Transcript THE PSYCHOLOGICAL IMPACT OF VISION LOSS

THE PSYCHOLOGICAL
IMPACT OF VISION LOSS
{MARGO SIEGEL, MSW
THANK YOU
 BACKGROUND
 SUMMARY OF TOPICS

INTRODUCTION




ALL PRESENTATIONS ARE SUBJECT TO BIAS AND/OR
SELECTIVE PROCESS…THIS PRESENTATION INCLUDED.
NO MATTER HOW MUCH I THINK I KNOW, SOMEONE
ALWAYS KNOWS MORE!
THIS PRESENTATION IS DESIGNED TO APPEAL TO
VARIOUS LEVELS OF EXPERIENCE AND EXPERTISE.
THIS PRESENTATION WAS DERIVED FROM YEARS OF WORK
EXPERIENCE, RESEARCH FINDINGS AND ACADEMIC
COURSEWORK AND PERSONAL OBSERVATIONS.
(RICHARD HARRIS, LICSW; NASW: RHODE ISLAND)
PRESENTATION ASSUMPTIONS,
BIASES, AND LIMITS
PARTIALLY-SIGHTED
(STABLE)
 PARTIALLY-SIGHTED
(UNSTABLE)
 CONGENITALLY BLIND

TYPES OF VISION LOSS
FROM YOUR
EXPERIENCES WORKING
WITH STUDENTS, WHICH
TYPE OF VISION LOSS
WOULD YOU BELIEVE TO
BE MOST CHALLENGING
PSYCHOLOGICALLY?
EXAMPLES
“A STRONG DISCREPANCY EMERGED BETWEEN
THOSE PATIENTS WITH DIFFERENT CLINICAL
PROGNOSES, THAT IS, BETWEEN THOSE BLIND
AND THOSE AFFECTED BY PARTIAL SIGHT LOSS.
THE PSYCHOPATHOLOGY PICTURE WAS WORSE
FOR THOSE WITH PARTIAL SIGHT LOSS WHO
DISPLAYED A MORE MARKED PRESENCE OF
DEPRESSED MOOD, ANGER, AND HOSTILITY.
CORRECTION OF GRADUALLY DETERIORATING
SIGHT SEEMED TO POSE GREATER PROBLEMS
THAN ADAPTATION TO TOTAL, DEFINITIVE LOSS”
(LEO ET.AL., 1999).
RESEARCH STATES:
REASONS:
 FEAR OF THE UNKNOWN
 VISION FLUCTUATES
 EMOTIONAL ROLLERCOASTER
PARTIALLY-SIGHTED (UNSTABLE)
“RESEARCHERS HAVE LINKED
THE RESPONSE TO BLINDNESS
TO A GRIEF REACTION, IN WHICH
PATIENTS MOURN THE LOSS OF
THE SIGHTED SELF” (LEO ET. AL.,
1999).
RESEARCH STATES:
ELISABETH KUBLER-ROSS
 5 STAGES:
 DENIAL AND ISOLATION
 ANGER
 BARGAINING
 DEPRESSION
 ACCEPTANCE
GRIEF AND LOSS
MENTAL HEALTH DISORDERS:
 ANXIETY
 DEPRESSION
 ASD
 SLEEP DISORDER
(CIRCADIAN
DYSCHRONOSIS)
DSM-IV-TR
“PEOPLE WITH VISUAL IMPAIRMENT
MAY BE ANXIOUS ABOUT THE
ATTITUDES OF OTHERS, WHETHER
NEGATIVE OR PATRONIZING, OR
AFRAID OF APPEARING CONFUSED,
ARROGANT OR UNINTERESTED IF
THEY DO NOT RESPOND
APPROPRIATELY” (FEU, 2003).
RESEARCH STATES:






EXCESSIVE WORRY
PANIC ATTACKS
OCD BEHAVIOR
IRRITABILITY
DIFFICULTY FOCUSING
SLEEP DISTURBANCE
SYMPTOMS: ANXIETY
“IT IS WELL ESTABLISHED THAT A GREATER
PROPORTION OF INDIVIDUALS WITH VISION
IMPAIRMENT EXPERIENCE DEPRESSION
THAN THOSE WITHOUT. STUDIES
CONDUCTED LARGELY IN THE U.S. HAVE
FOUND THAT UP TO A THIRD OF PEOPLE
WITH VISION IMPAIRMENT REPORT
CLINICALLY SIGNIFICANT DEPRESSIVE
SYMPTOMS” (REES ET.AL., 2010).
RESEARCH STATES:






