‘Staying “Fabulous”: Maintaining psychologically informed boundaries in professional relationships’
By: Dr Helen Miles
Tags: Pie, Relationships, Young People, Homeless, Boundaries

20.11.2020: For this week’s blog as the Lead for Psychologically Informed Environments (PIE) at the national youth homeless charity: Centrepoint, I have continued to think about some of the themes that have come up in 1:1 conversations and reflective practice spaces with ‘frontline’ staff, particularly around relationships. Specifically, considering that once we have formed relationships with those we support, how we manage these through our ‘boundaries’. Of course, the general notion of ‘maintaining our boundaries’ has become a lot harder this year during a global pandemic. Specifically, for those of us that are working from home to deliver a service (e.g. our National Helpline: 0808 800 0661, or our Floating Support Services) or within our ‘support’ teams, it can be difficult to separate our work and home lives when they occupy literally the same space. It has therefore been important that we create some kind of physical boundary with a ‘work space’ or a psychological boundary by ‘switching off’ our remote technology between our home and our work lives. This is not always easy to do, as we may not have a ready-made home office, or we may be missing that informal time with our work colleagues to make a cup of tea and share or process difficult information as we could when we occupied the same office space. However, as well as this notion of ‘work’ and ‘home’ boundaries, it is also important to consider our ‘professional boundaries’ within the relationships we form to support vulnerable young people in our supported accommodation services.

So what do we mean when we think about ‘professional boundaries’? Essentially, professional boundaries are the rules that set out what professionals should and shouldn’t do in the context of their working relationships. They also act to distinguish between our professional and personal identities or roles. They are critical, because as Peternelj-Taylor (2002) argues; establishing and maintaining professional boundaries enables service users (e.g. homeless young people) and support staff to engage safely in a therapeutic relationship. In other words, professional boundaries protect the young person, the keyworker and their therapeutic relationship helping both parties feel ‘contained’ by providing psychological safety and security (Brown & Stobart, 2008). They are therefore an important part of a psychologically informed environment or PIE, because a PIE is all about building therapeutic or safe, supportive, trusting relationships with those we work with. Boundaries also ensure consistent team working, set limits, avoid exploitation or abuse of those more vulnerable than ourselves, prevent misunderstandings, avoid staff burnout or fatigue as we can manage our emotional responses to this work, ensure equality of access, role model relationships, empower independence in those we work with, maintain focus and objectivity, and help manage challenging behaviours (Cooper, 2012).

An awareness of the need for boundaries in professional practice has been around since the 5th Century, when they were outlined by Hippocrates. His infamous ‘Oath’ highlighted the need to ‘stay within what one is trained to do’, the need for ‘confidentiality’, the need to ‘do no harm’ and to ‘work for the best of the client’, and outlawed ‘improper relationships with clients’. Consequently, most professional organisations including psychology, medicine, social work and nursing have therefore developed Codes of Conduct or Ethics, which include the importance of ‘maintaining appropriate professional boundaries’ (e.g. https://www.bps.org.uk/sites/www.bps.org.uk/files/Policy/Policy%20-%20Files/BPS%20Practice%20Guidelines%20%28Third%20Edition%29.pdf). As any kind of support worker we are always in a position of power compared to those we are ‘supporting’ (Yalom, 1989) and consequently, we must remain mindful of this in our interactions with them (see Cooper, 2012 for a helpful review and discussion about social care boundaries: http://www.respitenow.com.au/uploads/3/9/0/3/39035687/boundaries_for_carers.pdf). Those we support are likely to believe that we are the ‘expert’ and have the knowledge and authority to help or can refer them to other appropriate agencies. As such, even in the unlikely event that the homeless young people that we support are not vulnerable in any other setting, the power imbalance means they are vulnerable in relation to us and our relationship with them. This places us in a position of power and control, and with this power comes a professional responsibility.

Working in a homeless young person supported accommodation service can however present unique challenges for staff that influence professional boundaries. Many of the young people that we work with have a history of physical, emotional or sexual abuse, or are particularly vulnerable to exploitation by others (e.g. gangs, sexual predators). They may also have a complex attachment history, having had disrupted or rejecting relationships in the past, and may have experienced or witnessed previously high levels of aggression or violence. They are also still developing and learning to regulate their emotional responses. Consequently, when they enter our service they may often approach staff and engage quickly, trying to find attachment security by asking us personal questions or conversely immediately reject us as just another worker in a long line of workers that seemingly haven’t helped them in the past.

There are also prolonged periods of contact with our staff in supported accommodation services, as this is their ‘home’ environment rather than a more traditionally contained therapeutic hour as with a meeting with a social worker or therapist. Positively, this can therefore create many opportunities for informal interactions with staff to build a relationship with those they are supporting but it can also create the potential for boundary violations. For example, our staff are often involved in a wide variety of tasks with the homeless young people they support, which can include bedroom inspections, communal meal times, support for shopping and educational activities, as well as social activities within the service. In addition, where locum staff may have to be utilised to ensure safe staffing levels, this can result in staff on shift without a detailed understanding of a particular young person and their needs, history or challenges. This can if we are not careful lead to a slow blurring or insidious boundary testing by young people or a ‘chipping away’ by staff of procedural boundaries over time. It is often much easier to maintain our professional boundaries when we are subject to extreme threats, intimidation or aggressive boundary challenges.

