As part of our certification process, Vision Therapists are asked to respond to a series of Open Book Questions designed to assess and nurture the candidate’s knowledge. For the last several years, one question in particular has addressed the concept of patient motivation, and how each Vision Therapist applies their own techniques for motivating patients through home therapy, office therapy, with an eventual goal of completing a Vision Therapy program. At first glance, the level of difficulty the “motivation question” provides might pale in comparison to, say, the question about strabismus. But in reality, motivating our patients is probably one of the most difficult and most demanding areas of a Vision Therapist’s job. After all, you can read and learn from very objective information on strabismus, accommodation and ocular motility; but the area of motivation is decidedly more gray. Not to be understated, motivating patients does require some knowledge of how the visual system works, but it also requires a good mixture of creativity, imagination, and empathy. Personally, my skills in this area were put to the test last week and without patting myself on the back, I was tickled at the results.
At 15 years old, these twin brothers are concerned with very little beyond basketball and girls. School work, chores and certainly Vision Therapy home activities have all been relegated to a distant second station, if not third or fourth. They are nice boys and come from a nice family, and despite my many attempts to motivate them to work their visual system at home, it just is not happening. We’ve had the “do you really want to be here?” conversation, both individually and as a group and predictably they answer in the affirmative, citing simply that they are “too busy” to make time for VT home activities. They are GREAT kids with tons of potential but basketball, the shopping mall, video games, and yes, their may female followers, have all taken priority. Mom is frustrated and has tried everything she can, but still, they are not making much progress and I am left to try anything necessary to get their attention.
Last Friday I was looking forward to their sessions, as I always do, and was pretty disappointed when they arrived and almost instantly reported they had not done any home therapy since we last discussed the topic two weeks prior. Rather than chastise them, which clearly was not effective, I took a much more creative approach with my highly sports minded and incredibly vain young friends.
“You guys want to make a bet?” I inquired. “I’ll bet you can’t do your VT homework every day for a month.” Clearly I had their attention as they quickly inquired on the stakes. “Haircuts”, I answered. “If you don’t do your VT homework everyday for the next month, I get to shave your heads. Deal?” I extended my hand for a shake. When I made this offer, their mom was sitting in the corner of the room quietly, smiling with approval. “Since threatening you, revisiting your goals, and reminding you of the funds your parents are providing to put you through VT doesn’t seem to make a difference, let’s make it mean something. If I win, crew cuts for both of you. Deal?” Again, I extended my hand. “What if we win?” they quickly asked. “Will you run barf mountain with us?”
There is a place in Austin that these young men go to train for their athletic seasons. It’s a bluff near their school that they are required, by their respective coaches, to run up and down 10 times each morning and afternoon. The hill demands participants be in great physical shape as it is about 300 yards of a 60 degree incline. The kids affectionately refer to it as “barf mountain”, as many of them have pushed themselves to that point while training.
“Deal”, I responded. We shook hands, with their mother’s approval.
Yesterday both boys came in and they, along with their mother, were immediately pulled into another patient’s VT graduation ceremony. As is customary, the graduate was offered the opportunity to answer the “was it worth all the hard work?” question. As the graduate answered, I made eye contact with the boy’s mother. She apparently had the same thought I did. “Robert made a bet with my boys that if they don’t do their homework everyday for a month he was going to shave their heads. It worked! They’ve done it everyday this past week and I haven’t even needed to remind them!” she reported. One of her son’s quickly pointed at the calendar and chirped “barf mountain is only three weeks away. Hope you’re ready!”
Motivation can be tricky and not every attempt turns out positively. Occasionally though, if even by accident, we stumble across an idea that really catches the attention of a particular patient. These are great boys with a lot of potential and because of their current station in life, are motivated by maintaining their appearance and a little friendly sports-like competition. Luckily for me, I was able to feed into both areas simultaneously, with the support of their parents. If they do their home VT for a solid 30 days, running barf mountain is the least I can do to show them support. The point is they’re finally doing their home VT on a consistent basis. What they are not aware of is as part of my current exercise regimen, I already run the hill several times per week, so should I lose the competition “paying up” will not be as bad for me as they believe. Having them fail in VT, risking a lifetime of struggles, would be much worse than any pain caused by my running up and down a mountain with them one Saturday afternoon. They’re motivated to succeed, and we’re all winning.
There is one thing the three of us already agree on, however. “Barf Mountain” is an appropriate name…