How is this activity done and what equipment should I be using? Everyone starts there, and rightfully so.
Fourteen years into it, my philosophy is more goals oriented. For example, I will talk to my patients with strabismus for 5-10 minutes at the beginning of their session, just to understand how the world looks that day. In my mind, the one universal component with strabismus is it tends to be consistently inconsistent; they may have a completely different awareness than yesterday, or even our session last week. After understanding their current visual world, I modify activities and frame questions around how they’re seeing at that moment while always leading in the direction prescribed by the doctor. This is a skill that for me has come with experience. Nowadays, I put very little thought into the mechanics of an activity and lots of thought into the essence of it. Unless I break a piece of equipment, then its how do I fix this?
How do you explain Vision Therapy and your job to your children and how does being a therapist influence you as a parent?
Serving a population that seems to be mostly kids makes me very thankful that my kids do not struggle, and if they ever were to in any aspect of their lives, I would seek out all possible explanations before undertaking treatment. I’ve heard so many parents beat themselves up about not finding VT until after their child struggled for a few years and I always tell them that “you don’t know what you don’t know”. What they’re really saying is they wish they would have looked harder when their child first started to struggle. It seems to be a tough position of guilt to reconcile. I hope to never be in their shoes.
Who in your life, either past or present, would you like to spend a day with and what would they say about you earning COVT of the Year for 2013?
My last paramedic partner was named Raquel “Charlie” James. Apparently her head was huge at the time she was born so she was nicknamed Charlie Brown by her parents and it just stuck. She went by the nickname Charlie. She taught me so much about how to live my life, how to enjoy those around me, how to let go of anger by finding the humor in things, and mostly how to love my fellow man. In 2010, Charlie suffered a massive aneurysm while at a family barbeque and died a week later in the hospital. She was only 41. She really was an amazing soul who I miss talking to very much. I would love one more day to talk to her as she had an incredible impact on my life.
In terms of my award, she would whole heartedly congratulate me. She’d probably also remind me that it’s nice to be important, but it’s also important to be nice. She was a steadying force in that way.
Why did your first patient decide to follow in your VT footsteps?
I don’t know if I can tell you why, other than to say VT had a significant impact on her life. When Dr. Hong emailed me to say that Jessica had been hired as a Vision Therapist I initially thought it was a joke. Guess the joke was on me. It is pretty awesome though that the first patient I ever worked with on my own is now working in the office where I started as a Vision Therapist. I also owe Dr. Carole Hong a big thank you for bringing Jessica to Florida to join in my celebration. Certainly much appreciated!Pictured from left to right: Dr. Mary McMains, Jessica Bailey, Robert, Dr. Carole Hong
What advice would you give to new Vision Therapists considering certification?
Once they meet the requirements for applying, I would suggest choosing a mentor first thing. If you can find someone whom you work well with they can help assess your knowledge level, recommend reading material, make understanding the process so much easier and assist in making it all a smooth process. Some people communicate better with other therapists and some prefer to have a doctor mentor them. Either option is great, but choosing the right mentor for you seems key to understanding all parts and achieving a high level of success.
How was your VT Works blog born and what do you “get” from it?
I got divorced in 2010 and almost overnight went from being a full-time dad to seeing my kids one night a week and every other weekend. In trying to reconcile my emotions and at the same time trying to fill a void, I turned to many different solutions. Some were positive, and some not. I never did anything damaging or destructive, but my choices were not always the best. Being a single parent for the last three years has forced me to grow stronger, to be an individual and to find positives within myself – all areas of growth that I am very proud of. One of the main positives to develop was the idea start a blog, and since I do have some experience in VT, I began to write in my free time. I wasn’t sure what to expect, if anything. Things started slow in April of 2012 with maybe 10 views per post, and now almost 18 months later I have close to 200 followers and average about 500 views per post, mainly because of all the sharing that occurs.
Nowadays, my life is very positive and I mostly write in the evenings or on my lunch break as I seem to be busier and busier. Watching my blog grow, and receiving much positive feedback from those who read it, has been quite satisfying.
How do you create content for your blog?
A lot of it is day to day patient related. I’ll have an interesting thought while working with a patient or a parent will ask an interesting question. Some of it is in response to ideas that float across the VT related Facebook pages and some of the more educational material is just a function of my own learning and re-learning. I think most bloggers will tell you that once you “get into it”; your antenna is always up for ideas to write about.
By far the Sit Downs have been the most popular though, and I really have enjoyed the brief collaboration with the guest of the week. Dr. Dan Press and your interview (Karen Danoski COVT) both topped 1500 views on their respective weekends, with everyone else hovering between 1200 and 1400, thanks to the wonders of sharing on social media. By the time this post goes public, I expect ALL interviews I’ve posted to have been viewed over 2000 times. That is pretty awesome! I usually post Sit Downs on Friday mornings and then spend the weekend monitoring the views, just for fun. Pam Happ shared with me recently how nice it is to read the thoughts of others within our profession, which I think sums up the popularity of the Sit Downs. I had originally planned to interview only two or three people, but since they’ve really caught on, I’m working to post one interview per week. So far, so good.
How would you describe yourself in the Vision Therapy room?
I learned a long time ago that there is definite value in maintaining a light atmosphere in the VT room. We’re asking patients to maneuver their brains and look at things in a way they are not used to, which has to be challenging and in some cases will stir up emotional responses. So, as seriously as I take my patient care skills, my work, my education, my blog and my patient’s desires to improve their own lives; I really don’t take myself serious at all, and whatever it takes to help my patients feel good about themselves and smile while we’re working, I will do. I really work hard to maintain a balance between progress and fun.
Who has been the most influential person with regards to your Vision Therapy career?
Linda Sanet, hands down. I had the pleasure of working with Linda for about 5 years and she is amazing. I used to overhear her take a patient from total confusion to a great state of clarity with just a question or two and wonder where she had the idea to ask those questions. She would encourage me in gentle ways to go beyond my own comfort level and try new things with patients and since then, she has been the number one supporter of my blog. I often tell people that Linda is my VT hero, and I mean it. We have cultivated a great friendship which means a great deal to me.
I didn’t know Linda would be presenting my COVT of the Year award, so that surprise made it all the more special. I was honored that she did it and was quite choked up when she started describing our friendship. She really is an amazing lady.
What is the Vision Therapist Forum and who can join?
The Forum is a place for Vision Therapists to exchange ideas. I created it through Google in August 2008 and have been the owner/admin ever since. It basically works the same as a traditional List Serv. It is important for me that the Forum is a place of sharing and learning, so it has always been a “closed group”, meaning it is only open to Vision Therapists. To join, any therapist can send a request to firstname.lastname@example.org
What do you enjoy most about the COVD Annual Meetings?
The people. Beyond my love of meeting the first time attendees, I have my posse of friends that I pal around with and we have truly become like family. Invariably, we add one or two folks to our group every year as we always try to welcome newcomers, which is really awesome. This year, our friend Robin Vreeland was unable to attend, and all of us noticed the void. Beyond my immediate group, I have many professional friendships that are rekindled that truly make the meeting feel like a family reunion. I look forward to it every year!