Join us in this part II discussion around the challenges behind the healing curtain of helping others working as psychotherapists. In pt. II we discuss the more serious issues that can arise; from stalking, harassment, triangulation and manipulation tactics, being groomed for sexual advances or exploitative behaviors, coping with crisis, and mandated reporting. With over 13 years of experience in human services, I share insights, personal experiences, and practical tips for fellow healers to navigate sticky situations that we often do not consider when embarking on these careers of being of service. We discuss embracing the highs and lows, cultivating assertiveness skills and setting boundaries, and strengthening discernment and professional judgment, in the rewarding journey of supporting others. If you haven’t already checked out Part I of Navigating the Challenges of Working as a Psychotherapist or Healer, be sure to do so!
Disclaimer: I am no longer licensed and do not work in the field of clinical social work any longer, with that said this is not a form of clinical consultation, training, supervision, or advice. Always adhere to your state policies and professional ethics and training requirements when it comes to your work in being of service to others in these professional roles.
Resources Referenced:
Navigating the Challenges of Working as a Psychotherapist Pt. I
Transform Your Space for Healing: Tips for Creating a Therapeutic Office Environment
When Helping Hurts: A Spiritual & Clinical Take on Vicarious Trauma & Burnout Pt. I
Reclaiming Your Peace: Healing the Body, Mind, & Spirit from Vicarious Trauma & Burnout Pt. II
Table Of Contents:
Realizing this Work is Bigger than Me
When first starting out working in human services I was fresh out of high school, naïve, & idealistic. I thought that being of service would offer rewards of appreciation, connection, and working with others towards a mutual goal to improve quality of life. Don’t get me wrong I have certainly experienced these rewards more than I have the shadow side of things but man nothing prepares you for the school of hard knocks like experience does. Working with severe persistent mental illness, those enduring domestic violence, those with personality disorders, or those who were court ordered showed me quickly that the help I so badly wanted to offer was not always well received, wanted, or appreciated.
This took time to grieve, adapt, and create realistic expectations that this work was bigger than me and getting my needs met to fuel this passion to be of service. Though there were these hidden challenges, working with others taught me empowerment, healthy boundaries, self-care, acceptance, forgiveness, compassion, and learning to give without receiving. I have made mistakes and learned hard lessons and have held space for colleagues who have shared experiences so I have put together this two-part discussion on tips to navigating safely some tough situations that may help support other's working in Human Services.
Safety Risks
From cyberstalking, to full blown stalking, to threats and harassment from clients and their loved ones, or being assaulted.
Online Safety Tips
A best practice around social media is not to accept or make friend requests to clients on a personal account.
Set your social media profiles private and ask your immediate family members to do the same especially minors and educate them on not accepting unknown friend requests or responding to unknown messages.
Consider using a different variation of your name on social media so it’s not as easy to find your accounts.
If you have a business account made available to the public, be mindful of the level of access of your personal information given to the public when working with those with certain severe mental illness and personality disorder diagnoses.
If you are working with populations who endure severe persistent mental illness or have personality disorder diagnoses, it can be important in general to limit self-disclosures and avoid making references to places you frequent since boundary issues, delusional and distorted thought processes, and impulsivity can be common challenges faced.
Be clear, firm, and assertive when it comes to communicating boundaries on your privacy and personal life and if a violation occurs immediately reinforce those boundaries and if the violation is severe, discontinue services and assess if local authorities need to be involved.
Work Place Safety Tips
Our addresses are public information on local assessor’s websites and clients at times will access this and can show up at our homes and when this happens, it’s my opinion, along with a client showing up somewhere I frequented with a high likelihood they are there to run into me or they followed me there that these are a significant violation of privacy that creates potential threats to our safety and our family’s safety and results in termination of services and a referral.
This helps clients learn appropriate boundaries and the consequences of what occurs when those are not upheld.
It is essential to stay aware of your surroundings and trust your intuition if you sense something feels off whether you are being stalked or feel there is a threat close by.
Avoid being distracted or looking down at your phone when walking to and from your car, walk out with others, have a loved one on speaker phone when walking out if you don’t have someone to walk out with, carry a self-defense tool, and avoid leaving the office after dark if possible.
