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SPECIAL EPISODE – Boundaries and COVID-19

SPECIAL EPISODE – Boundaries and COVID-19

SPECIAL EPISODE – Boundaries and COVID-19

New Professional Boundaries Podcast

It’s April 2020 and the world is in the grip of a global 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

Wendy also talks about the stresses of working from home, teaches us how to use Box Breathing to get some relief, and how to use The Third Space model to use the shift between work and home to find a little peace, even when work and home are in the same location. 

Use the links above to subscribe in your favourite Podcast app, or click the play button to listen. Visit our Podcast page to see all episodes. Stay tuned for the Season Two, coming soon.

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Ep.5 Reasons for Transgressions

Ep.5 Reasons for Transgressions

Episode 5 – Reasons for Transgressions

New Professional Boundaries Podcast

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.

Dr. 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 wendy@davaar.com.au 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

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 counter transference: 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 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 wendy@davaar.com.au, 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 https://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.

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Ep.4 Those Red Flags

Ep.4 Those Red Flags

Episode 4 – Those Red Flags – What are they and do I really want to listen to them?

New Professional Boundaries Podcast

In Episode 4, Dr. Wendy McIntosh PhD, from Davaar Consultancy shares another potential Professional Boundaries transgression scenario, the red flags that were apparent, and how responding to those red flags in a different way could have prevented a challenging situation for a male teacher.

In this episode, Dr. Wendy discusses what the alerts that we call Red Flags might look and feel like, in more detail and some clever ways to respond to them. Red Flags Poster

This is the fourth 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.

Listen to Episode 5 here.

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 wendy@davaar.com.au 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

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:

References
Collins Dictionary accessed at: https://www.collinsdictionary.com/dictionary/english/intuition
Instagram post- https://www.instagram.com/p/B5d2GvqDiH9/ McIntosh, W.H. (2019).

Music clips in this podcast:
“Horizon Flare” by Alexander Nakarada (Found at http://FreePD.com Artist- https://alexandernakarada.bandcamp.com) &
“Inspiration ” by Rafael Kruz ((Found at http://FreePD.com Artist- https://www.orchestralis.net/)
License: CC 0 BY (http://creativecommons.org/licenses/by/4.0/)

Transcript: Podcast Four – Those red flags – what are they and do I really want to listen to them?

“Notice the red flags in your body – they are there for you to be conscious of the relationship dynamics” (McIntosh 2019)

Scenario
He had been a secondary school teacher for 12 years and had always been careful to separate his professional life from his personal. No complaints had been made against him in that time. No colleagues or peers had approached him with concerns about how he interacted with the students.
One day his Principal approached him “…… I need to have a meeting with you about your conduct with one of the year 10 students”.
The Principal had received a complaint from the parent of a female student. The complaint was that the teacher had not been paying her the same amount of attention that she witnessed him give to other students, especially to other female students. The parent was concerned that perhaps the teacher was discriminating against her daughter for some reason.

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 fourth episode in a planned series of six podcasts and I stay open to producing more as required.

I would love to have your input through questions, scenarios to explore or reflections from each episode. One of my aims for these podcasts is to have you engaged in the process with me. I know from experience that having discussions about boundaries and what it means for us in the work and services we provide is an important step in assisting us to understand motivations for our actions. Contact details are provided at the end of this podcast.

I want to thank listeners who have already made contact with me through email. I am delighted with the positive responses coming back to us about our podcasts. I am equally delighted that team leaders from two organisations have said that they will be encouraging all their staff to listen in. This is what I wanted to create – a broader platform from which robust and reflective discussions about boundaries can occur. So thank you, keep your emails coming.

In today’s episode we explore foundation stone number three – red flags.

As I was writing this episode I had an image of the flags of countries being carried during the initial and final march of Olympians for the Olympic games. The flags are held high, they move with the movement of the holder, with the movement of the breeze, with the movement of energy in the excitement and trepidation of the occasion.

Similarly, the red flags of professional boundaries move in front of us alerting us that something is occurring in the relationship for us to pay attention to. The red flags are the alert systems of our intuition or of other people’s observations. The red flags wave to us saying – slow down, pause, take a breath, check-in. Check-in with yourself, check in with a colleague, check-in with the patient.

The waving of the flags asks us to pay attention to the intense emotional responses that we may have towards a patient. The movement of the flags invite us to take stock, to ask – what am I about to do here, whose needs are being met, what options do I have right now in terms of developing/sustaining a respectful boundary with this other person?

Conversely, rather than questions, we come up with red flag commentary, “ok that was not such a good thing to say”, oops I might have crossed the boundary there” “I will have to be more careful in future with this patient”.

