It's April 2020 and the world is in the grip of a global COVID-19 pandemic. During this trying time, each of us needs help navigating this crisis. In this special episode Dr. Wendy McIntosh PhD, from Davaar Consultancy, discusses tapping into your support networks, the pressures of being at work during the COVID-19 pandemic, and the immense challenges of maintaining safe Professional Boundaries when we're all operating under additional pressures.In this podcast series, Dr. Wendy McIntosh PhD shares insights and strategies about developing and maintaining professional boundaries. Professional Boundaries are not limited to the clinical or therapeutic arena, anyone in any professional role, should be aware of Professional boundaries.

Episode 6 – Strategies to Set and to Repair Professional Boundaries In Episode 6, Dr. Wendy McIntosh PhD, from Davaar Consultancy, shares a Professional Boundaries scenario set in a child care centre. Although the lure of becoming friendly with the parents of the children who are cared for each day is attractive, it can be a pattern that can be tricky to reverse. Wendy describes steps to remedy this awkward situation and some hints on ways to help refocus the attention back on the customer and their child, rather than the staff member’s family.  Also discussed are strategies for establishing better boundaries in collegial relationships, and how it’s important that front office staff also exhibit a unified boundaries front. This is the final episode of Season One,  and rounds up our first season of the Professional Boundaries Podcast. Use the links above to subscribe, or click the play button to listen. Get access to all episodes here.  Stay tuned for the Season Two, coming soon. There are 6 episodes in this first season of the Professional Boundaries Podcast and we hope you’ll both enjoy and learn from each of them. If you’ve ever wondered about your own boundaries in your Professional role, or been alerted about the risks of crossings or violations, this podcast will help you learn what to watch for, and ways to stay out the danger zones. Dr. Wendy McIntosh welcomes both your interest and curiosity. Send Wendy questions at [email protected] or via Twitter, Instagram or Linked In In this podcast series, Dr. Wendy McIntosh PhD shares insights and strategies about developing and maintaining professional boundaries. Professional Boundaries are not limited to the clinical or therapeutic arena. If you are in a professional role – a nurse, a teacher, support worker, doctor, police officer, a prison officer, council worker, healthcare worker, or hairdresser. If you are a volunteer or belong to a theatre group, a choir, a sports club, there will be something in this podcast for you and the relationships you have with others. Setting boundaries in our life is necessary for our emotional, psychological, spiritual and physical well being. Setting boundaries is about our safety. Dr. Wendy McIntosh PhD Since 2005 Wendy has been developing her knowledge and interest in the area of professional boundaries. Wendy delivers workshops on boundaries in Australia (where she now lives) and Internationally when invited to do so. She is continually integrating learning and insights she gains from the work she does in professional boundaries. Wendy comes from a nursing, and predominately psychiatric nursing, background. Wendy consistently receives feedback on her passion, knowledge, and creativity as a presenter and facilitator. Enjoy exploring boundaries in this podcast series as Wendy takes you on your own reflective journey on your professional boundaries. References Alaric Hutchinson – https://www.goodreads.com/quotes/tag/present-moment Brooke Deterline – https://www.youtube.com/watch?v=wzicXbnmllc- Adam Fraser – The third space – https://www.youtube.com/watch?v=dpk_dssZXqs Cambridge Dictionary – https://dictionary.cambridge.org/dictionary/english/recalibrate Music clips in this podcast: “Arcadia” by Kevin McLeod (Found at http://incompetech.com) & Savannah Sketch”  ” by Kevin McLeod (Found at http://incompetech.com) License: CC 0 BY (http://creativecommons.org/licenses/by/3.0/) Transcript: Podcast Six – Strategies for Setting and Repairing Boundaries Scenario She worked with children at a child care centre. She had been used to sharing details of her own family including information about her children with parents whose children attended the centre where she worked. Initially, she had thought nothing about this self-disclosure. She assessed that sharing information about herself and her children assisted the parents to feel comfortable about leaving their children in her care. However, she had become aware that she was uncomfortable about sharing such intimate information with some parents. Being curious about this, she started to question her actions. She read about professional boundaries and discussed questions she had about her self disclosure with friends. With greater awareness and appreciation about boundaries, her concern grew about the patterns of interactions she had established in her relationships with the parents at the centre. She experienced increased discomfort with parents who would start each day asking her about her children. She realised that the focus had become about her and her children – the roles had reversed. She wanted to create greater separation between her home and work. She wanted to be able to leave her children at home where they belonged not in her workplace. How could she protect them, when she had been so disclosing of their experiences growing up. She felt a pang of disquiet that she had transgressed her children’s rights to confidentiality and privacy. She wondered what she could do to change her relationships with the parents. She was concerned that if she established boundaries on her self-disclosure that it could have a negative impact on the relationships she experienced with the parents. Perhaps even a negative impact on the centre. How could she stop the patterns of conversation that were now so well established in the meet and greet each day? Welcome to this Podcast series – Professional Boundaries, Your safety, your wellbeing. I am Wendy McIntosh from Davaar Consultancy and I am delighted that you are joining me on another journey into the world of professional boundaries. This podcast series invites you to reflect on your Professional Boundaries and to appreciate how knowing the five foundation stones of boundaries can assist you in the everyday work that you do. This is our sixth episode and today I focus on strategies. Strategies for you individually Strategies when you witness or become aware that a colleague has – or is about to transgress a boundary Strategies for organisations This is a good time to remember the four foundation stones that we have discussed in previous episodes. Reminding ourselves that when we understand those four stones in relation to the context in which we work, then we already have some strategies at hand. The four foundation stones that we have previously discussed can be informative guides in our professional boundary journey. Definitions (from episode 2) Professional Boundary framework (including over and under involvement and categories of concern) (from episode 3) Red Flags (from episode 4) and, Reasons for transgressions (episode 5) As I have stated on previous episodes I wanted the podcasts to be as interactive as possible and I have been inviting listeners to email me any questions, scenarios or reflections you have about boundaries. Thank you to those who give me scenarios to work with. I will continue to build them into episodes we produce. Keep your interactions coming and if you have any feedback that you want to put up on the various sites where you can access our podcast we would love you to do so. Contact details for ongoing discussions or questions with me are given at the end of this episode. Keep putting the word out about the podcasts to your colleagues, peers, family and friends. We are delighted that as well as our growing numbers of listeners in Australia, we welcome listeners from Europe, USA, Jamaica, Tanzania and South Africa. Brilliant. I am appreciating that the theme of professional boundaries is pertinent no matter where in the world we work. Whilst contexts will vary – professional boundary themes resonate no matter the country, the profession, or the organisation. This episode introduced a scenario that is common for participants who attend my workshops. With knowledge, awareness and insight about patterns of behaviour and potential risks of those patterns, participants are keen to change the interactions in the relationships they have with clients, colleagues, or family members of clients. The area of self-disclosure and how