Other therapists and healers have shared that they also have some form of self-defense tool or alarm system close by their seats or desk. For additional tips on setting up your office space with safety in mind along with the setup of using a personal alarm system and panic buttons, be sure to check out my Office Tour Video.
If you work at an agency, you can create safety plans and procedures on how to respond if someone arrives impaired or becomes threatening.
We used to have code words to say over the intercom that were non-threatening and wouldn’t disrupt the sense of safety of other community members who were being served. These code words would alert staff to respond accordingly if a gun was on the premise, if help was needed, if someone was threatening, or if we needed to go on lock down.
Thoroughly document all safety concerns and inform your supervisor or colleagues to explore ways to address this and ensure safety. And in serious circumstances involve the police and file a report.
Terminating Services Safely
Typically any time I did not feel safe, this called for a termination of services and I would have this conversation over the phone but if this is not an option:
Consider having a colleague or supervisor present with you.
Sit closest to the door.
Meet in a neutral meeting area instead of your office and if you have to meet in your office, consider keeping the door open.
If having a colleague present isn’t an option, have someone come walk by and knock to check in soon after meeting with the client and have them ask you to meet with them in private for a moment so you can step outside of the office and assess how the situation is going.
Keep a good amount of distance between you and the client if you need to quickly step out of the way of a threatening gesture and if possible try to have a table or object in between the two of you for added protection and deterrence.
Ultimately, I would avoid putting yourself in any situation you feel threatened in and would let a phone call suffice along with helpful referrals so their healthcare needs can be treated properly.
Referring clients with complex needs to a mental health center is often best so they have a wealth of resources available along with teams of healthcare providers, supervisors, therapists, case managers, psychiatry, and social workers.
Post-Traumatic Stress, Codependency Triggers, Trusting Your Intuition
We may have to address post-traumatic stress symptoms when our safety is threatened whether this is mentally, emotionally, or physically. Also referring other’s out of our practice may bring up our own fears and insecurities of not wanting to disappoint or hurt others because we may feel responsible for their feelings and needs but we must prioritize first the responsibility we have to ourselves to keep ourselves safe. If you notice these types of feelings happening be sure to watch part I to this video where we discuss codependency to help overcome these patterns. Also, it is essential to learn how to listen to your intuition and respond accordingly and to ensure the compassion you have for others doesn’t blind you to the needs of your own safety.
Identifying and Responding to Clients' Attempts to Influence Legal Outcomes or Triangulate within the Therapeutic Relationship.
Triangulation is a psychology term which refers to a dynamic where an individual involves a third party in a relationship or situation to help mediate. Triangulation when used as a form of manipulation is where an individual uses the third party to convey messages, control information, or break down communication between two parties to indirectly communicate to the other through the therapist rather than addressing issues directly and civilly. This can be requested through documentation, speaking on their behalf, or requesting the provider to testify on their behalf.
This can be a tactic to:
manipulate communication
control the narrative and outcome
evade consequences
shift responsibility away from one's self in a matter.
This can occur more often in legal situations involving:
custody battles
divorce
litigation
workers compensation claims
court ordered clients involved with child or elder protective services
court ordered clients involved in legal consequences around substance use and substance dependence treatment
those needing to fulfill probationary requirements
Clients may try involving a therapist as a third-party professional to be on their side and communicate to:
other family members
an ex-spouse
children
employers
legal professionals
case managers
probation officers
When a therapist remains neutral within the matter, encourages a client to speak on their own behalf when appropriate instead of doing this for them, and only reports the facts, this may not be accepted by the client, they can get upset, abruptly discontinue treatment, become threatening or assaulting, write negative reviews, make slanderous comments about you in the community, and can retaliate in several ways including making complaints to one’s place of employment, licensure complaints, or filing a lawsuit. When serious acts against you arise, it may be necessary to involve local authorities and seek legal counsel.
In these situations, it is essential to establish clear boundaries and assert your role as a neutral and supportive ally for the client along with providing education on what treatment participation looks like and what will occur if this is not actively engaged in.
Maintain a clear and consistent therapeutic focus and share how to succeed at fulfilling their therapeutic goals and positive outcomes and if that is done how the documentation will genuinely and honestly communicate their efforts and work in their favor towards receiving the type of progress reports, documentation, or testimony they are seeking.
