Vision Impairment | Chapter 7: Counseling

The first student characteristic to be considered is developmental stage. This issue is especially important if you are counseling the child individually since you will not see peer interactions in your office. The youngster with vision impairment has most likely spent more time alone in passive activities than same-age peers (Wolffe & Sacks, 1997). Children with vision impairments have fewer friends (Kef, 1997; Hurree & Aro, 1998) and may not have had the opportunities to develop appropriate social skills. In working with teenagers, it is important to note that individuals with vision impairments may need more support with some key developmental psychosocial tasks (Hurre & Aro, 1998). Bodily attractiveness is a central concern of teens during their sexual development. The teen with vision impairment may not have an accurate or positive concept of personal physical presence. A second important theme during adolescence is the struggle for independence. The teen with vision impairment has an additional struggle since some dependency upon others will most likely always be necessary. Analyzing how to ask for assistance when needed and ways to develop independent functioning are unique challenges. A third especially difficult area for the adolescent is coping with the need to “fit in” and not call attention to oneself in ways that are odd or outside the acceptable norms. Again, the necessity for some assistance may make the teen uncomfortable and lower self-esteem.

Suggestions:

• Group counseling is especially good for teaching social skills. Since you most likely won’t have enough students with vision impairments to create an entire group, select those with comparable levels of maturity but perhaps different needs in the area of skill development.
• It is important to have the teen focus on areas in which control has already been established. Encourage the student to make decisions about how necessary assistance is to be provided. Work out situations ahead of time so the student does not have to re-negotiate each request. For example, arrange special seating before classes begin. If a buddy is needed for physical education, make certain that this has been taken care of before the student starts class. Work with the Orientation and Mobility instructor to provide the student with sufficient time to learn new routes required by schedule changes. Role playing is especially helpful since the anticipation of new situations can cause a great deal of anxiety.
• Since appearance is of such importance during adolescence, provide opportunities for the teen with a vision impairment to talk with a trusted hair stylist, cosmetologist (for girls), and fashion adviser. The teen should be able to dictate personal style, but a good counselor can encourage and facilitate optimum results within these parameters.

Individuals with vision impairments, especially those who have been blind since birth or infancy, have a tendency to develop repetitive self-stimulating movements. These behaviors might include rocking, spinning, head-wagging or weaving, hand clapping, rolling the eyes back, or light-gazing (Brame, Martin, & Martin, 1998). Historically, there are many factors that have been proposed as contributors to the persistence of these “blindisms.” These include boredom (Warren, 1994; Troester, Bambring, & Beelmann, 1991) and communication problems (Bak, 1999).   In a comprehensive review of the research on stereotypic rocking, McHugh and Lieberman (2003) found this behavior to be persistent and chronic in many children, although it declines with maturation in others. Considering the negative effect attention to these behaviors may have on children, these authors question the wisdom of devoting energy to attempting to change some of these “blindisms”.  In another research review, DeMario and Crowley (1994) found that increased focus on students’ positive behaviors in general is an effective way to reduce activities considered to be negative.

Suggestions:

• During counseling sessions, as in the classroom, use distraction whenever possible to focus the child on more goal-oriented tasks.  A simple re-direction to bring the student’s attention back to a discussion or activity can be accomplished by a question such as, “What do you think about Joe’s comment?” or by handing a smaller child a crayon to encourage completion of a drawing.
• Make sure the student is appropriately challenged in the activities planned. A review of the child’s educational records, teacher interviews, and classroom observations can give you a good idea of abilities and interests.
• Give the child simple verbal feedback about inappropriate mannerisms.
• With older children, direct instruction in socially appropriate behaviors is effective. Help students find ways to interrupt the mannerism when they notice themselves engaging in a blindism.”
• Pay attention to when “blindisms” occur in your counseling sessions as they may indicate discomfort or anxiety around a topic.
• Evaluate whether these behaviors are interfering with important aspects of the child’s life.  If they are not, ignore these “blindisms” and encourage others to do the same (McHugh & Lieberman, 2003).

Remember the student with a vision impairment will need to be orientated to others in the room and will need lots of verbal cues during discussions.

Suggestions:

• Introduce yourself and anyone else in the room. If you are conducting group counseling, be sure to say the person’s name before continuing the discussion.
• Be descriptive of others in the group to give the student with a vision impairment cues. For example, “Joe, you look angry about Martha’s comment.”
• Be careful with any of your non-verbal indicators. The student with vision impairment may be exquisitely attuned to differences in breathing, shifting in your chair, or general restlessness.
• Do not be overly concerned with the student with vision impairment’s lack of emotional indicators in facial expressions. Without the ability to observe others, these may not be well-developed. Watch body language and especially hand and finger movements for emotional reactions (Murphy & Dillon, 2003).

The vision impairment itself may or may not be the focus of counseling. Remember students with vision impairments have all the problems and concerns of others at their level of development.

There are many expressions that use “blindness” or “sight” as metaphors. For example, “Do you see what I mean?” Do not worry if you use these expressions (Olkin, 1999).

Suggestions:

• If appropriate, ask about the vision impairment; however, keep a realistic perspective. For example, if a youngster expresses frustration with not being able to keep up with assignments, it would be logical to ask if difficulties with vision are affecting productivity. However, do not make the assumption that this is the only problem.  Disorganization, poor time management or even ineffective classroom instruction may be the most important factors.
• Unless there is a relevant reason (e.g., to use their help in accessing a service), do not tell about others you know who have this disability (Olkin, 1999).

• Help the student learn to explain the disability and needs in a clear, straight-forward way, since this will enable productive engagement with others (Yuker, 1994).

There are many expressions that use “blindness” or “sight” as metaphors. For example, “Do you see what I mean?” Do not worry if you use these expressions (Olkin, 1999).

The school is the larger system that needs to be involved in assuring a positive experience for the student with vision impairment.  The climate of this environment can have a tremendous impact on the student’s attitude and adjustment, also providing an opportunity for students without disabilities to develop an appreciation of commonalities despite differences.

Suggestions:

• As a counselor in the school environment, you are in a unique position to foster relationships among students.  Create opportunities for all students to work together outside the classroom. Invite students with vision impairments to work on projects with other students, assigning tasks with which they feel comfortable, so you can promote a sense of collaboration.
• Provide opportunities for the student with vision impairment to talk about personal experiences in a small group so that others can understand both the uniqueness and similarities of struggles and needs.
• Establish a group for students with disabilities who are functioning at similar cognitive levels to provide a sense of support. The student with a disability needs to be aware of membership in the larger community of the school but also able to share common experiences with others (Olkin, 1999).
• Provide information to the family and student about groups within the immediate area as well as the state and nation that are concerned with issues of individuals with vision impairments.  Again, it is important for the student and the