EXTREME SADNESS
FEELINGS OF HOPELESSNESS
LACK OF INTEREST
DECLINE IN GRADES
ISOLATION
SUICIDAL IDEATION
SYMPTOMS: DEPRESSION





DIFFICULTY WITH SOCIAL
INTERACTIONS/RECIPROCITY
FAILURE TO DEVELOP PEER
RELATIONSHIPS
REPETITIVE PATTERNS OF
BEHAVIOR
LANGUAGE/COMMUNICATION
DELAYS (ONSET PRIOR TO AGE 3)
BEHAVIORAL ISSUES/AGGRESSION
SYMPTOMS: ASD





SEVERE MALADJUSTMENT OF THE
SLEEP/WAKE SCHEDULE
BRIGHT LIGHT/BIOLOGICAL CLOCK
LONGER THAN 24 HRS. SLEEP CYCLE
INTERNAL
TEMPERATURE/HORMONAL
SECRETIONS
INSOMNIA/DAYTIME SLEEPINESS
SYMPTOMS: CIRCADIAN DYSCHRONOSIS
DIFFICULT Y IN DEVELOPING SOCIAL
SKILLS:
 ATTACHMENT THEORY (JOHN
BOWLBY); INTERPERSONAL
ENVIRONMENT (SELMA FRAIBERG)
 LACK OF MIRRORING
 CHRONIC MISATTUNEMENT
 PREMATURE ISOLATION
POSSIBLE REASONS FOR MENTAL HEALTH
ISSUES IN CHILDREN WITH VISUAL
IMPAIRMENTS
LACK OF
ENVIRONMENTAL
EXPERIENCES
 PARENTAL ATTITUDE
 SOCIETAL VIEW/STIGMA

OTHER REASONS






EARLY INTERVENTION
ADVOCATE AND EDUCATE
ALLY FOR STUDENTS/FAMILIES
FOCUS ON STRENTHS
REALISTIC GOALS FOR FUTURE
PROMOTE SOCIAL SKILLS
HOW CAN YOU ASSIST STUDENTS IN
YOUR SCHOOL/CLASSROOM?
A YOUNGSTER SHOULD BE
REFERRED FOR PRIVATE
THERAPY/COUNSELING
WHEN SYMPTOMS
CONSISTENTLY INTERFERE
WITH DAILY FUNCTIONING.
WHEN TO REFER?
CLINICAL THERAPISTS:
 SOCIAL WORKERS
(MSW)
 PSYCHOLOGISTS (PhD)
 PSYCHIATRISTS
WHO CAN PROVIDE MENTAL
HEALTH SERVICES?
COGNITIVE BEHAVIORAL
THERAPY (CBT)
 SOLUTION FOCUSED
THERAPY (FAMILY)
 PSYCHODYNAMIC
PSYCHOTHERAPY

THERAPEUTIC APPROACHES
INDIVIDUAL (ONE ON
ONE)
 FAMILY
 SUPPORT GROUPS
(STUDENTS, PARENTS)

