Imagine what it would be like to wake up one day and be unable to see. It’s a rare occurrence, but it happens – and it can have a devastating impact on your life and sense of identity.
I have worked for the past five years at Walthew House, a charity founded in 1882 that provides practical and emotional support for people who are blind, visually impaired, deaf, hard of hearing or have dual sensory loss.
Walthew House operates a free counselling service. People who are experiencing difficulties can self-refer, although the majority of referrals come through the local council’s sensory-loss team. Once a referral comes in, it is usually processed within two weeks, from the initial assessment to the first session. In general, I offer 10 weekly counselling sessions, with the option to re-contract for a further two sessions, if both parties agree and it would be beneficial to the client.
I am an integrative/holistic therapist, both by training and by nature. However, I would find it difficult to undertake this work without incorporating and acknowledging the basic principles of a more person-centred approach, particularly while forging a new relationship with the client.
I think it’s essential for the counsellor to come to terms with their own feelings and assumptions about being blind or visually impaired before they start work with clients. They can then hopefully avoid the ‘unintended yet damaging messages implied by their own beliefs’.1 Self-reflection isn’t always easy. I had to process some difficult feelings around my own fear of losing my sight. However, I believe that my self-awareness has helped me to empathise with my clients and made me more willing to ask them about their own experiences of blindness.
It’s a good idea to think in advance about some of the practical considerations of working with a client who cannot see. For example, you might have to guide a blind person to the room. I always arrange the room in exactly the same way for every session, so the client is more easily able to relax. Some people with sight conditions are sensitive to light. I therefore find it helpful to discuss the lighting with the client.
You might also want to modify your counselling technique. I pay particular attention to my tone of voice and sometimes describe my reactions, as the client might not be able to read my facial expressions. Some counsellors are wary of phrases such as ‘I see’ and censor their words. In my experience, it’s more useful to explore with the client the language around sight loss, so that you can understand its meaning and significance for you both.
Clients who come to Walthew House are dealing not just with loss of sight, but also with loss of independence. People who are visually impaired often depend on others to carry out even mundane tasks, such as reading a letter. I work with my clients to help them regain a sense of independence, but I think it’s important to acknowledge that independent people can still ask for help. In her memoir, How to kiss a blind girl, Sally Wagner, who lost her sight in adulthood, writes: ‘Independence doesn’t mean doing everything on your own. It really means giving yourself choices. Even an independent able-bodied person doesn’t cut himself off from all help.’2
The loss of independence that can accompany sight loss can erode a client’s self-esteem, as ‘…one of the major sources of people’s self-esteem is the continuous internal process of making decisions about their own lives, taking responsibility for their own actions and making judgments about their own competence’.1
Society’s attitudes and expectations can also have a detrimental effect on self-esteem. ‘The minimum expectations and negative attitudes experienced by blind persons in our society contribute to lowered self-esteem. Thus, the dynamic forces that operate upon a newly blind person’s experience may make their sense of worth and competence much more fragile.’1
Paul Leake, a relationship counsellor who happens to have been totally blind from birth, has experienced some of society’s negative attitudes. He told me: ‘I am conscious of the impression I make on other people and I am aware that, at least until people get to know me, they may consciously avoid speaking directly to me.’ Blind people can consequently become isolated, simultaneously shunned by and withdrawn from society.
Paul is also familiar with people’s low expectations of the visually impaired: ‘If I make the beds, probably not very well, I am praised as if I was some kind of saint.’ I often have to think about my own expectations of clients. If I expect less of a blind client, am I sending a message that they are incapable? And is that damaging to their self-esteem?
It’s perhaps not surprising that many of my clients go through a similar process to the five stages of grief:3 denial, anger, bargaining, depression and acceptance. It’s a fluid process, and the client doesn’t have to visit all the stages, but the aim is always acceptance. I try to help the client to accept the reality of their blindness and its impact on their identity. Hopefully, we can then move towards the realisation that they haven’t fundamentally changed. The challenge is to create a new direction for their lives, recognising their blindness but at the same time not allowing it to define them. As Paul says: ‘Being blind is part of who I am, but not the most important part of me.’
There is no specific psychology of blindness; sight loss is experienced differently by different people. We should also take care not to focus exclusively on the differences between the blind and the sighted. ‘Many misconceptions about blindness have existed for far too long. They exaggerate the one difference between the blind and the sighted, ignoring the many similarities.’4 As counsellors, we should strive to ‘see’ the person, not the blind person, so they can better ‘see’ themselves.
Cuts to statutory services are placing ever-increasing demands on voluntary organisations such as Walthew House. In an attempt to widen the range and accessibility of the service, telephone and couples counselling is now available. Walthew House is also in the process of producing a guide to anxiety in a variety of different formats, including talking books, Braille and large print. Whether we can continue to meet the growing demand for our services is perhaps the greatest challenge, but one we need to overcome in order to help and support people in the future.
Acknowledgement
I am indebted to Paul for his contribution to this article. Paul stressed that he does not speak for or represent all blind people, but his honesty and insight have been invaluable.
Chris Taylor qualified as a counsellor in 2014 and is an accredited member of BACP. He is IAPT qualified and also has his own private practice, specialising in couples work and supervision. Chris previously worked for social services, specialising in adults with learning difficulties.
References
1 Tuttle DW, Tuttle NR. Self-esteem and adjusting with blindness. Illinois: Charles C Thomas Publisher Ltd; 2004.
2 Wagner S. How do you kiss a blind girl? Illinois: Charles C Thomas Publisher Ltd; 1986.
3 Kubler-Ross E, Kessler D. On grief and grieving. London: Simon & Schuster UK; 2005.
4 Minton HG. Blind man’s buff. London: Harper Collins; 1974.