boundaries and training
Adam Blatner
adam at blatner.com
Tue Sep 12 09:46:05 CDT 2006
It's funny, but words like "psychosis" carry so much import. I'm not sure what that means. Confused? Hallucinating? Overly emotional? I am not sure that all "hallucinations" are psychotic--some are intense spiritual visions that the person is unwilling to confess as "not real." Some folks I've known with such visions or uncanny experiences are pretty solid in most roles.
That's why my emphasis was on the more subtle and pervasively problematic Axis 2 personality problems. These are the folks who make problems for others. Some are fairly high-functioning in vocational roles, or romantic roles, certain ones. They get fired or dumped or jailed when their manipulations play out, and often others suffer more than they do.
Some folks with psychotic episodes have good psychological mindedness, fairly good ego strength in some areas, and may be able to grow significantly. One might argue that the shamans of indigenous cultures go through psychotic episodes as part of their calling, and perhaps even their shamanic travels might be near-psychotic in content, though culturally contained.
This, then, reminds us about the problems of diagnoses, labels, words.
About that problematic case, though: The first question in my mind is whether the person who supposedly experienced the psychotic episode was appropriately concerned, followed up on personal business, or did that person go into denial and further avoid addressing these symptoms of work to be done. That was not clear.
Warmly, adam
----- Original Message -----
From: PATRICIA DESERT
To: list at grouptalkweb.org
Sent: Tuesday, September 12, 2006 9:20 AM
Subject: releasing info
Such a graceful and respectful and ethical way you handled this. And it brings up questions about what and to whom should an adjunctive trainer report on a trainees behavior. Suppose the trainee is homicidal, professing the intent to kill someone. This has me thinking as a trainer about the importance of a Consent Form and a Release under certain circumstances.
And I also will say that over the years I have met many professionals who teeter on the edge of psychosis, if not down right psychotic at times. The health care field is not immune to people suffering these kinds of disorders and despite them I believe good work is done. Of course damage can be and is done too. {sigh} P.
----- Original Message -----
From: Ann Hale
To: Adam Blatner ; list at grouptalkweb.org
Sent: Tuesday, September 12, 2006 9:44 AM
Subject: Re: client or trainee
About twenty years ago a student finishing up his last week of training hours before sitting for the practitioner exam came to a workshop with me and my co trainer. The person had already been admitted to the exam conditionally based on completing these last hours. Neither of us was the person's trainer or endorser. During the workshop the person went psychotic while directing.
That evening my co-leader and I were discussing this and I wanted to get in touch with the primary trainer, suggest the application for certification be held up. My co-leader said, (1) what about confidentiality we promise people? and (2) there is nothing in the certification standards that says a person can't have a diagnosis; they can be crazy as a hoot and still get through. These are minimum standards after all. Our choice was to talk with the trainee and encouraged the person to take more time before taking the exam. The person is certified.
----- Original Message -----
From: Adam Blatner
To: Johanna and Hamish ; list at grouptalkweb.org
Sent: Tuesday, September 12, 2006 8:05 AM
Subject: Re: client or trainee
Dear Hamish, you said,
"I am probably putting my neck out here given the tenor of the conversation - I am very engaged in this dialogue though."
It concerns me that people on our listserve may feel in any way inhibited in sharing ideas, sometimes in arguing a bit. I personally prefer that we maintain a measure of civility, but I don't need agreement.
What about what you said is putting your neck out? What do you perceive to be the norms of the conversation that would make this dialog anything less than completely safe and supportive of any kinds of input?
Some hypotheses?: One voice in me says that my intellectual theorizing can be off-putting, but I don't know that I buy that. I would prefer a more focused and rational critique.
Another voice suggests that there may be two types of themes (at least)--one for those conducting therapy, and a second for those doing more community-building-groupwork. Even for this latter, though, a measure of vigilance is needed.
Another concern: Am I too hard-nosed to think that it might be sentimentally idealistic to deny the existence of people whose complexes and personality style can be destructive. That there are indeed sociopaths, narcissists, malignant narcissists, control freaks, dependent, schizoid, passive aggressive personality disorders, histrionic personality disorders--I won't even mention the "b" word (yes I will, Borderline--so there), and others. (Axis 2 diagnoses, in the Diagnostic Manual.) All, if one gets up close and personal, have some history of what might be called victimization, perhaps trauma of some sort, deprivation. (So does everyone, if one examines closely enough.)
All might benefit from therapy, and some seek it, though as Fritz Perls noted, "Most people don't really want to stop being neurotic; they just want to get better at it." Or as Alfred Adler pointed out a generation earlier, the key has to do with the choice of goals. For many, it's personal vindication, a sense of control, what he called "superiority," even though on occasion that may be disguised as being pseudo-inferior.
