Imagine that you are in private practice. You are wrapping up your first session with a new client and he reaches out to shake your hand. What is your response?
Now imagine that you are doing clinical work in a correctional facility. Your client, a prisoner, reaches out to shake your hand at the end of a session. What is your response? Is there a difference between how you would respond in the first scenario versus this one?
Are there definitive right or wrong ways to respond to either scenario?
Changing How I Viewed Client Boundaries
Being in my final year of my Clinical Psy.D. program, I have the wonderful opportunity to practice providing clinical supervision to first year students. There is also a seminar component to this experience where the student-supervisors come together to process the experience and enhance our skills.
In both areas – sitting in supervision with my supervisees and being in seminar with my classmates – the issue of boundaries consistently comes up.
For example, my supervisees might wonder out loud how to clarify boundaries and expectations with a client who consistently refuses to attend their sessions, or my classmates and I might try to help each other navigate the differences (and levels of appropriateness) between self-disclosure with a client versus self-disclosure with a supervisee. It was through these discussions that I came to realize how different the idea of boundaries is for me (someone in a forensic concentration) as opposed to those in another (or no) concentration.
In my first practicum placement, a federal correctional facility, I was asked to read two things before beginning my work.
The first was a piece written from the perspective of an inmate about how he manipulated an institutional employee for personal gain and was able to walk right out the front door of the prison, undetected. The article is called Downing a Duck.
The second piece was a book titled, Games Criminals Play: How You Can Profit by Knowing Them, which gives example scenarios and advice about how to recognize and prevent manipulation.
The article and the book, presented from two different perspectives, show how a motivated inmate can use observations (e.g., a staff member’s social role amongst other staff) and seemingly trivial interactions (e.g., the inmate asking a staff member for a piece of gum, extra time watching television) to set a foundation for manipulating staff into lowering their defenses and/or violating institutional rules (e.g., escaping from prison).
Both Downing a Duck and Games Criminals Play greatly influenced how I saw myself in relation to my clients. I struggled in that first year when trying to reconcile the way that I was taught to view the therapist/client relationship with the way I was being trained to behave in the field. In those early moments of training, I was not sure about how I would ever be able to strike the balance between being constantly aware of – and guarding for – the potential for manipulation AND also promoting a positive therapeutic alliance.
Although it may sound odd, I also had a lot of first-year-student anxiety about how I would actually navigate a spontaneous invitation from a prisoner to engage in a handshake. How could I maintain boundaries BUT not damage what alliance could be formed?
Now, looking back, I recall that earlier-therapist version of myself when I sit with my supervisees and they work through similar internal struggles.
Working With Client Boundaries
So what did I do to get through early struggles with boundaries, you ask? Have I ever been offered a handshake by a prisoner – and what are the answers to the scenario questions above, you may wonder?
I got through it by utilizing my resources.
Not only did I receive individual and group supervision, but I also received supervision from an APA-intern at my site, a 4th year student-supervisor at my school, and had a clinical seminar. Whenever possible, I utilized one of these resources to process, question, and seek guidance in how to balance boundaries in a correctional setting while also staying true to who I wanted to become as a therapist and a forensic evaluator.
I think the most important thing I learned throughout the process was to trust myself, the process, and the reason for the institutional rules. I could integrate the information and expectations instead of feeling the need to compartmentalize. I’ve also held onto the bit of advice a former supervisor gave me that still rings true for me today: It is easier and safer to start off with strict boundaries and loosen them up if necessary than it is to start off with loose boundaries and try to tighten them when things go too far.
As for the handshake and answer to the scenario questions – I’ve had my fair share of invitations. And while I could certainly explain what happened and what my response was/is, I won’t.
I won’t, because I’ve also learned that not only do you have to learn what sort of boundaries are recommended/mandated by the different agency or institution for which you are working, but you also need to understand what YOUR own comfort level is as well as where your personal boundary lines should be drawn. For example, your institution may have a “no touch” policy to address physical boundaries, yet it may be fine with colleagues who keep pictures of their family in their offices where clients/patients can clearly see them.
If you feel that you want to be a little stricter in that respect and maintain more of a neutral art style in your office, then that is your choice.
It is okay to honor your own personal boundaries, too. Your personal style in executing those boundaries will be different than mine, which is why I think sharing my own personal formula may not be as helpful as it would be for you to explore your own thoughts on this subject. You would be surprised how few people do until there is a boundary violation!
Discussions around boundaries are important, so please feel free to comment below and share your own experiences. When was the last time you had an issue come up with boundaries with your client, and how did you approach it?