Saturday, March 15, 2008

Boundaries

I’m always working on boundary issues. So, why am I writing a blog? I’ve got to do something with my thoughts. And - I wish we had more social workers working in criminal justice, so I hope some will read this blog and be interested. This is my technical pensieve, Harry Potter fans will get the reference – for the rest of you, a “pensieve” is a repository of memories. You can put your memories in the pensieve and that way your brain doesn’t get too overwhelmed.

Anyway – If I could think of a different word, I’d use it. “Boundaries” just sounds too psycho-babble-ish to me. Maybe, I’ll say “limits” instead. I want to talk about limits – the place where I say, “Back off, you’re getting too close, or I am.”

When I was growing up in my large, enmeshed Catholic family, I desperately sought boundaries. I surrounded myself with three cereal boxes in the mornings to give myself a 2-foot area of private space. I’d put one in front of me and the other two boxes on either side and quietly eat my cereal. That way at lease I could have a little space of my own for about 10 minutes. I also remember spending a lot of time sitting on the roof or in a small treehouse. Sometimes I’d ride my bike to the neighborhood library. In our crazy, chaotic home, there weren’t many places to have “personal space.” The idea of boundaries was foreign. If I ever complained about not having my own room, my mother reminded me that she never had her own bed.

As I got older, I had to learn about boundaries – both in personal and professional relationships. I’m getting better. I’ve had to learn how to draw limits for myself and my friends and family. I’m learning to say NO when I need to.

Boundary issues are HUGE in mental health practice. We even have fancy names for them – transference and countertransference. Transference is when our client “transfers” feelings they have for someone in their personal life to the therapist. For instance, perhaps I remind my client of her mother, so she starts treating me like that. Countertransference occurs when we (the clinician) identify the client with a relationship in our personal lives. For instance, I may start treating a client like my daughter. I may start responding to her as I would a daughter, which is never good.

Boundary issues are so important with clients, that we have strict ethical rules. We are supposed to avoid dual relationships (I can’t treat a family member or friend for instance) and unlike attorneys, we can’t have sexual relationships with our clients.

We have these rules for the protection of clients. Despite our value of “working with” our clients, the fact is that we have great power in the relationship. We must be respectful and vigilant in protecting our clients. I always remind myself that while I may have seen thousands of clients over the years, they don’t see thousands of social workers. Some may see more than others, but what I say, how I treat them, even in a short session of 30 minutes can be very important.

I once had a client return to our office after five years. She said I kept your card and I remember what you told me five years ago – I’ve thought of it often. Wow. Panic. I remember thinking that I hoped I said something good. It turns out I did (whew). I told her that I hoped he wouldn’t keep hurting her, but if he did, to come back and see me. She did – five years later. Another one of those “magical moments”, I’d say.

Keeping up good boundaries is hard work. We have to be thinking about all kinds of communication. Not only what is verbally said, but non-verbal communication, and physical communication. We usually deal with some pretty heavy and shameful stuff in our sessions. We always want to end on a positive note – remind her of her strengths and good decisions. And depending on the client at the end of a session, I might shake her hand, pat her on the back, or even give her a hug.

Many of my clients have major issues with boundaries. Early on in their lives, they were either never taught about limits (trying to use this word instead) or they were taught that their limits did not matter. We work on those issues. Often, I have clients who call me several times a day, or make unreasonable demands. These are learned behaviors – and they can be unlearned. For someone like this, I try to model boundary setting, by not responding to her excessive demands. For instance, if someone calls me 4 times in a day, I’m not calling her back until the next day (unless it really is a true emergency – you learn to tell the difference).
I have to be careful not to "do too much" for my clients. This is a mistake I made much more often earlier in my career. It isn't healthy for the client or the social worker. Kind of the old "teach a person to fish" thing. If we do too much, the client won't learn to do for themselves and they'll still be in the position of depending on someone else.

Now, in the interest of limit-setting, my kids just woke up, so I am turning off my computer and joining my family for the weekend.

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