As helping professionals you can consider setting limits on outside involvement with legal matters if this is not an area you want to include in your services.
Client Attempts to Create Inappropriate Relationships
Clients may attempt to turn the professional relationship into a personal relationship whether this is to create a business relationship, a friendship, or a romantic relationship. Some signs of this may be through the client:
Offering excessive unsolicited compliments.
Excessive or frequent praise for how effective of a provider one is.
Making comments about the therapists attractiveness and appearance
Proposing business ideas.
Frequent and excessive calling, texting, or emailing in between sessions in order to seek a sense of intimacy or closeness with the provider.
Asking the therapist out to personal or intimate settings.
These are just some of the examples that can show signs of a client having compromised boundaries and it is our role to place firm boundaries around these types of interactions and sharing in detail the appropriate nature, role, and boundaries of a therapeutic relationship. Some ideas on how to approach this are:
Terminating the therapy work due to the objectivity of the therapeutic relationship being compromised.
Address these issues with the client to see if it can be a part of their healing work to improve healthy relationship skills.
Navigate ongoing work by maintaining firm boundaries, educate the client on appropriate boundaires, consequences if those are overstepped, and be consistent with reinforcing boundaries and consequences. Then work to address the root causes of this behavior.
If you work with other's who struggle with upholding appropriate boundaries its essential to receive regular supervision to maintain objectivity, grounding, and feedback on how to navigate these dynamics.
If these behaviors continue occurring after the behaviors have been addressed and boundaries reinforced, a referral may be the best option here along with connecting them to specialized treatment to address attachment trauma, codependency, or personality disorder behavior.
This will have to depend on each providers agency policies, level of comfort, and discernment around the appropriateness, safety, and efficacy of treatment with the client after these boundaries have been crossed. If services are discontinued, this can cause the client to feel abandoned, rejected, offended, and lead to previously mentioned forms of retaliation.
Sexually Inappropriate Behavior & Advances
Let’s start off by defining the term grooming which can often occur before an advance like this is made which refers to the process of building a relationship of trust, rapport and connection with another person for various reasons, often with the intention of controlling, manipulating, or exploiting the other person for personal gain. Grooming typically involves a pattern of behaviors and tactics designed to lower the other person’s defenses and make them more susceptible to manipulation and exploitation. This may involve flattery, gift-giving, excessive and frequent attention, and other forms of positive reinforcement, to create a sense of trust, dependence, or obligation.
When it feels like a rapport has been built the next step of grooming often involves smaller forms of boundary violations or oversteps to test the waters to see how the other person will respond. If they can in a sense, “get away with this,” then the behavior will slowly be amped up a notch and their advances will become more overt and inappropriate. Some of those who are used to relating in this way can be patient and do this over a long period of time seeking to build trust. Then when the increase in inappropriate behaviors occurs and it’s addressed with them they may hold off for a while but it is often only a matter of time before the next overstep happens.
When this occurs, we often start feeling some internal red flags of discomfort in our body or we have this hunch that something is not right. We may brush this off at first or it may be so clear within ourselves that we feel uneasy and our bodies are signaling to us a feeling of unsafety around the other person and their intentions. We may also have increased hypervigilance and feel exhausted after they leave the appointment. Other times we may feel a sense of disgust and feel emotionally or mentally violated even when the behaviors are more subtle.
My mentor refers to this as being slimed and offers reminders that,
"If you don’t feel safe then you are not and you need to remove yourself from an environment, seek supervision, self-reflect on what is happening or being triggered and set boundaries to ensure your sense of safety at all times."
These moments can be so uncomfortable but we have to learn to be uncomfortable and set these boundaries. When things like this occur, it’s in my opinion the therapy work is not going to be effective and they have a much different agenda for being there then we may realize. Those in human services often have trusting and accepting natures and hopefully would not relate to others like this but we must be careful that our passion of being of service does not outweigh the need to remove these dynamics from our practices and to do so quickly. When inappropriate sexual advances occur it is often associated with someone who meets criteria for a personality disorder and/or exhibits sexual deviant behaviors or perpetration which specialized treatment is needed.
