change the channel…

If patients were ever to “read the book” on effective Vision Therapy, imagine how our model of vision would be changed. Compliance with home programs would be higher, endurance through long rehabilitative programs would be stronger and determination to find supreme visual efficiency would be greater across the board.  Wouldn’t that be nice.  Without overstating the obvious, patients don’t know what we know, and a big part of our job is to help them understand.

So what do you do when faced with a patient who doesn’t “get it”?  The teenager who comes in because their mom or dad “makes them”. The second grader who fights and screams every week because learning long division the hard way the classroom is so much more exciting than going to a doctor’s office for therapy.  Or my personal favorite, the child who figures the best course of action is to misbehave the entire session thereby burning up the clock and limiting productivity – which incidentally should be taken as a strong sign of intelligence.  But what can we do?  How can we reason with the unreasonable? How do you rationalize treatment with someone who behaves irrationally about it? How to you explain the benefits of treatment to someone who wants nothing more than to be ANYWHERE but in your presence?

Just to clarify, I don’t think any of my patients (or your patients) are unreasonable or irrational; however, they do have their own unique communication style.  What may seem over the top or “out there” to us, is just the way they operate. Our job is to meet them there. This idea was brought into focus the last few weeks with a little 7 year old girl I’ve been seeing.  She is super sweet and comes from a great family.  However, given an opening, she terrorizes my Vision Therapy room by touching everything, interrupting other patients,  throwing things at the walls, and when asked to try something she simply responds “no thank you”, and sits with her arms crossed. I have tried VT with her parents in the room, and out.  I’ve tried having her work with a different therapist in our office.  I’ve tried speaking to her mom about different strategies for behavior. I’ve even called her teacher to discuss her classroom mannerisms. To a person, they are all shocked at her alleged behavior. Apparently this little girl is “an angel” – except in VT.  Now what do I do?

Change the channel.

Programmed responses are easy to fall into.  I do it all the time.  The challenging patient walks into the office, you greet them and bring them into the VT room, they start misbehaving and you immediately start in with a negative response (fill in your personal blank)….just like you did last week.  But what if this week you tried something different? Don’t react in the same way. Try something different. Maybe play along for a few minutes. Maybe sit quietly and just observe. Maybe use their hijinks as a segue to a funny story about your life as you pull out a piece of equipment. Maybe?  If communication truly belongs to the speaker, and my communication is causing a negative or unwanted reaction, time to own it and try something else.

With my little 7 year old friend, I did just that today – owned it.  As she always does, she came into our session ready to take over.  Rather than react as I normally do – trying to reason with her – I told her we were going to have a competition. The idea was to find out who could act the silliest for 60 seconds, yes I was even timing it.  When that 60 seconds was over we would see who could be the quietest for 60 seconds, and then we’d see who could spin in the chair the fastest for three revolutions. Of course, she won.  Ok, wait.  Am I seriously giving a child who enjoys misbehaving permission to misbehave?  Yes and no.

There is a reason the phrase shock value contains the word “value” – because it’s worth a lot. If my patient is expecting me to resist and maybe even try to redirect, what if I don’t?  What if I change my response? What if I let her have her moment without putting a negative spin on it and allow her to express whatever it is that behavior expresses, and then move on? These were my thoughts as our session started today, and you know what?  It worked.  For the first time in a long time, we had a great session.

Sometimes changing your own channel is the key.  Try a different approach – one they’re not expecting – and see where it takes you.  Bet you’ll be surprised 😉



Posted on October 21, 2013, in From My Perspective.... Bookmark the permalink. 6 Comments.

  1. Ah, yes, parenting strategies work even on other people’s children. I recommend the book “how to talk so kids will listen and listen so kids will talk” I bet there are amazing ways you could use the ideas in that book in a VT practice.


  2. I agree with the recommendation of the above-mentioned book, by Faber and Mazlish; they also have written another one I like called “How To Talk So Children Can Learn.” Written primarily for teachers, it has great application in the VT room as well


  3. Williams and Mint OD

    Robert, In addition to your helpful suggestion, sharing that you have difficult patients helps to lift everyone. We are looking into presentations which will help doctors and therapists deal with seriously challenged patients. Gary J. Williams


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