Psychosocial Aspects of the Adjustment Process
Adjusting to vision loss is a sequential process, which follows the
same pattern as that of adjusting to any of life's many traumas or crises.
Although there is much more involved when adjusting to vision loss, the
Office for the Blind and Visually Impaired (OBVI) would like to provide a simplified explanation based
on phases and explain the role of our staff.
Consumers may move through these phases quickly, slowly, or even get
hung up in one of them. Each individual moves at their own pace, and may
move forward one day and be set back another.
Our role as professionals is not only to provide technical skills that
accommodate for their vision loss, but also to facilitate them through
these phases of adjustment.
The following is a brief outline of generalized phases, based on Dr.
Tuttle's research on self-esteem and adjusting to blindness, and what our
role or response might be.
All of the staff with OBVI is equally
important in how they interact while an individual is going through the
process. Often, the critical element of a person's adjustment and how they
see themselves is the way someone interacted with them.
This includes the Rehab Specialists, Associates, Drivers and
Volunteers, or anyone else. Please remember that all are important.
Phase one: Trauma, or the "what hit me?" phase. This
phase is influenced by the individual's age, their life experiences, how
they perceive themselves, and the strength of their self-esteem.
The role of professionals: The news
of a vision loss has already been shared with the consumers, and we seldom
see individuals at this level.
Our role is not to take away hope, however, but to verify the vision
loss with kind and gentle understanding, with direct and simple frankness,
and without pity or condescension.
Phase Two: Shock and Denial. The shock reaction is healthy and
normal. It shields the individual from being suddenly overwhelmed by the
full impact of trauma.
This phase can be expressed as "this is not happening to me"
or by what has been described as a "mental numbness." This can
also be followed by the belief that an unrealistic miracle, a
medical procedure, or some new scientific discovery will restore vision.
"Hope for recovery is a very important therapeutic tool in all
other aspects of medicine, but can be a major deterrent to the adjustment
to blindness process" (Cholden, 1958, p. 23). We may see individuals
in this phase, looking for something that will allow them to see again.
The role of professionals: To interact with individuals in this
phase, the OBVI staff should simply make themselves available, provide physical
comfort, emotional support, and understanding. At this phase we should not
take away hope.
Patiently listening will help. Information should be factual and stated
in terms the individual will understand. Expect a great deal of
frustration during this phase.
Phase Three: Mourning and Withdrawal. During this time, an
individual may have the feeling that all is lost. Morning is a feeling of
being sad or sorry for a perceived loss of adequacy, self-esteem,
equality, belongingness, or control.
Expressions of hostility and anger are also common during the mourning
phase. This may be constant irritability or as an occasional sudden
Another common phenomenon during this phase is withdrawal or puling
back from contact with the physical or social world. Some withdrawal is
Unfortunately, withdrawal can become one's habitual manner of coping
(Schulz, 1980). Extreme withdrawal and self-imposed isolation are
unnatural and unhealthy.
The role of the professionals: During the mourning phase, part
of the role of the professional is being a good, discerning listener.
Continue to provide physical comfort, emotional support, and
understanding. Individuals may feel incompetent and inadequate during this
As a staff, we can counteract these feelings by providing easily
mastered practical solutions to personal and social problems. Keep in mind
however; some individuals during the mourning phase will resent the
well-intentioned encouraging remarks from sighted people.
The individual is not yet ready for lectures on the need for
rehabilitation, or advice about how lucky they are, or for sermons about
the many other successful people who happen to be visually impaired.
Answer questions with direct and simple frankness,
Phase Four: Succumbing and Depression. The "I can't"
phase. Some individuals describe this as "giving in" because of
their real or perceived loss of personal freedom or independence.
The areas of loss vary, but typically include a loss of: income, travel
(in particular is the ability to drive), recreational activities, social
Depression can also be described as "the D's." This includes
despair, discouragement, disinterest, distress, despondency, and
disenchantment. Depression may be a common fact of life, however, serious
and prolonged depression is not.
With support from staff, family, and friends the depressive states
become less intense and less frequent. The individual at risk, however, is
one without a support system and is left to deal with bouts of severe
Intense despair, despondency, and hopelessness may lead to suicidal
thoughts (Hicks, 1979), although most suicidal thoughts and death wishes
soon disappear (Fitzgerald, 1970).
The role of the professional: Much of the same approach
initiated during the Mourning phase will need to be continued. The
individual remains in urgent need of emotional support and understanding.
Expressions of resentment, frustrations, and hostility will be common.