to adjust that especially in longer-term professional relationships is worthy of exploring. As always any enquiry about a potential or actual transgression leads with my four boundary questions. Remember them? What was/is the intent or the purpose of the action / the content of the speech? Whose needs are/were being met? Were/are there other options available? (Generally, there will be a minimum of five options for each event) And the question I believe is essential – what stopped the person using another option? For this episode, we are going to get back into the car for a journey like we did in episode three when we discussed the boundary framework. So buckle up safely. Get comfortable and enjoy the learning. Remember if you have any questions, reflections or stories you want to share – don’t be a back seat driver – come up front with me and yarn. There are three main billboards ahead – Strategies for self, Strategies for colleagues, Organisational strategies. Many of the strategies presented in this episode come from the data I collect at the end of each workshop on boundaries. Consistent strategies emerge no matter the organisation or professional group that I work with. The strategies are consistent with articles written on professional boundaries. The strategies are consistent with those identified by participants who complete our internet tool on boundaries. We are going to stop at all three billboards and take time to absorb what they have to tell us, let us start with strategies for self. Strategies for self Preparing for the journey that is professional boundaries. I remember early on in my psychiatric nurse training one of our lecturers being very clear with us “You are not here to get your own therapy, you will not use the patients for that purpose, you need therapy … you go pay for it”. Few of us had any understanding about what she meant, however at various stages in our training and careers, most of us have had an experience that gave us that “ah ha” moment. This is what I love about the “ah ha” moments. We can have many of them at different times in our lives. Then one day, there is enough of the “ah ha’s for a particular behaviour that we actually get the big AH HA. The one that really creates a new link in our neural-pathways. This lecturer also wanted us to be very clear about our reasons for becoming psychiatric nursing students – “get to know the real reason you are here” she would say to us. It took me about 10 years to get very clear on why I was there. Self-awareness and insight is not necessarily an easy process but in terms of professional boundaries, I believe they are essential. Self-awareness I believe that understanding, effectively developing and maintaining professional boundaries is difficult if we do not have an awareness about our own motivations for the things we say and how we act in relationship to other people. Boundaries are much easier when the professional is very present to each moment in relationship with the client. For me, this includes the preparation to be with the client, the time after an interaction ceases and staying present when writing up a progress report about the client. I believe that it is important to keep checking in with self about how the relationship is progressing, being present with self is key to being present with another person. Being present Being present to the power – vulnerability dynamic in the professional relationship. Being present to one’s own vulnerability in the relationship. Showing up in the relationship. Life Coach Alaric Hutchinson stated – Bravery is the choice to show up and listen to another person be it a loved one, or perceived foe, even when it is uncomfortable, painful or the last thing you want to do. I have identified a number of showing up questions that helps to guide the work I do with an individual: Am I well enough to be at work today? Am I being triggered in this relationship and if so what is /are the triggers? What am I required to attend to in my responses to the other person? What am I contributing to the energy between us? Self-awareness, insight and being present top my list of strategies for self. What follows is my go-to list of strategies for self: Be clear on organisational/professional guidelines on boundaries – if you are not clear seek clarification Trust that saying no and setting limits can assist the relationship. I hold close a statement from a participant who attended one of my workshops a couple of years ago “if we never say no, then the yeses become irrelevant” (repeat sentence), I like that It is ok to pause, to take a breath before responding to the other person’s questions/comments Take time for self – ensure a balanced lifestyle Dress for work – that means if there is no specific uniform for where you work – create your own work wardrobe – thus when you dress for work – you are mindful of the professional relationships you will be encountering Seek counsel when unsure Pay attention to the red flags – do not ignore them as though they are unimportant Create a third space between work and home – time for you, just you, consider what you are leaving and what you are going to and prepare. I have put a link to the concept of the third space at the end of the written transcript for this episode which you can access from our website OK, I am almost ready to put the car into gear and move to the next billboard, however, before I do, take some time to consider the strategies you currently have in place for you. Are there some on the list you had not thought about before that you could integrate into the work you do currently and in the future? Note them down. Participants I see are always keen to have specific scripts that they can use when developing confidence in their professional relationships, especially when setting boundaries. I try not to be prescriptive in the work I do with them. I encourage each person to develop their own scripts that they will feel comfortable using. Like learning to drive a car, it can take many attempts before they feel comfortable and confident using new boundary scripts. Like learning to drive the car – sometimes the words will come out in a splutter, too fast, or too slow. It takes time, it takes practice to develop a new set of responses to the conversations we have with other people. As we sit at this billboard for self strategies here are some suggestions I offer re scripts: When setting and maintaining boundaries – keep what you are saying short – no more than five words – pause. Allow time so that what you have said reaches the other person. At all times hold great respect and dignity for the other person. Avoid what I call “a storytelling rationalisation” for the boundary, for the limit setting. Too much information and you will lose the importance of setting the boundary. Time and time again in workshops when we role-play with individuals to change their script they quickly become aware of the power of keeping to the purpose, keeping sentences short. It takes time, it takes practice, to change habits of a lifetime. Thinking about the scenario at the beginning of this episode – boundary setting is definably easier when we have boundaries in place from that first meeting. What is important in this scenario is that the person herself wants to change the dynamic. Changing patterns of behaviour with customers is harder when an employee is directed by a supervisor, employer, or regulatory body to make changes. That is why having self-awareness and insight enables changes to be more congruent for the person. In workshops, I talk about the need to recalibrate the relationship with the customer and to do that effectively we need to recalibrate our relationship with ourself. Recalibrate to change the way you do or think about something (Cambridge Dictionary) I imagine as I sit here with you in the car a few possibilities. As we sit here – you are the parent, and I am the employee in the child care centre. I am going to call you Belle, your child is called …Ross. The usual pattern is that you initiate the conversation with me when you arrive at the centre, you get in early with a question about my children. Today I am going to recalibrate our relationship. Today I am going to initiate the conversation with you and direct it. “Hi, Belle great to see you. Hi Ross, lots of activities for you today. Belle is there anything you need to know about Ross and what we will be doing today?”