Counseling the Person with Legal Blindness 

by Deb Marinos, CRC, LPC Intern

Imagine: your first consult with a new referral comes in, and they appear to be blind... but you can tell they’re not completely blind. You might feel uncomfortable asking questions or appearing to make assumptions about your new consult. I’m here to help.

First, legal blindness is defined by the Social Security Administration as a state in which vision is “20/200 or worse in the best eye.” With correction (usually glasses) a person with legal blindness’s vision is fuzzy and labeled Low Vision. They cannot recognize faces or read standard print. You might see a previous diagnosis of Macular Degeneration or Diabetes.

Some folks with slightly better vision can read and recognize faces; however they have great difficulty in moving around safely, finding objects and doorways. For these folks, you might find a previous diagnosis of Retinitis Pigmentosa or Glaucoma.

I’ve spent several years helping clients with various degrees of sightedness, and as a person dealing with sensory disability myself, I’d like to offer my colleagues some specific tips to help the counseling room be more accessible and help folks feel more connected to you.

Transportation is by far the biggest challenge and frustration, especially for those who used to drive. For this reason, rigid policies about lateness and missed appointments will be problematic to the relationship if not managed compassionately. If folks need at the last minute to cancel their appointment because the bus is running late, a phone session might be something to consider.

First: ask them! Do not assume. Accept clients’ stories of their unique sensory disability and its impacts. Each person has a unique experience and may feel discounted if not feel heard. Appearances can be misleading.

Ask what makes them most comfortable in greetings. Do they want you to identify yourself? Can they find your door through the door verbally, or by handshake, or signs? What helps?

Ask, ask, ask! Can they see the clock? Is the lighting hurting their eyes? What are they hearing? (they might be hearing the stress in your voice!). Chuckle when you smile, and make sounds when you are listening or showing compassion. Consider other senses.

Consider describing the features of your office space. Consider where you place breakable objects – the holidays’ sudden onset of new items, often breakable, can be a minefield. What would it feel like to just give specific directions: “At your three o’clock, a small table sits two feet away from you.”

Consider: can the client get out to the door out on their own? Will the therapist help – no matter what?

Make it easy to request accommodations ongoing. Make forms accessible by sending by email or recording audio. You might consider getting a “Pen Friend” by RNIB – it’s an easy recording tool that lets you record to a sticker that can be played back by person with no sight with headphones. Print forms in larger fonts by request.

Make it ok to clarify as often as needed. Imagine keeping track of your life in your head if you couldn’t write notes. Offer to record sessions on their smart phone. Offer a wide marker and 3x5 cards for notes.

Thanks for your interest and concern for all of your clients.

Deb Marinos, MS, CRC, LPC intern has worked with many clients with varying degrees of vision loss for several years. Her practice: Adaptability for Life, LLC provides interactive training for professionals who want to understand how to make their workplace accessible. www.adaptabilityforlife.com