The Role of the Therapist in Vision Therapy: Part 3

 Part 2 of this series emphasized the contributions that adult patients make in giving psychological depth and significance to what they are undertaking when they walk through our doors, and when they leave.  I’ve highlighted some of this previously and adult VT patients such as Susanna Zaraysky, Pam Kohn, and Greg Voth have added further dimensions to these considerations in Sovoto.

As you continue to listen to your patients, and see through the eyes of other patients as they comment publicly on their own blogs or in forums such as Sovoto, return to some of the classics you may have read such as Fixing My Gaze.  To the left is a sketch for the cover of FMG that didn’t make the final cut, and it depicts the idea of physiological diplopia.  In contrast the final cover conveys more of a sense of flux and transition within discovery.   Consider for example chapter 9, Vision and Revision:

“With the sight of the occluder, I felt myself slip back in time, back to being the little cross-eyed girl in my eye surgeon’s office.  The doctor was waving the occluder in front of my face and asking me to focus at a point a short distance away.  I felt naked and exposed, powerless and confused.  Dr. Ruggiero moved the occluder in front of one eye then the other.  ‘What is this?’ she asked.  ‘Your left eye turned in and just sat by your nose.  I haven’t seen this behavior since you started vision therapy.’  I told her that thoughts of my father and the standard eye alignment test had taken me back to my childhood.  Could she do the test again?  Dr. Ruggiero repeated the test, and with a determined effort, I brought myself back to the present.  This time, my eyes remained straight.  This experience both intrigued and frightened me.  I learned that I actually had two ways of seeing.  I saw with stereopsis almost all the time, but I could revert to my old strabismic ways under stressful conditions.  My experiences with vision therapy had already taught me that we can’t understand vision without making connections between sight, spatial orientation, and movement.  Now I discovered that we can’t understand how we perceive the world and how we adapt and learn without considering the whole person – the thinking, moving, and feeling person.”

Wow.  I’m tempted to leave this part at that, because it still gives me chills (in a good way) each time I read it.  This feeling of being able to share critical empathy with the patient, to be an effective guide, to modify and suggest and counsel but above all to listen mindfully and be present during the entire therapy session is a huge challenge for a therapist.  It is something that someone who is a new vision therapist would, understandably, find difficult to grasp, yet it is an essential skill set to develop.

At times it is possible to explore these changes with patients in a group setting, though at other times it would seem crucial to have the give-and-take that one-on-one exploration affords.  Nor by emphasizing the insights from adult strabismic patients should it be inferred that a therapist can’t glean powerful observations through younger patients or, in many instances from parents such as Stella’s mother.


Among the valuable resources listed in the COVD Candidate’s Guide when an OVT is preparing for COVT certifcation is the Sanet Volumes authored by Linda Sanet, COVT, available through OEP.  If you haven’t taken a look at it recently, the role of the therapist in vision therapy dovetails quite nicely with our discussions thus far, particularly through  The Why of Vision TherapyPiagetian Theory, and Chataquah.

– Leonard. J. Press, O.D., FCOVD, FAAO




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