Supervision: "Scariest Patient"

Since it was Halloween recently, during Art Therapy supervision, I asked everyone to portray their scariest patient. Since we work with sex offenders, often, we experience "scary" or "creepy" patients. This directive helped the therapists be more aware of feelings that are aroused by the patients we serve, and to discuss countertransference. Some therapists focused on the physical aspects of the patients, and others were influenced by actions and behaviors of a patient. For example, one therapist talked about a patient who engaged in bizarre and sometimes disgusting behaviors, and we discussed how he may do that as a protective measure since he was just admitted from prison where sex offenders are disliked and often harrassed by other inmates.

Supervision: How Sex Offenders Use Sex

During a recent Supervision group, I asked everyone to create an image of how one of the patients had used sex to manipulate staff, either in an Art Therapy group or just in everyday interactions. When working with this population, it is important to be aware of how the sex offender will try to manipulate or take advantage of staff, often using sex, either in a subtle or obvious way. The more aware we are of the attempts and intent, the better we can prepare ourselves to defend against it and deal with the patient. Several examples were given such as the patient who tries to touch staff's hand when she is handing him his art supplies. Also, there are those patients who speak very softly, so staff have to lean in closer to hear him. Some offer compliments or a sympathetic ear. All these practices serve as a test of boundaries, so we were able to discuss feelings around these circumstances and how best to address the issue with the patient.

Supervision Directive: Animal Metaphor

This week during our Art Therapy supervision group, I asked the Art Therapists to think of one of their patients and draw him as an animal. (If this patient was an animal, what kind of animal would he be?) This was a fun directive and it provided the opportunity to work within a metaphor. Since we work with sex offenders, some of the animal images were monster-like. Others included a ferret for a patient who was particularly sneaky and tried to take art supplies from the Art Center. Another was a fish in a bowl because he had difficulty expressing his needs, though needed the occasional acknowledgement. For one patient, represented as a fly buzzing around, there was a suggestion of the need for sticky fly paper for him. This could be translated into some activity that would keep him occupied for a period of time. Using this directive and working in the metaphor can help the therapist look at the situation differently, and possibly come up with interventions not thought of before.

Supervision: Positive Experience

During a recent Art Therapy supervision group, I gave the directive to create an image about a positive experience that each therapist had in one of their groups or with a patient. Often, we focus on all the problems we have with the patients since sex offenders are a hard population to work with. I think we forget to discuss what goes well and some of the positive results that we see. This can help us feel more rewarded and fulfilled in our work, and it can help our peers to share what has worked for us, helpful approaches and techniques. Talking about challenges and difficulties can drag us down at times, so sharing positive experiences can be morale boosting and more uplifting for a change.

Book Review: Without a Conscience

When I started working with sex offenders, I learned that quite a few are psychopaths. I was referred to the book, "Without a Conscience" by Robert Hare, who created a psychopathy checklist. The book was an easy read and gave me a better understanding of working with psychopaths. He shared examples of real life psychopaths such as Ted Bundy and Jeffrey Dahmer, as well as fictional psychopaths such as Hannibal. Hare elaborated on the symptoms of psychopathy such as being superficial, lacking remorse, being manipulative, being impulsive, etc. He discussed treatment of psychopaths which is difficult and entails self protection and damage control. Since 20% of inmates are psychopaths, this is a book worth reading if you work with the offender population.

Someone felt uncomfortable directive

This week in my Empathy group, the Art Therapy directive was to create an image about a time you noticed that someone else felt uncomfortable. This exercise was done to help the sex offenders identify signs of another's discomfort. Most were able to do this, though not all did something to make the other person more comfortable in the example he provided. One patient thought it was right to try to ask his victim how he was making her uncomfortable, instead of just walking away. However, some were able to describe what they did to make the person less uncomfortable, so that was positively reinforced. It was a good discussion about recognizing someone else's discomfort and then doing the right thing.

Supervision: Drawing to Patient

This week in supervision, we all drew a picture to a challenging patient (not actually to be given to the patient) to express how they made us feel. Previously, we had written letters to a difficult patient which was helpful to the supervision group. Since we are Art Therapists, I thought drawing would be a good way to express ourselves as well. The therapists discussed how the patients made them feel overwhelmed, frustrated, angry, annoyed, and drained, which is common with the sex offender population. They were able to discuss ways to deal with these issues and could just vent. It helped them to be more aware of their countertransference towards this difficult population. They reported that this exercise as well as the letter writing exercise were both helpful. One therapist said she preferred the letter writing because she could write down exactly what she was thinking and feeling in a precise way.