TYPES OF THERAPY
“I AM VERY CONFUSED BECAUSE SOMETIMES I
WILL BE TALKING WITH SOMEONE ABOUT
SOMETHING I AM VERY INTERESTED IN AND
THEY’LL GET THE IDEA THAT I AM TOTALLY
BORED. IN FACT, ONCE, WHEN I WAS TAKING A
CLASS, MY TEACHER THOUGHT I FELL ASLEEP
WHEN I WAS REALLY AWAKE AND LISTENING
RATHER CAREFULLY…I DON’T HAVE MANY
FRIENDS AND SOMETIMES I WONDER ABOUT
THIS AND WHY I AM ALWAYS SO
MISUNDERSTOOD. I WOULD LIKE TO LEARN IN
THERAPY HOW TO EXPRESS MYSELF BETTER SO
PEOPLE DON’T CONTINUE TO MISUNDERSTAND
ME” (JEPSON, 2004).
RESEARCH QUOTE:
QUESTIONS AND
DISCUSSION
IT’S YOUR TURN!
AMERICAN PSYCHIATRIC ASSOCIATION . (2000).
DIAGNOSTIC AND STATISTICAL MANUAL OF
MENTAL DISORDERS, FOURTH ED., TEXT REVISION
WASHINGTON D.C.: APA.
CARVIL, S. (2001). SENSORY IMPAIRMENTS,
INTELLECTUAL DISABILITY AND PSYCHIATRY.
JOURNAL OF INTELLECTUAL DISABILITY
RESEARCH, 45 (6), 467-483.
REFERENCES
CARVILL, S. (2001). SENSORY IMPAIRMENTS,
INTELLECTUAL DISABILITY AND PSYCHIATRY.
JOURNAL OF INTELLECTUAL DISABILITY
RESEARCH, 45(6), 467-483.
COOPER M., & LESSER, J. (2011). CLINICAL SOCIAL
WORK PRACTICE: AN INTEGRATED APPROACH.
BOSTON, MA: PEARSON.
FEU, M. & FERGUSSON, K. (2003). SENSORY
IMPAIRMENT AND MENTAL HEALTH. ADVANCES
IN PSYCHIATRIC TREATMENT, 9, 95-103
GREENSPAN, S. & WIEDER, S. (1998). THE CHILD
WITH SPECIAL NEEDS. DECAPO PRESS.
HARRIS, R. (2013). PRESENTATION: WORKING WITH
FAMILIES WHO HAVE A CHILD OR PARENT WITH A
DISABILITY. RHODE ISLAND: NASW.
JEPSON, L. (2004). FINDING THE PAPER CLIP:
MAINTAINING CONNECTION WITH CONGENITALLY
BLIND CHILDREN. JOURNAL OF INFANT, CHILD &
ADOLESCENT PSYCHOTHERAPY, 3, 509-528.
KUBLER-ROSS, E. (1969). ON DEATH AND DYING.
NEW YORK: NY, COLLIER-MACMILLAN.
LANGDELL, C., & LANGDELL, T. (2011). COPING WITH
VISION LOSS: UNDERSTANDING THE
PSYCHOLOGICAL, SOCIAL, AND SPIRITUAL EFFECT
SANTA BARBARA, CA: PRAEGER
LEGER, D., GUILLEMINAULT, C., DEFRANCE, R.,
DOMONTS, A., PAILLARD, M. (1999). PREVALENCE
OF SLEEP/WAKE DISORDERS IN PERSONS WITH
BLINDNESS. CLINICAL SCIENCE, 97, 193-199.
LEO, D., HICKEY, P., MENEGHEL,G., CANTOR,
C., FRANZP. (1999). BLINDNESS, FEAR OF
SIGHT LOSS, AND SUICIDE.
PSYCHOSOMOTICS, 40(4), 339-344.
MEFSON, L. , DORTA, K., MOREAU, D.,
WEISSMAN, M (2004). INTERPERSONAL
PSYCHOTHERAPY FOR DEPRESSED
ADOLESCENTS. NEW YORK, NY:
GUILFORD PRESS.
NOVICK, K. & NOVICK, J. (2005). WORKING
WITH PARENTS MAKE THERAPY WORK.
LANHAM, MD: ARONSON, ROWMAN & LITTLEFIELD.
REES, G., TEE, H., MARELLA, M., FENWICK,
E., DIRANI, M., LAMOUREUX, E. (2010).
VISION-SPECIFIC DISTRESS AND
DEPRESSIVE SYMPTOMS IN PEOPLE WITH
VISION IMPAIRMENT. INVESTIGATIVE
OPHTHALMOLOGY AND VISUAL SCIENCE, 51(6),
2891-2895.
SACKS, S., WOLFFE, K. (2006). TEACHING
SOCIAL SKILLS TO STUDENTS WITH VISUAL
IMPAIRMENTS. NEW YORK, NY: AFB PRESS.
SPENCER, E., DUPONT, R., DUPONT, C. (2003)
THE ANXIETY CURE FOR KIDS. HOBOKEN, NJ:
WILEY & SONS, INC.
TUTTLE, D., TUTTLE, N. (2004). SELF-ESTEEM
AND ADJUSTING WITH BLINDNESS, THIRD
ED., SPRINGFIELD, IL: CHARLES C. THOMAS.