. Or words to that effect. The focus is on the parent, on the child. Get in the driver’s seat take charge. Drive with presence, drive with safety. You say to me but what if Belle manages to get in and ask about your children what then? Great question – we get in the driver’s seat again. “Belle, I am keen from now on that we focus on Ross being here and how we can make this a good experience for him and you” … and keep the focus on Ross. You say to me but what if Belle persists in asking about your children. I respond….. well she may well do, after all, that is what I have allowed to happen. I have set up the expectation in the relationship. With consistent new messaging, however, Belle will get it that the focus is on her son and we will both move on. And so we too will move on – to the billboard on Strategies for a colleague. Let’s go. Strategies for a colleague In many respects developing strategies for a colleague who is about to or has transgressed a boundary is more challenging than managing our own boundaries. The very act of approaching a colleague about a transgression can create much stress and distress for many people. If a person comes from a family which had open communication and family members were celebrated for bringing forward concerns then it could be easier to approach colleagues with concerns. Similarly, if workplaces have open and transparent cultures that encourage employees to approach one another – then that permission can assist individuals to approach a colleague with great ease. Examples of Intrapsychic questions which can emerge for a person who wants to approach a colleague to discuss a potential or actual transgression they have witnessed include: What do I do? What do I say? What if I have it all wrong? What if my colleague gets angry? What right do I have to say anything? For a start, no one wants to be a dobber – right? Not sure what a dobber is – well according to the Collins Dictionary it is Australian slang for an informant or traitor. I have worked with many professionals who have not wished to report unprofessional and unethical behaviour of a colleague because they did not want to be viewed as a dobber. This intensifies in workplaces where there has been perceived punishment for employees who have raised concerns or reported a colleagues behaviour. For many the fear of ostracism and being made a scapegoat for reporting a colleague is stronger than making that courageous move, to put a boundary in place. What if we changed the intrapsychic narrative to say something different for example: I am doing this to support a colleague. The client requires me to be an advocate for them This is my duty of care I would want a colleague to let me know My profession requires me to do this The question of what to actually say to a colleague can also create turmoil for some individuals. In workshops, I talk about being curious with a colleague. If you approach with curiosity in tone of voice and words – then you may wake up a curiosity in your colleague. A curiosity about their behaviour, a curiosity about their intentions, a curiosity to ask further questions about what has been observed/heard. There are many folks I have seen who had been reported for boundary transgressions who had just not realised that their behaviour had been transgressions. No colleague approached them, no colleague gently challenged them, no colleague said: “I am concerned for you”. Post the event – they wish a colleague had approached them. They rationalised that because nothing had been said then there was no problem with their actions and they kept going. So many times professionals have said to me “I wish someone had told me that what I was doing was not ok”. “I didn’t know that what I was doing was a transgression, colleagues saw me and said nothing”. In previous episodes, I have slowly been teasing out the experience I had with a female patient when I put my body between her and a wall. In the episode on the boundary framework, I discussed Categories of Concern one of those being the giving and receiving of gifts. Well over many weeks I received different hand made gifts from her. She was an artist and I considered her work exquisite and beautiful. At no time in my receiving of a gift – did a colleague say to me – “watch out”, or “what are you doing” or “you know receiving gifts is not ok”. Perhaps when that relationship was in play in the 1980s when we were not so aware of boundaries – receiving gifts was no big deal. I suspect, however – if a colleague had been curious with me and wondered aloud with me what was occurring in the relationship, I may also have got more “present” about what was happening for me intrapsychically in the relationship. Perhaps I had not reached that 10-year mark of self-knowing for me. Now many organisations do have policies and or guidelines in place about giving and receiving gifts and this is good. It has become very clear to me over my years of doing boundary work if there are no clear policies or guidelines in place – staff will make up their own guidelines based on their own moral compass, based on their own sense of right and wrong. Familial and cultural patterns that they have experienced. What follows are some suggested statements that could be made to a colleague. A statement made with a curious tone of voice. A tone of interest rather than judgement or assumption. A tone that invites curiosity from the colleague. A tone that wakes them up to someone being genuinely present with them I am showing up for you as my colleague, I am curious about what you just said/did with that client I have never seen or heard you do that previously. I am curious When you were with that client I heard you say to them “yes I am your friend” I am wondering …. Strategies for approaching/supporting colleagues are enhanced in organisations which support and encourage staff to challenge one another about boundaries. The following are other strategies that can enhance a more cohesive approach to boundaries. Teamwork – that works and that requires good engagement between all members of the team Consistent approaches from all team members. I encourage robust discussions away from clients to examine and explore approaches to care, however front of office all team members must be consistent in the work they do with clients. When one member has different boundaries and approach that challenges boundaries of their colleagues – then that is a red flag – something is different here. Clients will pick this up. Clients will behave in different ways with different staff Checking in with one another – being clear on the purpose for the day Being courageous to name a behaviour – use the language of boundaries – rather than talking about “feeling that a transgression has occurred” use the language of definitions, use the boundary framework as a guide, name the categories of concern that have been triggered. The foundation stones of boundaries are there to guide you – use them thoughtfully. Never assume that the data you have is a boundary transgression – that is why it is so important to check in with your colleague – her their experience and understanding of their experience. Work together for a solution if for whatever reason there is a reluctance in your colleague to acknowledge/address a boundary transgression then in most organisations it will be necessary to escalate up Always report and inform your colleague that you will be ding that. Report in writing, report verbally. We are just about to move onto the third billboard – Organisational Strategies and before we do I want to clarify that when approaching and or reporting a potential or actual boundary transgression in a colleague ensure that you follow your organisations policy and guidelines on same. Organisational Strategies I trust that as we drive toward Organisational Strategies that you have been developing a list based on the previous two billboards. In order to ensure individual and collegial boundaries are in place, it is imperative that organisations have informative and perhaps even instructive policies and guidelines in place. When exploring organisational strategies it is important to understand the ways in which organisational culture can both challenge and complement professional boundaries. A fantastic TED talk that I share with many participants is that by Brooke Deterline. In her presentation, Brooke invites employees in organisations to become aware of patterns of unethical behaviour in the workplace culture and then to develop creative ways of challenging the cultural norm. Inspiring. Yes, I absolutely accept that challenging the cultural norm does come with risks. For some those risks can be high, including the potential to lose one’s employment. However in my experience working with participants on boundary issues – not challenging unethical or unprofessional practices comes at too high a cost including challenges to one’s integrity and one’s sense of self-worth. Challenges to the purpose of one’s being. Other workplace factors that can influence professional transgressions