Vicarious Traumatization

During Art Therapy supervision this week, I asked everyone to draw about a time they felt vicariously traumatized by a patient or they noticed that someone was vicariously traumatized from working with the sex offenders that we treat. Since all the patients at the hospital are offenders, the risk for vicarious traumatization is high. Some staff don't even realize that it happens to them. The supervisees were able to come up with several examples including seeing another clinician "lose it" after trying to deal with a difficult patient and the stress of trying to help staff deal with the situation, feeling physically ill when hearing a patient talk about his sex offenses, and being emotionally moved when hearing about the abuse that some of the patients have suffered. It was also noted that the patients themselves vicariously traumatized each other, and staff could vicariously traumatize one another as well as a result of trying to cope with this challenging population. This was a good exercise to help staff share their feelings and to be more aware of this phenomenon, as well as how they cope with the resulting feelings.

New Year's Resolutions

During Art Therapy Supervision today, I asked everyone to create a piece of art work based on their New Year's resolutions as an Art Therapist. These could include goals or where they saw themselves in the upcoming year. Answers were varied and included presenting at the next AATA conference, starting up a new group for the sex offenders that we treat, and growth as a clinician. I also like to use this directive with patients, as I think it can help people be more aware of what they would like to accomplish, and they can start thinking how they can meet their goals.

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.