EIGHTY PERCENT OF WHAT CHILDREN LEARN IS
FROM VISUAL SOURCES.
IT IS IMPORTANT TO PRE-TEACH CONCEPTS AND
ROLE-PLAY FOR COMPREHENSION; OBSERVE
DEVELOPMENTAL BEHAVIORS OF SIGHTED
CHILDREN AND THEN ASSESS SKILLS OF CHILD
WITH BLINDNESS.
ALWAYS PROVIDE DESCRIPTIONS OF NON-VERBAL
CUES; TEACH CHILD WITH BLINDNESS TO
ADVOCATE AND ASK QUESITONS FOR
CLARIFICATION; TEACH SIGHTED PEERS/ADULTS
THE CORRECT WAY TO PROVIDE INFORMATION
(E.G., ALLOW THE BLIND CHILD TO HOLD THE DOLL;
NOT JUST DESCRIBE IT).
ADDENDUM: TEACHING SOCIAL SKILLS TO CHILDREN
WITH VISUAL IMPAIRMENTS (WWW.PERKINS.ORG, 2011).


INDEPENDENCE WILL ONLY OCCUR BY
PROVIDING THE BLIND CHILD WITH MANY
SOCIAL OPPORTUNITIES; DON’T ISOLATE
WITHIN THE CLASSROOM OR HOME
ENVIRONMENTS; GO OUT INTO TH E
COMMUNITY AND TALK TO PEOPLE TO INSTILL
CONFIDENCE.
THE VISUALLY IMPAIRED CHILD NEEDS TO
TAKE RISKS; INTERACT WITH MANY TEACHERS
AND PEERS; NOT JUST ONE
PARAPROFESSIONAL; MANY NEIGHBORS AND
FAMILY MEMBERS.


THERE IS ACCESS TO SOCIAL LEARNING IN
DAILY LIFE; TAKE ADVANTAGE OF ALL
ACTIVITIES.
“HANDS BECOME EYE.” PERMIT HANDS-ON
EXPLORATION OF NEW
SURROUNDINGS/INCLUDING FACES TO
MATCH VOICES.


SOCIAL SKILLS PRACTICE PROMOTES SELFCONFIDENCE AND SELF-RESPECT. BEING
ACTIVE IN LIFE AND TAKING RISKS
PREPARES THE CHILD FOR HER FUTURE
LIFE.
IT IS CRUCIAL THAT BLIND CHILDREN HAVE
AVAILABILITY TO POSITIVE ADULT ROLE
MODELS WHO ARE ALSO BLIND OR
VISUALLY IMPAIRED WHENEVER POSSIBLE.
HOLBROOK, M. (2006). CHILDREN WITH VISUAL
IMPAIRMENTS: A PARENTS’ GUIDE.
BETHESDA, MD: WOODBINE HOUSE, INC.
LENNOX, T. (2012). LIVING FULLY WITH LOW
VISION AND BLINDNESS. TRAFFORD
PUBLISHING.
ADDITIONAL READING
MAGEE, B., & MILLIGAN, M. (1995). ON
BLINDNESS. NEW YORK, NY: OXFORD PRESS.
MARTIN, H. (1996). WHAT BLIND PEOPLE WISH
SIGHTED PEOPLE KNEW ABOUT BLINDNESS!
ORLANDO, FL: MARTIN PUBLISHING.
RUBIN, L. (2012). DO YOU DREAM IN COLOR?
INSIGHTS FROM A GIRL WITHOUT SIGHT .
NEW YORK, NY: SEVEN STORIES PRESS.
RUBIN, L. (2003). THE MAN WITH THE
BEAUTIFUL VOICE. BOSTON, MA: BEACON
PRESS.
SACKS, S., KEKELIS, L., GAYLORD-ROSS, R.
(1997). THE DEVELOPMENT OF SOCIAL SKILLS
BY BLIND AND VISUALLY IMPAIRED
STUDENTS. NEW YORK, NY: AFB PRESS.
SPUNGIN, S. (2002). WHEN YOU HAVE A
VISUALLY IMPAIRED STUDENT IN YOUR
CLASSROOM. NEW YORK, NY: AFB PRESS.