towards clients and indeed collegially include; shame and blame cultures, vicarious trauma, workplace bullying and moral distress. I will discuss most of these in more detail in part two of our boundary seres, yes stay tuned more on that at the end of this episode. So what strategies can organisations have in place to ensure staff, customers and the organisation … kept safe boundaries. First and foremost it is necessary to have clear policies and guidelines on professional boundaries. Inclusion of information about the five foundation stones provides staff with good information to assist them. Ensure role modelling of boundaries through all levels from CEO’s, Managers, team leaders and … Role modelling collegially and with customers. Mixed messages of saying one thing and role modelling something different creates boundary disturbances and trust is eroded – eroded within the organisation and experienced by customers. Good education/training on boundaries for all staff. It is clear at the end of one-day workshops that I conduct that participants want more. In one day they are appreciative of what they have learnt and they are hungry for more. Hungry for more information and skills on boundaries. They are awakened to the importance of boundaries. They are excited about what they can do to change their own behaviour and to return to their units, their teams, their organisations to implement changes. I see the benefits in yearly refreshers. As I said in an earlier episode developing professional boundaries skills takes time and practice. Lots of practice. I encourage teams to use the workbooks I have developed as conversation points. I invite them – next time you are together as a group – choose a page, explore the questions posed together – are you on the same page (in the workbook, but also in terms of role modelling boundaries to clients). Yarn, discuss, agree, disagree, yarn more. It is also beneficial that staff have easy access to Employee Assistance Programs as a safe and confidential place that they can go to for counselling and support when they identify a need for themselves or a colleague. I believe that organisations have a Duty of Care to their staff to ensure that they have regular breaks, over the course of a shift. That when employees leave work at the end of a shift – they leave work. Phones turned off, no expectations that they will do work – especially if they are not being paid to do work. To enhance professional boundaries – employees need a break from their work – when work comes home at night with them they are not having a break. A line has been transgressed. When organisations transgress lines with their staff – it is a powerful message that is delivered. A more powerful message would be – we value who you are, we celebrate that you have time away from work for you, for your family. Well that us just about the end of this journey. The end of part one of this podcast series on professional boundaries. I have enjoyed sharing this podcast series with you. I am excited to prepare for part two. I have continued to learn about boundaries with each episode I have written. What a privilege for me that you have travelled with me. As I warm up to thinking about part two I have already identified specific themes I want to cover. At this point the As I warm up to part two of this podcast series I have identified a number of themes that I want to cover – so far these include: Collegial boundaries and in that episode I will explore further workplace bullying, moral distress and compassion fatigue Attachment and boundaries Understanding the limbic system to assist us in boundaries Shame and boundaries – understanding the connection Isolated practitioners / working in private practice – other boundary challenges to consider I and my team look forward to producing part two for you. This podcast series has been written by myself, Wendy McIntosh. A big thank you to family and colleagues who hear each podcast before it is released and who provide valuable editing feedback. Thank you to Nikki Fryn, my internet guru who has done the production for these podcasts. As I said earlier I would love to hear from you our listeners any questions, scenarios, reflections that you want to be discussed as part of a podcast session. There is still much to learn and each question and scenario posed provides opportunities to expand learning about professional boundaries. My email address is [email protected], you can also contact me through our social media of twitter and installer. I would be delighted for podcasts to be as meaningful as possible to all who listen. So join with me. You can access our podcasts through a number of sources including our website davaar.com.au/pbpodcast The spelling for Davaar is D for Discussion, A for awareness, V for Visceral, A for Action, A for Alert, R for Red flags. Thank you for listening, let’s meet again in part two where we uncover, explore and discuss more professional boundary ideas.

Episode 5 – Reasons for Transgressions In Episode 5, Dr Wendy McIntosh PhD, from Davaar Consultancy recounts a Professional Boundaries scenario about a Police officer in a small town and the various events that led to his transgressions. You’ll hear how, in hindsight, it was clear that unresolved issues from his own history left him at risk of this particular boundary violation.  Learn about how taking a candid look at our own history might give us hints about Red Flags warning us of likely vulnerabilities before problems transpire. Wendy also discusses Consistency or the lack of it, a particularly powerful Red Flag that usually deserves our immediate attention. This is the fifth part of a dialogue that be will be continued in the following episodes. Use the links above to subscribe, or click the play button to listen. There are 6 episodes planned in this first season of the Professional Boundaries Podcast and we hope you’ll be back to enjoy and learn from each of them. If you’ve ever wondered about your own boundaries in your Professional role, or been alerted about the risks of crossings or violations, this podcast will help you learn what to watch for, and ways to stay out the danger zones. Dr Wendy McIntosh welcomes both your interest and curiosity. Send Wendy questions at [email protected] or via Twitter, Instagram or Linked In In this podcast series, Dr Wendy McIntosh PhD shares insights and strategies about developing and maintaining professional boundaries. Professional Boundaries are not limited to the clinical or therapeutic arena. If you are in a professional role – a teacher, support worker, police officer, a prison officer, council worker, hairdresser. If you are a volunteer or belong to a theatre group, a choir, a sports club, there will be something in this podcast for you and the relationships you have with others. Setting boundaries in our life is necessary for our emotional, psychological, spiritual and physical well being. Setting boundaries is about our safety. Dr. Wendy McIntosh PhD Since 2005 Wendy has been developing her knowledge and interest in the area of professional boundaries. Wendy delivers workshops on boundaries in Australia (where she now lives) and Internationally when invited to do so. She is continually integrating learning and insights she gains from the work she does in professional boundaries. Wendy comes from a nursing, and predominately psychiatric nursing, background. Wendy consistently receives feedback on her passion, knowledge, and creativity as a presenter and facilitator. Enjoy exploring boundaries in this podcast series as Wendy takes you on your own reflective journey on your professional boundaries. References: Sir Walter Scott Quote – https://www.ncbi.nlm.nih.gov/pubmed/12678303 https://www.merriam-webster.com/dictionary/intrapsychic Thomas Gutheil, (1989). Borderline personality disorder, boundary violations and patient-therapist sex: Medico-legal pitfalls. American Journal of Psychiatry, 146, 597-602. The Drama Triangle – https://www.youtube.com/watch?v=E_XSeUYa0-8 Recommended reading on Transference King, R.,& O’Brien. T. (2011). Transference and countertransference: Opportunities and risks as two technical constructs migrate beyond their psychoanalytic homeland. Psychotherapy in Australia, 17 (4), 12-17. Music clips in this podcast: “Lightless Dawn” by Kevin McLeod (Found at http://FreePD.com) & “Pond” by Rafael Kruz ((Found at http://FreePD.com Artist- https://www.orchestralis.net/) License: CC 0 BY (http://creativecommons.org/licenses/by/3.0/) Transcript: Podcast Five – Reasons for transgressions According to Aristotle – “All human actions have one or more of these seven causes: chance, nature, compulsions, habit, reason, passion, desire.” Scenario He was a police