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.

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. 

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. 

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.

Art Therapy with Forensic Population

Due to a recent loss of a tool during a studio group, we've had to overhaul our procedures for handling tools in the Art Center. When I first started at the hospital when it opened, I had no experience with forensics, and did the best I could in setting up policy and procedure. Through an on going learning process, I've discovered that a good part of forensic Art Therapy includes safety and security. Every item has its place. Everything is labeled. Items must be specifically checked out to patients. Every tool has to be accounted for. Every sharp and hazmat has to be disposed of properly. Back stock inventory must be accurate. We are constantly organizing and counting items. This is obviously time consuming and frustrating, and still subject to human error.  It takes adjustment and flexibility on the part of staff and patients. However, when the environment is safe, then that creates a space where therapy and healing can take place.

Empathy through Art Therapy with Mentally Ill Inmates

I recently started an Empathy through Art Therapy group with our small population of mentally ill inmates at the hospital. In our first group, I asked them to create a picture of what empathy means. Some didn't really know, so first we discussed what empathy is, and gave some examples. We also talked about the difference between empathy and sympathy. Some still had some difficulty with the concept, but they were all willing to give the directive a try. One man drew several faces of a person trying to have empathy for another person.  Other patients drew about their own experience of feeling empathy for someone else. I hope this group can help these patients understand better what empathy is, and help them practice feeling empathy for others, in an effort to help them to not re-offend.

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.