Managing Your VT Room – Part 1 – An Ounce Of Prevention

One question which seems to surface from time to time in my world revolves around managing VT sessions; or perhaps put a better way, strategizing a session from start to finish. Ideas, such as which activity to start with, which to end with, and how to transition from one to the next. Questions, like how to manage an obstinate patient, what to do if you realize you’ve made a mistake, and how to know when a patient is being completely truthful, are all valid thoughts to ponder. Mindsets, like how well a therapist and patient work together, this patient requires a lot of behavior management, or this patient can be inapproriate, are all places you’ll need to be comfortable with.  So, over the next several days I’ll be moving away from the “nuts and bolts” of Vision Therapy, and will be discussing my approach to managing the intangibles, the variables, and the ambiguities of a VT session.

Prepare Your Ass Off

Benjamin Franklin once wrote “an ounce of prevention is worth a pound of cure“, and last time I checked, ol’ Ben was a pretty accomplished fellow.  Which means Ben’s words, when applied to a VT session, can only take on one meaning – know who’s coming through the door before they arrive. If you do this, you’ll greatly increase your chances of a positive session. Even if you see the same patients every week, even if you’ve known the patient for years, even if you happen to see your patients in public somewhere and they told you their entire life story, you still need to prepare. For those who have gone through the COVT process, or who are considering the COVT process, you spend months and months learning about VT, writing and re-writing OBQ’s, taking a written test, discussing VT with your cohorts, and still I would bet every dollar I have that you spend every last minute preparing for the oral examination right up to the moment where it’s time to get dressed the day of.


Because you’re in front of the examination board and you want to do a good job. You want to sound intelligent. You want to be accepted as a knowledgeable source in the world of Vision Therapy, and you want people to know that you’ve taken it upon yourself to understand your craft well.

Allow me to let you in on a little secret – you have that same opportunity during every Vision Therapy you conduct.  The game is the same, but the stakes are much higher. Think about it…

When in front of a patient or parent, most of us want to do a good job. We want to sound intelligent. We want to be accepted as a knowledgeable source in the world of Vision Therapy, and we want people to know that we’ve taken it upon ourselves to understand our craft well.

If you screw up in front of the exam board, most likely you’ll get called back to clarify a few things and you’ll be fine. But what happens if you screw up in front of a patient? Would it be embarrassing? Would they complain to the doctor? Might they begin to think you don’t really know what you’re doing? Is there a chance they’d seek out a different office after a few too many mishaps? Are there real life consequences to deal with?

Suddenly that COVT oral examination seems easy.

So how should you prepare? Here’s some steps I often take when beginning a new patient:

  • Read the patient history! It’s a goldmine of information which offers details about the patient’s visual system, compensations, lifestyle, behaviors, and external factors which might affect the dynamics of their VT sessions. And I’m not too proud to admit, I learned this one the hard way. Although many doctors and therapists I’ve worked with tried to pound this into my hard head, it wasn’t until the day about 8 years ago when I asked a young boy during an orientation “where his dad worked?” that I finally realized the importance of knowing the history of a patient. His dad had died of cancer the month before. If I had only read the patient history, there it was, plain as day.
  • Ask questions of those around you! I have been a Vision Therapist for almost 17 years, I received the Vision Therapist of the Year award in 2013, I currently manage 7 other Vision Therapists in two offices, and I promise you there are VT meetings where I drive my doctor absolutely nuts with numerous questions about a confusing patient.  The latest example was when she asked me to “try binocular prism rotations to counteract a cyclotorsional inadequacy”.  I had never done (or even considered) binocular prism rotations, and to be honest, I thought she made a mistake. Why would you rotate prisms binocularly? But then I asked the doctor, and suddenly it made sense why with the particular patient, an attenpted binocular prism rotation might work. My point is, there’s no excuse for not asking. Do you want to know what makes my VT heros the great therapists that they are? They’re still learning, they’re asking questions, and they’ve been around a lot longer than me and I promise you they have forgotten more about VT than I’ll ever squeeze in my brain.
  • Clean your room! If my mom ever stumbles upon this post, guaranteed she’ll fall off her chair when she reads that first sentence. Cleaning my room was the bane of existence as a child. But in all honesty, a clean VT room makes for a productive session in the same way good notetaking makes for good patient care. Keeping your VT room tidy is easy, it will save time as you transition from activity to activity, and it will spare you from having the “where the heck are the…” look on your face in front of a patient.
  • Get your head right! Whatever you may have going on outside the office, be it postitive or negative, leave it outside. You’re not at work to solve your own problems or to brag on your likes and dislikes to co-workers. You’re there to help patients, period. Find a way to compartmentalize your personal life and set it aside for the next 8 hours. Prepare to get in the moment with your patients, and stay in the moment until the day is done.

This is a good start. Happy Preparing!

More to come…


Posted on June 21, 2016, in From My Perspective.... Bookmark the permalink. Leave a comment.

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