Consequently, it is important that we, as staff, reflect and consider what might influence our ability to set professional boundaries with those we support, whether this is individually, within our 1:1 or supervision sessions or within our group reflective practice spaces to ensure team adherence to policies or procedures, and consistency with our colleagues. Cooper (2012) for example, has a useful assessment tool for us to reflect on our boundaries (c.f. http://www.respitenow.com.au/uploads/3/9/0/3/39035687/boundaries_for_carers.pdf — see page 18) although we can also just consider what our answer to these standard questions might be. For example, what subjects or conversations do we feel are appropriate to talk to young people about? What is appropriate dress for work? When, if ever, is it appropriate to touch a young person? What might it mean for a young person if we tell them where we are going on holiday or talk about our children? It can also be helpful to think about why we have chosen the ‘helping’ role we have? To whose benefit are we carrying out this particular role? How does our role shape our identity? Our answers will be personal and unique to each of us but it is important to remember, as I can still recall today from many years ago in my first role in a prison setting when the officer doing the security training shouted(!) repeatedly at those of us attending; “they [the young offenders] are not your friends”.

Therefore, what do appropriate professional boundaries in a PIE relationship look like? Firstly, it is important to note that it is always our responsibility, as a professional member of staff, to set and maintain clear boundaries because often the homeless young people we work with may not be able to for the reasons noted above. The key is to be both sensitive and yet assertive with the young people we support. For example, it is important to explain why we can’t do or say something inappropriate that they have asked us or why they need to stop doing something inappropriate because of the ‘rules of service’. They probably will not like this at the time, but it ensures that they understand the limits or boundaries within our service, particularly as they may not have had these imposed in the past. Of course, it is important to understand and validate their possible feelings of disappointment or frustration, and possibly to try and find a more appropriate solution to an issue whilst still ‘holding’ the boundaries. I often had young people express annoyance about something I was unable to do for them at the time, but afterwards they would comment that they preferred to work with me because they “knew where they stood” and that I was “fair to everyone”.

Sometimes seeing the bigger picture is key here and of course not taking things personally. Young people can be difficult, frustrating, rude and upsetting at times. They can also be nice, friendly, grateful, inspiring and uplifting. However, their reaction to us can sometimes be about what we represent to them (e.g. parent, social worker, wider system) and not about us as people, so as long as we know we have been kind, respectful and have tried our hardest to help us then we should not be judging ourselves by their reactions to us! Perhaps even taking a moment to think about the young person and what we know about their previous history may also explain their reaction to us, and therefore we need to only take responsibility for what we can directly control (i.e. our own behaviour) and not that of the wider system or another person’s previous interaction with them. It is also easier to maintain our professional boundaries if we are aware of, acknowledge and accept the emotional intensity of this work, and then process our natural feelings through support, supervision, handovers, debriefs or reflective practice rather than let them effect our future judgement and interaction with that person.

Moreover, our boundaries should always be in the best interests of the young person (i.e. their needs not ours) and based on trust, honesty, respect and the appropriate use of our power. We must always ensure quality of access (i.e. not prioritising one young person over another because we ‘like them’) and work as a team (e.g. ‘no secrets’) to reduce ‘splitting’ and ensure consistency. We should never disclose detailed personal information, although of course we can share our distress at the failure of our favourite football team losing a crucial match! We need to consider our behaviour and language, as often we become ‘role models’ for the young people we support and we should not accept (or offer) personal gifts or money from those that use our services. Importantly, we must endeavour to be on time for our appointments with young people, or apologise and explain our delays (even when they fail to attend or are late) and assertively but sensitively challenge aggressive or sexual behaviours directed towards others or ourselves. Being aware of our personal space, and not touching others is also important, as this can quickly lead to misunderstandings.

These may seem like obvious things, but in order to create a psychologically safe and secure space for those we support they are critical to reflect upon, discuss and maintain in our professional working lives. Sadly, I have seen the worst-case consequences of boundary violations in a previous role (e.g. a sexual relationship between a male inpatient and female nursing assistant) and the extreme negative consequences (e.g. suicide of the latter) that this led to. However, even on the less extreme end of this scale, boundary violations can lead to negative consequences (Cooper, 2012). These include unrealistic expectations from a young person that a staff member cannot meet, a young person withdrawing from a vital service they need as they do not feel safe, emotional damage and breaches of trust, resentment and anger leading to verbal or physical aggression against you or other staff or young people, dependency and disempowerment of the young person and a distraction from their appropriate goals, the appearance of impropriety and abuse, and a lack of protection against (false) accusations, team dynamic issues such as ‘splitting’, and staff attrition.

Finally, by having professional boundaries we can work within what Vikki Reynolds calls the ‘Zone of Fabulousness’ (c.f. https://www.youtube.com/watch?v=XLmxb2sc_Nc). Having had the pleasure of meeting with and supporting many of our ‘frontline’ staff over the past year at Centrepoint I know many of them are fabulous, and of course never more so than now in a COVID-19 global pandemic. However, the ‘Zone of Fabulousness’ is a great way to think about how we manage our professional boundaries with the young people we work with remaining between ‘disengagement’ on the one side and ‘over-involvement’ on the other, and how we support each other in ‘collective self-care’ to maintain this. I highly recommend watching the short You Tube video above and reflecting on to what extent we stay within our ‘fabulous’ zone at work, and what might impact on us not being quite so fabulous! Another simple way of conceptualising the idea of getting close but not ‘too’ close to those we support is illustrated by the graphic image at the start of this blog of ‘Stonehenge’. This famous ancient historical site in South West England consists of many stones placed upright with other stones placed across them to be held aloft. If the upright standing stones are placed too close together then they cannot support the stone between them. If the upright standing stones are placed too far apart then they also cannot support the stone between them. The ‘Zone of Fabulousness’ that we all seek to achieve in a PIE informed professional relationship is to have the upright standing stones just far enough apart that they each stand independent, but close enough that they can offer the support needed…