There are several red flags that I will explore in this podcast. They include the red flags of:

  • communication (verbal and nonverbal),
  • taking work home
  • experiences in the body – intuitive (internal) and actual movements (external)
  • comments from clients, their family members, colleagues

I will begin by discussing the red flags of intuition and movement in/of our bodies

Intuition is defined in the Collins Dictionary as unexplained feelings that a person has that something is true even when there is no evidence or proof of it. Our intuitive messages will start as a whisper, a gentle teasing – then will grow in volume and movement if we continue to ignore, dispel or even argue against our knowing. Our intuitive alerts – you know the ones – rising hairs on the back of your neck, the swirling in your stomach. Other intuitive responses in our body include pressing fingers above our eyebrows, tightening of our jaws, neck pulling back, hand outstretches facing upwards, pulling on one of our earlobes, a feeling of sickness. It is as though our body is waving red flags that say – drawing back, keep quiet here, anchor yourself down.

These are the hunches, the gut feelings. Perhaps there are words that go along with the feeling such as “something is wrong here”, “this is very strange”, “this does not feel safe”. For me, intuition can invite us to waken up, to don that Sherlock Holmes curious inquirer hat. In boundary work, it is important to recognise the alert centres in our bodies and to listen in to the messages our bodies are giving us.

There are many participants whom I have worked within boundary training who learnt from an early age not to listen to their intuitive self. To quieten their intuitive alert system. For some, it was dangerous to share their experiences with others especially their caregivers. Individuals who had been told in childhood that “they got it wrong” that what they were feeling “was not true” have a greater struggle in their professional role when their intuitive alert system says “watch out here”.

For those individuals, the boundary work with themselves becomes the most integral work they do with me. Professional boundaries starts and ends with the individual, with I, with me. I in relationship to myself and with the other person. In order to effectively manage the boundary with the other person, I have to learn to manage the boundary with myself. I have to erase old teaching about not trusting myself and integrate into my being – I have to trust that my intuitive self is wise and knowing. To trust that I am enough.
I encourage participants to identify and seek out a colleague whom they assess holds their best interests at heart. I say to them – let that trusted other be your eyes and your curiosity until you have trained yourself to be your own best boundary awareness guide. Yes trained yourself. I absolutely believe that boundary work requires exquisite self-training. To notice what we notice. To take notice of what we notice. To be curious about what we notice. Those four boundary questions introduced in previous episodes begin that lovely and at times disturbing self-awareness exploration about self and boundaries.

What was/is the intent and purpose?
Whose needs were/are being met?
Was/are there other options available?
What stopped/stops me using other options?

Boundary training requires us to understand the motivations behind the actions that led to the transgression/s. It requires us to acknowledge old role responses in us – the scripts and behaviours from childhood, from our family, our tribe, our community, our land. To recognise their part in getting us to this place in life where we now find ourselves and to change what is required to keep us safe in our professional role. To maintain our well being.

I believe that boundary work requires us to notice the movement of our arms, our hands. Noticing the ways our bodies react to the invites or criticism of other people we are interacting with. The movement of our bodies becomes the red flags when we are aware of what the movements mean for and to us. The subtle and loud changes in our body that can lead to significant changes in a relationship. Changes that we might not take notice of and yet the client reads something different in the movement. Perhaps that subtle movement sets up a fantasy about possibilities in the relationship that the professional would never consider.

I reflect with participants about the movement in their body – the body moving to accept an invite, arms reaching out to initiate or reciprocate a hug – a movement that occurs before a thought enters consciousness. It is so important to recognise the movement in our body and to then create a pause and to allow questions to emerge internally – what am I doing here, what other options do I have?

I know from the work I do – that this taking stock, this having a pause, this creating space to let the question in, does require a retraining in our bodies.

Taking work home – red flag…..
It may be that the red flags will be more obvious to our patients, to our colleagues and peers than they are to us. Perhaps even our family members experience something in us that we are not so conscious of in ourselves. Those experiences that we take home and the ways in which our tone of voice, content of speech or emotional expression in our bodies change perhaps highlighting something different about this client that we have taken home (psychologically or emotionally). Sometimes it is the wiseness and naivety of our children that is a red flag for us. Like the child who speaks a truth about the lack of clothing on the emperor, our own child or children may speak out and say “mum, dad, why do you always talk about work, I want you to read a story to me, or “I had something important to tell you about school today, but you don’t seem to be listening”. Many participants have shared with me – that it is the statements from their children that is the loudspeaker to their own quietened intuitive voices.

The clarity of a child’s expression into the busyness of our working life can be very sobering. It could be that the truth-speaking red flag from our children resonates more with us than anything a colleague says to us. As I say to participants – when we are in the depth of a relationship with clients we might not always be aware of how our behaviours and speech content is perceived by others. It is not uncommon that someone else in our lives will notice the depth we are earlier than we do.

