Hi Everyone. I chose to discuss boundaries in general as I feel boundaries are something that facilitates our survival and longevity in this field. What I wanted to specifically discuss was boundaries with clients. A situation that I struggled with in the beginning was finding what I felt were appropriate boundaries with a family I worked with who were from Eritrea. The reason I struggled with finding healthy boundaries with this family was because in their culture, when a guest came to their home, they offered tea, food, something, to show their respect and appreciation. Another difficulty I had was that our culture puts a different emphasis on time than their culture does. A result of these two factors made my visits with this family very long, spending a disproportional amount of time with them as compared to my other families. I was very conflicted with this because I wanted to honor their culture and traditions, grow my report with them and facilitate our relationship. At the same time I had other clients I needed to see and at times needed to go home to my family at the end of the day. Also, I felt some guilt around sharing these meals with them because I knew it was an added expense for the family and for them to be living in extreme poverty paying for food for me, while I am not struggling to buy food, did not feel comfortable for me. Eventually I was able to work out a balance by talking with them about my concerns and preferences. I explained that I enjoyed sharing meals with them, but needed to limit it to 1x/month (previously was 1x/wk). Also, I tried to limit the hospitality to just tea as I knew that would not be as costly to them. Additionally, I explained some of my responsibilities as their case worker and other family's case workers. Defining our relationship as a professional relationship was also difficult for me because often they refer to me as another family member, which honored me that they thought that highly of me. At the same time, it showed me the importance of setting those boundaries so our relationship did not get blurred. We now work very well together and they understand that when I say I need to go that they need to respect that too. We still share meals together upon occasion and have a good working relationship.
Andrea, Excellent Post. I really appreciate your sincerity in sharing your own journey with boundary setting. Team, I think boundary setting is one of the strongest assets that can be on your clinical tool set. However, Andreas point is well taken, Howe do you honor ones culturural norms/mores' without compromising your ability to set boundaries? It think it relates back to our discussion last week of honoring the NASW code of ethics by learning about some of this family's cultural needs and in that sense I think that we owe it to this family at least in intial assessements to really allow for that time not only before meeting c the family but with the family as well. And I think it is good practice to incorporate this time into theses situations. However, in the real world we don't always have the luxury of time and we may have to set some parameters around time and what activities we engage in with the family and in this sense I feel comfortable drawing from Maslow that the most important thing I need to do with clients is keep them safe. I don't think safety should be used as but merely a starting point if you can't afford this time. You really can't go wrong with the safety angle. It is amazing how receptive family's are to this approach. I am just letting it flow, other ideas ................
Team, I went to an interesting discussion this week hosted by one of my fellow social workers on compassion fatigue and it reminded my of your post on Boundaries in the Work Place Andrea. Because the main point I took from that discussion is that the majority of burn-out or compassion fatigue doesn't actually come from our clients that we work with. Research shows that compassion fatigue actually comes from everything else around the work place irrespective of the client, IE behaviors of fellow co-workers, lack of resources and other things that are our of your control. One of the great self-preservation techniques that we can learn is to be able to set boundaries with the things we can control at our jobs whether that is with clients, co-workers or administrative staff. I think it is something that new clinicians struggle with in the beginning through much trial and error ...............
I first heard about compassion fatigue when I was going to school and doing my internship. I felt myself reacting to things that I normally wouldn't react to and I couldn't figure out why the change in my attitude and one of my counselor colleagues told me about compassion fatigue. I was able to work through the situation and started doing more self-care and my attitude started to improve. Recently I started having the same reactions while working with clients to do annual recertifications for their housing and updating Independent Service Plans and having each client really resist to the point of being verbally abusive to me. I have had to on two different occassions tell the client that I needed to leave and I would come back when they were ready to talk but really it was me that had to leave because I could feel myself getting frustrated and going nowhere with the situation. About a week later the people came back and we were all in a better frame and were able to continue the work. I was sharing this with Derek and he reminded me of compassion fatigue. Again I have had to step back and make strides to change my attitude and start taking care of myself.
Client placed boundaries which Andrea wrote about are so important to a progressive relationship . Andrea’s story re-affirmed for me how positive some client boundaries can be. Her ability to support her clients’ as well as respect their cultural selves can only prove to create a successful relationship. As I read her post I realized energies put towards client boundaries can be viewed as positive energies with movement forward. On the other hand I struggle with viewing workplace boundaries as positive energies used to benefit our clients. I do know the worth at times for creating an environment of defined boundaries in the workplace but sometimes the scales tip towards focusing on workplace dynamics and the needed boundaries vs. client based solutions. Hence Derek’s post some workplace burnout. You attempt to appropriately support your client but may find yourself using more energy than you have to circumvent workplace dynamics.
