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.

Music and Art Therapy Directive

A Music Therapist colleague and I facilitated a Music and Art Therapy session to try to foster more interdisciplinary groups within our Rehab Department. She sang and played the song "Demons" by Imagine Dragons on her guitar. We then asked the patients to create an image relating to the song or what they got from it. Some images depicted darkness and difficulties while some exhibited support and hope. One patient drew his inner child behind a brick wall, and spoke about protecting his inner child. The patients had positive comments about the combination of the modalities, and later the staff discussed possible groups that could be done using Music and Art Therapy. We discussed empathy groups, lyric analysis, and healing as potential group themes. It seemed like a helpful way to encourage collaboration and a better understanding of each other's disciplines. 

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. 

Supervision Directive--Getting Feedback from Peers

An Art Therapist who went to the recent AATA conference shared a directive from a workshop he went to. He asked us to write down something at work that was bothering us. Then he asked us to create an image about our difficulty. He gave everyone a pad of post-it notes, and asked everyone to look at each other's art and writing, and to write a note to that person with words of advice or support or encouragement. After, everyone could read what the others wrote, and maybe gain a new perspective, or find something that resonated for him or her, or just feel supported.  It was a helpful exercise, and one that could also be used with patients.