Instead, Adler noted that what is needed is an alignment with community feeling, Gemeinschaftsgefuhl (what a mouthful!), a concern for the overall health of the whole.
In other words, there are people whose psychological complexes can be quite destructive to group function, and also individual relationships.
So back to the point. If one is training for group facilitation, for community building, how do we not go into this role in a naive fashion?
Anyway, which of the many things you say below, Hamish, do you think are uncomfortably controversial? Warmly, Adam
Well yes it seems clear to me that the therapist / Trainer with Melissa did not function in an ethical manner.
However it also seems that to say the answer is just 'not to do some things' like 'have dual roles' is a simplistic response. In terms of role functioning it seems there is a lot more going on than just dual roles.
It is also seems that the trainer/therapist is doing a range of things which one with dual roles does not have to do and it is these things which are harmful.
I am not arguing against 'not having dual roles' I just think that it is valuable to reflect in the extra things that are actually present or missing.
Re: Some of our New Zealand/Australian colleagues have interesting smaller communities,
and may be more involved in community-building. What is a group facilitator. Interesting
term. What are the contracts implied in this role? Might at times there be role
components involved (or perhaps should be involved) that the facilitator has insufficient
skill in managing? What if there are 34 identified skill-role-components and the group
facilitator has mastered 28. What is the chance the facilitator would clearly know / admit
to the 6 missing skill areas, and recognize when situations would arise when skills
involving any of those missing areas are called for, and be able to get help to deal with
those situations. I know it sounds like a lot, but I think it's a fair question.
Adam I think this is fair also. I like your idea of the extra areas of facilitator functioning which one still has to master and being cognizant of this. There is a role relationship and if these various areas still needing mastering then the trainer or the therapist needs to be creating a role relationship which assists this development - not ignoring it so their own needs are met.
I also like your post about gate keeping for different professions a lot and see this as an important role.
Warmly H
Subject: Re: client or trainee
Dear Melissa, thank you for sharing. That was a great example of the
student-trainee-client's experience of problematic boundaries!!! I'll be others have
experiences from that viewpoint, and/or the therapist-trainer's perspective. Feel free,
colleagues, to disguise the case completely.. the key point is just to name some issues,
such as:
-- the client wants to pay "in kind," by doing various tasks for the
trainer/therapist, such as office work, editing, etc.-- and then is slow or seemingly
careless in performing those tasks as assigned... but of course, the client might consider
the trainer/therapist to be excessively exacting. Money is less "negotiatible"
-- the client continues in certain interpersonal behaviors that the trainer deems
incompatible with working as a therapist-trainer. Perhaps one can live and work in other
jobs with those issues unchanged, but in the judgment of the trainer, this is not possible
if one is to be certified as a therapist-group facilitator. Certain issues we can continue
to work with as therapists, certain issues are too big, too distorting. Mild
counter-transference is a slight problem compared to these elements of distorted
personality functioning. The client, however--as trainee/client-- is in denial, and in a
way, because of the dual relationship, must be in denial, because s/he wants to be
certified or graduated.
-- the client misses too many sessions, always has excuses, wants extra or prolonged
sessions, gives gifts, and in other ways engages in any or many of the maneuvers that
become danger signals to the trainer-therapist
-- either trainer or client are strongly tempted and make even beginning moves
towards romantic or sexual involvement with each other, or even become overly interested
or involved in the romantic-sexual lives of the other... again, fine for a client to
disclose these to a therapist if that's part of the contract, but not if there is even a
hint of hope that the client will shift into trainee
to-become-a-therapist-director-group-leader-like-the-therapist.
Some of our New Zealand/Australian colleagues have interesting smaller communities,
and may be more involved in community-building. What is a group facilitator. Interesting
term. What are the contracts implied in this role? Might at times there be role
components involved (or perhaps should be involved) that the facilitator has insufficient
skill in managing? What if there are 34 identified skill-role-components and the group
facilitator has mastered 28. What is the chance the facilitator would clearly know / admit
to the 6 missing skill areas, and recognize when situations would arise when skills
involving any of those missing areas are called for, and be able to get help to deal with
those situations. I know it sounds like a lot, but I think it's a fair question.
Well, that's enough for now. Warmly, Adam
----- Original Message -----
From: "Melissa Monahan" <melissa_erin_monahan at hotmail.com>
To: <list at grouptalkweb.org>
Sent: Monday, September 11, 2006 1:35 PM
Subject: Re: client or trainee
> This dialogue is so important.