Another boundary issue that I have come up against is gift giving/receiving. I know each work place has different guidelines to this and I am wondering what you all feel about this. I had a client the first year that I was in my current position at Christmas time want to give myself and one of the other case managers a gift. It was something that she had in her house. We both told her that we were unable to accept gifts and she was offended and insisted that we take the gifts. We talk to our supervisor and she told us to take them to the office. We let them set for several months and the client came to the office and saw the gifts and stated "Oh I see what you do with gifts" I explained to her again about the policy of our agency regarding gift giving/receiving." I think it is very difficult for clients to understand the concept of case managers/clinicans being unable to accept gifts because most of them are doing it to show their appreciation to the workers for the work that they are doing. What do you ladies think about this and have you had similar experiences you would like to share.
I think that boundaries are a necessary tool for keeping the client safe, as Derek mentions. Safe in knowing that the work we're doing is about them, and not about us. Safe in realizing that we can and will take care of ourselves (so they're free to be honest). Safe in knowing that they won't be victimized, as many have been in the past.
About the family that Andrea wrote about: I appreciate her thoughtfulness in really thinking about what boundaries are appropriate in that situation. I think the flexibility in the solution that Andrea came up with (having a meal with the family once a month)is in line with my take on boundaries. I believe that having boundaries that are well thought out, somewhat flexible (yet in line with the code of ethics), and that we're comfortable expressing is necessary when we're working alone in client's homes.
These are a couple examples of situations (one in my second practicum, and one in my current job) where I considered appropriate boundaries: The first had to do with accepting gifts from a group of clients who were largely homeless substance-abusing men. In this case, I ran a stonecarving group, and one of the men carved an arrowhead and gave it to me. This workplace had a strict ban on accepting gifts from clients, and this made sense to me, as it seemed important to maintain a clear differentiation between "case manager" and "friend."
In the second situation, two of my clients who live together planned to get married to each other, and invited me to the wedding. I talked with my supervisor, and we agreed that I would only go to the wedding, not the reception, and wouldn't bring a gift. I went, but later was chastised by the director, who said it was a boundary issue. I still struggle to determine for myself whether I think it was a mistake, or not.
I completely connect with what Derek and Laura stated in regards to compassion fatigue. At my last job, I worked on the inpatient oncology floor of a hospital. As I'm sure you can imagine, it was easy to feel powerless in the face of clients who were all dealing with a potentially life-limiting illness. I was witnessing the debilitation or even death of people I had grown to care about on almost a daily basis. At the same time, the care management department was undergoing serious upheaval due to new leadership and cost-cutting pressure from the hospital administration. One of the major impacts of this transition was their attempt to literally double social workers' caseloads by forcing us to take on multiple floors of care, as opposed to just the one on which we were currently working. Being emotionally and physically drained as it was, I took particular issue with this change, and fought tooth and nail to have it reversed. As time went on, I found myself expending much more energy on internal hospital issues than I was on my clients' needs. I found that my priorities not only put me at odds with the administration, but was causing me to do a great disservice to my clients by not being as present as I had previously been. Looking back, this attitude change was clearly an act of self-preservation. I viewed my job frustration as stemming from my clients' dire situations, when in actuality it had come from within. I cared deeply for my clients, and was protecting myself from their seemingly inevitable demise. Since I couldn't change the physical outcome of my clients' diseases, I focused on a departmental issue with which I felt a greater sense of control. I had lost sight of the bigger picture--that is, while I had no power in regards to an individual's disease course, I could have a huge, lasting effect on how the client and his or her loved ones coped with the situation on an emotional, financial, and logistical scale. I know that I had a profound effect on many lives by taking care of details which enabled loved ones to spend time with each other without having to worry about where the money was coming from for the treatment, or how they would manage the patient's care. This was an extremely powerful lesson for me, and one I will take with me to whatever population I work with in the future.