officer, recently graduated from the police academy. As a child, he had witnessed and experienced domestic violence from his father to his mother. As a young child, he wished that he could have done something to stop the violence. He had hopes that someday his father would have an accident, an injury or would die so that he never came home again. As a young officer he accepted a posting to a rural and remote area, he was glad to leave the city behind. Glad to leave his trauma behind. His father was no longer alive he had died whilst driving home one night under the influence of alcohol. He assessed that his mother would be ok without him being there, they had regular phone contact and he always felt reassured at the end of the phone calls. He was a few weeks into his positing and he was enjoying his new role. He was taking some time to establish a network of friends. He was the only officer in the village, his colleagues operated out of the main station which was 50 kilometres away. One night he received an emergency call to attend a domestic disturbance in the village. He knew the address, he had met the young woman who lived there and he liked her. He had heard through the village grapevine that her partner would beat her on a regular basis. The protocol was that he had to wait for other officers to arrive to assist him rather than go into such a situation on his own. He knew his colleagues would take some time to get there. There was protocol and there was his reaction. He did not wait. He drove to the house, jumped out of the car and as he entered the house, he announced who he was. Welcome to this Podcast series – Professional Boundaries, Your safety, your wellbeing. I am Wendy Mcintosh from Davaar Consultancy and I am delighted that you are joining me on another journey into the world of professional boundaries. This podcast series invites you to reflect on your Professional Boundaries and to appreciate how knowing the five foundation stones of boundaries can assist you in the everyday work that you do. This is our fifth episode. As I have stated in previous episodes I wanted the podcasts to be as interactive as possible and I been inviting listeners to email me any questions, scenarios or reflections they had about boundaries. I am delighted to say that I now have podcast listeners contacting me with scenarios they wish explored during an episode and two folks who have approached me to ask that we have an episode specifically on collegial boundaries. So thank you for that, we will build your themes into future episodes. Keep your questions, scenario, and reflections coming. Let us keep boundary discussions alive and robust. Contact details for ongoing discussions or questions with me are given at the end of this episode. I realised as I was thinking about content for this episode that there was one theme that I had not yet integrated as a thread through my previous episodes. That thread is consistency. Consistency in the way a professional works with a customer they see on a regular basis. Consistency in the work a professional does with a number of customers. Consistency in a team approach. Consistency modelled throughout an organisation. Boundaries are more challenging to have in place – when an organisation is loud about its mission statement, vision statement and expectations about how employees conduct themselves and then team leaders, supervisors, and management team – loudly role model something quite different. Talk about setting up moral distress in a workforce. Talk about taking work home. Talk about feelings of unfairness and injustices. Talk about employees wanting to do more for a customer than what the professional role requires. Well, we will talk about these further as we continue on our boundary journey. In today’s episode, we explore foundation stone number four – Reasons for boundary transgressions. I have developed a multilevel model to explore and explain the reasons for transgressions. I find that factors from all four levels contribute in some way to influencing a transgression. The four levels that I focus on are the Intrapsychic, Interpersonal, Organisational, and Broader System. I will give a brief introduction about each level and then using the scenario of the police officer I shall describe each level in greater detail. Let’s start with the Intrapsychic Level Intrapsychic is defined in the Marion Webster dictionary as “being or occurring within the psyche, mind, personality”, for me the Intrapsychic also includes a person’s beliefs and moral compass. At this point, I want to pause to consider – when I talk about the Intrapsychic in terms of boundaries, I include that of the individual client and of the individual professional. Remember, the professional is always responsible for commencing, maintaining and where necessary effectively ceasing the professional relationship. This is because of the inherent power/vulnerability dynamic in the relationship. However, there may also be other vulnerabilities in the client (beyond them being a client of the service) that predisposes a professional to be at greater risk of boundary transgressions with that individual client. I will explore this more, later in this episode. At the core of the Interpersonal level is the relationship between the professional and the other person, for example, the professional and a client, the professional and a colleague, the professional and a client’s support person. This level includes the dialogue, the interaction, the communication, the spoken and the unspoken, the dynamic of power and vulnerability, the social roles ascribed to each person such as nurse-patient, hairdresser-customer, support worker-customer, teacher-student, counsellor-client, police officer-customer. At the Organisational Level– it is important to consider how policies and procedures, guidelines, mission statements, job descriptions, Duty of Care, resource allocation, and expectations can challenge or compliment professional relationships. Expectations of supervisors and team leaders of their staff, expectations of staff about their team leaders and supervisors, collegial and peer expectations in a team. Sometimes it is just too tricky to sort out expectations from .. well ..expectations. Other themes to consider at the organisational level are workplace cultures, is this a safe place in which to work, is this a shame blame workplace or one that is transparent and open. Is there accountability role-modelled at all levels? How are professional boundaries modelled in this workplace? Finally the Broader systemic considerations – by this I mean the factors that impact the work of the organisation such as relationships and expectations of other services who have a reliance on or partnership with the organisation. Broader systemic influences could involve legal, criminal, educational, health, housing, Centrelink. Broader systemic factors can influence the organisational factors, this in turn impacts on the interpersonal relationship, this, in turn, can impact on the intrapsychic experience of the professional and the client. Let me explain further. “Oh, what a tangled web we weave, when first we practice to deceive!” (Sir Walter Scott, 1808). Well okay, I am not sure about the deceiving bit, however, boundaries sure can be a tangled web that is woven by many people, by many situations, by many expectations. You may recall in an earlier episode my comment that as a professional you are never alone with a patient in the interactions you have with them. There will always be at least one other person and generally a crowd in that interaction with you. The other person/s will not be physically visible in the room with you, however, you may well hear the whisper of their words in your ears, experience the gentle tap of their finger on your shoulder, or visualize them in front or beside you. The other person or persons can include, the patient’s family member/s, your colleagues, your supervisor, the CEO of the organisation you work for, the CEO of an organisation in partnership with your organisation. If you are a professional who is answerable to a regulatory body – then representatives from that body may also make an appearance in your thinking, your experiencing of the relationship with the patient in that moment of interaction with them. Confused? Okay, let me slow this down a bit. In boundary workshops, I set up a sculpture of the four levels using materials, objects, and participants. Representatives in each level have a voice and address the professional who has identified a scenario they wish to explore. The busy noise, confusion and conflicting expectations come alive as many voices state what they expect from the professional in terms of their relationship with the