Managing Your VT Room – Part 4 – Failure Has To Be An Option

If there’s one area where most Vision Therapists fall short, me included, it’s probably in the “give yourself a break” arena. We all want to do well, we all want our patients to do well, we all want our sessions to go well, and all want our patients to feel good about VT when all is said and done. If only we had that kind of luck.  Before you beat yourself up too much, remember my worst session ever involved an 8 year old boy throwing equipment at my head, screaming expletives as he ran out of the office, and then darting across 4 lanes of traffic before I even realized what was going on. Forget getting fired, that morning I was pretty sure my day was going to end in an orange jumpsuit and handcuffs. Lucky for me, things worked out thanks to this young man’s savvy mother who happened to be in the parking lot as her son darted. The silver lining here is his eruption helped mom to understand her son’s inner strife, and she was able to address it directly with a child psychologist. Although this occurred several years ago, I still keep in touch with their family, and my young friend is off to college in the fall. All is well.

As I wrote the above paragraph, I was reminded of something which applies greatly to this post…

Dr. Bob Sanet has taught me many lessons, and to qualify one as more important that another is not always easy; however, there is one life lesson he offered not long before I left San Diego which continues to resonate above most others. Simply put, life experience, just like a good VT session, is a series of assessments and course corrections; “treat life like a VT session” Dr. Sanet would tell me. In my world, this means if you don’t like what’s going on, assess what is working and what isn’t, and then change the process to bring the outcome the desired place. It sounds simple, and to some people it may be innate, but for me, absorbing and implementing this thought process was a both a challenge and blessing.  The point being we need to stay in the process, constantly. Keep that mind.

9 Minutes

There’s an entire population of patients who I affectionately refer to as the “9 minute crowd”.  The thought process being I’m usually about 9 minutes into a VT session when I realize nothing I’ve prepared is going to work today and I need to improvise, and fast.  Sometimes this is due to poor behavior (ever encountered a kid who had to leave summer camp to attend VT? Spoiler alert – you’re not their friend), sometimes it’s an adult who is fatigued and/or visually exhausted after work, and sometimes it’s just an anomaly.  People have bad days. So what do we do? We’ve prepared our session well, we’ve gathered all the necessary equipment, we’ve reviewed needed concepts with our doctor, and now 9 minutes in we realize none of it will work today. What do we do? My favorite example of a 9 minute patient is a little 6 year old boy who comes to see me who has been diagnosed with Down Syndrome. I’ve known him since he was 1 1/2 years old and if I was ever to openly admit loving one of my patients, he would be the one. He’s adorable, he’s non-verbal, and most days he is in charge. I can prepare all week for his visit (and sometimes I do) and 9 minutes in we’ve burned through the 6 or 7 activites I’ve prepared, or he’s thrown them all across the room in disgust, and we’re off into uncharted territory. Now what?

Since I’m writing about it, you’re probably thinking I’ve discovered some hardened fast solution to bypass the bad VT sessions, or perhaps after 17 years in the VT room I’ve learned to avoid these situations. You’re probably thinking I’m about to give a “guaranteed to work” solution.

Well, you’d be wrong.

What I have discovered, and what I’m hoping to share, are strategies I’ve tried for managing those bad sessions more effectively. So in no particular order, here goes:

  • Learn to Transition – If there’s ever a time in which you’ll lose a patient’s attention or even the momentum of a VT session, it’s while transitioning from one activity to another.  We’re cleaning up blocks, we’re cleaning up blocks,  we’re cleaning up blocks, we’re cleaning up blocks…I’m grabbing the Clown vectogram and sliding it into the Vecto stand, and voila, my patient is looking out the window, disturbing another patient, pulling out their favorite board game, or sniffing the treasure box. “Ready to look at the Clown?” Uh…no. We spend the next 10 minutes getting back on task. One strategy I try to employ is to always have a few quick and fun activities ready to go (of course, these are relative to each patient) to keep the patient’s attention while we transition to the more involved areas.  As an example, the Wayne Saccadic Fixator, which requires little to no therapist interaction, can be completed by the patient while the therapist sets up a vectogram.  The idea is to keep the patient engaged continually, even if you travel “off the beaten path” for a moment.
  • Buy a Trampoline – I love our trampoline. In fact, the more I learn to manage the challenging sessions, the greater affection I have for our trampoline. My reasoning is simple; it changes the channel. Picture this, you’re in a session with a young patient who quite clearly has no interest in cooperating – “you’re stupid, this is boring, I hate it here” – one of those sessions. Conventional wisdom tells us 99 times out of 100 the feedback to such behavior is going to be negative and the downward spiral will begin. Try something different. Be the 100th caller. Change the channel. Buy a trampoline. “Seems like you’re having a bad day. Want to jump for a few minutes and forget about this stuff?” I cannot tell you how many sessions were headed south and with this one simple maneuever, we were back on track.  You’d be amazed at how 3 minutes of mindless jumping can change a patient’s willingness to participate.
  • Employ a Good Cop – If you’re lucky enough to work in an office with more than one therapist, work this one out ahead of time, because someday you’ll need it.  Come up with a code word, code phrase, as some kind of indicator that there’s trouble in Denmark. The move is very simple, and usually quite effective – switching patients on the fly. In our office we don’t have a code word for this; rather, we have an understanding that at any given moment, any therapist may ask if their patient can join an activity with a different therapist.  Sometimes this leads to a few moments of a group activity (2 patients and 2 therapists) and sometimes we will just switch patients. Again, this tactic is utilized to try to change the channel away from the negative and into a more positive light. Sometimes giving a patient the “fresh start” with a new face is just what they need to rally and steer the session back into productivity.
  • Fail Forward – If you want to be a good therapist, you’re going to fail here and there. It’s the way it goes. There will be tough VT sessions similar to tough days in life. It’s just the way life is sometimes, and it’s the way VT goes, but it’s not the end of the world. Always remember becoming a good therapist is about taking a risk and putting yourself out there. Learn to reject rejection. Take responsibility for your work. Take it seriously and never personally.  Failure is temporary, should not permeate outside of the now, and applies mostly to isolate incidents. Keep your expectations of yourself realistic, focus on your strengths, and get good at varying your approach. Don’t ever forget achievers learn to bounce back, because every setback is an opportunity for a comeback. Embrace those moments where things turn out poorly, learn from them. Be better, smarter, and stronger next time.

We’re all going to have bad sessions, it’s just a bi-product of working with people. Sometimes no matter how much you prepare, no matter which strategies you employ, no matter how good a relationship you may have built with a patient, some sessions will go poorly.  There’s no getting around it. If all else fails, please remind yourself the sun will come up tomorrow, and next week when the patient arrives, you get to try again.

Stay in the process.


Posted on July 7, 2016, in From My Perspective.... Bookmark the permalink. 5 Comments.

  1. You are talented beyond measure! Well said! Thanks! I’m planning to quote you: “Every setback is an opportunity for a comeback!” Is that ok?


    • Robert Nurisio COVT

      Thank you for the kind words. Feel free to use the line, although it’s doubtful it’s an original, so no need to give me credit. Surely, I heard it or stole it from someone somewhere 😉


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