The child or other family member experiences the red flag of our distraction, of our concentration being elsewhere. They experience in the relationship with us at that moment that we are not actually present with them – we are in fact focused on that client at work. That focus could be intense feelings that we have about the client and or the system we work in – anger, rage, despair, frustration, love, loyalty, unfairness. In the bulge of emotions, it is more difficult for us to pause and to ask – what is going on for me here, what is happening for me in relationship to this client that I have taken them home with me. I have psychologically and emotionally taken them in through the front door of my home and sat them down in between myself and my family. What is it about the relationship, about this client that I have brought them home? What follows are a number of steps/strategies that I assess are integral to effective boundary work.

First step – being aware of what is happening internally and how that is being experienced externally by others.
Second step – making a decision to stop thinking about the client, about work and that may require us to make a statement such as “and that’s enough now”. That’s enough now, I am not at work, I am at home and that is where I need to be.
Third step – may require us to actually move our body – change position whilst making a clear statement.
Fourth step – creating time at work to reflect on what has enabled the client to come in through the front door.
Fifth step – to discuss with a trusted other
Sixth step – to recalibrate the professional relationship with the client. Understanding that the client may not actually be experiencing from us the intensity of the feelings we have. What I mean is an internal recalibration for ourselves. And if required in the professional relationship with the client.

These are some steps/strategies that we can put in place for ourselves as we wander the boundary landscape. Ensuring as much as possible that we do not get to close too the edge and certainly to halt us stepping over the edge. I will discuss strategies more fully in podcast six.

Other take-home red flags include –

  • sleep disturbance due to worry about the client and outcomes for them,
  • phoning work to talk to a colleague about a client’s progress
  • contacting the client from home

I want to revisit the scenario with the teacher and the student and add some further context.
The teacher had been teaching the student in his class for six months. He had been aware early on in his professional relationship with her that he had feelings for her that was professionally unacceptable. He did not discuss his feelings with anyone else. He had felt ashamed of his feelings and was fearful that if he did talk with a colleague or his Principal that it would have negative consequences for him.

He made a decision that in order to keep his professional relationship with the student safe that he would never be alone with her and if she made approaches towards him in any way he would decline.

What he was less aware of, however – was that in ensuring that he was careful not to give the student any mixed messages or any messages that he was interested in her, he was gradually moving further away from the Zone of Helpfulness into the under-involved area of the boundary framework.

He would turn away from her when she approached him. When he was addressing the class he would never look at her. If she did approach him to ask questions about the content of the classes he would be (in her words) “short with me, as if he didn’t care about my work, I got really nervous about approaching him to ask any questions about what we were studying”.

In discussions with his Principal, the teacher was able to reflect in greater depth about his communication responses to the student. He appreciated that her experience of him probably was right. He had not identified that he had been so obvious, he had not realised the red flag that was waving in front of him. That of communication – the verbal and nonverbal responses that can tell a story and be interpreted in multiple ways.
His principal suggested and the teacher agreed to counselling to assist develop strategies to ensure that he was not discriminating against the student or perceived to be discriminating with future students.

The teacher was able to link the feelings he had for the student with a much older role system for him. In the counselling sessions, the teacher developed greater awareness of his communication style with the student and the genesis of his communication approach to the student.

So let’s take some time to explore communication in professional boundaries further. It is important that we look here at two way communication – professional to patient, patient to professional. Two way between colleagues. This red flag of communication also considers the tone of voice, volume, speed and use of silence.

A consistent theme that participants in workshops express to me is their discomfort with silence. One strategy to manage their discomfort is to start talking, talking about themselves, their family, their interests. It is important for them to fill the silent gaps. I think the answer to the question whose needs are being met in filling the silence is clear here.

This is an area where that exquisite boundary training is necessary – to learn through experiential learning that being silent in a relationship with another person can be ok. It might take a few experiential tries for some folks, however each time they practice being silent their body settles a little bit more and then when they state “ah ha, I’ve got it now”, they appreciate how empowering for the other person silence can be. An integral process in the retraining of an old role – is that they are not being rude by not answering immediately – that in fact creating a pause before answering has much better outcomes for the professional relationship.

Other communication red flags that have been identified includes that of self-disclosure, asking questions of the client that will not have any clear benefit to the professional role, but again allows the professional to feel comfortable. Questions are better than silence, right ….mmm not always.

being too close in someones personal space,
leaning in close – when standing or sitting back allows a greater safe space for both people
when giving a report/handover about clients care the tone of voice for a “favourite” is gentle and soft – where for a client who is “bothersome” it is harsh and critical

Comments from others – students, clients, clients family members, colleagues, own family.
Context is important and this is relevant in terms of communication between the professional and the other person. Context includes the tone of voice, is there a negative, positive or neutral slant to the spoken content. I also want to acknowledge that the comments I am about to share – may well be the truth for the individual who is speaking them and of themselves do not mean that a transgression has occurred, however, they are red flags to alert us to the possibility of a transgression, they alert us to consider the impact of the comment on us, They alert us to ask – am I doing anything different here with this client than with the others I provide a service to?

