personal and professional boundaries

1. PERSONAL AND PROFESSIONAL BOUNDARIES PRESENTED BY Gloria J. Fiedler, MSW, LCSW HIV/AIDS Program Manager and Clinical Lead Case Manager

3. Personal and Professional Boundaries The First half of this presentation will focus on personal boundaries the second half will focus on professional boundaries

4. Boundary Definition Our sense of how we are different from others Exist for our protection Ensure appropriate behavior and keep us from offending others Enables us to get close with each other without being overwhelmed

5. As professionals we see many diverse people every day with different needs. For example: The young gay homeless man The African-American mother of three The Hispanic man who won�t tell his family he is HIV positive The Native American Female who survives by living with anyone who will take care of her. PERSONAL AND PROFESSIONAL BOUNDARIES

6. Personal Boundaries We see people who have no boundaries, rigid boundaries, partial boundaries, and even sometimes healthy boundaries. We have our own personal boundary issues as well as professional boundary concerns.

7. Client�s Point of View Today I want to take on the persona of a client you may have and become her voice. I want to let you know how her life experiences have affected how she may interact with you. I am the Native-American Woman.

8. HEAR ME NOW� Do not think I represent all of the Native Americans in our country; there are many different tribes. Some of us grew up on the Reservation and some of us are Urban Indians. We have different cultures, languages and beliefs�sense of time I am Lakota, raised near the reservation by mixed-heritage parents

9. This slide probably could be beefed up a little bit. This slide probably could be beefed up a little bit.

10. How close I want people in my personal space Who will touch me and how they will touch me With whom I will have sex

11. Physical or Sexual Abuse I feel: Shame, wrong inside Worthless Alone, unacceptable

12. Are greatly influenced by my parents Are to protect me like an internal shield Are to help me determine which feelings are mine Allow me to deflect other people�s negative feelings

13. By role reversal Emotional incest (my parents shared adult secrets with me) Shaming and humiliating me Enmeshment (I�m expected to have same feelings as parents)

14. Let me accept or reject information from the outside world Allow me to know what I want and need Help me to make informed decisions

15. Intellectual Boundaries My intellectual boundaries were blurred by tight parental control of my thoughts. I am confused by distorted communication and disinformation. I am limited by my parents lack of education and prejudices.

16. I am dependent on what others think I distrust my own beliefs and thoughts I am forced to see reality not as it looks to me but as others see it Often ridiculed or overruled for my ideas� The text on this slide is inconsistent. The last bullet, for example, seems to be a continuation of a previous sentence like other bullets on previous slides..but what is the previous sentence? The 2nd bullet seems to reference the 1st bullet as opposed to the slide �title.� The slide title needs to be a title�.The text on this slide is inconsistent. The last bullet, for example, seems to be a continuation of a previous sentence like other bullets on previous slides..but what is the previous sentence? The 2nd bullet seems to reference the 1st bullet as opposed to the slide �title.� The slide title needs to be a title�.

17. This allows me the ability to believe there is a Power in the universe greater than myself. This allows me to embrace and respect my humanness I can make mistakes and still be loved

18. Spiritual Abuse My parents acted like God or less than human. I wasn�t comforted as a child when I was in pain. I fell out of love with myself and disconnected from my spirit. Top text needs to be a title Top text needs to be a title

19. Boundary Violations I have been telling you about the boundary violations I�ve experienced. Let�s look at this a little more closely so you can see how this affects me. There are two types of violations: Distance Violations Intrusion Violations

20. Distance Violations occur: When intimacy is less than what is appropriate to the relationship If closeness is an appropriate part of our relationship and it doesn�t occur

21. Intrusion Violations occur: When someone inappropriately touches me If someone offends me If someone attempts to control how I thinks, believe or feel

22. As the survivor, I bear the brunt of emotional shock but my immediate system is also harmed. My life and life choices are damaged and will remain so unless information and change affect my experiences.

23. Repairing Boundaries Let�s talk about how my case manager helped me begin repairing my boundaries. My case manager noticed I had a hard time talking with her and that I didn�t trust her. She told me about these boundaries and boundary violations and gave me some ideas that worked for me.

24. I pay attention to when I feel fear or shame. Support groups helped me reclaim my boundaries and I learned to respect other�s boundaries. I learned that if my boundaries are being consistently invaded or abused, I need to distance myself from the person. continued

25. Repairing Boundaries, continued I learned to gently confront myself with Self-Talk. I compliment myself. I practice positive daily affirmations. I�ve learned to comfort myself with different thoughts and world views. The slide title needs to be a slide titleThe slide title needs to be a slide title

26. Repairing Boundaries, continued I�m learning to trust my emotions. I have learned to actively question thoughts, beliefs. I learned to question family rules and memories.

27. Repairing Boundaries, continued I learned that each of us has our own spiritual journey. I learned to confront my families idea of a destructive spiritual higher power. I finally accepted a referral from my Case Manager to work with a mental health counselor.

