Setting Boundaries with Parents

You may find the occasional parent who lacks limits. Ok, maybe there are a lot of them out there. Some examples are:

* Dependent - You get several "urgent" calls or voice mails a week asking you to stop by, between appointments. Or to give phone advice about an immediate situation. It's as though they believe that their child is your only client. Not as bad as "What About Bob?" but close. That's why my outgoing voice mail message says, "If this is an emergency, please call 911."

* Passive-aggressive -  An example is parent who won't talk to teachers, themselves, but ask or hint that they would like you to discuss an academic issue with the client's teacher. Just because you may conduct therapy at school, and at home, does not mean that you are required to play messenger. This is a time to insist that the parents and teachers communicate directly with one another. I've seen teachers try to do this, too, by the way.

* Long-winded - These parents are probably lonely and starved for adult conversation. Some of them just want you to be their own personal therapist, as well. This is a time to refer out, whether it be for a parents group or for an appropriate therapist.

Although these situations can seem difficult, they are excellent opportunities to process and model boundary-setting for parent training purposes. You do have "parent training" on most of your treatment plans, right?

There have been times that I don't immediately answer a call from one of these "boundary-less" parents (I might be with another client or getting ready for work). I do feel a twinge of guilt, when that happens. But I tell myself that I will empower, not enable. Amazingly enough, when I do call the parents back, the situation has usually been handled

Paperwork

It's getting close to the end of the month and time to complete paperwork. This is my least favorite part of the job (except for having to make those dreaded "abuse" calls). Of course, I do a little bit of paperwork, throughout the month, so I don't get too bogged down at the end. Sadly, the majority of my paperwork is during "crunch time" -- by the first of the following month.

I have been working at agencies for several years, but it has taken me a while to get the time-management thing down, especially with paperwork. But now, I'm taking less Medicaid cases because I have to write a note for each session with them.

I learned that there are other client funding sources that therapists can use that only require notes once a month. Huge difference in time savings! Even registered interns can take these cases, as they are not from private insurance sources. Each state probably has its own, so I won't go into specific names. Ask your agency supervisor for the ones in your state.

It sounds as if I am more interested in making money than seeing clients. First of all, we do have to make a living, so I'm not ashamed to earn money doing what I love and where my gifts lie. I will not be unethical in my notes or use people in order to make money. But the way I look at this is: the less paperwork I have, the more time I have to spend with my clients. I also value my down time. It keeps me emotionally healthy, so I can be a better therapist for my clients.

First Week of School

Last year, I accepted the notion that I would not be able to see my clients, at school, the first week of school. After all, it was a hectic week for teachers and staff. I didn't want to "impose," so to speak.

This year, I took a different approach.

I contacted the schools, beginning Monday morning. I introduced myself as a contracted vendor for the school system, asked for the client's teacher's name and extension, and promised to deliver a parent consent on my first visit.

Once I contacted the teacher, I gave the same spiel and asked what time would NOT be convenient. That gave me the flexibility to see the client any other time. As opposed to asking what time WOULD be convenient, which limits a therapist.

If I already had clients from the previous school year, who were at the same school, I focused on seeing them the first couple of days. That was because the school already had a parent consent in place and I already had an established relationship with that school.

This week, being the first week of school, I only offered to do classroom observation. This helped me to see how a client was getting accustomed to a new teacher or school and to develop a baseline of behaviors. This also allowed me to slip in, before getting a schedule, and possibly get some collaboration with the teacher. It was also a chance to get in a new school and/or build rapport with the new teacher. In rare cases, because I was so non-confrontational, a teacher would let me go ahead and pull the student out for therapy.

Today, I dealt with a very inflexible teacher, who had decided to go over the issue with her administrator before getting back with me. She said that I could only see my client during "specials" (music, art, PE, etc.). Because that client happened to be a very easygoing child, I was willing to work with this teacher. Otherwise, I usually do not see my clients during times that they would, otherwise, enjoy. So, hopefully, you will either have a flexible teacher or a flexible client. :-)

Introduction

I am Bonni, a mental health counselor and contracted therapist for my local school district. I have been facilitating therapy, off and on, for about five years. For over a year, I have been consistent in providing counseling services for children, at school and at the home. I have Medicaid clients, as well as clients who have other public insurance providers. Most of my clients, although not all, come from impoverished backgrounds.

I created this blog in order to help other contracted therapists. It is intended to increase your support system, as well as answer any questions you may have.

Please contact me if you have any input or additional questions.