Healthy adult with eye contact strain when listening in conversation

This concerns an adult patient of mine. He has difficulty making eye contact comfortably when he is listening to anyone he is in conversation with. He reports becoming aware he had this problem when a high school classmate said he looked all around when talking to people. He has been aware and self-conscious since then. He does look at me, however, he either looks too intensely into my eyes or at my lower face in a frozen manner because this is a strain for him. His eyes do not seem to move very quickly as is natural for most people. This difficulty is always present, irrespective of his mood or level of trust in the person. When he speaks he feels freer to look around but when he listens the difficulty is always present.

He has found relaxation exercises helpful for his general anxiety and depression but it has not helped his eye contact problem. He is 40 yrs. old, well-functioning and married. He is physically healthy, had an eye exam recently that did not reveal any problems. He wears eyeglasses sometimes for distance or reading. Can you suggest exercises or treatments to address this? Many thanks.

A LICSW


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Ah, my guess is that he is dealing with auditory and/or visual processing issues. Your descriptions were right on target with the proper information I would be seeking to direct you… thank you! I am not diagnosing him by any means but I would have him (and you) start doing some research on auditory processing disorders and visual processing disorders.

What may be happening is that he is struggling so hard to process the information he is hearing and/or seeing that he can’t focus on anything else.

I would suggest finding a vision therapist (sometimes called a developmental optometrist… not sure if that is the name for adults too, but vision therapist is a more generic term) who can look at how the eye muscles (not purely vision, like a regular eye doctor) are working and how the brain is processing visual stimuli/input. They can do exercises with him to help him process visual input better. There are also programs online you can get, but I am not an expert in this, so I would start with the vision therapist.

I do have a lot more information on visual processing, including a real story your patient may relate to… a famous TV producer, Jess Oppenheimer, in one of my newsletters. It is lengthy, but I feel it will be quite valuable and may help him have some light bulb moments (and lead him to some great resources)! It is called Visual Processing Deficits; Often Misdiagnosed, Clearly Visible.

Additionally, a neurologist or speech/language pathologist will evaluate and treat any potential auditory processing issues… I recommend a speech language pathologist, as I KNOW for a fact they evaluate and treat what is often referred to as Central Auditory Processing Disorder. See if you can help him get hooked up with one for evaluation and treatment if indicated.

See if this helps. Thank you for being interested in helping him and looking for the right answers to address his individual problems. I don’t think it is psychologically based, but rather physical, as you seem to also indicate. Have him get the evaluations to find out for sure, ok?

Anyone else have a similar story or ideas for such a wonderful counselor? Please share… she would be very appreciative, I’m sure! Thanks in advance.