Red flag comments from clients can include:

  • “you are so nice, I wish all the other staff were as nice as you”
  • “I really like it when you are on”
  • “I hate you, you are so cruel”
  • “you are my favourite teacher”

Red flag comments from clients to a colleague about you:

  • “oh yes she told me all about her holidays”
  • “yes he keeps in touch all the time, see these messages”
  • I wish you were as kind as …..”

Red flag comments from colleagues to you:

  • “I noticed how you were with that customer, I haven’t seen you act with other customers that way”
  • “oh you are so series about …. lighten up”
  • “how come you are so invested in ……”
  • “why do you always want to look after …… when you come to work?”

Red flag comments from family members of clients:

  • “dad really likes you”
  • “can you come and visit Mum when you are not working?”

So we will now take some time to further explore the scenario with the teacher and use the red flags to assist us. If we look at the red flag of the intuitive and behaviour – it was clear that the teacher had acted on his intuitive warning signal that he was experiencing unprofessional feelings towards the student. That was good – he listened and he acted.

The experience of the feelings he had was in itself not a transgression – as people, we have a variety of feelings for other people that are not always comfortable or appropriate for that context. What is more relevant is what we do with the feelings we have at that time. And this is especially important when considering professional boundaries and clear power – vulnerability dynamics. The teacher was in a position of power, the student was vulnerable. Other power – vulnerability considerations could be age and gender differences. In this scenario, the teacher made the decision that in order to protect himself he would switch down on being interested in the student. His actions, however, are another way in which he demonstrated his use of power.

If we look at the red flag of communication – the student clearly articulated what she had experienced and the negative impact that had had on her and her learning. The teacher was open to accepting the feedback from the student and recognised that his communication skills in managing role conflict in himself required him to do some counselling.

The take-home red flag only became clear as the teacher reflected on his actions. He had tried so hard not to think about the student at home that in fact “trying hard not to think about her” became a focus for him. On his hour drive to and from work each day he would reflect on his interactions in the classroom. He was pleased that he had not “lead her on”. He had not appreciated the cost of his under involvement with her and as it transpired with himself.

If you were to consider yourself in the role of the teacher – what strategies would you put in place for yourself?
If you were the Principal of the school what further actions if any might you have taken with the teacher?

At the end of the previous podcast, I left you an invite to consider my actions with the female patient. I want to add another bit of context which I think will assist further. I had made a commitment to myself early in my career that I would not work overtime if requested to do so. I had made this commitment to myself appreciating in terms of my physical, psychological and emotional well being one shift was long enough. On the day of the incident, I had been working an early shift. The management team in consult with the treating psychiatrist had made a decision that the patient was going to be under constant observation for 24 hours. Staff who were on shift were asked if anyone would like to work overtime. My hand went up.

That was my big red flag and I ignored it. I forgot the commitment I had made to myself to my well being, to my safety. I did not pause long enough to reflect on the invite to do overtime. I did not stop to ask “why this patient, why now?

Had I listened to that big red flag – the outcome could have been different.
I went into the patient’s room filled with emotion and a wish. A wish to make things better for her, emotion that a human being did not deserve to feel the pain that she did.

On the boundary framework – I had stepped right out of the Zone of Helpfulness and was driving fast down the road of over-involvement. As I kept driving away further away from the zone, I was also professionally under involved with the patient. In reflection, my transgression was a violation, my actions driven by my wishes, my needs, my clinician had gone to sleep behind the wheel.

If I consider my actions under the categories of concern – I had stepped away from my professional role when I put my body between the patient and the wall. Did I enter into a dual relationship with the patient? Well here is another complexity to boundaries. In the context of what dual relationships actually means in the professional literature – no I was not in a dual relationship. If I consider however unconscious dynamic processes and especially that of transference and countertransference then I absolutely was.

Did I access or disclose information not required for me to provide the care I was being paid to give? Well, my behaviour disclosed much even if my speech did not. The final category of concern Was there an exchange of gifts, services, money between myself and the patient?

Well, that’s for another episode…

As I draw towards the end of this episode I invite you to consider your red flags. The ones that guide you and perhaps, more importantly, the ones you ignore. Consider the ways in which the red flags can guide you in your well being and your safety as you establish, maintain and as necessary end the professional relationships that you have with other people.

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 wendy@davaar.com.au, you can also contact me through our social media of Twitter and Instagram. would be delighted for podcasts to be as meaningful as possible to all who listen. So join with me.
The spelling for Davaar is D for Donald, A for awareness, V for Visceral, A for awareness, A for alert, R for Red flags.

Thank you for listening, let’s meet again in episode five.

