VT Works

Most of us can picture the patient immediately. The one who finishes an activity and asks, “So what did you learn from that?”, or the patient who performs a task reasonably well and then questions why it remains in the program at all. The session begins to feel less like Vision Therapy and more like an ongoing audit, where each activity must be defended, justified, and proven correct before the patient is willing to engage further.

These patients often approach Vision Therapy, and likely life, through a binary lens. A skill is either good or bad, passed or failed, complete or unnecessary. If they can do it, it must be fixed. If they struggle, it must be broken. The nuance that lives between those poles, where most functional vision work actually occurs, can feel uncomfortable or even unacceptable. Gray space invites uncertainty, and uncertainty invites debate.

What makes this particularly challenging is that many visual skills do appear intact when performed in isolation. A patient may converge on demand, track a target accurately, or read fluently in short bursts, and from their perspective, performance equals mastery. From a clinical standpoint, however, we are often observing how the system behaves under load, such as speed, repetition, fatigue, divided attention, or emotional pressure, that difference, while subtle, is significant.

When a patient insists on debating the correctness of their performance, they are often relying on conscious reasoning to evaluate a process that is largely non-conscious. Vision Therapy does not only retrain cognitive knowledge; it retrains systems. Efficiency, flexibility, and automaticity are not easily measured in a single moment, nor are they always felt by the patient as they emerge. This disconnect can quietly fuel frustration on both sides.

In these moments, it is tempting to explain more, to justify the activity, clarify its purpose, and offer increasingly detailed rationale. Ironically, this often reinforces the problem. Each explanation invites another counterpoint, another question, another attempt by the patient to intellectually “solve” the Vision Therapy rather than participate in it. The session gradually shifts away from experience and toward negotiation. A more effective approach imight be to shift the frame altogether. Instead of focusing on whether a patient can do a skill, the focus becomes how the system performs while doing it. Is it efficient? Is it consistent? Does it hold up when conditions change? This reframing removes the pass/fail mindset and replaces it with a continuum, one that more accurately reflects how visual systems function in real life.

Binary thinkers often struggle with the idea that being good at something is not the same as being reliable at it. A skill that works only when conditions are ideal is not yet integrated. Vision Therapy exists to strengthen performance across contexts, not to confirm that a patient can succeed once in a controlled environment. This distinction is rarely obvious to patients unless we name it clearly and consistently. At the same time, this is where our responsibility as Vision Therapists comes into sharper focus. It is easy to label these patients as “binary thinkers” or “debaters” and move on. Those descriptions may be accurate and clinically useful, but if we stop there, we miss the other half of the therapeutic equation. Every question a patient asks, no matter how repetitive or challenging, lands within a relationship, and within that relationship, communication is a shared responsibility.

When a patient questions the value of an activity or challenges the correctness of their performance, it may be tempting to hear resistance or distrust. Sometimes that is present. But other times, what we are hearing is a mismatch between how we are explaining the work and how the patient processes information. Speaking clearly does not guarantee being understood. Effective communication depends on how the message is received, not just how confidently it is delivered.

Patients who rely heavily on logic and correctness often listen for structure, relevance, and orientation. They want to know where something fits, what it connects to, and how it moves the larger picture forward. When explanations remain overly abstract (i.e. “this builds integration” or “this supports the system”) the patient may struggle to anchor the information. The result is often more questions, not fewer. As therapists, we sometimes underestimate how much reassurance patients need before they can tolerate ambiguity. For someone who already feels uncertain about their own performance, unclear explanations can amplify anxiety rather than curiosity. In these cases, the debate is not really about being right; it is about trying to feel oriented. Recognizing this shifts our response from defensiveness to attunement. Communicating effectively does not mean over-explaining or justifying every choice. It means tailoring the explanation to the listener. Some patients benefit from knowing the immediate goal of an activity. Others need to hear how today’s work connects to last week’s or supports something meaningful in their daily life. The same activity can, and often should, be framed differently depending on what helps the patient stay engaged. It also requires listening beneath the surface of the question. When a patient asks, “Why are we doing this if I’m good at it?” they may really be asking, “Am I wasting my time?” or “Am I missing something important?” Responding to the emotional content, rather than just the factual question, often reduces the need for debate altogether. None of this requires relinquishing authority or allowing Vision Therapy to become a negotiation. Clear structure and confident leadership remain essential, but authority paired with attunement feels different to patients than authority alone. When patients feel understood, they are often more willing to trust, even when they do not fully understand every step of the process.

Ultimately, our goal is not just to improve visual function, but to guide patients through a process that feels coherent and purposeful to them. When we take responsibility for how our words land, not just how they are spoken, we strengthen the therapeutic alliance. And in that space, where clarity, listening, and experience meet, progress tends to follow more naturally.