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.

Exploring Entitlement through Art Therapy

Next quarter we are starting a new Art Therapy group to address the high risk factor for sex offenders of excessive entitlement.  We ran a pilot session with a group of patients and asked them to draw a time they felt excessively entitled and how they handled it. They were all able to think of an incident right away, and a few of them were able to relate feeling entitled to committing their crimes. Other examples included one patient who wanted to cash a check at a bank, but was told he had to wait until it cleared, so he got angry and yelled at the staff until he was asked to leave, and another patient who plays sports and feels entitled to take his anger out on other players. We asked the patients for feedback on how to make the group more appealing to patients since it is a challenging topic and many patients may be in denial of being entitled. It was helpful to have actual patient input, and to see how well the patients could do with the topic. 

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.

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.

Empathy for Patient

During a recent supervision, I asked the Art Therapists to draw a patient they felt sympathetic or empathetic towards. We often complain about patients since sex offenders are difficult to work with, so this was a change from our usual venting. This directive also helped explore transference and counter transference. The hospital frequently has staff who have inappropriate relationships with the patients, so it was also important to see how something like that can get started and discuss how to prevent that from happening.