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Ep.3 Professional Boundaries Framework

Ep.3  Professional Boundaries Framework

Episode 3 – The professional Boundaries framework. Staying in the Zone of Helpfulness

New Professional Boundaries Podcast

In Episode 3, Dr. Wendy McIntosh PhD from Davaar Consultancy shares another Professional Boundaries scenario and ways to identify when a professional’s behaviour risks boundary crossings or violations, or if a transgression might already have occurred.

Listen as Dr. Wendy explains the Professional Boundary Framework model she uses in her workshops to help participants get a visceral feeling of the Professional Boundaries continuumThis episode introduces powerful and specific questions to ask while examining situations that are ripe for crossings or Professional Boundaries Frameworktransgressions and delves deeper into the reasons that they occur. The discussion of Red flags continues in this episode.

This is the third 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.

Listen to Episode 4 here.

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 wendy@davaar.com.au 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

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:

Gutheil, T. G., & Brodsky, A. (2008). Preventing boundary violations in clinical practice. The Guildford Press: New York.
Quote from Plato – https://www.brainyquote.com/authors/plato-quotes

Music clips in this podcast:
“Perspectives” by Kevin MacLeod (https://incompetech.com) &
“Middle Earth ” by Jason Shaw (https://audionautix.com)
License: CC BY (http://creativecommons.org/licenses/by/4.0/)

Transcript: Podcast Three – The professional boundary framework – where possible keep in the Zone of Helpfulness

Scenario
She lived and worked in a small town.
She was only six months into her role as a support worker
She had lived in the community for 5 years.
She was aware of the organisation’s code of conduct which had a section on boundaries.
She had read the document, she had assessed that she had a good understanding of the content.
She was surprised then when her team leader asked to see her, a complaint had been made against her.
The complaint had been made by the daughter of a customer she was seeing. The complaint stated that the support worker had got too close to the complainant’s mother, the complainant stated “she (the support worker) is spending more time with my mother than is required. Now my mother makes comments to her like “you are just like a daughter to me, dear”.

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 of exploration, revelation and for some, consolidation, on the theme of professional boundaries. This is our third episode in a series of six. Each episode focuses on a different aspect of professional boundaries and aims to extend your understanding of professional boundaries. Further, the podcast explores ways in which Professional Boundaries can assist you in your work and perhaps even in your everyday life. Feedback from participants who have completed training with me, share how insights and learning they gained about professional boundaries has assisted them with boundaries in their personal relationships.

I would love to have your input through questions, scenarios to explore, reflections from each podcast. One of my aims for these podcasts is to have you engaged in this process with me. I know from experience that having discussions about boundaries and what it means for us in the work and services we provide is an important step in assisting us understand motivations for our actions. Contact details are provided at the end of this podcast.

The beginning is the most important part of the work – Plato
This episode focuses on the foundation stone of the Professional Boundary Framework. I really enjoy exploring the framework in the boundary workshops I conduct because I use an experiential process to assist participants. Using different colours of materials I present the framework as a sculpture on the floor. This means that I and participants can walk up and down the framework and have a visceral experience of where they might be on the framework in terms of work they are doing with patients, and or collegial relationships. In the invite to folks to experience the framework, I invite them to be curious about what might take them out of the Zone of Helpfulness into the continuum of an over or under involved relationship with the other person. In exploring the framework through action I also ask participants to be aware of red flags and also strategies to assist them to return to the Zone of Helpfulness.

Major benefits I see to understanding the boundary framework in the context of professional relationships is that we can use it as –

a risk assessment framework (we can pose the question – where on the continuum am I)
an awareness framework – (we can pose many curious questions – what / who led me here?)
a solutions framework – (ok this is where I am – what do I need to get back to the zone of
helpfulness)

I am thinking that it would be useful to describe the framework to assist you have a picture of it as I invite you to wander up and down exploring the two scenarios presented at the beginning of the podcast, revisiting my scenario from podcast two – Caring enough to put my life on the line and also reflecting on relationships you have with patients and or colleagues. For an image of the boundary framework similar to what I use in the workshops I deliver, you can visit our website and in the podcast section, you will be able to see the framework. For the purpose of this podcast, I will explain it as though we are in a car driving.

Imagine you are at an intersection on a road, in boundary land this intersection is the Zone of Helpfulness also referred to as the Safety Zone and Therapeutic Relationship Zone. If you turn left you are going into the over-involved area, if you turn right you are going into the under-involved area. In this road, the interaction is actually the safest place in which to practice. At either end of the left hand or right-hand turn, there is a big road sign that says illegal. We definitely do not want to end up there. As we look in either direction what we see is that the roads are an ever darkening shade of grey until the endpoint here the word illegal is black.

If I turn left into the over-involved road – some commonly reported behaviours will be demonstrated – spending unpaid time with a client, lending a client money, interacting with the client on social media, giving gifts to the client that could include, food, clothing, tickets to the movies. On the over-involved road, the professional may spend a lot of time thinking about the client and how to make things better for them, perhaps there is some magical thinking about how to make their circumstances better for them. Better – as perceived by the professional.

