How patients test boundaries

I recently provided an Art Therapy directive for the Rehab Therapy department during a training to help everyone be more aware of how patients try to test or cross our boundaries. It was interesting to hear others' experiences and how they dealt with being tested.  Some of the scenarios included being asked for a loan, being told you are attractive, having a patient try to enter your office, and being asked personal questions such as favorite sexual position.  It seemed that the men were tested more for getting things, and the women were tested more for physical/sexual boundaries.  We discussed various responses to these patients, and I hope it was helpful for everyone to share, hear, or talk about this topic. It's important to stay aware and alert with the forensic population in order to prevent over-familiarity, and promote healthy boundaries.

How patients charm and manipulate

As a follow up to a previous supervision where we discussed a colleague who had an inappropriate relationship with a patient, I asked everyone to draw a time when they felt that a patient was trying to charm or manipulate them or "lure" them in somehow.  There were some general responses of feeling surrounded by tentacles or being tossed around on waves.  There were specific answers like a patient asking to be enrolled in all of one therapist's groups or how a patient will speak softly, forcing you to lean in to hear him.  Many times patients will compliment you or try to give you something, and oftentimes it's a way of grooming or testing your boundaries.  So, it's always good to be aware of different ways patients try to charm or manipulate in order to get their way. This can help staff defend against it and avoid complacency.

Inappropriate boundaries

In supervision we discussed a co-worker who admitted to having an inappropriate relationship with a patient. Working with sex offenders who are charming and manipulative, this occurrence is more common than one might think. This population preys on people who have a weakness or vulnerability that they can exploit to their advantage. The group was understandably upset. There was shock, sadness, and anger. There was hostility toward this co-worker for damaging the reputation of the department, and there was also compassion and sympathy for this person and all the issues that contributed to this unfortunate end result. There was discussion on how to prevent this kind of thing from happening, and what we can do if we see a colleague getting into a similar situation. Mainly, it was important that it was brought up, and there was an opportunity for everyone to express their thoughts and feelings if they wanted to do so.

Patient Discharge

Once, in supervision, we discussed one patient who would be discharged soon. There was some media about it, so I read an article about him to the group. Then, we all created an image about the situation based on our own impressions. The responses were varied, from a large eye representing him being under constant scrutiny, to an image about the public not wanting him in their neighborhoods, yet harboring their own secrets about the abuse that goes on in their own homes.  One image was about the stress the patient has to deal with, another about how controlled the patient is in his art work, perhaps to counterbalance all the things that are out of his control or his dislike for feeling out of control. The exercise helped staff feel empathy for the patient and illuminated ways to be supportive of him during this transitional time. 

Helping New Staff

In supervision recently, I asked everyone to create an image with her/his best advice for a new Art Therapist who just started working at the hospital. Since the rest of us had been working at the hospital from a few months to several years, we all had various tips and suggestions for working with the sex offenders. The images included themes about asking questions, walking purposefully, self care, not losing your keys, and telling patients "I don't know, but I'll get back to you."  It's overwhelming to start work in a large, bureaucratic institution, so it's good to have as much support as possible in the beginning. We all gave our drawings to the new Art Therapist to refer to down the road.

Stress Management through art Therapy

I recently had the opportunity to offer an Art Therapy directive at a Stress Management workshop offered to the community. I asked everyone to draw a Mandala, and fill it with their stress. I told them they could use whatever images, colors, shapes, etc. that they wanted to represent their stress. Most participants were very receptive to trying Art Therapy and got into the exercise. One woman drew several small images representing how she felt stressed about her granddaughter and how to teach her about being responsible about finances. Another person drew a jumble of jagged lines of various colors to represent stress. One participant used different symbols to express different areas of stress in her life and how she has been coping with it. This can be a good directive because sometimes just getting out your feelings can be helpful. Another directive could be to draw a Mandala with a calming or peaceful image. Mandalas are meditative and containing, so they can be a helpful tool in managing stress. 

Supervision Directives

In supervision recently, I've been asking a different Art Therapist to give a directive each week. This has been helpful in providing fresh, new directives for the group. One therapist had us portray a cleansing image, as that's what she was needing at the time. Another therapist had us create a group mural which was fun and collaborative. This past week, a different therapist had us make an image of what we are good at. I'm looking forward to all the different directives we'll experience in the upcoming weeks. 

If you were an animal...

This week in supervision, one of the Art Therapists gave us the idea for the directive, "if you were an animal, what would you be?" We all created 3D animals or images ranging from mole, to snakes, to turtle, and elephant. Mine was a dragon. Most of us related our animal to how we felt of ourselves at work, from having to protect ourselves, to having thick skin, to having to be strict (me). This is a good directive to use with patients because they can feel safer working within the metaphor when talking about their animal's characteristics or feelings.

Sharing successful directives

During a recent supervision, I asked the Art Therapists to have in mind a directive that had worked well in one of their groups. I asked one supervisee to present her directive for the rest of the group to do. The directive was to create a timeline using symbols for significant events, indicating if the event was positive or negative. It was a good exercise because it gave the therapists a sense of how the patients might feel when presented with an Art Therapy directive. Some of us were confused and had questions. Some of us didn't know where to start. Some of us only had a couple of events, some had many events. The supervisee used this directive with PTSD clients in the past, and you could see how it would be interesting to hear about the different events and how they effected their behavior.

New Year's Goal

Since it's the beginning of a new year, in supervision, we drew about our goals for the coming year, as Art Therapists. Everyone's goals were different, from being more organized, to using new directives, to going with the flow more. This can also be a good directive for patients to help them think about what they would like to work on or accomplish, short term or long term. They can also discuss how to achieve their goals and get feedback from peers.