(Note: family members who are providing much of the needed support and
understanding will often not be able to comprehend just why they have
become the targets of this hostility and resentment. Share with them your
Negativism and depression have a way of perpetuating themselves.
Redirect thought patterns onto the good and positive and redirect mental
energies toward setting realistic goals, developing social contacts, and
other appropriate activities.
Phase Five: Reassessment and Reaffirmation. The "Life is
still worth living" phase. This phase is sometimes called "the
turning point." This re-evaluation can lead to a reaffirmation of
life and its possibilities.
One of the issues to be resolved during this phase is the question of
self-identity. If an individual attempts to function "as if"
they could see, they will continue to experience uncomfortable
discrepancies in life.
This "denial can also take a passive form in which the individual
verbalizes acceptance of the vision loss but does nothing to adjust to
it" (Dover, 1959, p. 336).
A much more positive situation arises when the individual recognizes
themselves as essentially the same person as before the trauma with the
majority of personal attributes intact.
They realize, however, that they have to deal with things differently
now. The reassessment phase also involves the process of determining the
individual's strengths and limitations.
The role of the professional: The support network of family and
professionals continues to play an important part during the reassessment
and reaffirmation phase. The professional has the responsibility to help
foster a positive frame of mind.
Encouraging a positive outlook can be accomplished by setting a
positive example and through discussion, as well as allowing the
individual to experience success in training.
With respect to the reality of blindness and its implications, all
staff must provide frank, factual information about the person's condition
and prognosis when asked. The fact of vision loss has to be confronted and
accepted before any further adjusting can occur.
This one aspect of providing realistic feedback must be done without
any hint of patronizing or condescension. The staff can:
- assist the individual to cope with their social and physical
environment (or, where necessary to restructure it),
- help establish realistic attainable goals, gain insights into their
own strengths and desires,
- clarify attitudes and feelings, and
- help determine the motivational factors that contribute to the
Providing realistic feedback without patronizing or condescension is
the key. (Discuss individual consumers you have concerns about with your
Rehab Specialist or Field Supervisor)
Phase Six: Coping and Mobilization. The "I can" or the
"Some things I do in a different way" phase. Coping refers to
the process of learning to manage the demands of one's physical and social
Learning new skills and developing resources. People in the coping
phase frequently comment that they feel self-conscious in public. This
phase is where all of us as a staff can have the most effect on our
consumers by being encouraging and supportive.
Emphasis is on ability, and the individual should be encouraged to take
an active part in planning any activity they participate in. A little
confidence gained from a successful experience has a way of generating
even more confidence.
The role of the professional: Our role in the coping phase is to
facilitate the development of appropriate adjustment behaviors and
attitudes. This is when the consumers do best in the rehab process.
According to Dr. Tuttle: accurate information about vision loss and its
implications MUST be available.
Second, a sequential program to teach the adaptive skills is required
And third, fostering the development of healthy attitudes and feelings
toward the vision loss, self, and others is vital. When interacting with
consumers, please remember that:
- Consumers may demonstrate a fear of failure and need our support.
- There will be periodic reappearances of anger and frustrations.
- And the staff need to encourage the three components of the
- the knowledge of coping - cognitive
- the behavior of coping - action
- the feeling of coping - affective
Phase Seven: Self-Acceptance and Self-Esteem. The "I like
me" and the "I am somebody" phase. Successfully meeting the
demands of life does not necessarily result in, but certainly contributes
to, positive self-esteem or self-acceptance.
A self-accepting person is one who has learned to accept all of his or
her personal attributes, the strengths along with the limitations, the
assets and liabilities. Self-approval and self-respect are all key
ingredients of self-acceptance.
This phase is often after we have seen them. With newly acquired
skills, self-acceptance and self-esteem of this phase, the individual is
ready to relate positively with others and build relationships based on
who they are.
This acceptance is a "two way street" however, and is a
continuous process for all of us (sighted or blind).
The role of the professional: Consumers with an understanding
that an unfamiliar situation or trauma may temporarily throw then back
into some earlier phase of the adjustment process, will be in a better
position to cope.
During this phase, we can provide feedback that we understand life can
be as full and as rich as they want it to be. Defense mechanisms such as
denial and repression are no longer necessary.
We can discourage the "as if" or "if only" games,
and encourage the cognitive (understanding and awareness) and affective
(developing a positive attitude) components of the process.
For all the staff, instilling a desire to continue to grow in
self-understanding and problem-solving skills will be key to a consumer's
During this phase, the consumers is encouraged be less dependent on the
staff here and use local resources from the community.
Last Revised: August 17, 2010