> As a student of Drama Therapy, as well as a Psychodrama trainee, I can
> appreciate the fine and delicate line that MUST be drawn between the
> therapist/trainer and client/trainee.
> As a creative therapeutic novice, I had chosen to extend my trainer's role
> to include that of individual therapist. At that time, she was more than
> happy to expand her professional repertoire and make a monetary deal. This
> maneuver, however, eventually proved disastrous, as the boundaries became
> increasingly vague.
> For example:
>
> *Her asking permission to eat salad during a one-on-one session.
> *Delegating duties, that included phone calling and drumming up business for
> her group/workshops.
> *Assuming I'd drive her home following a back-to-back individual session and
> training evening.
> *Explicitly suggesting, during one-on-one psychodramatic work that, one day,
> we'd have an office together and she would send me child clients because,
> after all, sometimes being a solo practitioner gets "lonely."
>
> While I acknowledge that reality is subjective, I do believe that some of
> the boundary issues stemmed from my trainer/therapist's insecure and egoic
> need to be regarded as someone with a "gift" for psychodrama, or "one of the
> best psychodramatists around" and "a role model of honesty for my clients."
> Conversely, I am a newcomer, and instinctively welcomed any/all guidance as
> well as professional mentoring.
> After emerging from a profound crisis, I realized how informal and skewed
> the relationship was; how compromised MY therapeutic process had become (and
> at some pricey hourly rates). While such nuances certainly don't CAUSE one's
> crisis, they're not of much HELP either.
> Eventually, I suggested she continue to be my psychodrama trainer, but
> divulged my decision to work one-on-one with someone else.
> This was, naturally, met with bewildered criticism and, then, an ultimatum
> to either work with her in individual therapy or leave her psychodrama
> group. While I understand her motivations were---always---well-intentioned,
> that kind of strong-arming hammered the proverbial nail into the
> psychodramtic coffin, and I chose to abort the relationship.
>>From this experience, I learned so much about the boundaries necessary to
> distinguish a client from trainee, and I thank my former therapist/trainer
> for that.
>
>
> ~Melissa Erin Monahan
> New York City
>
>
>
>>From: Carole Oliver <caroleolivernj at optonline.net>
>>Reply-To: list at grouptalkweb.org
>>To: list at grouptalkweb.org
>>Subject: Re: client or trainee
>>Date: Mon, 11 Sep 2006 08:41:18 -0700
>>
>>Peter, everyone has their strengths and weaknesses as clinicians. Working
>>on one's boundaries issues are important, however, it is also equally
>>important to know your self enough to set strong boundaries with some
>>pretty explicit rules, no dual relationships. Kudos to you to be able to
>>maintain all those dual roles, I know I wouldn't want so therefore probably
>>would not be good at it----- Original Message -----
>> From: Peter Parkinson
>> To: list at grouptalkweb.org ; grace at graceworks.co.nz
>> Sent: Sunday, September 10, 2006 12:22 PM
>> Subject: RE: client or trainee
>>
>>
>> I practiced psychodrama for 15 years in a community of 800 people. About
>>500 of these were utilizing psychodrama for their development. As a result
>>my boundaries and that of my staff had to be both clear and powerful. It
>>was inevitable I would share the role of Director, doctor, colleague,
>>committee member, fellow sportsperson etc. with one individual. There was
>>no way of escaping this scenario, in fact it was the norm rather than the
>>exception. Every psycho-dramatist goes through the progression of
>>client/group member, auxiliary, trainee and then colleague. Professionalism
>>and personal development is about clarity of boundaries, and I believe that
>>is not good enough to be saying "my boundaries are not very good' and
>>thereby justifying evading the issue. Life is for living fully, and therapy
>>does not end at the consulting room door. Boundaries and fine tuning them
>>is our work, let's get on with it. A person s not a "trainee" or a
>>''client', they, like all of us, at times, assume these roles, the role of
>>client lasts about an hour, then its time for a change of role on both
>>sides.
>>
>>
>>
>> At times I would be in the main street of this country town and someone
>>would assume, erroneously, that I was in the role of their doctor and ask
>>me about a lab result. At that particular moment I was embedded in the role
>>of the window shopper, and I would respond that they would not want me to
>>be thinking of them as a disease or an illness every time that I saw them.
>>To this comment I usually got a laugh of awareness and a spontaneous
>>agreement to see me or a staff member about the requirement IN THE SURGERY.
>>And not on he street.