If I turn right onto the under-involved road common experiences are a disinterest in the client, talking about them in negative tones, use of pet names – such as pet, darling, dear. An emotional distancing that is cold and rigid. There may also be neglect and abandonment of the client’s needs.

There are four large billboards which have important messages for us to consider in terms of professional relationships. Each are a guide to assist the professional reflect on the context of their role. These billboards are visible on both the over and under involved roads.

The largest billboard is World considerations – such as the Universal Declaration of Human Rights

The next billboard is Federal and state legislation on safety and professional regulatory expectations (laws relevant to the countries in which you live and work)

Another billboard represents organisational policies, procedures, and guidelines with professional boundary expectations in there.

The final billboard represents the job description and expectations of the professional role

These four billboards (represented as circles in the image we present on our website), and all they contain, form the CONTEXT of what is required in the professional relationship between a professional and a client. Be that as an employee such as a support worker, teacher, police officer, council worker, health professional or an independent practitioner such as a counsellor or health professional.

There is another element to the road – that is a pathway that also goes left and right form the intersection. The pathway is uneven. This pathway symbolises the actions and speech content of the professional and the interpretation/understanding that the client has, about what was said, what occurred. Remember from podcast two my assessment that what I did was a careless thoughtless act, the patient’s interpretation – someone cared enough about her to put their life on the line.

Let me explore that idea of interpretation of actions with some further discussion on the scenario from this podcast. I shall begin with some context.

The customer was in her 70s. She was known to the support worker because they lived in the same community. Prior to the commencement of the professional role their interactions had been brief community interactions when they met at social events. The only family member the lady had was her daughter who lived in another town and could only visit her mother every month when she would stay overnight with her. The support worker’s paid role was to visit the client twice a week to take her shopping, ensure she had enough food and to help her prepare meals if required.
As the professional relationship developed – the support worker found that she looked forward to spending time with the client. The time they spent together extended into unpaid time – the support worker would visit the customer in her own time. She started to take meals that she had prepared, to the customer.

When the team leader inquired as to the extra time and meals provided the support worker responded “well she is so lonely, I just did what any caring person would do. The customer always tells me how much she enjoys my visits”.

It is so easy for two completely different interpretations, two different meanings, two different stories to be created in a single act, in a single sentence, in a pattern of behaviour.

When the team leader talked with the customer – she responded “she is very nice to me, other support workers have not done that, come to visit me or bring me meals. She is like my daughter – that’s what my daughter does for me”. The customer also made another comment to the team leader which amplified a red flag for the team leader. The comment was “I feel so sorry for her. You know she lost her own mother just over a year ago”.

So I now pose some questions to you –
did a transgression occur and if so was it a crossing or a violation?
was it over or under involved?
– or both?

When we briefly revisit the definitions discussed in podcast two, we are reminded that a crossing occurs once and is generally considered to be thoughtless or inadvertent. A violation is a pattern of behaviour where the needs of the professional supersede the needs of the client.

Based on those definitions we could assess that in the scenario – the boundary transgression was a violation. Was the transgression over or under involved, or indeed both? Well, that question may take some time to discuss. So we are going to pause here to consider this very important question – was the behaviours of the support worker over or under involved or both?

I have learnt through the hundreds of sessions I have conducted with professionals, through scenarios presented and explored in the workshops I conduct, that an over-involved professional boundary actually informs us that it is the person who is over-involved, not the professional. Hang in with me whilst I explain further.

If I am acting in the requirements and expectations of my professional role in the context that I am employed then I cannot actually be professionally over-involved, however, I absolutely can be personally over-involved. I have become personally over-invested in the person and in the relationship I have with the other person.

Now, this is where I really appreciate the complexities that are professional boundaries – if I am personally over-involved then there actually is a very good chance that at the same time I am professionally under involved. The personal aspect of the relationship has become so important to me that I stop noticing what I need to be noticing in my professional role, the role that I am being paid to do.

In all examples of where I have worked with individuals due to over-involved transgressions when we explore the under-involved aspect of service provision – whilst hard and confronting to hear – individuals appreciate that the professional objectively switched down or off and the emotional personal got going.

You could use the framework right now to further understand the complexity of being personally over-involved and professional under involved by reflecting on a situation from your professional role, historically or currently. It is always beneficial to consider an over-involved scenario and then identify – am I also under involved here.

Place yourself on the framework – how far away from the intersection – that safe Zone, that Zone of Helpfulness – have you travelled with your client. Look back and notice that the further away from the intersection you are, the further away you will also be from providing the care, the service that you are being paid to do – thus, you are also under involved.

Context is important.