patient. It gets so loud that many times the voice of the patient goes unheard as the professional tries to manage the needs of all the stakeholders that they have identified as being involved in the service provision for the patient. All those stakeholders that are symbolically“in the room” with them and the patient. In this experiential presentation of the four levels I ask the professional to notice what they notice in response to the busy noise – a common experience is relayed – “this is too much, I cannot meet everyone’s demands, I have to focus here on the relationship with the patient, at the time that I am engaging with them”. I have to pause, I have to breathe, I have to sort out the priorities of what is expected of me in relationship to my patient” This exercise allows a very big “ah-ha” realisation for some individuals, the push and pull effect of different expectations from many of the stakeholders who have some invested interest in the relationship between the patient and the professional. Sometimes those expectations are unrealistic. Sometimes those expectations could be in conflict between stakeholders, between stakeholders and the professional. A common expectation conflict I explore in workshops is the wishes from family members that the professional do more for “the patient”. Do more than what the professional can do either in terms of their employment and in some cases their professional regulations. In the wishes to have their needs met, family members do not consider the organisational or professional restraints that could be there for the professional. The family just want their needs met, their loved one to be looked after. Generally, it is after the fact – when a professional has given more, done more, gone the extra length to meet the family’s wishes that a complaint is made. Basis of the complaint – the professional was getting too close to the patient. It is also worth considering – here – whose needs are really being met by the professional attending to the families’ wishes rather than setting a boundary that is required for them to stay in the zone of helpfulness expected by the organisation and / or regulatory body? Consistency is key. Consistency in the way a professional works with a customer they see on a regular basis. Consistency in the work a professional does with a number of customers. Consistency in a team approach. Consistency modelled throughout an organisation. So let me now explore the initial three levels in greater depth using the scenario with the police officer to assist me. In the intrapsychic level, there are a number of personality types (also referred to as complexes, or syndromes) that are at greater risk of transgressing professional boundaries – these are named as – martyr, saviour, rescuer, rogue, opportunist, psychopath. Common intrapsychic wishes for personalities who fall into the martyr, saviour or rescuer roles include a wish for magical powers to make things better for the customer and or the hope of being admired or idolized by the customer. When I explore with participants the origins of their rescuer role, many identify childhood experiences related to the family of origin dynamics as the beginning of that role response for them. In some professional relationships, the customer can idealize the professional and this may completely complement the professional’s wish to be idealized. So begins a relationship of fantasy with expectations that can never be truly met. Gutheil in 1989 wrote … “the sealed off environment in which therapy often takes place can turn into a “magic bubble”, a collusion of mutual admiration and / or mutual need that becomes impervious to the restraining influences of consultation, supervision, good judgment, and common sense”. Although Gutheil had written this specifically about the therapist-client relationship, I have worked with professionals from many different professional backgrounds who have also experienced the magic bubble of collusive admiration and need. This is especially true in situations where the professional is working in rural and remote areas, isolated from peer groups, distanced from their families. Away from supervision and professional counsel, there can be an increased risk of developing familial relationships with customers as the professional seeks to find a connection that has meaning for them. To have a sense of belonging somewhere – that belonging may then be the development of a friendship or sexual relationship with a customer. If we consider the young police officer in the scenario at the beginning of this episode, there are a few red flags waving. His own experience of childhood trauma, his wish that he could have done more to stop his father’s violence, working in a town 50 kilometres away from colleagues. Difficulty establishing connections in his new environment. Our scenario continues …….when the young officer entered the house – the couple were standing a distance from one another – voices were raised, however, there were no obvious signs of physical contact at the point the officer entered the house. He raised his voice, he raised his gun. He does not remember much else until he heard another voice and gradually recognised it to be the sergeant from the other station. We will return to this progressing scenario later. Many times when I have replayed with some participants their transgressions where a customer was physically harmed by them, they describe having no clear memory of events, rather they describe a reactive process to a situation. Raising their voice to a shout, hitting out at the other person, in one instance kicking a client who had fallen to the ground. As we slowed down the replay of their behaviour individuals were more able to fill in some gaps as to the triggers that led to the transgression and more importantly to make links between their past experiences and what had occurred in the transgression. Those “ah-ha” moments so integral to awareness and potential for change. It may well be that a professionals vulnerability to transgressing a boundary arises from the very motivation that led them to their chosen profession – the hope of escaping one’s own problems by focusing on those of another person, the hope of meeting one’s own dependency needs vicariously by attending to those of the client. For example, Miller (1981) explored the theory that many psychotherapists were compelled as children to satisfy their parent’s unconscious expectations at the expense of their own emotional and development needs. Could this also be true of some police officers, lawyers, council workers, members of parliament, health professionals? Driven unconsciously by a desire to do better, be better, whilst moving further along the over-involved road. I wonder. Was the young officer’s actions motivated by childhood wishes to protect his mother played out as a police officer – acting to protect another woman he considered vulnerable and at risk? I also consider in this Intrapsychic level, the impact of health, family and work stressors that can result in internal conflict and thus increase the potential for boundary transgressions, let me tease this out further. When an individual is experiencing symptoms of a psychiatric or medical illness there can be an impact on decision making, emotional responses to situations and behavioural changes they can all increase a vulnerability to create a boundary transgression. Many participants I have worked with for boundary transgressions discuss current relationship stressors including, controlling partners, partners or children with a mental illness or disability, a medical condition, financial difficulties all of which again have influenced decision making in terms of the professional relationships including accepting “loans of money” from clients to help pay bills, having clients become lodgers in their homes for extra “rent money. A common enough theme for individuals I see who have become over-involved with a client is that of a history of childhood trauma that has included experiencing domestic violence, neglect, physical and or sexual abuse. I am not saying here that every professional boundary transgression occurs because the professional has a history of childhood trauma because I do not think that is the case. However, there is a common enough theme in the work I do for me to highlight it. What I will say here however is that I have found that when there is intrapsychic conflict about what an individual wants to do vs what they are required to do by their organisation and or their professional regulatory body – they are at greater risk of acting reactively in the professional relationship with another person. Consider for example a scenario where a professional is given an