Touchstone craft project

For Art Therapy supervision today, we all made touchstones using clear acrylic stones. We cut images or sayings from magazines that were meaningful or inspirational to us. Then, we used mod podge to adhere the images to the stones. A couple of the Art Therapists weren't that into it in the beginning, but at the end had made several unique touchstones.  One Art Therapist said it was a nice way to relive memories. Some made stones for themselves as well as gifts for others. They could be made into magnets as well. It was a fun activity to do before the holidays. 

Expressive Therapies Summit in NYC

Earlier this month, a colleague and I presented at the Expressive Therapies Summit in NYC. Our presentation was on the use of art therapy to address dynamic risk factors in sex sex offenders. It was a great experience and we were also able to attend some other interesting presentations. I attended a workshop about the Lahad six part story which I shared with my fellow art therapists when I returned from the conference. I also attended a workshop on visual reflection and narrative therapy. My colleague attended a felting workshop and made some very cool projects. It was great to learn about new methods and techniques, and meet other expressive therapists. It was a very refreshing and inspiring experience. 

Experiencing countertransference

Since we have several new art therapists, I wanted them to be more aware of transference and feelings of countertransference that they may experience with the sex offenders at the hospital. So, I asked the group to create an image about a time they felt countertransference with a patient. Countertransference implies there is transference by the patient, but we used a looser definition to encompass any strong reaction to a patient. Many therapists had patients who reminded them of someone they knew, so in those cases, it was important for the therapist to be aware of potential reactions, and to possibly address any personal issues through their own therapy and supervision. Some therapists felt that they were treated as a parental figure, and had to be careful of their care taking feelings. Other therapists felt that they were being flirted with, and had to think about their feelings in response to that. It is important to be aware of countertransference and other strong feelings we have about patients when working in forensics as the patients can be very charming and manipulative as well as angry or self-loathing. Not being mindful can lead to boundary violations and inappropriate or unprofessional behavior. Supervision provides an opportunity for discussion, more self-awareness, and support by peers.

Meditation using art

I was reading about all the benefits of meditation, so I've been trying to practice it more. In a recent Art Therapy supervision, I handed out a bunch of images of art work cut out of a desk calendar that a colleague gave me. I asked everyone to choose an image that appealed to them, and put it in front of them. Then, we closed our eyes and focused on our breathing for a few minutes. Next, we opened our eyes and looked at our image, observing the colors, lines, composition, etc. After that, I asked everyone to to close their eyes again, and imagine stepping into the image, then explore it.  Then, we "exited" the image, and opened our eyes.  I then had everyone create an image about their meditation experience. One person said she had had a headache all day, and that it went away after our short meditation. This can be done as a supervision exercise for self care or as a directive with patients.

Supervision--Feeling frustrated

After a few frustrations with patients during the week, during supervision, I asked everyone to create an image about a recent frustration. I was thinking everyone would have a work related frustration, but most images were about frustrations about life in general, from medical issues to buying a house, to dealing with friends' issues. Then I realized that while everyone probably had experienced frustrations with patients or staff during the week, their other frustrations might be more troublesome or even impact their work, if not dealt with. It was a good opportunity to vent and to also gain support from others, which was the main point of the exercise in the first place.

Yourself represented by the natural environment

During a recent Art Therapy supervision, I asked for a suggestion for a directive. One therapist asked us to draw ourselves/energy as an element in nature. It was very interesting that each of us chose something different, from a volcano to a tornado to lightening to wind to a body of water. Each of us got to say how our drawing represented our personalities, and we were able to hear feedback from peers that offered us a different perspective. A good directive for supervision or an Art Therapy group/session.

Termination with patients

In a recent Art Therapy supervision, we discussed how to terminate with patients.  Since we work in a long term facility, it would be more common that the therapist would leave before the patient, though the termination would be similar if the patient were to be discharged. We've had therapists in the past who have left without telling patients in their groups that they were leaving which is unethical and unprofessional. Saying goodbye can be difficult for anyone, even a trained therapist, but it is the therapist's responsibility to know if this is an issue for her/him and seek supervision or therapy, so the therapist will be able to properly terminate with patients. We talked about the importance of giving patients as much notice as possible, so they can process any feelings that come up about loss, rejection, or abandonment. It is also good for the therapist to be able to say a meaningful goodbye. I had a couple of therapists practice how they might inform a group of patients that they were leaving while the rest of us role played the patients. It is also important with the sex offender population to terminate appropriately because many of them have issues about women, and we wouldn't want to reinforce any of their negative beliefs by terminating improperly. The role playing was a good exercise to help staff think about how they would handle termination. 

