Guidelines about Boundaries in THERAPY

This is my post for my Tuesday “words” post.

Finding a therapist that is a good fit is hugely helped by the internet. In addition, if you’re confused at any point about the therapy and your therapist’s boundaries, You can find a lot of top ten lists online about therapist’s boundary violations.

In fact, here is a great list of 30 things to watch out for in your relationship with your therapist. All are very good things to notice; a few things on the list are sometimes ok if you feel your therapist has your best interests in mind (ie. when therapy is free of charge, what are the terms of the contract?)

http://www.therapyabuse.org/p2-wrong-questionable-treatment.htm

Here is another good, slightly humorous view of top ten things you might not know about therapists:

http://www.bustle.com/articles/61462-10-things-therapists-wish-youd-understand-about-what-they-do

I thought I might have something to add to these very good tips and important boundaries to the only thing I think might be missing from these types of lists:

THE INTERNET and SMART PHONE DOS AND DONTS in THERAPY

The internet and other technology make every field completely confusing again and cause us to scratch our heads and reconsider the way we do what we do. From the law to the music business to anything, we need new GUIDELINES:

The Internet (social media, websites, etc.)

DO NOT GOOGLE or LOOK UP former patients:

One interesting mention of the internet in the second link was about how therapists do think about former patients more than you’d imagine but we still don’t/shouldn’t google them to see what is going on with them.

I know that is a good one, as I have been tempted, when thinking about a former patient, to look them up and see how they’re doing/what they’re doing. I have NOT done so with anyone, as I saw a big STOP sign in my head and it was a fleeting “fantasy”.

Social Media makes things extra fun and confusing:

USE SOCIAL MEDIA THERAPEUTICALLY ONLY:

It is great for people to find support and other people going through their experience, whatever media they are using, Youtube, Facebook Groups, Facebook, Pinterest, etc. I often recommend to patients who are interested and use social media, that they look for support groups and other things online, AS WELL AS out in the physical world.

I have watched a few Youtube videos made by patients and listened to Podcasts. The reason is important: The patient wanted me to and asked me to and it was always an important aspect of their therapy work, especially self-esteem and recovery topics. I have even used Youtube videos in session when appropriate.

In addition art therapy gives a patient alternate ways to express him/herself, including through social media. Think of it as similar to brining in some art you made between sessions that is relevant for therapy.

SOME DON’TS OF SOCIAL MEDIA. Some seem obvious:

DOn’t be Facebook “friends” with any patient and with former patients, with some exceptions about former patients. You cannot control patients accidentally seeing posts of yours and finding out you know someone in common. There are proper ways to handle this which would be a post in itself. Start with asking your patient about it  or if you found something, telling them as soon as possible and exploring this.

DON’T connect on  LINKED IN with patients and most former patients. If you’re in the same field, art therapy, you may not be able to avoid some LINKED IN stuff and can have a little more flexible boundaries about it. I never accept Invitations to Connect from current patients; I don’t usually bring it up unless my patient is on LINKED IN a lot or brings it up themselves.

TWITTER: Can I “follow” some patients on Twitter? My answer would be what’s the reason? I have avoided it except in cases where someone had something important related to treatment on Twitter. As a rule, I abstain.

FACEBOOK PAGES: I have public Facebook pages that I cannot avoid patients finding and considering “liking” my page. As they are related to therapy and art, I consider it ok for patients to do that only if they decide on their own for some reason. Also, I do not look a lot at who is “liking” my pages and don’t care much about how many followers or who. IF you’re very into that, be aware of any feelings about patients liking your posts or not…

In some cases you may have liked someone’s Facebook page and then found a patient involved with it. There are cases when you can’t avoid this, especially having patients who are/were art therapists and got a diploma from the same place. Your worlds will be very close and it’s a good boundary test to be aware of this. (IF I am attending an event or workshop etc. and a patient is likely to be there, I process this with the patient before hand.

BLOGS:

This is a huge question mark for me. Do any of my patient s or former patients follow or ever read my blog? I actually don’t know. When I post here, I am aware that a patient may come across my blog, so I do have that in mind. As a rule, if it does not come up, I of course do not bring it up, and if it does in the future, I would of course explore the topic with my patient. I have read a patient’s blog only if they give me the link and it is connected to their recovery and they want me to see it.

Therapist bloggers out there: Please share any further guidelines and experiences! You can put it in my comments section.

Blogging Classes: Most therapists out there don’t take these classes, but I do, and I even recommend some of them to patients. If I recommend a particular class, I do not enroll in it, even if I thought I wanted to before. If I found a patient in a class, I would address that and most likely leave the class or at least stay passive (no posts or comments on Blogging U site).