Exhibistionistic Exploitation
Another form of inappropriate dynamics that can arise may not involve the client making advances to you but they may use the therapeutic relationship as a means of exploiting through a term called exhibitionism. They will share information that has a shock factor or involves disturbing details that deviates from cultural norms and social acceptability. These type of deviant behaviors or perversions can be referred to as exhibitionistic behavior which comes from a means of seeking attention, approval, or validation for provocative or shocking behavior that involves a disregard for social norms and boundaries.
They may share disturbing accounts of former crimes involving bodily harm towards another or interest in unusual, violent, or criminal based behavior. They may say they need to disclose this to process through it as a part of their treatment but are actually using the therapeutic relationship to receive gratification by sharing unexpected, deviant, and disturbing disclosures.
In these cases, it calls for specialized treatment and is best to refer them to practices where there are teams of individuals working together to support treating behaviors like this. Then treatment can become more direct and candid about the inappropriateness of these behaviors and help them learn social skills and legal consequences to improve and maintain occupational and social functioning.
It may also be helpful to provide a referral to a therapist that is the opposite sex of the client’s sexual interest to help minimize inappropriate transference.
Some providers will want to have a candid discussion with clients who have these personality and boundary characteristics to help them cultivate self-awareness and improve upholding healthy boundaries. However, this isn’t always helpful to communicate these concerns if the client is impacted by a personality disorder and you are not the specialist they will be working with to address this. Because often when clients have these characteristics and are confronted by examples of their inappropriate behaviors they will deny this, incite blame and accusations that the therapist was the one coming on to them or is judgmental and shaming, or gas light the provider to deny the occurrence and disorient the reality of the experience.
This can fuel a fire of embarrassment, hostility, and denial for the client and be used as ammunition for projection, blame and defensiveness leading to a range of different forms of retaliation.
When communicating and referring a client because of the lack of reciprocating healthy therapeutic boundaries, something to this effect could be stated to the client,
"With all things considered I do feel it would be best to discontinue services together as I feel my objectivity to be of therapeutic value in offering treatment has been compromised because of these boundary violations or your mental health needs are outside of my level of competency but I have some names of providers who will be able to assist you.”
Mandated Reporting & Responding to Crisis
Mandated reporting refers to a legal requirement to report known or suspected cases of abuse, neglect, and in some state’s violent crimes, assault, and battery. Failure to report can result in legal and professional consequences, such as fines, loss of licensure, and civil or criminal liability. It is important for individuals who are subject to mandated reporting requirements to be aware of their obligations and to follow the appropriate reporting procedures in their jurisdiction.
This can involve:
Calling the police department to do welfare checks for those enduring homicidal and suicidal intent.
Calling and informing someone they may be in harm’s way.
Reporting child, disabled adults, or elder abuse or neglect to protective services.
Reporting someone’s involvement in a violent crime or being the victim of a violent crime.
When calling for welfare checks, request a crisis intervention trained officer also known as a CIT officer if available as they have a mental health and de-escalation trained approach.
There are times it is also necessary to refer clients to the hospital or to call the police for a welfare check, to make a report, or to transport them for a psychiatric evaluation due to issues related to:
Panic
Anxiety
Depression
Self-harming or self-mutilating behaviors
Suicidal or homicidal ideation
A manic or psychotic episode that is impairing functioning
The client needing to go to the hospital or detox due to significant impairment from intoxication.
Certain injuries endured from an assault or domestic violence.
It's helpful to make a list of the phone numbers you may need to have on hand for these situations such as:
The police department
Emergency room addresses
A local crisis center
Emergency psychiatric services
Domestic violence shelters
I would create these business sized cards that I would give to others that had the numbers and addresses to emergency and crisis support in the need for after hours support. I have included the crisis card template you can use for this under Resources Referenced. I also included a safety plan that was used when in practice that you are welcome to use as a template. Also be sure to let clients know about your after hours support and if you are not available for this it can be helpful to give each person one of these crisis cards at the initial intake appointment and include a local crisis hotline number on your voice mail.
When having to make a report:
Share as much information that is relevant and available.
Document thoroughly and debrief with mentors or supervisors.
