B is for Behind (Already!) or Boundaries

I decided a few days ago that B was going to be for Boundaries—a relevant topic now that I am a counselor and caregiver (see A is for Alzheimer’s). But then life intervened in unexpected ways and while I should be cranking out my C is for . . . blog, I’ve still not gotten around to B. Also, there’s the little matter of a poem to go along with. Every time I sit down to write a poem, I get interrupted. Poetry is challenging enough without constant interference. I wrote one the other night, but I’m not sure it is suitable for public consumption—in fact, I know it isn’t. So, back to the drawing board.

A few words about Boundaries. Boundaries are those imaginary lines that we draw in the sand between us and the rest of the world. The word “no” is a boundary, as in “No, I cannot help you move this weekend (or ever).” Boundaries are personal bubbles, as in “if there are 90 empty seats in the movie theater, don’t sit right next to me if you don’t know me.” I am continually amazed at how often this boundary gets violated (especially in Bellingham). Boundaries can be fences, hedges, the edge of the lawn, a strategically placed flowerbed, or (if you are Cheeto Satan) a $65 billion wall between countries. What all of these borders, imaginary or actual, have in common, is they separate me from the rest of you in some way, or us from them, or my yard from your yard, or my body from your body, or my time from your time. Stepping across the line means I am choosing to merge some part of myself with you.

As a counselor, having boundaries means that I must keep our relationship confined to the counseling setting. It’s a bit odd, this particular boundary because while you (the counselee) may chose to tell me (the counselor) many intimate details about your life, I will not reciprocate with intimate details of my own. Normal relationships (friendships, intimate partners) rely on the mutual sharing of such information across boundaries to create a sense of closeness. You tell me an intimate detail, a secret, something you’ve not shared before, and I reward you with a secret/intimate detail of my own, our friendship grows, intimacy flourishes, the exchange is reciprocal.

Not so in counseling or therapy, which works differently. You tell me (the counselor) a secret, and I reflect it back to you, usually with a question. Something like “what meaning might you assign to the anger you have for your father?” or “what would it mean to you if she asked you out on a date?” or “how has being abused as a child affected your parenting of your own children?” Or maybe even (if I’m feeling stuck) “how do you feel about that?”

As a counselor, I have to have Boundaries because how helpful would it be if you disclosed your traumatic childhood to me, expecting insight and healing, and I said to you “Wow! My childhood was traumatic too”? Or, even if I did determine that some level of self-disclosure might be warranted (a quick rule of thumb re: self-disclosure: it can be ok if it helps the client, but not if it’s only for my own sake, i.e. to make me feel better), how helpful would it be if I confused you by having loose boundaries in the therapy room but then ignored you when I ran into you at the supermarket? If I took your money (or insurance payment) under the auspices of helping you but came to rely on your feedback and your insights? If you leave a counseling session knowing more about your therapist or counselor than he/she knows about you, somebody’s Boundaries are too loose.

Therapy is a very specific sort of exchange, one that depends on firm Boundaries. Less than firm Boundaries create all sorts of havoc and may result in the counselor or therapist losing their license. Lapses in ethics often result from lapses in Boundaries and can be a very slippery slope. Loose Boundaries can lead to inappropriate friendships and perhaps even sexual liaisons between therapists and clients. Sleeping with a client is never a good way to help them heal. It might make the client feel special initially, but will eventually destroy them (and probably the counselor as well).

Even something as seemingly benign as a friendship can become problematic between a therapist and client. As your friend, I have a vested interest in telling you things you want to hear, things that will keep you as a friend. As your therapist, I have a duty to tell you things that you might not want to hear but need to, things that will help you heal and move forward, things that a friend wouldn’t tell you. Boundaries make it possible for me to be your counselor.

Confused yet? It’s tricky, I know. But trust me, this is one lesson you’re better off NOT learning directly.

Related Haiku (this is an old one, but relevant)

Please do not invite
me in and then abandon
me at the threshold

E is for (what else?) Ethics

 

EDon’t have sex with your clients. Just. Don’t.

Washington State law forbids it and even goes so far as to outlaw intimate relationships with former clients. Forever. The American Counseling Association (ACA), in section A.5 of its 2014 Code of Ethics prohibits sex with current clients as well, as do all of the other professional organizations, but they don’t put a complete ban on sexual relationships with former clients forever, instead imposing a five year moratorium on sex with former clients.

And still. Therapists have the dubious distinction of being disciplined most often for violating this particular ethical code. In fact, they (we) outpace all other helping professions in this area, leaving lawyers, doctors, and even massage therapists in the dust.mother

But say your aspirational ethics around this issue are intact. Say you are really clear that you would never, ever engage in a sexual relationship with a client or former client, or with their family members. There are still a thousand different ways to violate client trust or for a counseling relationship to go off the rails.

The ACA’s code of ethics state that the primary responsibility of the counselor is to respect the dignity and promote the welfare of the clients (Section A.1). The document goes on to say that counselors must act in such a way as to avoid harming their clients (Section A.4). It’s a lot like the Hippocratic Oath: First, do no harm.

But what causes harm, exactly?