I find setting boundaries can often be difficult, but is so important in our work. This is something that I’ve had to work hard on and be mindful of, as my personality is more of the “people pleaser” type and I am not big on confrontation. A boundary-setting struggle that comes to mind is my first job after graduating with my BSW. I worked in an adult day health care center where the clients were mostly older adults. Because I look young for my age and had minimal experience, many of the clients immediately put me in the “granddaughter” category, rather than seeing me as a professional. I had to work very hard to build good boundaries and do good work in order for them to see me as a social worker and not a potential date for their grandsons. In addition I had the added challenge of working with co-workers who did not have good boundaries, and in fact several who interacted with the clients outside of the center as well. When one of the older clients started bringing me gifts in an attempt to court me, my coworkers teased and encouraged him rather than helping me set boundaries and maintain a professional relationship! At the time I was too shy to speak up to my supervisor about my coworkers behavior and struggled through it myself by trying to build strong boundaries in the relationship with the client. Now with the experience and confidence I have, I would certainly turn to my supervisor for support in this type of situation. I think I would also try to discuss my concerns with my coworkers individually instead of just ignoring their lack of boundaries. It does make it difficult when your attempts to act professionally are undermined by those around you.
All great posts. Through mistakes in past jobs, I have come to realize that boundaries are what keep the client safe, as well as myself. It is something I have to be constantly aware of; as Christy stated above, I tend to want to please as well. When I set good boundaries, more often than not, there ends up being a degree of openness that perhaps wouldn't be there if I had tried to make things easy by not being clear about boundaries.
I also struggle more with work boundaries more than boundaries with clients (again, the people pleasing coming out). I identify with what Dana said, and it can take a lot of energy out of you to deal with office personalities & politics. I remember when I first started my current job-I had been off for 6 months, and was ready and willing. This time would be different- I would take care of myself and make good boundaries. Like Peggy and others have mentioned, when I am starting to feel frustrated and burnt out, I know it's time to take a step back. Looking forward to the discussion tomorrow night!
I am sorry that I did not get a chance to participate in this weeks discussion. It's been a hectic week and honestly I have some compassion fatigue (not client related) going on myself.
I have read and appreciate everyone's post and look forward to a great discussion tonight!
Hi Everyone. I chose to discuss boundaries in general as I feel boundaries are something that facilitates our survival and longevity in this field. What I wanted to specifically discuss was boundaries with clients.
ReplyDeleteA situation that I struggled with in the beginning was finding what I felt were appropriate boundaries with a family I worked with who were from Eritrea. The reason I struggled with finding healthy boundaries with this family was because in their culture, when a guest came to their home, they offered tea, food, something, to show their respect and appreciation. Another difficulty I had was that our culture puts a different emphasis on time than their culture does. A result of these two factors made my visits with this family very long, spending a disproportional amount of time with them as compared to my other families. I was very conflicted with this because I wanted to honor their culture and traditions, grow my report with them and facilitate our relationship. At the same time I had other clients I needed to see and at times needed to go home to my family at the end of the day. Also, I felt some guilt around sharing these meals with them because I knew it was an added expense for the family and for them to be living in extreme poverty paying for food for me, while I am not struggling to buy food, did not feel comfortable for me. Eventually I was able to work out a balance by talking with them about my concerns and preferences. I explained that I enjoyed sharing meals with them, but needed to limit it to 1x/month (previously was 1x/wk). Also, I tried to limit the hospitality to just tea as I knew that would not be as costly to them. Additionally, I explained some of my responsibilities as their case worker and other family's case workers. Defining our relationship as a professional relationship was also difficult for me because often they refer to me as another family member, which honored me that they thought that highly of me. At the same time, it showed me the importance of setting those boundaries so our relationship did not get blurred.
We now work very well together and they understand that when I say I need to go that they need to respect that too. We still share meals together upon occasion and have a good working relationship.
Andrea, Excellent Post. I really appreciate your sincerity in sharing your own journey with boundary setting. Team, I think boundary setting is one of the strongest assets that can be on your clinical tool set. However, Andreas point is well taken, Howe do you honor ones culturural norms/mores' without compromising your ability to set boundaries? It think it relates back to our discussion last week of honoring the NASW code of ethics by learning about some of this family's cultural needs and in that sense I think that we owe it to this family at least in intial assessements to really allow for that time not only before meeting c the family but with the family as well. And I think it is good practice to incorporate this time into theses situations. However, in the real world we don't always have the luxury of time and we may have to set some parameters around time and what activities we engage in with the family and in this sense I feel comfortable drawing from Maslow that the most important thing I need to do with clients is keep them safe. I don't think safety should be used as but merely a starting point if you can't afford this time. You really can't go wrong with the safety angle. It is amazing how receptive family's are to this approach. I am just letting it flow, other ideas ................