When in doubt on whether something we have learned needs to be reported, it is best to call the reporting lines and share the details and allow them to determine if its required to report. Its better to report than underreport to ensure safety for all.
Making these reports can lead to anger from clients or their loved ones and result in confrontation, threats, and retaliation. Take all threats from clients or their loved ones seriously and take added efforts to keep yourself safe.
In situations where it felt like my safety would not be jeopardized by doing so, I would share with the clients the need to make a report. Clients with healthier boundaries, self-reflection skills, and insight will understand this necessity and often assist us in making these reports by providing as much detail as necessary.
This can be disruptive and distressing for clients so we can hold compassion for them in that regard but we do not need to subject ourselves to emotionally abusive confrontation if that arises.
Self-care and rest after these long days is essential along with seeking emotional support to process through these stressors.
Mandated reporting, welfare checks, and referring to emergency psychiatric care is necessary and can save lives but it is also a difficult position to be in and can cause us to feel like we are betraying the trust or rapport of our clients. Something that one of my mentors would share is that,
"We are not the client's friend, we are friendly professionals and it is our priority to our clients to ensure safety whether this is accepted or not."
Having to make these kinds of reports were some of my worst days because of the fear and concern I had for others and felt helpless at times to help others in these circumstances. Self-care was essential and if you need any ideas on practicing self-care, I created a comprehensive guide on that in my video on healing from vicarious trauma and burnout.
Cultivating Discernment, Acceptance of Mistakes, and Self-Compassion
We will not be perfect as helping professionals, we will make mistakes, and we will miss things at times because we too are growing alongside our clients but we will learn and grow through experience and there will be times we have to forgive ourselves when we did not trust our instincts or we missed something but every lesson has something to teach us to help us grow wiser as long as we stay humble to that fact and open to growing and improving as healers and helping professionals.
Talking with your supervisor or mentors to gain a range of different approaches and perspectives on a regular basis can help you cultivate decision-making skills, discernment, and professional judgment to navigate challenging situations most optimally. Attending therapy yourself and processing work-related stressors can be another great way to support your learning and professional development.
When being of service to other’s, be gentle on yourself, practice forgiveness, release expectations of perfection, and work through the discomfort triggered with clients in your own healing work that you are hopefully engaged in regularly. The more balanced and supported we are, the better we are able to support others.
Lastly, be mindful to internally check in on yourself on a daily basis and notice what your body and intuition is signaling to you and be as honest with yourself as much as possible on whether there is a bypassing of your boundaries or red flags showing up about a situation or a person. We have to become comfortable being uncomfortable at times when needing to have difficult conversations around boundaries and reinforcing consequences when they are overstepped. There is no way around it, it is going to be distressing to our nerves at times and awkward especially at first but it is going to teach us wisdom, assertiveness, empowerment, healthy communication skills, healthy boundaries, decision-making skills, self-trust, and attunement not only with others but also with ourselves.
This is a very general statement, but it seems as though many healers have a touch of codependency, and this is when this can be used against us by certain clients who will use these sensitivities and vulnerabilities to test boundaries. This good hearted nature can be accompanied with naiveté where we see the best within others and do not consider some do not have the same kind regards for us as we do for them. When this happens it can feel like we enter a minefield of being disoriented and confused when working with clients whose psyches are wired differently than ours and they navigate relationships through disguised intentions. My mentor often reminds me that,
"We cannot use ourselves as a reference in that we cannot assume that because we wouldn’t do something dishonest or hurtful to another that they would not do that to us."
This doesn’t mean we have to close our hearts and be mistrusting it just means we must balance our open hearts and trusting natures with healthy discernment. Learning how to cultivate a wise and discerning mind takes time and experience and our intuition balanced with logic becomes our greatest allies for this growth.
Closing Thoughts
Thank you for joining me in this conversation and be sure to subscribe to the email list to be notified of future content, also if you know of someone who may benefit from this discussion, please share! Also join us in the comment section on the YouTube video if you have any gems of knowledge to share to help support us in this work or if you have a story to share and how you navigated this.
I wish you strength, confidence, empowerment, and successful careers. I will see you in the next post on how to become to most effective healer.
Comments