If we consider those four important boundary questions from podcast two we can also get further data:

1. What was the intent or purpose of the support worker’s actions?
First base to provide care for the customer (remember she was also being paid to provide care within the remit of her paid role)
Burrow down – she felt better because of the extra services she provided. She also liked to hear comments from the customer that no other support worker had shown so much care, that made her feel wanted.

2. Whose needs were being met?
First base the customers – burrow down – the support worker felt needed by the customer and that made her feel good, more significantly however was that being with the customer reminded her of being with her mother. Being with the customer she experienced a comfortable and familiar relationship. The professional’s emotional and psychological needs
were being met.

3. Was there other options for the support worker?
Yes many, however in order to allow any other options to present – the support worker would have had to have awareness that was she was doing did not meet her organisational code of conduct.

Had the support worker had an awareness of her actions she could have spoken with her TL before continuing on the journey she had started.

The support worker stated that she had understood the code of conduct content in terms of boundaries – yet her actions demonstrated this was not the case. She really was surprised to learn that not only had she transgressed the boundary – she had violated the boundary. Her prior understanding of boundary violation was that it must be close to or an actual illegal activity, such as fraud, assault, neglect. She thought that developing a sexual relationship would also be considered a violation. She had never contemplated that visiting the customer in her own time and providing meals would be considered a violation. For the organisation in which she worked, it was. Context is important.

4. What stopped her using another option?
In this scenario – a lack of awareness and not enough knowledge or experience to assist her to discern that her behaviour was a breach of her organisations expectations for her role. In a later podcast we will learn that personality features, relationship issues at home and or in the workplace, influence of drugs and or alcohol, workplace cultures of bullying, vicarious trauma and burnout can be influencing factors in terms of stopping individuals using options in the professional relationships they have with their clients.

It was clear when data was collected that the support worker had not acted out of malicious intent, she had however used the power of her role to get her own needs meet. She had not fully appreciated the organisational requirements regarding boundaries. At no time was she curious about her pattern of behaviour or what it might mean for the customer or her daughter, or indeed for herself as a support worker, her employer or her colleagues.

I am just going to let that seep in for a little while and at the same time introduce another element that is integral to the boundary framework, and that is Categories of Concern.

Wearing our Sherlock Holmes inquiring hat – I see that the categories of concern element invites us to ask further curious questions to assist us solidify was there a transgression and if so what kind.

The four categories of concern are:

Professional Role (or Therapeutic Role)
This refers to the job/role description and the context in which a person is employed. For some individuals, this will also require consideration of professional regulatory requirements.

Dual / Multiple relationships
Dual refers to having a professional relationship with a client and at the same time having a personal relationship. This can occur in two ways.
Firstly the initial relationship was service provider (professional) and service receiver (customer). The power dynamic exists – the professional has power the customer is vulnerable. Due to personal over-involvement, a secondary relationship develops (financial, sexual, friendship, service such as lawn mowing, car servicing, house painting). The professional is still been paid for providing a professional service and at the same time is conducting a dual relationship outside of working hours. Context is important here and it is important to clarify with the organisation which employs you and the professional group you belong to – what is the time frame for when a client is no longer considered a client.

The second dual relationship to consider is when there is a pre-existing relationship – family members, neighbours, sing in the same choir, play in the same football team and then one person becomes a client of the service to which the professional belongs. In such circumstances it is important that the professional discusses the pre-existing relationship with their team leader and look at options of service delivery – perhaps another person on the team can attend to the client. If that is not possible due to limited resources then the professional would have to talk with the client about “this new role relationship” they were about to commence and establish clear boundaries about that relationship. It would also be important that the professional is supported by the TL due to the increased complexity of the relationship.

Multiple relationships are also a reality in small communities where a professional providing services to the community such as as a teacher, health professional, police officer, etc also live in the community – and have other roles with a client such as neighbour, attend their children’s school activities together, attend the same drama group, shop in the same shops.

It is ok to be in multiple relationships, it is the reality when working and living in a small community. The responsibility for the professional is to always ask the questions what role am I in just now and how do I respond to that question, that invite, that feedback from the other person. It is always the responsibility of the professional to be clear with the individual that they are engaging with. It will always be the responsibility of the professional to maintain the boundary and reset limits when and if transgressions occur.

The third category of concern to consider is that of – Access to / disclosure of information
It is always good to ask questions such as – what is the minimal amount of information I require about the patient in order to provide the service I am paid to do?
Similarly, in terms of self-disclosure, it is important to consider the context of the role the professional is being paid to do in order to understand how much information they are required to disclose about themselves.

How much is not enough, how much is too much – will be directed by the context. The important questions to ask as professionals self disclose to the patient is:
What is the intent/purpose of this disclosure?
Whose needs are being met? (remembering that it is always important to burrow down to those uncomfortable responses. They are uncomfortable because they are actually wise guides for you)
Do I share this information with all patients or just this one?
If I just share with this patient – what is occurring in our relationship?
If I share similar self-disclosure with all patients – what meaning does that have for me?