>>
>>
>>
>> Cheers
>>
>>
>>
>> Peter Parkinson from New Zealand
>>
>>
>>
>>
>>------------------------------------------------------------------------------
>>
>> From: list-bounces at grouptalkweb.org
>>[mailto:list-bounces at grouptalkweb.org] On Behalf Of Carole Oliver
>> Sent: Monday, 11 September 2006 6:35 a.m.
>> To: grace at graceworks.co.nz; list at grouptalkweb.org
>> Subject: Re: client or trainee
>>
>>
>>
>> grace, I agree that the psychodrama community is small and we know many
>>people, first as clients and then maybe in a psychodrama/training group.
>>The roles can get murky. I think it requires a therapist who can be very
>>strong with boundaries. I am a pretty friendly accessible therapist and so
>>I find it harder to keep very strong boundaries between training,
>>supervision, group[p member, client.
>>
>> It is difficult to sort it all out. As for me, I wont see a person in
>>individual and be their trainer. If they are in my group which is a
>>therapy/psychodrama group, they can log hours but if they are indivual
>>clients, I wont do just a training group or supervision group with them.
>>Does that make sense?
>>
>> ----- Original Message -----
>>
>> From: Grace
>>
>> To: list at grouptalkweb.org
>>
>> Sent: Tuesday, September 05, 2006 3:14 PM
>>
>> Subject: RE: client or trainee
>>
>>
>>
>> Kia ora Peter,
>>
>> Yes, I like your view of your work as education or adult education (we
>>sometimes refer to what we do as psycho-education), although I do believe
>>it is deep learning that we facilitate in the group of people we work with
>>people, so I have a new descriptor to use. Thank you!
>>
>>
>>
>> I have also been pondering on the reality of dual relationships
>>especially living in a small country where the degrees of separation are
>>few. It's pretty difficult here in Aotearoa/NZ to meet people in either
>>work or social situations who don't have an acquaintance in common. I
>>think Moreno gives us a great tool in Role Theory, enabling us to become
>>conscious, to identify and warm up deliberately to the roles necessary to
>>respond adequately in situations where dual relationships such as Client /
>>Trainee exist. One such role might be something like a 'responsible
>>professional' who is able to bring a wealth of technical and ethical
>>expertise into practice when making decisions, when in doubt consulting
>>with supervisors and networks. I really like that this approach engages
>>the professional in the 'deep learning process' also, giving us the
>>opportunity to continue growing our ability to be creative and spontaneous
>>rather than referring to entrenched and conserved rules that squash
>>vitality and imply that there an end to what is really an infinite process.
>> This is NOT the easy road however! And we won't always get it right-
>>can we live with that?
>>
>>
>>
>> Cheers
>>
>> Grace
>>
>>
>>
>>
>>
>>
>>
>>
>>
>>
>>----------------------------------------------------------------------------
>>
>> From: list-bounces at grouptalkweb.org
>>[mailto:list-bounces at grouptalkweb.org] On Behalf Of Peter Howie
>> Sent: Tuesday, 5 September 2006 2:10 p.m.
>> To: Adam Blatner; list at grouptalkweb.org
>> Subject: Re: client or trainee
>>
>>
>>
>> Dear Adam,
>>
>> Sorry Adam but I can't help myself.
>>
>> "So there's a cultural lag-- a need to recognize this sub-field, but
>>still the main field of psychodrama is based on the conventional model of
>>psychotherapy-- and training certification is also geared to this, albeit
>>loosely. "
>>
>> I came across this quote as I was perusing some early ANZPA thesis.
>>
>> "I have always tried to show that my approach was meant as much more
>>than a psychotherapeutic method--my ideas have emphasized that creativity
>>and spontaneity affect the very roots of vitality and spiritual
>>development, and thus affect our involvements in every sphere of our lives.
>>Furthermore, I have always wanted to have people attend to the processes of
>>health, as well as to the problems of illness; thus I am glad that Dr
>>Blatenr has noted the applications of psychodrama in the home, school and
>>world of business" J L Moreno, M.D., 1973 in Forward to "Acting In" by Adam
>>Blatner.
>>
>> Part of our discussion involves, at an underlying level, how the
>>conserves of the psychotherapeutic communities/world (Psychology,
>>Psychoiatry, Counselling etc) have dominated some of this discussion. It
>>may not be so much about the dilemmas that arise from boundary issues with
>>clients/patients/trainees but more about how this work is conceptualised.
>>Personally and professionally I think viewing most of our work as that of
>>education or adult education works for me. Deep learning is deep therapy.
>>Still working on this idea.
>>
>> Cheers
>>
>> Peter Howie
>> Brisbanew, Australia
>>
>>
>>
>>
>>
>>
>>
>>
>>----------------------------------------------------------------------------
>>
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