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.