invite to attend a birthday party of a child whom they have been providing care for. The professional’s intrapsychic self is thrown into conflict. Personally, the individual wants to say yes, professionally they know they should not. In the intrapsychic conflict, there are significant biophysiological changes stimulated by the release of Cortisol into their body. In a nanosecond, a new motivating factor emerges that of not wishing to let the other person who gave the invite down – so the professional accepts the invite. Another intrapsychic level of conflict is then triggered – the professional then worries about what their team leaders response will be if they find out the professional attended the event. That worry may further intensify the intrapsychic conflict which results in the professional not attending the event. Post the event a potential new consequence presents, a question from the person who gave the invite – “why did you not come”, perhaps an expression of anger and or disappointment is directed towards the professional, “you have let me down”. That comment can hurt deep inside if I have a wish to be liked or idealized by the clients I serve. I will experience hurt. Sometimes a more painful comment is made such as “our child was so disappointed that you were not there, they had a specific gift to give you” – ouch that one can really hurt. Remember context is important. It’s worth checking in with the organisation you work for. Can I attend a birthday party, a funeral? Do I attend in my own time or paid time? Do I wear my uniform or civvies? Always good to check these things out at an organisational level. Context is important. Scenarios like this are good times for those reflective boundary questions – Why this child, why now? Why accept this invite when I have said no so many times previously to invites of other children I look after. Perhaps the red flag is waving saying – there is something different here, I am not being consistent. Consistency is important. Consistency in the way a professional works with a customer they see on a regular basis. Consistency in the work a professional does with a number of customers. Consistency in a team approach. Consistency modelled throughout an organisation. In the interpersonal level, it is good to be curious about the unconscious dynamic relationship that could be occurring and this is where models such as Transference and The Drama Triangle provide many “ah ha” moments for individuals I work with. I will use the scenario that is unfolding with the police officer to explore these models. First some further information about the scenario. The officer was reprimanded for his behaviour and for not following protocol. He rationalised with this sergeant that he appreciated he acted inappropriately and that he would ensure he would never take such action again. At no time in the discussions between himself and his sergeant was his childhood discussed. At this point in the young officer’s professional journey – he was not making any clear links between his childhood and his actions at work. A few weeks later he accidentally met the young women at a petrol station, they got into conversation. She asked him if he wanted to go with her for a coffee. He was off duty, he said yes. They had coffee in a public place. In the initial social meeting – they did not discuss the night that he had come to the house. Rather the conversation focussed on common interests they found they both had. The woman terminated the conversation saying she had to get home before her partner returned from work. That began regular meetings between them and as the relationship grew the woman disclosed more about the relationship she had with her partner. The officer’s concern for her safety was heightened each time they spoke. He was aware of but did not make any links about the feelings of fear and anger that were surfacing in him. He started to talk with her about leaving the relationship, he would keep her safe, that they could move away together. One week after their last meeting – the officer was asked to go to a meeting with his sergeant. A complaint of stalking had been made against him by the partner of the woman. The complaint focused on the time that the officer had spent with the woman. The woman stated that the officer had been pressuring her to leave her partner against her wishes. Further, she stated that she had not wanted to argue against the officer because she was not sure what he would do to her or her partner. What was the purpose or intent of the officer’s actions with the woman? Whose needs were being met? Was there other options that the officer could have used – especially at that first invite to coffee? What stopped him using the other options? I trust that I have provided enough information form previous episodes that you have come up with some responses to those questions using the boundary framework. I am now going to introduce you to The Drama Triangle to help us explore the role of rescuer, perpetrator, and victim that played out in the relationship between the officer and the woman and her partner. I will then consolidate further with using the transference model to highlight unconscious expectations, wishes, and desires operating at the time. I want to acknowledge that these are not the only models through which to explore reasons for boundary transgressions however both have been around many decades and still hold true when understanding unconscious dynamics in relationships. If you are unfamiliar with the drama triangle you may find it useful to access a short video through the link provided at the end of the podcast transcript which is available on our website. The drama triangle grew out of the larger framework of Transactional Analysis. It was developed by Karpman in 1968. Karpman suggested that if possible we avoid getting into the triangle in the first place through awareness about our intrapsychic self, the relationships we are in and relationships we want to be in. Good boundaries and good support mechanisms in organisations we work in. Karpman was keen that as individuals we understood our process of introjection and projection. Introjection refers to the ideas and attitudes of others that we adopted. Projection is where we project our feelings or characteristics onto another person in the current relationships we have. Karpmen was clear the professional’s usual gateway to the triangle is through the role of rescuer, at some point the professional will be perceived in the role of perpetrator and then will end up in the victim role. In the victim role, the professional has experiences similar to the person they “rescued” such as a sense of hopeless, feeling unsupported, perhaps experiencing anger and resentfulness. In debrief sessions that he attended the police officer was able to see how he had enacted all three roles and that he had ended up in the role of victim. In the beginning of his relationship with the woman, he had assessed that she was a victim in need of rescuing. In his rationalisation he was ideally suited professionally to stop the abuse because he was a police officer. Personally, he was of an age and body size to stop the abuse – something he had not been able to do for his mother. Before long he moved from the role of rescuer to that of perpetrator – a complaint was made against him that he had been stalking the woman. Within a much shorter time frame, he moved from perpetrator to victim. In the work I have done with professionals I have consistently seen the drama triangle played out. Professionals come to the attention of their organisation and or regulatory body for boundary transgressions. Acts of perceived kindness in the professional may well be viewed through the lens of perpetrator by those looking in. Those other stakeholders including a family member or support person for a client perceive a very different relationship to the one the professional sees. Those other people get concerned and they make a complaint. Sometimes it is the complaint that really raises those red flags that had gone unnoticed or ignored in the interactions between the professional and the other. There is an important role for organisations to offer employee assistance of employee support programs – be that counselling and or supervision to assist staff to understand the intrapsychic motivating factors that can end with boundary transgressions. In order to effect change, change in thinking, it is important that bridges, connections be made between relationship experiences from childhood and what is experienced in professional relationships with other people, clients and or colleagues. Now let’s go a little deeper interpersonally for the police officer and explore his behaviour through