ReplyDeleteTeam, I went to an interesting discussion this week hosted by one of my fellow social workers on compassion fatigue and it reminded my of your post on Boundaries in the Work Place Andrea. Because the main point I took from that discussion is that the majority of burn-out or compassion fatigue doesn't actually come from our clients that we work with. Research shows that compassion fatigue actually comes from everything else around the work place irrespective of the client, IE behaviors of fellow co-workers, lack of resources and other things that are our of your control. One of the great self-preservation techniques that we can learn is to be able to set boundaries with the things we can control at our jobs whether that is with clients, co-workers or administrative staff. I think it is something that new clinicians struggle with in the beginning through much trial and error ...............
ReplyDeleteI first heard about compassion fatigue when I was going to school and doing my internship. I felt myself reacting to things that I normally wouldn't react to and I couldn't figure out why the change in my attitude and one of my counselor colleagues told me about compassion fatigue. I was able to work through the situation and started doing more self-care and my attitude started to improve. Recently I started having the same reactions while working with clients to do annual recertifications for their housing and updating Independent Service Plans and having each client really resist to the point of being verbally abusive to me. I have had to on two different occassions tell the client that I needed to leave and I would come back when they were ready to talk but really it was me that had to leave because I could feel myself getting frustrated and going nowhere with the situation. About a week later the people came back and we were all in a better frame and were able to continue the work. I was sharing this with Derek and he reminded me of compassion fatigue. Again I have had to step back and make strides to change my attitude and start taking care of myself.
ReplyDeleteClient placed boundaries which Andrea wrote about are so important to a progressive relationship . Andrea’s story re-affirmed for me how positive some client boundaries can be. Her ability to support her clients’ as well as respect their cultural selves can only prove to create a successful relationship. As I read her post I realized energies put towards client boundaries can be viewed as positive energies with movement forward. On the other hand I struggle with viewing workplace boundaries as positive energies used to benefit our clients. I do know the worth at times for creating an environment of defined boundaries in the workplace but sometimes the scales tip towards focusing on workplace dynamics and the needed boundaries vs. client based solutions. Hence Derek’s post some workplace burnout. You attempt to appropriately support your client but may find yourself using more energy than you have to circumvent workplace dynamics.
ReplyDeleteAnother boundary issue that I have come up against is gift giving/receiving. I know each work place has different guidelines to this and I am wondering what you all feel about this. I had a client the first year that I was in my current position at Christmas time want to give myself and one of the other case managers a gift. It was something that she had in her house. We both told her that we were unable to accept gifts and she was offended and insisted that we take the gifts. We talk to our supervisor and she told us to take them to the office. We let them set for several months and the client came to the office and saw the gifts and stated "Oh I see what you do with gifts" I explained to her again about the policy of our agency regarding gift giving/receiving." I think it is very difficult for clients to understand the concept of case managers/clinicans being unable to accept gifts because most of them are doing it to show their appreciation to the workers for the work that they are doing. What do you ladies think about this and have you had similar experiences you would like to share.
ReplyDeleteI think that boundaries are a necessary tool for keeping the client safe, as Derek mentions. Safe in knowing that the work we're doing is about them, and not about us. Safe in realizing that we can and will take care of ourselves (so they're free to be honest). Safe in knowing that they won't be victimized, as many have been in the past.
ReplyDeleteAbout the family that Andrea wrote about: I appreciate her thoughtfulness in really thinking about what boundaries are appropriate in that situation. I think the flexibility in the solution that Andrea came up with (having a meal with the family once a month)is in line with my take on boundaries. I believe that having boundaries that are well thought out, somewhat flexible (yet in line with the code of ethics), and that we're comfortable expressing is necessary when we're working alone in client's homes.
These are a couple examples of situations (one in my second practicum, and one in my current job) where I considered appropriate boundaries: The first had to do with accepting gifts from a group of clients who were largely homeless substance-abusing men. In this case, I ran a stonecarving group, and one of the men carved an arrowhead and gave it to me. This workplace had a strict ban on accepting gifts from clients, and this made sense to me, as it seemed important to maintain a clear differentiation between "case manager" and "friend."