Consider the following scenario (borrowed from my Ethics textbook): You are the only counselor in a small town. Another therapist is a two-hour drive away. When you moved here, you became good friends with the school principal, and her son and your son are best friends. She asks if you would see her son professionally. His grades are slipping. He has started acting out at home. He’s defiant and surly. She doesn’t have time to drive two hours each way to take him to a different therapist. Could you just talk to him a few times? You want to help.

What to do? What to do? What could possibly go wrong?

How about this situation: You’re seeing a client who is a writer. You, too, dabble in the written arts. The client mentions his blog during a session, and as soon as he leaves you Google his name, find his blog, and settle in to read it. Your curiosity piqued, you search for him on Facebook. Research, you tell yourself. What you find out will help you understand him better. The next time he comes in you say, “Great blog! I have one too. You should check it out. And if you have any feedback on my writing, I’d love to hear it.”

ethics cartoonWhat’s wrong here? Why not bond with a client over a shared passion? Maybe trade a few sessions for a critique of the novel you’ve been working on. After all, the writer doesn’t have a surplus of cash. It would be a win-win. Right?

No. To borrow a phrase from Cheryl Strayed’s book of quotes Brave Enough: “The short answer is No. The long answer is No.”

You are the therapist. He is the client. It is a one-way street. You must consider all the ways in which your actions could possibly harm the client. You are not friends, buddies, colleagues. You are the keeper of deep secrets, a confidant, a compassionate listener, a mirror. Just in asking, you’ve violated the trust implicit in the counseling relationship. And the client is paying you for a service. Asking for a personal favor, for feedback places an extra burden on the client, a burden he did not sign up for.

Okay. One more. How about this? You are seeing a client who struggles with self-esteem, with feeling heard and being seen. She shares with you some of the poetry she has written. You tell her it is beautiful and moving and wonderful. You email her a couple of poems from your favorite poets and hope they resonate with her the way the do with you. She sends you more of her poetry. It really is beautiful, full of amazing metaphors and gorgeous imagery. You tell her as much. She should be published, you say. She glows in your effusive praise.

What? Is there a problem?

The short answer is Yes. The long answer is Yes. Now the client is seen. Now the client is heard. But by you. Instead of helping her gather her inner resources and find her intrinsic value, you’ve taken a short cut. Basically, you have given her the needle and the spoon and pushed the plunger down, mainlining self-esteem. You are now her source, her dealer, her heroin. Congratulations, you’ve created an addict.boundary issues

There are so many other things to consider here as well. What is poetry? Who sends poems? Poetry is the language of love. People in love send poetry. Poetry is metaphor—a word can have a thousand meanings in a poem. What you read and what the client meant might be vastly different.

What would an ethical counselor do in any of these situations? And why? An ethical counselor must always consider the needs of the clients first. In some respects, a therapist has to see the future and ask herself, “How will my actions and words now impact my client down the road?” “Will I be helping or hurting my client by taking this action?” “What is my motivation?” “Am I getting my own needs met or am I meeting my client’s needs?”

Instead of praising a client’s poetry, ask them what writing poetry does for them? What do they get when they create? How do they feel when they are writing? What’s their process? Explore. Ask questions. Help the client find her own meaning in her work.

I could write for days on this topic. But the bottom line is this: There is a power differential in the therapeutic relationship. The ethical therapist uses her power for the good of the client. Never for herself.

And I’d love to hear your thoughts on the scenarios I’ve presented. What could possibly go wrong in each of these situations? Let me know what you think!

Lesbian Identity: A Quiz, the Results, and What I Learned

This quarter, as I continue working towards my Master’s degree in Clinical Mental Health Counseling, I am taking a course on counseling the LGBTQ population. Here is the course description as it appears in the syllabus: This course provides an overview of clinical issues, contemporary theories, interventions, and research relevant to the treatment of sexual minorities. This population includes Lesbian, Gay, Bisexual, and Transgender clients, as well as those clients who identify as other than heterosexual (e.g. Queer, Pansexual, Omnisexual, etc.), or are questioning their sexual orientation or gender in any way. Psychological, social, cultural, and developmental issues are explored within the contexts of theory and practice. Emphasis is on affirmative mental health services for sexual minorities, including the importance of developing an awareness of the cultural, historical, and social realities of gay, lesbian, bisexual, and transgendered individuals. Readings, discussion, videos, presentations, experiential activities, and guest lectures/panels will serve to heighten awareness of problems such as homophobia and heterosexism as they affect the therapeutic setting, the counseling relationship, and the process of psychotherapy.

Students have to pair up to lead class discussion each week, so I signed up for week two (last week), which was to cover Lesbian Identity. I wanted to be done with the assignment early on in the quarter, AND who better to lead the discussion on Lesbian Identity than an actual lesbian?

Imagine my dismay when I realized the articles we’d been assigned to read were all sadly out of date. Two were at least ten years old, and the third, a study done on 15 lesbians who lived in the UK, looked at clothing and hairstyle choices and how they correlated to coming out, data that hardly seemed relevant for a counselor in training in the Pacific Northwest.