Freud’s theory of transference. Originally transference referred to the emotional responses of a client towards their therapist. Falling in love, idealizing the therapist, a wish that the therapist would rescue/save them from whatever internal or eternal perpetrator they were experiencing. Internal refers to an intrapsychic perpetrator role (self-talk, self-belief), external refers to another person. When the client perceives that the therapist cannot save them, or more damagingly believes that the therapist is acting in the same way as someone in their past or current personal life that then becomes a transference of anger, betrayal, enragement and even annihilation. I experience transference as a really useful process to reflect on work I do with individuals. Content that emerges in interactions be that verbally, behaviourally, unconsciously can be red flags that there is something requiring attention in the relationship. Although transference was originally developed for the therapeutic relationship I see transference being played in everyday professional – client relationships and with colleagues. How many times have you been disappointed when the team leader does not live up to your expectations? How many times as a supervisor have you experienced frustration because your team members do not do what you asked them to do? Intense emotional responses to what – yes the here and now – the adult to adult, professional to professional ….. I propose however that if we ask ourselves the following questions when we are in a heightened emotional response with a colleague there is a good chance that the present, the here and now interaction has triggered a much older role system response in us – that of the disappointed or enraged child. That of the hurt wounded child. Questions we can ask ourselves “how old am I right now” “what relationship do I know this from?” These are good questions to also ask when we experience intense emotional responses to the clients we work with. Our responses to the questions may well highlight the transference we are experiencing. The police officer was able to reflect that he had been enraged about the behaviour of the woman’s partner to her, even although he himself had never witnessed physical abuse, he had heard through the village grapevine, he had heard what the woman shared with him. He had the stories, he did not have actual visible data. However much older memories and experiences were being triggered for him, that of his relationship with his mum. He was also surprised to experience that he was angry with the woman because she had not left her partner. With some burrowing down – he also gained insight into the anger he experienced that his mother had never left his father. With support provided by the police service – the officer gained valuable insights – painful as they were, they were significant “ah ha” bridges between the unmet expectations and wishes from his childhood to his current personal and professional experiences. Another significant insight was that he had been vulnerable as the only police officer in the village. He had experienced a sense of isolation such as he had experienced in childhood. He understood that meeting with the woman had no sexual connotations for him, what was driving his actions was a wish to rescue and in equal measures a wish to connect. His transference towards the woman and her story was very strong. At some level, his needs were being met. In discussions with his sergeant, it was decided to move the officer from the isolated role into a setting where he had greater access to both supportive peers and ongoing counselling services. His organisation was able to work with him to maintain him in a police officer role and also support him personally. We have explored the scenario of the police officer through the levels of the Intrapsychic and Interpersonal, now we will continue to discuss through the organisational level. Organisational Level Questions to ask about the organisational level include: are the policies and guidelines about professional boundaries clearly written in a language that resonates with staff? Are job descriptions clear? What opportunities are available for employees to engage with team leaders or supervisors to clarify what the job description says verses the unwritten expectations of the organisation? What support mechanisms are available when staff identify that they could be or have indeed transgressed a boundary? How consistent are the teams in which you work? How consistent is the organisation in terms of your expectations or job descriptions? Without a doubt, if there is inconsistency in teams and in organisations there will be an increased risk of boundary transgressions. If there is a lack of policy or guidelines on boundaries then staff will do what humans do well. As individuals, as groups, they will join dots to make sense of the situation from what they know to be truths from their family, their community, their previous life/work experiences. In the workplace, if there are no clear guides about how to establish, maintain and effectively cease professional relationships, within the context of that organisation and professional role required, then employees will make up the relationship rule of engagement that works for them. They will bring in their own mores, moral compasses, and beliefs. After all, that’s how we survive as humans. The police officer was new to his role, he had recently graduated to the position. Like many professionals who read about boundaries in policies and codes of conduct, like many students who hear stories from lecturers about the risks of boundary transgressions, the officer thought he understood what was required in his professional role. At one level he did. At a much deeper intrapsychic and interpersonal level he did not. Consistent feedback from participants I see informs that boundaries are not explored in any great or robust detail in the organisations in which they work. Boundaries is a topic for a tick box in orientation. As I trust has been described in these podcasts, boundaries can be as easy as a tick-box, yes I understand, however, the complexity is – boundaries are not tick-boxes, boundaries are about me, I in relationship to myself and to the other person. Boundaries require more than a tick box. Boundaries require Sherlock Holmes inquisitive curious hats and times given in workplaces to explore and understand those complexities. More about that in the next episode. Back to the police officer, as a beginning practitioner in his new role, there was professional inexperience and naivety about such a highly emotive situation. There was also the reality of his isolation professionally and personally and the lack of immediate support for him to access. It is important that team leaders and supervisors understand the team dynamics. That team leaders and supervisors role model the boundaries they are asking their staff to demonstrate. Role model and discuss and be curious. Other workplace factors that can influence professional transgressions towards clients and indeed collegially include; shame and blame cultures, vicarious trauma, workplace bullying, and moral distress. I will discuss these in more detail in episode six when exploring strategies and solutions. Before I move to finish this episode, I have some more questions to pose to you about the scenario with the officer. Was the transgression a boundary-crossing or violation? Was the transgression over or under involved or both? What categories of concern did he tick (based on the information presented here)? Have a think and I shall give you my responses to those questions in the next episode. This podcast series has been written by myself, Wendy McIntosh. A big thank you to family and colleagues who hear each podcast before it is released and who provide valuable editing feedback. Thank you to Nikki Fryn, my internet guru who has done the production for these podcasts. As I said earlier I do love to hear from you our listeners any questions, scenarios, reflections that you want to be discussed as part of a podcast session. There is still much to learn and each question and scenario posed provides opportunities to expand learning about professional boundaries. My email address is [email protected], you can also contact me through our social media of Twitter and Instagram. I would be delighted for podcasts to be as meaningful as possible to all who listen. So join with me. You can access our podcasts through a number of sources including our website http://davaar.com.au The spelling for Davaar is D for Donald, A for awareness, V for Visceral, A for Action A for Alert, R for Red flags. Thank you for listening, let’s meet again in episode six.