Compassion fatigue

In honor of Mother's Day, we did a supervision session on compassion fatigue. This is associated with vicarious traumatization and burnout, all of which staff are susceptible to working with forensic populations. I handed out a short article that talked about the symptoms, as well as ways to cope with it. One suggestion was to use relaxation and meditative techniques, so we all drew an image of our ideal self care getaway. One of us went to Italy, another swam with dolphins, another went on a spa retreat in the mountains. It is important to address these kinds of issues periodically and encourage self care when working with forensic populations. 

Boundaries in Forensic Mental Health

I recently ordered the book Professional and Therapeutic Boundaries in Forensic Mental Health Practice, edited by Anne Aiyebusi, to use at work. It is written from a nursing standpoint, but most of the literature is relevant to any disciplines working with a forensic population. During a recent supervision session, I read some scenarios from the book and asked everyone how they would handle the situations. This provided staff with the opportunity to think about how they might respond, and it brought up similar situations that had happened to them in the past, which we discussed. The book contains helpful and thought provoking information, and serves as an important reminder to attend to our boundaries with patients who can be highly charming and manipulative. 

Art Therapy Poster Presentation

I recently had the opportunity to present a poster at the Forensic Mental Health Association of California conference. The poster was on The Use of Art Therapy to Address Dynamic Risk Factors with Sexual Offenders. The poster gave a description of Art Therapy, listed some dynamic risk factors for sex offenders, outlined how we facilitate Art Therapy at the hospital, and displayed some patient art work. This was my first poster presentation, so it was good experience for me. I had to convert a PowerPoint presentation to fit onto a poster. I struggled with the layout, and sought out feedback from peers. Then I had to figure how to use spray adhesive! At the conference, I was able to meet and interact with many different people and answer questions about my poster and where I work. I try to present at conferences to help other disciplines learn about Art Therapy and how it can be helpful with their clients, as well as challenge myself professionally.

What makes a good facilitator/staff member?

Today in Art Therapy supervision, I asked the Art Therapists to make a list of characteristics they thought a good facilitator/therapist/staff member should have to work with the forensic populations that we treat at the hospital. After everyone made their list, I gave them a list of qualities that was complied from patients when I asked them the same question. We compared our list for overlaps and differences. There were many overlaps including empathy, being authentic, and challenging the patient. Many of the therapists listed good boundaries while none of the patients did. When I was having the patients do this exercise, I asked them why they didn't list boundaries, and they said that it was a given. Though, obviously, from staff's perspective, and in reality, it's not a given at the hospital. Then I asked the Art Therapists in supervision to create an image about one of the listed (patient or staff) qualities that they would like to work on or improve. Many of the therapists responded to one characteristic a patient listed about the ability to break down barriers. Other images included using diplomacy, facilitating group dynamics, and being a positive role model. The topic brought up interesting discussions and food for thought. 

The importance of self awareness and introspection

This week in supervision, I asked everyone to think of some of their issues or baggage and to represent them symbolically.  Then, each person could reveal as much as they felt comfortable talking about or just speak generally about the topic. Mainly, I wanted the Art Therapists to think about how what has happened in their past or what is going on in their personal lives can affect their work as therapists. For example, if you have experienced abuse in your past and you are working with abused patients, that may affect your ability to work with this type of patient, particularly if the patient is an abuser as well. It is especially important when working with the forensic population to be mindful of your boundaries, and what might cause you to cross boundaries. Sex offenders are very perceptive and manipulative, and it is easy to be fooled by their charm. They pick up on your weaknesses and vulnerabilities and try to exploit them. We also talked about how lack of confidence and over confidence can get you in trouble. We discussed the importance of your own personal therapy if your own issues are impeding your ability as a therapist. Hopefully, bringing up this topic will help the therapists think more about their own issues and how those issues can affect their work.