The findings certainly didn’t match up at all with my own experience. Coming out for me had nothing to do with how I dressed—I started shopping in the boys’ department when I was a child. Ask my mom. My short haircut has nothing to do with being a lesbian and everything to do with being lazy. And the fact that I look hideous in long hair. Never mind that all the women in Bellingham—lesbian, straight, queer, bisexual—look and dress alike. There’s a uniform: fleece, jeans, hiking shoes, short hair. We all look the same, a confounding and complicating fact of life for the women (and men!) who reside here.

So, armed with my indignation and determined to find more useful data, I put out a call to my Facebook friends. Would any of them give me permission to use their pictures and their sexual identities for a Lesbian Identity Quiz? The responses overwhelmed and heartened me. Assent and identities flooded my inbox. My friends—lesbians, straight women, bisexual women, queer women, were all intrigued and excited about this project. I began creating a PowerPoint slide show, the most stunning one I have ever made, full of my friends’ bright, shining, and beautiful faces.

And it wasn’t just about the pictures. Women sent me stories too, about their sexual orientations, their choices, their gender identities. Intimate stories. I had been gifted with very personal revelations. My excitement for the project grew as I realized I had tapped into something elemental here. Don’t we all want to be seen? Don’t we all want to know how others see us?

The enthusiasm for this project caught me a bit off guard. I heard from some Facebook friends I hardly know, from others I hadn’t heard from in years, from some I have never even spoken to in person. A few I had been close to once upon a time. And a handful with whom I have just a nodding acquaintance. The eagerness surprised me, heartened me.

A couple of people sent me specific pictures, but the rest told me to use whatever I wanted from their Facebook photos. I set about culling just the right pictures from dozens of Facebook feeds. Some were easy to find, others not so much. Many pictures were taken with significant others: wives, husbands, lovers, kids. I needed clear, easy to see photos that wouldn’t reveal anyone’s identity in an obvious manner, i.e. no wedding or family pics.

I didn’t want to bias the results via the pictures I chose, but I faced a dilemma: what picture actually best represents someone? Given the opportunity to choose a picture of a straight woman in a dress or a cowboy hat, which would I opt for? Or, my friend who has a biracial baby—what message would it send if I included a photo of her holding her child? For my lesbian friends, would I choose photos of them that emphasized their more masculine traits or their more feminine sides? I have to say in retrospect that my choices probably skewed the results.

I set up the slideshow with six pictures per slide, and when I clicked the mouse, the pictures disappeared one at a time, revealing each woman’s sexual identity (lesbian, bisexual, queer femme, or straight). I printed slideshow handouts to give to each class member, so they could write their best guesses next to each picture. I looked at my work and was proud. This was going to be a kickass class discussion and presentation. I could hardly wait.

Imagine my surprise then, when I introduced the quiz in class and the instructor immediately objected. “Wait a minute,” she said. “Is everyone comfortable judging other people like this? I’m not sure this is okay.”

I stood there, stunned, and wondered for a moment if I had made a serious error in judgment. I explained that I had everyone’s permission, that each participant hadn’t just agreed but had enthusiastically and wholeheartedly opted in. My classmates rallied to my defense, shutting down the instructor’s objections in short order. I passed around the handouts and fired up the slide show.

When they had finished the quiz, I went through the slide show quickly so they could compare their answers. I didn’t linger over individual identities, nor did we discuss anyone’s picture or what made someone look like a lesbian or a straight woman. Instead we talked about what it was like to judge people based on appearance. One female student said she refused to make any judgments about the individuals, saying they all looked like beautiful women to her. The instructor refused to take the quiz, as well. But she also refuses to label herself. Honestly, I have to say I have some judgments about that.

We discussed the safety of being identifiable, the politics of passing for straight. I (being the only self-identified lesbian in the room) talked about the changes in the past ten or fifteen years. How I used to feel like no one would know I was a lesbian because gays and lesbians weren’t part of the social or political discourse. Now, I feel like I’m always identified, categorized, and labeled. The discussion meandered from there, eventually covering a variety of topics, but one that we kept bumping up against and then turning away from, how to meet this population in our counseling offices.

And there’s the lesson—or should have been. How will we counsel lesbians when they come to us? What will we know about Lesbian Identity? Is it important that we know how a dozen or so UK lesbians changed the way they dressed when they came out? Or better that we know it’s nearly impossible to identify someone by the way they look? That 50% of the time we can tell a straight woman from a lesbian? That hardly anyone will know a queer femme when they see one, and more often than not bisexuals are invisible?

My tiny experiment revealed that, in this instance at least, we are right about our assumptions approximately 50% of the time regarding sexual orientation. I’m sure there are many more ways I can exploit the data for better/more interesting information, and I have my more mathematically inclined friends working on that for me. I’ll publish those results when I get them. In the meantime, here is what I have.

What are your thoughts, Readers?

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Quiz Results: Number of guesses in each identity. The * indicates the correct identity
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Percentage of correct guesses, broken down by orientation.
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Bar Graph representing guesses. Correct orientation is across the bottom, number of guesses in each category
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Percent of correct guesses of each photograph