In the second situation, two of my clients who live together planned to get married to each other, and invited me to the wedding. I talked with my supervisor, and we agreed that I would only go to the wedding, not the reception, and wouldn't bring a gift. I went, but later was chastised by the director, who said it was a boundary issue. I still struggle to determine for myself whether I think it was a mistake, or not.
I completely connect with what Derek and Laura stated in regards to compassion fatigue. At my last job, I worked on the inpatient oncology floor of a hospital. As I'm sure you can imagine, it was easy to feel powerless in the face of clients who were all dealing with a potentially life-limiting illness. I was witnessing the debilitation or even death of people I had grown to care about on almost a daily basis. At the same time, the care management department was undergoing serious upheaval due to new leadership and cost-cutting pressure from the hospital administration. One of the major impacts of this transition was their attempt to literally double social workers' caseloads by forcing us to take on multiple floors of care, as opposed to just the one on which we were currently working. Being emotionally and physically drained as it was, I took particular issue with this change, and fought tooth and nail to have it reversed. As time went on, I found myself expending much more energy on internal hospital issues than I was on my clients' needs. I found that my priorities not only put me at odds with the administration, but was causing me to do a great disservice to my clients by not being as present as I had previously been.
ReplyDeleteLooking back, this attitude change was clearly an act of self-preservation. I viewed my job frustration as stemming from my clients' dire situations, when in actuality it had come from within. I cared deeply for my clients, and was protecting myself from their seemingly inevitable demise. Since I couldn't change the physical outcome of my clients' diseases, I focused on a departmental issue with which I felt a greater sense of control. I had lost sight of the bigger picture--that is, while I had no power in regards to an individual's disease course, I could have a huge, lasting effect on how the client and his or her loved ones coped with the situation on an emotional, financial, and logistical scale. I know that I had a profound effect on many lives by taking care of details which enabled loved ones to spend time with each other without having to worry about where the money was coming from for the treatment, or how they would manage the patient's care. This was an extremely powerful lesson for me, and one I will take with me to whatever population I work with in the future.
I find setting boundaries can often be difficult, but is so important in our work. This is something that I’ve had to work hard on and be mindful of, as my personality is more of the “people pleaser” type and I am not big on confrontation. A boundary-setting struggle that comes to mind is my first job after graduating with my BSW. I worked in an adult day health care center where the clients were mostly older adults. Because I look young for my age and had minimal experience, many of the clients immediately put me in the “granddaughter” category, rather than seeing me as a professional. I had to work very hard to build good boundaries and do good work in order for them to see me as a social worker and not a potential date for their grandsons. In addition I had the added challenge of working with co-workers who did not have good boundaries, and in fact several who interacted with the clients outside of the center as well. When one of the older clients started bringing me gifts in an attempt to court me, my coworkers teased and encouraged him rather than helping me set boundaries and maintain a professional relationship! At the time I was too shy to speak up to my supervisor about my coworkers behavior and struggled through it myself by trying to build strong boundaries in the relationship with the client. Now with the experience and confidence I have, I would certainly turn to my supervisor for support in this type of situation. I think I would also try to discuss my concerns with my coworkers individually instead of just ignoring their lack of boundaries. It does make it difficult when your attempts to act professionally are undermined by those around you.
ReplyDeleteAll great posts. Through mistakes in past jobs, I have come to realize that boundaries are what keep the client safe, as well as myself. It is something I have to be constantly aware of; as Christy stated above, I tend to want to please as well. When I set good boundaries, more often than not, there ends up being a degree of openness that perhaps wouldn't be there if I had tried to make things easy by not being clear about boundaries.
ReplyDeleteI also struggle more with work boundaries more than boundaries with clients (again, the people pleasing coming out). I identify with what Dana said, and it can take a lot of energy out of you to deal with office personalities & politics. I remember when I first started my current job-I had been off for 6 months, and was ready and willing. This time would be different- I would take care of myself and make good boundaries. Like Peggy and others have mentioned, when I am starting to feel frustrated and burnt out, I know it's time to take a step back. Looking forward to the discussion tomorrow night!
Great Work Team!
ReplyDeleteI am sorry that I did not get a chance to participate in this weeks discussion. It's been a hectic week and honestly I have some compassion fatigue (not client related) going on myself.
ReplyDeleteI have read and appreciate everyone's post and look forward to a great discussion tonight!