I have learnt that in asking such questions the answer about whether or not a transgression is about to or has occurred is revealed.

The final category of concern is that of Giving and receiving gifts, services, money.
Gifts can range from a bag of mangoes to a piece of jewellery worth thousands of dollars, to a house.
Services – includes activities that are not part of the job description nor service requirement from the organisation. Services may occur during the paid time that a professional is with a client or in time away from working hours. Services include and are not limited to; washing cars, doing laundry,
car servicing, walking dogs, hairdressing, massages.
Money – might be in the form of a professional lending a client money or vice versa. Client may pay for bills that the professional require to be paid. Money may include being left a significant amount of money in a person’s will.

Context is important.

We can now use these categories to concern to further explore the scenario with the support worker and the customer.

In having contact with the customer in her own time – had the support worker stepped out of her professional role?
The answer is yes – there was nothing in her job description that said she had to have contact with the customer outside of work hours

Was the support worker operating in a dual relationship with the customer? – yes she was

Did the support worker disclose information that was not required within her job description?  Yes. One red flag being the information provided by the customer that the support worker’s mother had died a year previously and she knew this because the support worker frequently talked about her mother when they were together.

Was there a giving and receiving of gifts services, finances – yes the meals would be considered both a gift and a service.

So in this seemingly innocuous transgression – the support worker had actually triggered all four categories of concern.

Again I repeat she was not a malicious person. She did not act with intent to use the power of her role with the customer’s vulnerability. However, that is actually what had happened.

A consistent comment made to me during workshops on boundaries is – “I don’t want to become robotic, I don’t want to lose my humanity, I don’t want to stop caring about the clients I see”.

I allow the comments to sit for a while because they are an expression of genuine concern for participants. Then I bring forward the notion that if we actually understand and appreciate the complexities that are boundaries, when we stand firmly in the knowledge that each foundation stone provides to us, when we engage in robust discussions about boundaries with colleagues and in the organisations where we work – then individuals experience a more authentic, generous and respectful relationship with the other person or persons.

The foundation stone that really assists participants appreciate the wonder of this – is that of the reasons for transgressions. When participants understand the dynamics that influence the patterns of behaviours they have with clients, those ah-ha moments free them up to be much more discerning in those professional relationships.

Before I move towards the end of this podcast – I would like to invite you to start considering strategies that could perhaps have been of assistance to this support worker, to decrease the risk of her transgressing the boundary with the customer. Just as importantly, if you were her team leader what would your next steps be with her.

I see that it is essential in that first meeting between the professional and the client to discuss the context of the professional roles and to invite an exploration of the other person’s understanding of what is being said and what the expectations are. In subsequent meetings it is important that the professional checks in with the client that the understanding is clear, looking for red flags that may indicate that a boundary transgression is about to occur or indeed has occurred. Commentary from a client such as “you are just like a friend to me”, “you are the son I never had”, or “I wish all nurses were as kind as you” may indicate that curious questions are required about the relationship. Ah yes those red flags. I will be waving them loudly in the next podcast.

I have one further question to pose to you now that you have information about the boundary framework and categories of concern. When I stood between the patient and the wall, was my action a boundary-crossing or violation? Was the transgression over or under involved or both?

I will share more about my reflections of those questions with you in the next podcast.

You may recall in the previous podcast my reference to a list of needs that could be operating in the professional when they transgress a boundary. The list of needs include:

Physical including hugging, kiss on cheek, hand on should, hand on back
Psychological – where the professional self discloses personal information of themselves, where a professional may seek counsel from a customer and collegially where a team leader or supervisor over shares and seeks counsel from a junior member of staff
Emotional – where the client becomes the caretaker, counsellor for the professional
Financial – giving and receiving money, paying bills
Services – where the professional provides a service such as lawn mowing, car maintenance, hairdressing and does not charge the person rather they are conducting the service out of an act of kindness, it is also possible that the client may provide such service to the professional as a way of thanking them for their care
Spiritual – in such instances the professional directs the conversation towards a spiritual or religious nature even when the other person has clearly stated I do not want to discuss this, or where the professional prays with the client and that is not part of their job description
Sexual – where the professional engages in a sexual way with the client – through comments, touch, sexual engagement.

One book that I have found very useful, and to which I refer to many times is Preventing Boundary Violations in Clinical Practice by Gutheil and Brodsky. Whilst the focus of the book is on the therapeutic relationship, it contains many gems to help extend an exploration of boundaries and what it means in the professional encounter.

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 wendy@davaar.com.au, you can also contact me through our social media of twitter and instagram and LinkedIn. I would be delighted for podcasts to be as meaningful as possible to all who listen. So join with me.

The spelling for Davaar is D for Donald, A for awareness, V for victor, A for awareness, A for Alert, R for Red flags.

Thank you for listening. Let’s meet again in session four.

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