Group Scribble Drawing

During a recent supervision, we made a group scribble on a long piece of butcher paper. Each person chose a different color marker and we took turns making a scribble to fill up the page. Then everyone was invited to walk around the paper to see what images they could find in the scribble. Then, everyone could use whatever media they wanted to bring out that image. It took a few minutes to get going, but soon images were being pulled out all over. This is a good exercise to get people to loosen up and use their imagination. It can also be good for clients to address problem solving or boundaries. 

Boundaries workshop

At a recent conference in a forensic setting, another art therapist and I had the opportunity to offer an art therapy experiential on boundaries. We asked participants to think of a time that a patient crossed their boundaries and to create an image about that. Participants were invited to show their art work and talk about their experience. One person talked about a patient who grabbed her, another shared about a patient who was being manipulative with him, and another new staff told of a patient trying to intimidate her. Discussion included ways to develop rapport with patients without physical touching and setting clear verbal limits as well as other ways to deal with patients with poor boundaries. Participants were able to offer each other feedback and tips. The group discussion illustrated that we were not alone in our challenges in dealing with boundary issues with a difficult population, and were indeed able to support one another. 

Self-disclosure directive

One of the art therapists suggested this topic, so in supervision, I had everyone make a collage of info or topics they felt comfortable sharing or talking about with patients, and those they were not comfortable with. One therapist said she talked about her dogs in the pet therapy group while another therapist said she never talks about her pets with the patients. We discussed times we revealed too much, we overheard other staff disclosing too much, and what to do if you felt your co-facilitator was sharing personal information during a group. We also talked about how to deal with patients who ask personal questions, as sex offenders commonly do. Everyone has his or her personal boundaries, and the therapists were asked to think about theirs, and when sharing personal information to think how or if it is therapeutic and beneficial for the patients to know. 

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. 

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.

How patients test boundaries

I recently provided an Art Therapy directive for the Rehab Therapy department during a training to help everyone be more aware of how patients try to test or cross our boundaries. It was interesting to hear others' experiences and how they dealt with being tested.  Some of the scenarios included being asked for a loan, being told you are attractive, having a patient try to enter your office, and being asked personal questions such as favorite sexual position.  It seemed that the men were tested more for getting things, and the women were tested more for physical/sexual boundaries.  We discussed various responses to these patients, and I hope it was helpful for everyone to share, hear, or talk about this topic. It's important to stay aware and alert with the forensic population in order to prevent over-familiarity, and promote healthy boundaries.

How patients charm and manipulate

As a follow up to a previous supervision where we discussed a colleague who had an inappropriate relationship with a patient, I asked everyone to draw a time when they felt that a patient was trying to charm or manipulate them or "lure" them in somehow.  There were some general responses of feeling surrounded by tentacles or being tossed around on waves.  There were specific answers like a patient asking to be enrolled in all of one therapist's groups or how a patient will speak softly, forcing you to lean in to hear him.  Many times patients will compliment you or try to give you something, and oftentimes it's a way of grooming or testing your boundaries.  So, it's always good to be aware of different ways patients try to charm or manipulate in order to get their way. This can help staff defend against it and avoid complacency.

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.

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.