DOs and Donts of SKYPE/Video session: A big topic to address in future…

This is by no means an exhaustive list. Next post could be about the SMARTPHONE and boundaries. It’s a fascinating aspect of therapy and books or at least long chapters could be written about the uses and abuses of the SMARTPHONE technology…

 

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Valentine’s Day Post: Be Your Own Valentine!

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I used to have a very jaded view of Valentine’s day as a marketing ploy for chocolate, flowers, stuffed animals with hearts and other stuff, as well as this idea of high expectations and not a great day for single people, of which there are many in NYC.

Even when not single, I thought this holiday was tacky and so mainstream boring; every day challenge is to be loving and celebrate love and give gifts that are not expected. However, since having a child age 3 and up, my point of view has totally changed. I see how the day can be fun and a celebration of love not between romantic partners, but for family, friends and the idea of inclusion in terms of school age kids’ making valentines for everyone in their class, especially age 4 to at least 8 or 9, when gender is not so important and children are excited to make valentines for their friends and family. Of course being an artist and art therapist, I have used the day as an occasion for making art with my child and patients. 

The idea of making your own valentine came from my child when she was 4 or 5. We were cutting out little hearts to decorate for each person in her class. The first one she made she liked so much she asked if it could be for herself. “I like this too much; I want it to be mine!” she said, excitedly. How cool was that. From the same person who said, “of course you have to love yourself,” when we were talking about who we loved the most. What a great idea, while making valentines for others and focusing on who you love, to make one also for yourself. I think she ended up keeping two of her own. We always make one for the teacher and she makes me one and I make her something extra special each year. All home made with art supplies.

This year was no different. Valentine’s Day happened to fall on a Friday, one of my busiest days in my practice. I went to work thinking, I want to make valentines’ cards with my patients and invite and challenge them to make themselves a card. I had a few phone sessions which worked out well for this directive too.

The main idea is to make yourself a Valentine’s Day card and in so doing , remind yourself to love yourself. WIth each patient who did this, I asked them if they would be comfortable for me to make them a card. Nobody refused! For adults this was definitely more oriented toward female clients, or it might have been that everyone I did this directive with was comfortable already with making art in the session, so they happened to all be women.

Anyway, for the people who came in person, I had lots of materials out all day, including: colored cardstock paper for the card, sharpies colored and metallic, decorative paper, foam heart shapes and other shapes, jewels, rhinestones and lots of fun stickers… I had fun in the session making each patient their card, and discovered a new kind of card — the triple decker card. I had cut a small peice of colored paper for a card and realized it needed to be bigger, so I added another card and glued it on top. Sort of like a stacked cake. 

This directive is a simple example of how great art therapy can be for helping people appreciate and accept themselves as they are right now, not who they have been or want to be. Also, accepting a card from me seems to be a sort of connection to their own therapy process and their appreciation of their work on liking themselves in art therapy. The card from the art therapist functions on many levels; as a “transitional object”, as a concrete object to represent the therapeutic relationship, as an indication of the trust that has built in the relationship with the therapist, and as a positive kind of statement about being in therapy and feeling good about it.

Making Valentine’s cards all day long from 8am until 8pm was definitely a fun and different way to spend Valentine’s day. I think throughout the day about 6 of the 8 sessions I had involved making Valentine’s. With the phone sessions, there was a fun part of the process involving knowing what we were making and having a surprise email afterwards, emailing back and forth photos of our cards and knowing that the patient would be getting their card next week.

I also made a Valentine for my colleague during our peer supervision and she made herself a birthday card. At the end of the day, I realized I had not had time to make a card for myself! As an art therapist I am a firm believer in doing the art you ask your patients to do always, so I knew I would be making one for myself. Yesterday while drawing with my daughter, we ended up making Valentine’s for each other; I had already given her two on Valentine’s, but as I started my own one, she asked for it, so I had to make a whole new one for myself. I had fun doing it, especially enjoying writing the phrase: “Happy Valentine’s Day to Me”, with the idea that anyone can look at my image of my valentine and say it to him/herself!

I am happy to be less jaded as I age, and a convert to all things childlike: hearts, rainbows, glitter, beads, Valentine’s Day, stencils, coloring pages, mosaics, all of which I had much disdain for when in art therapy school. Thankfully, I now know better and have a much more broad view of art making and art therapy.

Happy Valentine’s to me and to you and your Self! Make yourself a Love card as a reminder to love yourself every day…

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Photos: Top, my own card to myself, Sharpie on collaged paper cut out heart
First on bottom: Triple decker pieced together card for a patient, mixed media on cardstock
Second on bottom: detail of above
Third and fourth: other valentine’s cards made by me for patients
Fifth and Sixth: front and back of a card I made for my daughter
Last photo: Part of a Valentine made for a patient