I’m supervising a veteran counselor who has persistent boundary issues. She’s been at this agency for almost twenty years and acts as if she is above the need for clinical supervision. But she’s setting a bad example for the younger counselors. She has clear favorites among her patients who get special treatment that the others don’t, and I’m pretty sure she’s enmeshed with a few of them in inappropriate ways. The Director doesn’t want me to discipline her because of her seniority and her reputation in the community. But is there something I can do to help with the younger staff?”

The obvious answer is regular inservices on professional boundaries. I’d consider bringing in an outside trainer if one’s available. Given her status, you want to avoid the perception that you’re in conflict. Be careful not to criticize her in front of others. No loud sighs, no eye-rolling when she does something that annoys you. Discussions of her conduct should be in private.

You can use your existing supervision process to role-model appropriate behavior for the younger staff.

You mentioned the issue of enmeshment, roughly defined as ’emotional over-involvement with a patient or family.’ It’s a countertransference issue and a genuine hazard in our field. If allowed to continue, it can lead to some pretty spectacular incidents.

How to tell when you’re enmeshed

Some warning signs:

  • You find your own feelings fluctuating with the client’s progress (or lack of it)
  • You find yourself devoting a disproportionate amount of time or effort to one case
  • You focus more on the client’s behavior than on the goals on the treatment plan
  • You feel frustrated or annoyed with the client

What causes enmeshment?

  1. Attraction to the rescuer or authoritarian role
  2. Feeling of personal responsibility for outcome rather than process
  3. Personal feelings for the patient

Solutions

  • Step back from the case. Instead of aggressively pursuing treatment plan goals, talk the case over privately with a supervisor. Revisit goals and objectives. Should the plan be modified?
  • Ask for feedback from colleagues about their observations of this patient
  • Consider a transfer of the case to another clinician

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