In preparation for my recent workshop at the Adelphi Conference on Clinical Supervision, I decided to focus most of the short session on my research (Pepper, 2014). This decision was based partly on the fact that I didn’t know beforehand the level of experience of workshop attendees, what their goals were for our workshop or even how many participants had registered. I wanted us all to be on the same page, so to speak, and thought a brief lecture of my findings would be a good place to begin. My basic thesis is that at many group training institutes across the country, there exists a conflict of interest between the organizations’ need to treat and the need to train. Independent of theoretical orientation and the personalities of leaders, abuses of power often occur when the boundary is blurred between therapy and not therapy. The need to treat is clinical and the need to teach is educational. To combine both under the same roof contaminates both. Training institutes can’t have it both ways because there are both ethical and clinical consequences to this blurring of boundaries. While this axiom applies to analytic institutes for individual psychotherapy as well for institutes for analytic group therapy, the probability of treatment contamination is exponentially greater for analytic group institutes because of the increased likelihood of many different types of combinations and permutations for blurred boundaries in the group setting.
But when some of the participants were incredulous that such things existed, finding it difficult to believe that teaching and training actually took place under one roof at some training institutes, I decided I had to change course, and focused instead on the more general issue of need for safety in the supervisory relationship. There was a consensus in the group that this would be a better place to start. While the group consisted of a mix of clinicians with varying work experiences and levels of training, all were eager, bright and inquisitive about the issue of secure boundaries. Despite their differences, the members were closely matched in their psychological sophistication. As a result, we were able to make a smooth conversational segue since the keynote speaker of the conference’s opening plenary, Dr. Rebecca Shahmoon-Shanok emphasized the importance of safety in the supervisor-supervisee relationship. I believe this a point well taken. I remember hearing Harville Hendrix say the same thing during a talk on couples’ therapy. He said that more than anything else, couples report that they most value feeling safe in a relationship.
Several attendees picked up on this thread and gave examples of instances where a supervisor paid lip service to the need for safety but didn’t abide by it in their work. I supported this point and said that it never ceases to amaze me how bright, psychologically-minded clinicians miss the obvious when it comes to examining their own behavior. There seems to be a blind spot in regard to self-awareness. The following then are excerpts from our workshop where participants shared their experiences with blurred boundaries in supervision. My role naturally evolved into an organic opportunity to link their examples to the eight dangers of blurred boundaries which I describe in my book.
For instance, one attendee (I’ll call her Melinda) gave an example of her supervisor who in the spirit of openness, shared a story of his own countertransference toward an intrusive patient, not realizing that he may have been part of the problem, inadvertently perhaps, but nonetheless in the process of telling her the story, may have revealed more about his nether side than he had consciously intended. The supervisor told Melinda that his practice was in his posh home, a 5th Avenue brownstone. ‘Sam’, a workshop participant said– “It sounds like he was bragging”. Would he have told you where his home office was, had it been in less posh living quarters, like a studio apartment in Queens? The group didn’t think so. But this is not the end of the story. She told us that the shared bathroom between the living quarters and the treatment room, was next to his bedroom, one flight above the treatment room. The patient in question, had after using the bathroom, wandered around and peeked into the bedroom only to find the bed was unmade. Barry, another participant of the workshop, added that the patient’s imagination might have been sparked by this, wondering what the unmade bed said about the emotional state of her psychotherapist. Who knows what it meant. The point is that the patient was placed in a highly charged emotional position, tempting her voyeuristic fantasies. But rather than take responsibility for setting up the scenario, the supervisor told Melinda that he was furious with the patient for snooping. What he didn’t consider was that having a home office blurs a boundary, most certainly when the treatment room is in the living quarters. It occurred to Melinda that her supervisor had created an over stimulating environment by having the shared bathroom next to his bedroom and that some patients might find this too enticing to ignore. The treatment was contaminated and hence unsafe. This was an example of one of the eight dangers that I called over-stimulation. This occurs when the clinician’s transparency is too arousing for patients. It often takes place in cases of treatment taking place in the home office setting where too much of the therapist’s real life is on display and largely out of the therapist’s control and conscious awareness.
Interestingly, Melinda shared with us that she didn’t confront her supervisor with her view of what had happened. When someone asked why not, she said that she feared that the supervisor would become defensive and not be open to looking at scenario from another point of view. In fact, she feared the worst. She believed that the unspoken message of the supervisor’s attempt at openness was in reality —“don’t cross me even if I’m out of line”. She told us that she had felt inhibited. I then pointed out that her inhibition was an example of another one of the eight dangers of blurred boundaries, the one that I call –‘the conspiracy of silence’.
Another attendee, Marty, recalled having seen a senior clinician at his analytic institute do a demonstration supervisory session with an audience volunteer at a training conference. He reported that he had to laugh because prior beginning the demonstration she turned to the audience of several hundred people and said:” We all agree to keep these proceedings confidential”. ‘Can you imagine?’ Marty said. At the very least, there must have been at least several members of the audience recording the proceedings. I said that a more authentic disclaimer would have been to turn to the volunteer supervisee and say: ” Be aware that nothing that you say here is confidential”. This was another instance of an unsafe environment and an example of another danger of blurred boundaries that I call—‘breaches of confidentiality. . I then told the group about an article (Pepper, 2015) that I recently wrote about the illusion of confidentiality in any group setting. One finding was that from a legal perspective, any communication between more than two people is not protected by laws of confidentiality. As a final example, Lois told us a story of having attended a supervision training seminar where the presenter broke another type of boundary that left her feeling unsafe. .
The presentation had been scheduled for a morning and afternoon session with a lunch break in between. The talk was running over time as the speaker was about to begin the next section of his talk, which was now too close to the planned lunch break; but instead of putting it off until after lunch, the presenter unilaterally decided to extend the morning session when he said:” I hope you’re all not too starving but we’ll continue this morning session for another 35 minutes.” While others may have seen this as no big deal, was a big deal to Lois. It meant that she was not being consulted in a plan change that affected her. It felt like a control issue, the speaker was pulling rank on the audience. Lois felt insulted and unsafe but said nothing and neither did anyone in the audience of over a hundred clinicians. Barry said that he had been at the same conference and was shocked by his own passivity and that of the audience. He asked himself: ”why didn’t I speak up and at least question the speaker’s decision to change the group contract without any discussion?”. Lois said that she read the speaker’s unspoken message to be that his needs trumped everyone else’s, hardly a safe place for a supervisee, or a patient for that matter, to be. Here was another example of one the eight dangers is that I call the ‘emperor’s new clothes effect’ .In this case, no one confronted the speaker’s fait du accompli and thereby colluded with him against themselves and protected his narcissism.
As our workshop drew to a close, I asked the group for any final comments. Rachel said that she thoroughly enjoyed the discussion. She said that it was thought-provoking. Michele said that she hadn’t realized how complicated boundary issues could be. Harry lamented that the meeting was ending while there was so much more to discuss. The group agreed that they would be most interested in continuing our discussion at a future conference. I was very pleased with the intensity and insightfulness of the group interaction. It reaffirmed my belief that the subject of boundaries is an often overlooked, but nonetheless necessary topic for all clinicians to consider.