28. I learning that setting healthy boundaries takes practice and patience. Setting these boundaries takes help and encouragement I�ve learned to love myself and others by the examples and models I see around me. You are one of those models.

29. I�ve identified childhood boundary violations and the offenders, and acknowledged how I feel about them. I�m examining the state of boundaries in my present relationships and cleaning them up. I am increasing my self awareness and taking care of my physical, emotional, intellectual and spiritual needs.

30. Pushing yourself beyond your limits This slide needs to be reworked! It�s too much text for one slide.This slide needs to be reworked! It�s too much text for one slide.

31. And Roles Define Appropriate Closeness and Distance Immediate family Friends Nurse Mental Health Therapist Unknown man on the street HIV/AIDS Case Manager

32. Professional Boundaries We�ve been discussing Personal Boundaries. Now let�s look at Professional Boundaries and how they affect my life and my relationship with you.

34. Parent / Child Teacher / Student Employer / Employee Doctor / Patient HIV/AIDS Case Manager / Client Police / Citizen Mental Health Therapist / Client Some of these are examples of power relationships that aren�t under the personal boundary category�I would think. Yet, this slide is in the personal boundary portion of your presentation.Some of these are examples of power relationships that aren�t under the personal boundary category�I would think. Yet, this slide is in the personal boundary portion of your presentation.

35. They have greater responsibility in the relationship to ensure that boundaries are clear and respected. People in relationships that have power over them often attempt to cross boundaries to improve their situation. Look for a different way to word this bullet. Grammatically, it doesn�t flow as well as it could.Look for a different way to word this bullet. Grammatically, it doesn�t flow as well as it could.

36. Something to think about� People new to the helping field try to cross boundaries in a safe manner. People who have more experience set firmer boundaries because they know there is no safe way to cross boundaries.

37. Are the line that separates the Case Manager from me. Are the emotional and physical space that gives me room to focus on my own healing and not on theirs. Are limits that control the professional�s power so that I am not hurt.

38. Dictate our interactions. Are flexible limits that change depending on my vulnerability and your role. Are the parameters that keep you as objective as possible.

39. Doing the right thing because it is the right thing to do Becoming more aware of and more sensitive to ethical issues and ethical standards regarding HIV/AIDS Case Management Being able to reach thoughtfully reasoned conclusions and applying ethical principles to case management activities.

40. Are ethical responsibilities to me Apprising me of my rights Serving me with professional skill, loyalty and determination Not practicing, condoning or collaborating with any form of discrimination towards me Seeking advice and consultation from colleagues and supervisors when in best interest of me (continued)

41. Withdrawing services promptly and make service referrals appropriately and cautiously only under unusual circumstances, giving careful consideration and minimizing possible adverse effects to me Terminating service to me and professional relationships when such services and relationship are no longer required or no longer serve my needs. Making referrals (continued)

42. Not exploiting me for your personal advantage; i.e. don�t use my valuable time to share your own frustrations, grief or loss Not engaging in sexual activity with me Avoiding relationships that conflict with the interests of me, i.e. don�t ask me to take care of your pet while on vacation

43. I will feel pressure to socialize I might unintentionally disclose personal information or gossip I may develop an attraction towards you or dislike you I may feel pressure to spend money (who will pay?) I may develop feelings of or actually be exploited (I have to do this?) I may make inappropriate requests Issues Regarding Blurred Boundaries

44. Avoidance Alignment Seeking healthy relationship Power Play Sex Some reasons I may make personal advances

45. Is intentional and willed behavior Each case manager is responsible for this behavior Consultation with supervisors and peers is an excellent approach when the ethics are not clear

46. Accepting gifts? Taking care of a my pet? Taking me to a social event? Providing me with some of your old clothes or furniture? How would you decide if this was an ethical behavior?

47. Duty to Adequately Record (also best way to protect yourself and the agency as well as me) Duty to Warn (has been litigated in all states) Duty to Keep Confidential Duty to Report (Child and Adult Protection) Duty to Avoid any form of sexual impropriety (remember that my perception is my reality)

48. Unless I give you written consent I disclose my intent to commit a crime or harmful act I disclose or you see abuse or neglect of a child/vulnerable adult I choose to take legal action against you and you consult with an attorney to protect yourself

49. I am a minor and victim or subject of crime I endangering my life or others You consult a physician or seek assistance for me in case of medical emergency

50. Thank you for doing your job Initially I didn�t understand how all these rights, ethical standards and duties were important to me. Now I see how they protect me especially when I am unable to. Thanks for providing me a safe environment receive services in�

51. Boundaries for Codependents written by Rokelle Lerner and distributed by Hazelden Ethical/Legal Considerations of Case Management distributed by Washington State Department of Health NASW Presentation of Legal Risks Boundary Materials developed at Queen�s Medical Center Day Treatment Program and Snohomish Health District by Gloria Fiedler

52. The End