We all know boundaries are important. Given that relational patterns of patients in trauma work are more frequently those of intrusion and rejection, assessing the patterns are doubly important. In forensic psychology, these patterns are also doubly complicated. I have experienced the visceral pull to cross boundaries and the intrusion of others trying to cross my boundaries in forensic settings across multiple types of relationships: with patients, other professionals, and supervisors. As a student in the classroom, the boundary lines look easy to navigate. However, the communication of trauma and the countertransference aspects of relationships make the experience of holding these boundaries requires work beyond simply knowing what one should do.
As a practicum therapist in community mental health working with court-mandated adults, I took a strict approach to sharing information. I gave the spiel of informed consent and releases of information. Initially, I thought this would be adequate, and that the whole ‘court-involved’ thing would be easy and straight-forward. However, a probation officer or case manager often called to get more information than was strictly covered by the release of information. I had to learn ways to avoid breaching confidentiality while maintaining a positive working relationship with these other professionals. There were also other releases dictated by their court involvement that required me to disclose more information that had potential negative consequences for the patient. The temptation to go outside ethical bounds was stronger than I anticipated.
I wanted to be able to share with probation officers or case managers’ information such as a patient’s relationship with someone who is endangering their sobriety; I also did not want to share information that I was supposed to including a patient’s occasional alcohol use. I knew what needed to be done and did it, but the pull felt foreign to me. Avoidance is not my forte and the desire to avoid made me question myself. I consulted with a mentor and realized that what made the alternative actions (i.e., oversharing with the other professional or failing to report patients for probation violations) so appealing was that they would allow me to avoid conflict in a way reminiscent of the permissive and often neglectful parents of my patients. The patients’ disclosures were tests – possibly unconsciously driven – that would see how reliable and consistent I really was.
As a practicum therapist at a juvenile detention center, the information sharing was more clearly defined, and anything learned in the intake and testing could go into an assessment report. The pulls I felt while working with these youth were not about disclosure of information. The mental health services were fully embedded in a system of corrections. By nature, forensic settings tend to have at least remnants of a punitive stance that can perpetuate patterns of chronic traumatization. Many of the youth reported being victims of abuse and seemed to be in the process of becoming aggressors; or, their trauma symptoms were creating problems in their community. The unique combination of punitive and therapeutic efforts lent themselves to re-enactments of the familial and community abuse relationships that contributed to the development of their offending behaviors.
While there is more support for intervention in youth facilities than adult facilities, there were still dismissive and sometimes hostile attitudes toward intervention providers at the juvenile detention center. Often, we as mental health providers, teachers, and other intervention staff would find ourselves in the position of defending against the presumption that we are there to make excuses for the residents. This would sometimes polarize staff into positions of trying to prove they are not too soft and of becoming punitive or arbitrarily authoritarian. It would also push intervention staff towards positions of trying to take stands against correctional staff and defending residents even when they needed to be held accountable. I felt both temptations and occasionally caught myself starting to fall into the roles of punitive or permissive authority figure.
Supervisors can make a huge difference when working through these kinds of struggles. Ideally, as a student, I can bring these struggles to my supervisor without fear. However the supervisory relationship’s dynamics can mirror the dynamics of the systems of which they are a part. In this instance, I found myself struggling to prove myself in a supervisory relationship that, in many ways, mirrored the oscillating dynamics of the punitive and permissive authority figures in the youths’ lives. I was given shaming criticism that did not indicate clearly in what way I was failing to meet expectations. I had anticipated that it would be a trauma-heavy population but not that I would feel so unsupported. It was not the multiple reports of child abuse that went nowhere or the many horrors of these youths’ lives that they shared with me that made me feel overwhelmed; it was the lack of support and contempt my supervisor had for me and my concerns.
I considered finding a way to quit, maybe even quitting forensic work, even though I felt I worked well with the youth and had worked well with the adult forensic patients from my previous site. I discussed the situation with my seminar at school, consulted with my monthly consultation group, and did my best to engage minimally with the supervisor, offering up little information about countertransference. This resulted in feeling less attacked but isolated while at practicum. Then I confided in a fellow practicum therapist, and over time we all began to share more and support each other. With this support, I was better able to advocate for myself with this supervisor and we were able to get some processing and peer support incorporated into our group supervision. When we organized and asked for these things together, it could no longer be dismissed as being unusually needy or too frail for forensic work as it had been when any of us alone had inquired. These were different rules of engagement than I had ever had in a supervisory relationship. It required an entirely different set of boundaries.
As I anticipate working with sexually violent predators on internship, I believe I will face a combination of boundary demands. The insidious attempts to groom potential victims of many sex offenders often reflect the dual dynamics of intrusive and rejecting behavior. The cold threats used by sex offenders have some subtle similarities to the gaslighting behavior seen in others in the community. I will need to hold the conflicting temptations to see only the victim in the offender or to see only the predator. I will need to be therapeutic without endangering myself. I will need to not only hold my own boundaries with them but support them in building the boundaries that they have not developed for themselves.
I am hopeful that the peer support of my fellow interns, the positive supervisory relationships at my internship, and my consultation groups and mentors will help me navigate these boundary demands as well as the challenges I have not anticipated as I begin the clinical work of internship. I am confident that I will always feel the pull to stray from the boundaries that I need to hold. However, learning what pulls me and why is an important part of my development as a trauma-therapist-in-training. I know I have a lot more to learn about trauma work. If I ever stop learning and seeking support, and if I allow myself to become complacent, I think that is when I will be in danger of breaking boundaries and/or burning out.
About the Author
Mavis Ring, MS, MA, is a doctoral student at the APA-accredited Clinical PsyD program at The Chicago School in Chicago. She earned her MS in marriage family therapy from Capella University’s CACREP-accredited program and her MA in Clinical Psychology from The Chicago School of Professional Psychology. She worked with adults, youth, couples, families, and groups in a variety of settings including community mental health, neuropsychology private practice, and forensic settings. Her most recent practicum was at a maximum security juvenile detention center, and she is currently beginning internship at a state hospital with adult patients civilly committed as sexually violent predators.